Memorandum by SAMH
SAMH is the leading not-for-profit sector organisation
in its field in Scotland providing accommodation, support, training,
employment and structured day services for people with mental
health and related problems including homelessness, addictions
and other forms of social exclusion. In addition, we operate an
information service, offering general mental health information
and specialist legal and benefits advice. SAMH campaigns on a
wide range of mental health issues, and works to challenge the
stigma and discrimination experienced by people who live with
mental health problems, influence policy and improve care services
in Scotland.
GENERAL COMMENTS
SAMH welcomes the opportunity to respond to
the European Green Paper on mental health and strongly endorses
the European Commission's acknowledgement that there is no health
without mental health. SAMH's response to the Green Paper will
first of all consider each of the three proposed strands of an
EU strategy on mental health and will then consider the specific
questions posed in the paper. Throughout this document we refer
to "mental health problems" rather than "mental
illness" or "disorder". We do this because we believe
that this is a less stigmatising form of words.
DETAILED COMMENTS
Strand 1—Creating a dialogue with member
states on mental health
The Commission proposes to create a forum between
member states which will lead to an action plan for mental health,
possibly based on the January 2005 WHO Mental Health Action Plan
for Europe, along with the EU Public Health Programme's "Mental
Health Promotion and Mental Disorder Prevention: a Policy for
Europe".
SAMH would welcome such a forum and the opportunity
it would provide to create pan-European debate on mental health
and to learn from experiences in different member states. In order
to set up such a forum it would be vital to ensure that people
who have experience of mental health problems were invited and
supported to participate both in discussions about mental health
and in constructing an action plan, with the attendant necessary
resources.
SAMH believes that the WHO Mental Health Action
Plan for Europe is a largely positive and aspirational document
which in general would serve as a suitable model for a European
Action Plan. However, SAMH has some reservations about the WHO
plan, as follows:
1. The Plan makes no reference to recovery[83]
from mental health problems
This is the most significant omission from the
WHO plan that SAMH has identified. Recovery as a concept has received
a significant amount of attention in recent years in the mental
health field, and for good reason. Mental health services have,
in the past, frequently robbed people who use them of their hope
and aspirations, focusing on managing symptoms and maintaining
people in illness. This has the effect that too often, once a
person has developed a mental health problem, he or she is no
longer seen as someone with the potential to be a useful and productive
member of society, but simply in the passive and recipient role
of a "patient".
A Mental Health Action Plan for Europe must
be grounded in the belief that recovery from mental health problems
is not only possible but is in fact probable for the majority
of people. The belief in the ability of people with mental health
problems to recover is fundamental and must feed into all other
aspects of the plan, including staff training, public education
and the challenging of stigma and discrimination.
2. The Plan does not place sufficient importance
on involving people who have experience of mental health problems
The WHO plan does emphasise the need to involve
people who have experience of mental health problems in challenging
stigma and to recognise their experience and knowledge in planning
services. However, SAMH feels that it does not go far enough in
requiring that people with experience of mental health problems
should be consulted on and involved with every aspect of mental
health, including policy, stigma and training.
3. The Plan does not sufficiently emphasise
the need for early intervention
Quite rightly, the Plan suggests actions for
mental health promotion and for adequate primary care and community-based
care. However, this misses out an important element of mental
health service provision: the availability of straightforward
early interventions. SAMH is aware that, all too often, people
who are in the early stages of a crisis or developing mental health
problem are turned away from services because they are quite simply
not considered to be "ill" enough. This leads to the
person's condition becoming worse, perhaps until the point when
they require admission to hospital, when all that may have been
required was support at an early stage. Mental health services
must be provided to meet the whole spectrum of needs and with
the clear intention of providing support as early as possible.
Such support will include talking therapies, user-led crisis services
and therapeutic drop-in centres, but must be based on the requirements
of people who use the services. It should also be recognised that
in many countries, a significant proportion of mental health services
are provided by the not-for-profit sector. The sector must therefore
be a key partner in the development of a strategy on mental health.
Despite these concerns there are several suggested
actions in the WHO plan that SAMH strongly welcomes, in particular:
— to make mental health an inseparable
part of public health;
— to require that the impact of any
new policy on the mental well-being of the population should be
assessed before its introduction and evaluated thereafter; and
— to ensure parity of funding in relation
to comparable health services.
SAMH also notes that the Plan proposes actions
to tackle the stigma and discrimination associated with mental
health problems, and would suggest that the anti-stigma programme
in Scotland, "see me", would form a good model for use
in devising other national and local anti-stigma campaigns. Along
with four other mental health organisations, SAMH campaigned for
funding for "see me" to be set up and is now one of
the organisations responsible for managing the campaign. The "see
me" campaign has won several awards and, more importantly,
there are early signs that it is having a positive effect.[84]
The Green Paper also suggests that the Forum
would consider the need for Council recommendations on suicide
prevention and mental health promotion. SAMH has a particular
interest in suicide prevention, given that Scotland has one of
the highest rates of death by suicide in Western Europe.[85]
Any recommendations that helped to maintain a strong focus on
suicide reduction would therefore be welcome.
Similarly, a Council recommendation on mental
health promotion, particularly one framed in the context of the
WHO Plan's emphasis on long-term investment, programmes for children
and young people and healthy workplaces, would be welcome. SAMH
would hope that such a recommendation would lead to greater recognition
of the links between physical and mental health and greater integration
between public health campaigns focusing on physical and mental
health.
LAUNCHING AN
EU PLATFORM ON
MENTAL HEALTH
SAMH believes that this is an appropriate aim
of an EU strategy on mental health, and would particularly welcome
the opportunity to identify best practice in mental health services
and in promoting social inclusion from across the EU. Again, SAMH
would emphasise the need to involve people who use mental health
services in all aspects of this area of work. Furthermore, any
effort to identify best practice in social inclusion should take
a holistic approach rather than simply focusing on areas relating
to mental health. It is important to acknowledge that social exclusion
cannot be resolved simply by focusing on a person's mental health
problem: indeed one of the underlying causes of social exclusion
of people with mental health problems is the tendency to focus
exclusively on their medical symptoms rather than addressing the
underlying cause of their difficulties[86].
Issues that should be explored include equality and diversity,
employment opportunities, access to both physical and mental health
care, housing, social networks and skills development.
DEVELOPING AN
INTERFACE BETWEEN
POLICY AND
RESEARCH ON
MENTAL HEALTH
SAMH is not yet in a position to support or
otherwise the proposed "indicator system" which would
include information on mental health and its determinants, impact
assessment and evidence based practice. More information is needed
on how this would be developed and who would be involved in this
development process. SAMH anticipates that it would be necessary
to involve a wide range of stakeholders including the not-for-profit
sector and people who use services, to avoid an inappropriate
focus on medical models of mental health problems.
SAMH supports the overall aim to ensure a better
interface between research knowledge and policy-making, but cautions
against an over-reliance on research into drug treatments. Equal
importance should be placed on research into the effects of diet,
exercise, talking therapies and other forms of therapeutic support
on mental health. The strategy should encourage member states
to make substantial levels of funding available for non-pharmaceutical
treatments for mental health problems. It may be useful to refer
to the 2004 SAMH publication, "All You Need to Know? [87]"
which reports on a Scotland-wide survey of people who use mental
health services on their views about psychiatric drugs. Many service
users have reported significant benefit from alternative and complementary
therapies and many would like greater access to and availability
of such treatments.
The rest of this response will deal with the
specific questions put by the Commission.
How relevant is the mental health of the population
for the EU's strategic policy objectives, as detailed in section
1?
The policy objectives outlined in section 1
of the consultation are to put Europe back on the path to long-term
prosperity, to sustain Europe's commitment to solidarity and social
justice and to bring tangible practical benefits to the quality
of life for European citizens.
SAMH believes that the mental health of the
population is critical in each of these areas. The consultation
identifies that a high proportion of GDP is lost each year in
the EU due to mental health problems, and it is self-evident that
this will have a detrimental effect on the prosperity of the EU.
In Scotland, 79 per cent of people with mental health problems
are unemployed.[88]
This has a cost to the economy in terms of the loss of potential
earnings and the cost of incapacity and other benefits, not to
mention the negative effect on individuals' self-esteem and confidence
of being unemployed. Improving the population's mental health,
as well as addressing the stigma attached to mental health problems
and supporting people into work, would have a positive effect
on the EU's economy.
It is also clear that if Europe's commitment
to solidarity and social justice is to be sustained, the inequalities
experienced by people with mental health problems must be addressed.
These inequalities range from being unable to find work and facing
stigma on a daily basis to being treated in unsuitable wards or
institutions which are often unpleasant environments which do
not provide appropriate therapeutic activities. It should also
be remembered that people do not experience inequalities solely
in the context of their mental health: people with mental health
problems may also experience discrimination because of their sexual
orientation, economic status, gender, ethnic origin or religion.
The needs of each individual must be considered if the EU is to
maintain its commitment to social justice.
Finally, improved mental health must surely
contribute positively to the quality of life of European citizens.
To demonstrate this, we only have to return to the WHO's statement
that there is no health without mental health. A focus on positive
mental health and on early intervention to prevent unnecessary
deterioration in mental health will have positive effects on the
economy, on individual well-being and on the quality of life of
the general population.
Would the development of a comprehensive EU-strategy
on mental health add value to the existing and envisaged actions
and does section 5 propose adequate priorities?
SAMH supports the development of a comprehensive
EU strategy on mental health, in the belief that it will lead
to an EU-wide focus on mental health and to improvements in population
mental health. SAMH does believe that the priorities identified
in section 5 are appropriate but would wish these priorities to
be underpinned by a commitment to consistently involve people
with experience of mental health problems in putting these priorities
into action.
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?
SAMH believes that these initiatives are appropriate.
It will be important in attempting to co-ordinate activities between
member states to consider the very different starting points that
each state has in terms of its population mental health. It may
be helpful to agree a set of principles or core values that each
member state should commit to upholding in developing both its
mental health services and its mental health promotion activities.
SAMH would be pleased to see the EU-wide adoption of the Millan
principles which underpin the Mental Health (Care and Treatment)
(Scotland) Act 2003.
May 2006
83 "Recovery is happening when people can live
well in the presence or absence of their problems and the many
losses that may come in their wake, such as isolation, poverty,
unemployment and discrimination. Recovery does not always mean
that people will return to full health or retrieve all their losses,
but it does mean that people can live well in spite of them".
Mental Health Commission of New Zealand. Back
84
Well What Do You Think: The Second National Scottish Survey of
Public Attitudes to Mental Health, Mental Well-Being and Mental
Health Problems, Scottish Executive, 2004. Back
85
Scotland's Suicide Rate Compared with 16 Western European Countries
1950-2003, Choose Life. Back
86
Mental Health and Social Exclusion-Social Exclusion Unit Report,
Office of the Deputy Prime Minister, 2004. Back
87
All you need to Know? SAMH, 2004. Back
88
Disability and Employment in Scotland: a Review of the Evidence
Base, Scottish Executive, 2005. Back
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