Memorandum by the NHS Confederation
INTRODUCTION
1. The NHS Confederation welcomes the inquiry
on the European Commission Green Paper on EU Mental Health Strategy
2. The NHS Confederation is a membership
body that represents over 93 per cent of all statutory NHS organisations
across the UK, including 90 per cent of Primary Care Trusts (PCTs)
and 100 per cent of Strategic Health Authorities (SHAs). Our role
is to provide a voice for the management and leadership of the
NHS and to represent the interests of NHS organisations. We are
independent of the UK Government although, of course, we work
closely with the Department of Health and the devolved administrations.
3. Our evidence sets out our general views,
based on feedback from our members.
4. The NHS Confederation also leads the
UK delegation to HOPE, the European hospital and healthcare federation.
We have therefore made a similar contribution to HOPE's submission
on this strategy.
OVERVIEW
5. Mental health problems cause difficulties
in almost every aspect of society. Economic prosperity is affected
by absenteeism and poor productivity, insurance costs for disability
insurance claims are increasingly onerous and welfare benefits
to support the unemployed place a huge burden on the tax-payer.
6. Mental illness undermines social cohesion,
especially for those excluded from the workplace. People with
mental health problems suffer from community isolation even after
de-institutionalisation. This is not ameliorated by public concern
about risk, and the reality that many criminal offenders have
diagnosable mental illness.
7. Most importantly, however, mental health
problems severely reduce the quality of life of those who are
ill. The effects are felt in their personal relationships and
social networks, and more systemically in terms of their downward
occupational mobility.
8. The UK and other member states have made
great strides in improving the way in which mental health problems
are addressed. However, there is much more to be done. We look
forward to the advances to be made from taking a Community approach
to mental health.
Whether an EU strategy on mental health would
be appropriate. If so, what elements might it contain?
9. A great deal has been achieved at member
state level to combat the effects of mental health problems and
to tackle the determinants of mental illness. An EU strategy that
enables information-sharing and cross-pollination of ideas will,
wherever possible, permit common responses to common problems.
The open method of co-ordination is an ideal tool for such exchange.
10. Given the EU's existing competence in
health promotion, it is sensible to tackle the promotion of mental
well-being. However, there is much more that could be done in
schools and for young people. The identification and prevention
of problems before adulthood is now acknowledged as a major priority
for re-organising mental health services. It should therefore
be the cornerstone of service change across member states.
11. We already know how to reduce suicide
and depression and we are rapidly improving our knowledge of substance
abuse. However, it is likely that prevention could be much more
effective if knowledge was shared across member states.
12. Tackling stigma, social exclusion, discrimination
and the myths of mental illness is absolutely crucial. Instrumental
to this would be national commitments to raise the employment
rate of those with mental illness. When considering the contribution
that social inclusion makes to dynamic and competitive economies,
it is clear that mental health is relevant to more than just health-related
policy initiatives. The business case for increased labour market
participation is a compelling one.
13. Research and information is essential,
as is access to a common data-set to enable cross-border learning
and policy exchange. Learning should centre on policy and practice
based on the best available evidence. We suggest that the European
Commission support a more pro-active, research-based strategy
for mental health. This would include a multi-phase and long-term
attempt to gather evidence and promote research into mental health
issues. An evidence base supported by social, scientific and policy
related research will create a robust platform for an evolving
and maturing mental health strategy for the EU.
14. The proposed strategy refers to health
inequalities within as well as between member states. We urge
the European Commission to focus particularly on the differential
use of services by different ethnic groups. We have much to learn
about improving access for black and minority ethnic users across
the European Union.
15. We would also suggest that a Community
strategy pay attention to the workforce requirements implicit
in each proposal. Professional roles and the degree to which staff
are substituted varies between member states. However, multi-disciplinary
teams play a pivotal role in health service organisation and can
be used to deliver services in pro-active and creative ways.
CONCLUSION
16. We are aware of the difficulties in
mainstreaming mental health services in a climate of increasing
pressure on health budgets. However, we believe that a collective
approach to prevention, promotion and inclusion, under-pinned
by robust evidence-based research will only be positive for citizens
of the EU.
17. Finally, we would like to thank the
House of Lords for the opportunity to comment on the EU Mental
Health Strategy.
May 2006
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