Memorandum by The International Longevity
Centre UK
The International Longevity Centre-UK believes
that the European Commission 2005 Green Paper "Improving
the mental health of the population—Towards a strategy on
mental health for the European Union" represents an excellent
framework for action and will hopefully lead to a new generation
of policy reforms across Europe.
The Green Paper makes the point clearly that
mental ill-health is poorly recognised and that politicians, professionals
and the general public are poorly aware of the burden it poses.
The point that mental ill-health in Europe is second only to cardiovascular
disease in its toll on morbidity and mortality may make a powerful
addition to the Green Paper.
We are particularly interested in contributing
to this consultation as we have recently published a report entitled
"Severe mental illness in Europe—from policy to practice"
Green Paper consultation. The report is available on:
http://www.ilcuk.org.uk/downloads/Severe%20mental%20illness%20report%20pdf%20Mar%2006.PDF.
The purpose of this report is to highlight the
particular issues relevant people with severe mental illness.
We recognise that the Green Paper aims to keep a broad scope and
encompass all mental ill-health, however we would argue that the
focus is too much on depression and that too little mention is
made of some of the less prevalent but very severe mental disorders,
such as schizophrenia and bipolar disorder. It may be worth mentioning
that, whilst in many cases actions and policies may address all
mental ill-health, however in some cases, disease-specific approaches
may be needed.
We have endeavoured to address the three questions
specifically posed by the Green Paper and to provide further comments
thereafter.
ANSWERS TO
THE 3 QUESTIONS
POSED IN
THE GREEN
PAPER:
1. How relevant is the mental health of the
population for the EU's strategic policy objectives?
The Green Paper states that "there is no
health without mental health". The magnitude of mental health—with
one person in four being affected—means that none of the
EU's strategic goals can be achieved if mental health is not improved
across Europe.
To ensure that its proposals lead to concrete
actions across Europe, the Commission may wish to emphasise further
in the Green Paper the severe burden that mental ill-health poses
on individuals affected, their families and society as a whole.
For example, severe mental illness reduces life expectancy by
between eight to 20 years in those affected. The Green Paper should
clearly state that the social and economic burden posed by mental
ill-health is growing across all European countries. If this burden
is left unaddressed, Europe will fall short of achieving sustainable
health and social care systems, achieving optimal prosperity and
productivity, and ensuring that our populations achieve the best
possible quality of life:
— The Green Paper may further underline
the high prevalence of mental ill-health, the burden it poses
on health and social care systems, individuals and their families
and society at large.
— It should also make clear that governments,
the public and professionals need to recognise that, like obesity,
mental ill-health has a profound impact on all aspects of society
and that targeting resources towards its prevention and appropriate
health and social responses is both urgent and necessary if we
are to achieve EU strategic goals.
2a. Would the development of a comprehensive
EU-strategy on mental health add value to existing and envisaged
actions?
We strongly support the development of a comprehensive
EU strategy on mental health. Whilst existing initiatives on mental
health supported by the Commission as well as by the WHO represent
significant progress in enabling people with mental ill-health
to achieve better health and social inclusion, much still remains
to be done.
Moreover, significant discrepancies exist between
countries in the place accorded to mental health in policy priorities
and resource allocation, as is made evident in the WHO Mental
Health Atlas. Guidance and, to a certain extent, pressure from
the EU may help harmonise the approach to mental health across
member states and ensure that it is given suitable attention across
all countries.
We recognise that member states are exclusively
competent for the financing and organisation of health services
and care. Nonetheless, the EU plays a critical role in motivating
and validating national level initiatives, particularly when non-governmental
stakeholders are seeking to instigate policy reform. Thus the
creation of an EU strategy on mental health will provide a powerful
steer to national initiatives.
Furthermore, the creation of a comprehensive
EU-strategy that bridges across different sectors and departments
will provide an important example to guide national policy development.
One of the key challenges with mental health, and particularly
severe mental illness, faces is to know where to "place"
it within overarching debates about the future of health and social
care, user empowerment, social inclusion and discrimination. Some
countries consider mental ill-health (and hence severe mental
illness) as a disability, whereas others treat it as a chronic
disease within policy frameworks:
— We welcome the creation of a comprehnsive
EU-platform on mental health.
— We hope that the creation of this
platform may encourage similar initiatives at the national level,
and may help the EU engage different national policymakers on
the topic of mental health to translate EU goals into national
agendas.
2b. Does Section 5 propose adequate priorities?
The priorities outlined in Section 5 are comprehensive,
however we feel that further priorities to be added are:
— raise awareness of the burden of
mental ill-health, and of particular mental health conditions
such as severe mental illness, across European institutions, professionals,
and civil society;
— recognise that mental health is a
critical component of physical health, and vice versa; and
— provide guidance and encourage better
practices in the care of people with mental ill-health across
Europe.
These are addressed further in Question 3 below.
3. Are the initiatives proposed in sections
6 and 7 appropriate to support the coordination between member
states, to promote the integration of mental health into the health
and non-health policies and stakeholder action, and to better
liaise research and policy on mental health aspects?
The initiatives proposed in sections 6 and 7
are appropriate, however we would make the following amendments
and suggestions:
(i) Targeting vulnerable groups in society
(Section 6.1.1, p 9)
Amongst vulnerable groups, we believe it is important
to include those affected by severe mental illness. People with
severe mental illness face particular challenges to social inclusion.
These include:
— Poor understanding of severe
mental illness by professionals, patients, carers, policy-makers
and the general public.
— Increased risk of stigma and
social inclusion.
— Barriers to access to effective
treatments in many settings.
— Significant risks of relapse
in the case of treatment failure.
— Lack of patient choice and empowerment.
— Significant human rights issues.
Whilst many of these challenges are common to
all those facing mental ill-health, people with severe mental
illness are particularly vulnerable to these challenges.
— The Green Paper should make mention
that promotion and prevention programmes must take into account
the particular circumstances and barriers that are faced by the
individuals or populations they are addressing. Targeted solutions
will be most effective and engagement of those with particular
conditions and from particular communities in devising these solutions
is essential.
(ii) Addressing mental ill health through
preventive action
We welcome the preventive actions proposed by
the Green Paper, however we would argue that these actions can
only be achieved if sufficient resources are devolved to their
achievement, if professionals receive adequate training to recognise
their role in enabling prevention.
Moreover, whilst we recognise that treatment
of mental ill-health falls beyond the direct remit of the EU,
we urge the Green Paper for the sake of completeness to include
in this section a call for better access and information on available
treatments for all mental conditions. The barriers to treatment
that exist across member states need to be overcome if we are
to reduce the burden of mental ill-health in our communities.
Access to appropriate care is a critical component and goes hand-in-hand
with social inclusion.
We urge the Commission through the Green Paper:
— to make explicit the need for
targeted resources and investment in mental health prevention
and treatment; and
— to recognise that significant
barriers to treatment exist across Member States and that efforts
to eliminate these barriers are critical to allowing the social
inclusion and quality of life of those affected by mental ill-health.
(iii) Promoting the social inclusion of
mentally ill or disabled people and protecting their fundamental
rights and dignity (section 6.2)
Individual and carer empowerment:
We feel that this chapter of the Green Paper
would benefit from a dedicated section which underlines the critical
role that patient/family engagement plays in advancing social
inclusion and human rights for people with mental ill-health.
This section should also mention the critical
role of joint training of patients, family members, professionals
and policymakers in advancing social inclusion. The Leonardo programme,
supported by the European Commission, provides an excellent example
of such an initiative. Other examples include Prospect, developed
by Eufami, and Profamille, run in Switzerland.
— We urge the Commission to recommend
explicitly the engagement of persons with mental and their families
in the development of policies, information materials and service
provision as a vital step to reform.
— We also urge the Commission to high
the critical role that joint training programmes that bridge across
different sectors and stakeholder groups may play to foster removal
of stigma and increased social acceptance and understanding of
mental ill-health.
A change in paradigm:
We share the Commission's goal of increasing
de-institutionalisation and moving the nexus of care for people
with mental ill-health to the community. However, we feel that,
particularly in the case of severe mental illness, it is important
to acknowledge that this switch has often been ill-managed and
that considerable gaps in treatment still persist today. The development
of appropriate mental health services in the community has not
been achieved in many countries. The greatest shortage in most
countries appears to be in services that bridge across social
care and healthcare.
Thus we urge the green paper to recommend:
— The provision of improved training
for all specialist and non-specialist health and social care staff
working with people in the community and facilitate these strategies
via EU-level initiatives.
— The good coverage of sheltered housing
and community schemes for the entire population corresponding
to local need.
— Investment in social reintegration
programmes for people with severe mental illness at the crucial
stage of re-entering the community following specialist treatment.
Evolution of local support services
Local solutions to the challenges of severe
mental illness have made an enormous difference within local communities.
These local partnerships will, to some extent, need to evolve
organically if they are to be effective. National and regional
policy makers can make the difference by ensuring those local
actors who "dare to care" are resourced, connected to
others, listened to, and above all, respected.
— We recommend that Member states are
encouraged to provide and facilitate flexible and long-term funding
for local level schemes, recognising the crucial role of NGOs
and other non-governmental care providers in working for the public
good.
C. SUMMARY
Mental ill-health in Europe is second only to
cardiovascular disease in its toll on morbidity and mortality.
We welcome the Green Paper as an important vehicle for communicating
the importance of addressing mental health at EU- and national
level with utmost urgency. Mental health and physical health are
linked. Actions and approaches to reduce the burden of mental
health may learn from efforts aimed at reducing the burden of
physical health.
Most importantly, at the heart of all initiatives
aimed at improving the health and quality of life of people with
mental ill-health lies the issue of their empowerment and social
integration. Access to appropriate prevention, health and social
care is a critical component and vehicle towards social inclusion
and the destigmatisation of people with mental ill-health.
| 
