Memorandum by Mental Health Foundation
1. INTRODUCTION
The Mental Health Foundation welcomes the opportunity
to submit evidence to the Select Committee on the European Union.
Our mission is to help people survive, recover
from and prevent mental health problems. We use innovative research
and community projects to address issues of mental well-being
for the whole population as well as to improve the support, services,
rights and social inclusion for people with mental health problems.
People who use mental health services are at the heart of all
our work—as employees, advisors, volunteers, and supporters.
We gather and provide information for anyone who is experiencing
mild to severe mental health problems, and people with dementia.
We also provide information for their friends, families, carers
and providers of mental health services. Our work encompasses
children, adults of working age, and older people.
2. WOULD AN
EU STRATEGY ON
MENTAL HEALTH
BE APPROPRIATE?
An EU strategy designed to facilitate exchange
and collaboration between member states would be of value to individual
states and contribute to a greater understanding and consensus
in regard to mental health policy and practice across the EU.
In the UK alone, costs incurred as a result of mental health problems
are approximately £93 billion per annum. One in four people
will be affected by mental health problems at some point each
year, yet discrimination against people with mental health problems
is still a pan-European problem. We therefore regard the promotion
of mental health and the prevention of mental health problems
as key priorities in keeping with the goals of prosperity, solidarity
and social justice and quality of life for all citizens.
A European Union Strategy on Mental Health will
have the potential to increase understanding and information-sharing
across member states and complement existing national policies
as laid out in documents such as the Department of Health's Choosing
Health White Paper and Making it Possible, a framework
for the implementation of a public mental health strategy in England.
We welcome the recognition in the Green Paper
of the importance of exchange between member states, of working
vertically at all levels, from individual to EU Community level,
and of working across sectors. Mental health should not be perceived
as a distinct health or a social issue, but as an underpinning
factor which impacts across all areas of society. We stress the
importance of policies which encourage integrated working and
information sharing across sectors encompassing areas such as
education, employment, business and the environment.
The Green Paper attempts to cover all aspects
of need in terms of both public mental health and mental health
services for people with diagnosed mental health problems. However
we would like to see more clarity and focus in regard to the role
of a population-wide EU mental health strategy. We believe that
at EU level, it may be more useful initially to distinguish between
these interrelated, but separate areas of concern.
As set out in the Mental Health Foundation's
report "Choosing Mental Health", public mental health
is concerned with improving the mental health of a whole population.
It needs to take a view across the lifespan of all members of
the population and take into account gender, ethnicity, disability,
social class, sexuality and spirituality. It is our view that
a clearly defined European strategy on mental health is entirely
appropriate to tackling public mental health. This would usefully
support member states" national strategies on the second
area of concern—the provision of services for people already
experiencing mental health problems.
3. WHAT ELEMENTS
MIGHT IT
CONTAIN?
We agree with the four priority areas set out
in the EU green paper: promotion, prevention, social inclusion
and further research. However we would like to see a more detailed
strategy or action plan to drive forward implementation throughout
the community.
3.1 Investment
In order to reduce the human and economic costs
of mental ill health, investment is required in long term strategies
to raise awareness, tackle discrimination, reduce social exclusion
and promote mentally healthy lifestyles amongst member states'
populations. These will be key components in producing a prosperous
community in which all citizens experience good quality of life.
It has been calculated that the cost benefit of better mental
health care would be a net saving across government as a whole
of some £3.1 billion a year (Making it Possible, p 9). This
does not take into account the savings from promoting mental health
and preventing problems in the first place. An EU strategy should
be backed up by a robust economic analysis showing potential savings
through investment. Member states with fragile economies should
be supported in implementing priority areas of an EU mental health
strategy.
3.2 Children and Young People
Strategies should include a focus on whole-school
approaches to mental health promotion, the reduction of bullying
within schools, the provision of universal support to parenting
and mechanisms to monitor progress on promoting children's mental
health. Young people in their teens and early twenties need services
designed to address their particular needs and issues. There needs
to be less reliance on medication and further research into identifying
effective ways of building resilience. Early intervention is a
crucial component of mental health that can significantly reduce
the human and economic costs of mental ill health across the life
course. This should be sufficiently resourced. (See Lifetime Impacts,
The Mental Health Foundation 2005)
3.3 Workplace
Employers and employees should be made aware
of their duties and rights under EU and national law around work/life
balance and disabilities issues. If member states laws are inadequate
in this regard, they should be encouraged and supported to implement
legislation. Strategies are needed to tackle discrimination by
employers against people with mental health problems through national,
regional and local initiatives. The European Commission could
lead by example in this regard by implementing positive and proactive
employment initiatives for staff with experience of mental health
problems. Agencies responsible for the provision of financial
support for people out work as a consequence of mental health
problems should take account of the fluctuating nature of mental
health problems and enable a flexible and non-punitive re-entry
into the workplace through return to work approaches such as transitional
employment and individual placement and support.
3.4 Lifestyle
The Green Paper places emphasis on prioritising
"high quality mental health and treatment services".
While we wholly endorse policies which support the continued development
and improvement in availability and quality of services for people
with mental health problems, we would urge the Commission to also
incorporate within any mental health promotion strategy a strong
focus on core lifestyle factors such as diet, physical activity
and alcohol/substance use.
3.4.1 Diet
The links between diet and mental health are
being increasingly understood. Studies have ranged from examining
individual responses to diet changes in randomised controlled
trials, to population-based cross-cultural comparisons of mental
health and food intake. Dietary changes have been found to have
a significant impact on problems such as anxiety and depression,
schizophrenia, Alzheimers disease and Attention Deficit Hyperactivity
Disorder. We propose the promotion of healthy eating at all levels
and across sectors. Any such strategies will need to link up with
member states food and industry sectors in order to make healthy
food attainable and affordable for all members of society. (See
Feeding Minds, Mental Health Foundation, 2006)
3.4.2 Physical Activity
There is also a substantial body of evidence
to show that physical exercise can be as effective as anti-depressants
in treating mild or moderate depression. In April 2004, a report
by the Chief Medical Officer on the impact of physical activity
and its relationship to health stated that: "Physical activity
is effective in the treatment of clinical depression and can be
as successful as psychotherapy or medication, particularly in
the longer term". In December 2004 the National Institute
for Clinical Excellence recommended in its guidelines for treating
depression in primary and secondary care that: "Patients
of all ages should be advised of the benefits of following a structured
and supervised exercise programme of typically up to three sessions
per week of moderate duration".
In view of this, there are strong reasons for
promoting exercise therapy as a first-line treatment. In contrast
to the negative side effects of medication, exercise has coincidental
benefits and can be used to treat a mix of physical and mental
health problems. It is a sustainable recovery choice; less costly,
it promotes social inclusion and it is popular. Treatment completion
rates are often much higher than with medication. However, research
carried out by the Mental Health Foundation found that although
exercise referral schemes are in place in the UK, only 5 per cent
of general practitioners use them as their first line of treatment.
We propose exercise be promoted both amongst the general population
at local, regional and national level and that policies targeted
at prevention and treatment are comprehensively communicated to
healthcare practitioners through the use of "exercise champions".
(See Up and Running, Mental Health Foundation, 2005) There is
a need for further action research on the most effective ways
of increasing exercise uptake and reducing the barriers to physical
activity among the most vulnerable and disadvantaged groups including
low income, people with mental health problems and older people.
Practical solutions for enabling participation are needed.
3.4.3 Alcohol
Little has been said in public policy documents
about the way the general population relies on alcohol. However
alcohol can have a significantly detrimental effect on mental
health. We recommend that all alcohol-related public health materials,
training and teaching should cover mental health aspects of alcohol
misuse/use. Increased education about the association between
alcohol use and mental health in schools should be used to alert
people to the potential risks of using alcohol.
3.5 Mobility
The strategy should take into account the increased
migration between states and issues around cultural sensitivity,
language and state responsibility.
3.6 Research and Monitoring
The Green Paper acknowledges the importance
of developing a mental health information, research and knowledge
system to underpin Community actions on improving mental health.
A European public mental health observatory
based on the UK regional models would provide a useful platform
for the setting of over-arching key public mental health indicators,
data collection and evaluation. This would enable all European
countries to collect comparable data and track changes over time.
Other initiatives might include:
— The identification of cost benefits
arising from mental health promotion.
— A standardised toolkit that can be
applied across all settings.
— Any process involving the setting
of indicators, monitoring and evaluation should incorporate service
user defined outcomes as a core element.
— Service user involvement at local,
national and community level should be measured.
3.7 Service User Involvement
It is crucial that people who use mental health
services and their carers are central to any thinking about an
EU mental health strategy that sets out plans for mental health
service provision, however this is not a strong focus in the Green
Paper. There is a need to consider ways in which to build capacity
for a high degree of service user and carer involvement at community
and member state level. Commissioners may find it useful to link
in to the NGO Service User involvement Group established following
the World Health Organisation's Declaration on Mental Health in
2005.
3.8 Social Inclusion
People with mental health problems often experience
isolation and exclusion from fundamental aspects of life such
as employment, quality housing, social networks and education.
In order to meet the policy priority of equality and social justice
set out in the Green Paper, it is important the strategy sets
out practical ways in which to recognise and support diverse needs.
Under the theme of social inclusion, we would like to see a real
focus on reducing stigma and discrimination and on recovery orientated
approaches such as flexible supports and phased approaches towards
community development and involvement, such as the clubhouse model.
The media plays a central role in contributing
to public perceptions of mental illness. However in the vast majority
of cases it serves only to reinforce the most negative misperceptions.
The media therefore play a key role in challenging stigma and
raising public awareness. Consideration and planning should be
given to ways of disseminating the most effective delivery of
social inclusion.
4. HOW MIGHT
IT COMPLEMENT
AND ADD
VALUE TO
THE STRATEGIES
OF MEMBER
STATES AND
THE ACTIVITIES
OF THE
WORLD HEALTH
ORGANISATION AND
OTHER INTERNATIONAL
BODIES?
4.1 Health and Social Care Policy in England
A European Strategy on Mental Health would complement
Department of Health policy by providing an underpinning framework
linking key health and social care policy initiatives, which otherwise
appear disconnected and do not maximise opportunities for cross-agency
working, for example:
— Standard One of the National Service
Framework for Mental Health—Promoting Mental Health and
Tackling Stigma and Discrimination. This requires the NHS in England
in partnership with other agencies to promote the mental health
of their local population, and to tackle the stigma, discrimination
and exclusion experienced by people with mental health problems.
— The National Service Framework for
Children and Young People sets out standards and strategies which
include the promotion of mental health and well-being, prevention
and early intervention, including parenting support and the protection
of maternal mental health.
— The Choosing Health White Paper outlines
the agenda for public health over the next three to five years.
It identifies mental health as a priority issue and is part of
a growing awareness of both the economic and public health case
for a greater focus on promotion and prevention.
There would be similar benefits in relation
to policy in Scotland, Wales, and Northern Ireland.
4.2 Equality and Social Inclusion Policy
Other key areas in which a European strategy
would add value to UK policy are:
— Social Inclusion agenda—An
EU mental health strategy would support the programme set out
in Mental Health and Social Exclusion which covers discrimination,
employment, mental health promotion and access to fundamental
rights such as decent housing and education.
— The Disability Discrimination Act
clearly legislates that people should not be discriminated against
on the grounds of disability including disability as a consequence
of poor mental health. An EU strategy may help to ensure all member
states implement similar legislation.
— General Medical Services Contract—A
European Strategy on Mental Health will complement and potentially
place greater emphasis on the need to make general mental health
promotion and screening a priority within the Quality Outcomes
Framework guidance within the GMS contract.
4.3 WHO Policy
An EU strategy would directly support the priorities
set out in the World Health Organisation's Declaration on mental
heath, namely to:
(i) foster awareness of the importance of
mental well-being;
(ii) collectively tackle stigma, discrimination
and inequality, and empower and support people with mental health
problems and their families to be actively engaged in this process;
(iii) design and implement comprehensive,
integrated and efficient mental health systems that cover promotion,
prevention, treatment and rehabilitation, care and recovery;
(iv) address the need for a competent workforce,
effective in all these areas; and
(v) recognise the experience and knowledge
of service users and carers as an important basis for planning
and developing mental health services. (Helsinki Declaration 2005)
5. CONCLUSION
The Mental Health Foundation supports the intention
to develop an EU-level strategy on mental health and feels this
would add value to the work done by member states. In particular,
elements relating to public mental health should be enhanced,
as these have the greatest opportunity to promote the wellbeing
of the whole population and address many of the issues relating
to disability, social exclusion and stigmatisation currently experienced.
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