Memorandum submitted by Samaritans
A. INTRODUCTION:
SAMARITANS
Samaritans is a non-religious, non-partisan
organisation representing 202 organisations across the UK and
Ireland working under a constitution that seeks to support people
in distress and despair, including those considering suicide.
Befrienders Worldwide, for which Samaritans
runs the secretariat, extends this mission to a further 200 organisations,
in 38 countries, across the world.
Samaritans was founded by the Reverend Chad
Varah in 1953 and is regarded as the UK/I's first "helpline",
providing support to people in distress and despair, including
those considering suicide. Samaritans is a volunteer led organisation,
headed by a small board of trustees and an association made up
of the lead volunteer from each of the 202 autonomous federated
branches. Samaritans network of branches developed slowly as a
community led initiative wherever suicide was recognised as an
issue.
Communities outside the UK/I began to develop
similar activities and in 1974 they came together to form Befrienders
International, which was also founded by Chad Varah. In 2003 Samaritans
took on the co-ordination of the network which now aims to provide
an exchange of support, knowledge and experience whilst linking
externally for mutual learning and influencing. The Befrienders
Worldwide multi-language website is the principal global resource
for people in emotional distress, with up to 80,000 "hits"
every month.
The other activities of the, newly named, Befrienders
Worldwide network include providing advice and resources to members
and potential members in setting up services and a long running
twinning scheme to foster visits and exchanges. The twinning project
has a record of success showing the benefits of effective listening
across language and culture.
In order to maximise impact Samaritans works
closely with our sister organisations IFOTES and LifeLine International
to extend good practice across the globe, including on the media's
portrayal of suicide. As part of this coalition we are in the
process of partnership development with the World Health Organisation.
B. GENERAL COMMENTS
ON THE
CONSULTATION
Samaritans/Befrienders Worldwide welcomes the
adoption of the Green Paper and applauds the process which has
enabled a number of stakeholders, including our organisation,
the opportunity to share its views with the Commission. We hope
that the engagement with a diversity of actor remains a fundamental
part of the continuing programme including its delivery.
As mental health becomes increasingly synonymous
with well being it is seen by Samaritans as a subjective concept
and one we feel that services have to recognise as such. This
is because caught up in the issue of whether a person accesses
mental health services, is how they feel about their mental health
and whether they consider such services relevant or helpful. Samaritans
now talks about emotional health, since this is arguably a less
threatening and medicalised term. In our emotional health promotion
and emotional support workstreams we recognise that people express
their needs differently and as such may wish to use other language
to describe their mental health. In essence, it is vital that
services adopt a holistic approach to mental health and begin
by listening to how people wish to discuss such issues.
The stigma surrounding mental health and the
resulting discrimination experienced by people in distress is
a major determinant of their quality of life. The stigma and discrimination
present in mental health services, other services and in the general
population must be addressed as a priority.
C. SPECIFIC COMMENTS
ON QUESTIONS
RAISED IN
THE CONSULTATION
PAPER
Question 1. The relevance of good mental
health of the population, and our beneficiaries, for the EU's
strategic policy objectives
1.1 The statistics for the burden of mental
health are increasingly well known, we have figures that show
the forecast for those who will have an episode of mental illness
(one in four[74]),
the number of days lost in the UK due to stress in the workplace
([75])
and the fact that by 2020 Depression will be the greatest cause
of morbidity in the world. [76]However
there is a need for more information specific to the Europe and
this is the first reason why we would commend the adoption of
a Europe wide policy for mental health.
By drawing the research of individual states
together it will be possible to assess the impact of policies,
environment and societal changes and trends into the widest picture
of emotional health. A basis for this research can be found in
the work of researchers such as Knapp and Patel. By making a case
for mental health that is linked to a strong economic argument
we believe that greater efforts will then be made to address this
situation.
1.2 The people of Europe are amongst the
most mobile, thanks to the competitive nature of transport, portability
of qualifications and the open borders between member states.
As new states join we have seen major movements of their populations
into the more developed areas seeking employment opportunities.
At the other end of the scale there has long been a movement of
people, often retired, from Western Europe toward the warmer,
and sometimes cheaper, southern areas.
The central place of work as a part of European
lifestyles means that there is an opportunity to use it as a key
part of health promotion activities but it is a necessity to ensure
that a good work-life balance is promoted to those in employment.
Samaritans have recognised the central role of work and developed
activities to improve emotional health and well being in the workplace
which in turn also address the stigma.
The mobility, which enables Europe to remain
economically buoyant and flexible, is a key priority of the EU.
However we would support the view that dependent on the origin
of the "patient" and the destination of country in which
they reside for work, the quality level of mental health accessible
to these groups varies significantly. [77]There
is also increasing evidence[78]
that wealth does not lead to an increase in happiness further
supporting the view that an effective work-life balance must be
found.
Migrant workers are noticeable in the UK in
that they often work in sectors requiring low skills and in which
pay levels are barely above the national minimum. For example
in rural areas agencies such as Citizens Advice[79]
have recognised that significant migrants are working as crop
pickers. As migrants are often coming in from new accession countries
which are those with higher rates of suicide and combined with
a lack of their normal support networks this can bring further
marginalisation and stress upon individuals. A major English food
manufacturer has recently been in contact with Samaritans having
identified just such a support need for their seasonal Polish
workers.
In order to make our service accessible to migrants
we offer a variety of initiatives. Samaritans advertise our services
(available via telephone, face to face visit, letter, email, textphone
and SMS text message) both nationally and locally, in a variety
of languages. Our services can also be delivered in over 50 languages
via Samaritans volunteer language bank.
1.3 However help seeking behaviour is a
not a common characteristic of Europeans and cultural issues mediating
against this must be addressed. These traits can establish themselves
as a part of a national, self-fulfilling, stereotype that can
act against good mental health. Where a country is establishing
itself as a tourist location where vacationers "get away
from it all" there can be a reluctance to accept that mental
health remains an issue. An anecdotal report from a Samaritans
branch based in a country popular with retiring British citizens
states that they receive a lot of calls from individuals, many
of them widowed, who having retired there with their partner are
now alone and feel adrift in the health care system. Due to Samaritans
awareness levels with British people the branch is seen as a dependable,
though unofficial, part of the healthcare provision. However the
branch receive only minimal support from the government there
as the country wishes to portray itself as a "happy place"
in order to protect the tourist industry.
We would wish to see support for the continued
provision of helplines and other support service to those in distress
and despair, including those considering taking their own lives.
The work of Befrienders Worldwide in conjunction with partners
makes up a significant part of this support and recognition for
it must be included in any strategy. We would further welcome
initiatives to increase the participation of the voluntary sector,
and of service users, in the development and implementation of
measures to support those in need.
1.4 If the aim of the strategy is to provide,
and increase access to, quality mental health services then investing
the required resources is necessary to provide those choices.
This means offering long-term therapeutic support, requiring not
only resource commitment but also a commitment to partnership
with those stakeholders, including agencies such as Samaritans,
to develop methodologies which complement each other and add value
to the total service offering. To achieve this level of working
Samaritans would like to see an agreed standards framework covering
mental health services. As a measure of good practice this would
include some form of assessment that identifies risk.
1.5 In order to overcome language and cultural
barriers we would hope to see a simple EU wide mental health promotion
campaign that would, as appropriate, overarch or fit in with members
states' own initiatives. Where member states do not have suicide
prevention or mental health promotion strategies in place they
should be encouraged to develop these and measures to enthuse
and supports members states to support initiatives within their
own countries should be made available. World Suicide Prevention
Day and World Mental Health Day (respectively the 10 of September
and October) should be used as key activities in this work.
Question 2. The value added, to our service
or our beneficiaries, through an EU strategy and its components
2.1 Through the partnership Samaritans has
with IFOTES and LifeLine International (operating as Volunteer
Emotional Support Helplines or VESH) we would be able to use the
common reference tool of an EU wide strategy to further develop
our joint working activities to optimise their impact. We currently
share a common platform at events such as at the 2005 International
Association of Suicidology conference in Durban.
Our strong commitment to inter-agency collaboration
reflects our recognition of an increasingly mobile society, and
the need for services to keep pace in terms of being available
across borders and with varied means of access. Everyone is responsible
and accountable for ensuring that relevant rights are respected
for all groups at risk, and especially for those facing high stigma
mental health issues.
The Samaritans email service demonstrates the
cross-border nature of emotional support, with up to a third of
emails coming from outside the UK/Ireland.
2.2 The development of this partnership
also offers increased potential for the sharing of experiences
and best practice and a chance to evaluate how successful an EU
strategy is across a Pan European partnership. We would hope to
see that any policy whilst including suicide and mental health
also extends its scope to bring in other areas. As a provider
of a helpline (amongst other services) we would look to the Commissions'
role in developing ICT as a key part of the strategy. We already
foresee that further opportunities to extend and improve our service
delivery may become available due to developments in telephony
and ICT:
— Voice over Internet Protocols (VOIP)
would potentially enable all non face to face contacts including
email, voice and SMS text messages into Samaritans to be channelled
digitally.
— Harmonised European Short Codes (HESC)
(such as 112) which connects callers to emergency services, such
as the police, in whatever country they are in will be examined
to see how they may benefit our beneficiaries.
However there are other areas that we would
also hope to see the EU strategy reflected in. As part of its
work on the Department of Environment, Food and Rural Affairs'
Rural Stress Action Plan Samaritans has input into a checklist
to "rural stress proof" policies. Given the role of
the CAP in European policy and potential reforms in the future
this would be a system we would advocate for in future policy
development and of particularly relevance to rural communities.
We would also look towards this strategy being
one that proposes the need for early intervention work in schools
and workplaces and one that in line with the work of Jenkins,
McCulloch, Friedli and Parker[80]
includes both risk reduction and health promotion activities as
equally valuable activities and necessary if success is to be
achieved. Samaritans has, in line with the relevant strategies
of the UK and Ireland, developed interventions in both of these
areas and aims to further develop our emotional health promotion
work in the future.
2.3 An EU strategy should aspire to simplifying
and streamlining activities, building on existing agreements and
principles and avoiding duplication. This should take place at
all levels ensuring that international agreements such as the
Helsinki Declaration of 2005 feed down to individual member states
and are implemented. As has been seen in previous research[81]
the lack of consistency in data collection and indicators has
made cross comparison difficult if not impossible and the need
for clear and agreed objectives, intervention and indicators are
critical if effective medium and long term evaluation is to take
place.
2.4 It has been shown in some studies that
there is link a between alcohol use and mental health, specifically
suicidal behaviour. But the evidence linking alcohol abuse to
increased impulsivity and then suicide remains, in the view of
Samaritans, inconclusive. It should also not be forgotten that
these substances are also likely to be used as a support mechanism
by some people. Research into the links remains necessary and
we would wish to see this continue. However until this is more
conclusive we would wish to see a strategy in which the promotion
of healthy choices is a priority and where any actions to deter
people from substance abuse take place in a supportive environment.
2.5 It is disappointing that self-harm does
not figure in the Green Paper and Samaritans would point to the
report of the UK National Inquiry into Self Harm "Truth Hurts"[82]
to inform additional recommendations. Though self-harm is related
to emotional distress, and interventions not specifically focused
on self-harm can improve emotional well-being, it remains important
that interventions are based on an understanding of self-harm
and respond to it as a specific issue.
2.6 The strategy fails to engage the need
for Media to be engaged with both as a group to influence and
a channel to utilise. Samaritans has for many years produced media
guidelines on the representation of suicide and these have been
the basis of many other guides. We continue to work across the
UK and Ireland to develop media guidelines and monitor media output
in order to inform journalists and their audiences of positive,
non-stigmatising and alternative messages on the portrayal of
mental ill health and suicide. This is supported by work with
government and industry to develop codes of conduct. The EU strategy
enables Samaritans to disseminate this work to a wider audience
and share our best practice. We would call for Media to be incorporated
in the strategy and are happy to share further information on
this issue.
We would also seek to see measures in the final
strategy that encompasses New Media and particularly our concerns
over the overtly graphic portrayal of suicide methodologies that
are available over the Internet. We aspire to the promotion of
positive choices and would wish to see Samaritans and our sister
organisations prioritised by Internet Service and Search Engine
Providers (ISPs). The company AOL has already agreed to prioritise
services like our own and we will continue to work with ISPs to
enable this wherever possible. We do not advocate for the banning
of these sites as we strongly believe that this would not prevent
them from existing and merely drive them underground and increase
stigma.
Question 3. Are the initiatives proposed
appropriate to support the co-ordination 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?
Samaritans are keen to see the creation of an
EU wide network, but would caution that this should not be at
the expense of existing interagency networks and should seek to
work with them. In addition to our own work within Befrienders
Worldwide IFOTES, there is work underway by SME, EPHA, IASP and
many others, which will be of significant value to the development
of this strategy. Samaritans looks forward to the strategy and
engaging further in its successful implementation, we would be
willing to meet with representatives of the Commission or other
implementing agency at their convenience to discuss any of these
issues raised in this response in greater detail and how Samaritan
may contribute.
May 2006
74 WHO-Investing in Mental Health 2003. Back
75
HSE-Stress Management Guidelines. Back
76
WHO-Prevention of Mental Disorders 2004. Back
77
The State of Mental Health in the European Union. 2004. Back
78
Happiness. Lessons from a new science. Richard Layard. Penguin
Books 2005. Back
79
Supporting migrant workers in rural areas. Citizens Advice. September
2005. Back
80
Developing a Mental Health Policy. Maudsley Monograph 43. 2002. Back
81
"The State of Mental Health in the European Union. Back
82
Truth Hurts: Report of the National Inquiry into Self-harm among
Young People. Mental Health Foundation 2006. Back
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