Memorandum by Turning Point
Turning Point is the UK's leading social care
organisation and a registered charity. We provide services for
people with complex needs, including those affected by drug and
alcohol misuse, mental health problems or those with a learning
disability. We run services in over 200 locations in England and
Wales.
Our portfolio of over 20 mental health services
includes crisis support, assertive community outreach programmes,
supported housing, residential care and specialist provision for
people with personality disorders. Our service users are similarly
diverse. In 2004-05 we worked directly with 89,736 clients of
whom 5,856 used mental health services. We also helped 37,479
more people through services such as needle exchanges and telephone
helplines.
The majority of Turning Point clients have a
combination of needs. For example, we estimate that at least one
in five of the people we support with mental health issues also
need help with serious substance misuse and our experience mirrors
national trends that 50 per cent of people in drug or alcohol
services also have a mental health problem.[89]
(1) How relevant is the mental health
of the population for the EU's strategic policy objectives, as
detailed in section 1?
Mental Health is extremely relevant to the strategic
objectives outlined in section 1. The Green Paper recognises that
there are strong links between good mental health and long-term
prosperity, both for countries nationally and at an individual
level. The mental health of a population is essential to the economic
prosperity of the EU: for example, women provide the majority
of unpaid childcare. If they are not supported in terms of their
mental health, then these childcare costs will have to be met.
Evidence suggests that provided that a person
is in appropriate employment, with the right support, working
can improve a person's mental health. Benefits include not only
more financial independence and stability, but also social interaction
and increased self-esteem.
However, as the Green Paper acknowledges in
its references to quality of life, Turning Point strongly believes
that in considering a country's prosperity, it is essential to
go beyond purely economic indicators, to look at how it treats
its most vulnerable citizens, many of whom are not in work.
The majority of people who Turning Point works
with have overlapping needs, such as mental health and substance
use problems or mental health and a learning disability, sometimes
combined with an offending history or unstable housing. Such people
have valuable contributions to make to society far beyond economic
terms. However, these people are being denied the right to contribute
to society to their full potential because many social care agencies
and other services in this country are not designed to support
people with complex needs.
In England, there has also been a growing impetus
for mental health to be seen from a rights based perspective.
The Disability Discrimination Act 2005 broadens the definition
of disability by removing the requirement that a person's mental
illness be "clinically well-recognised" in order for
that person to gain protection from discrimination.
The new Disability Equality Duty requires that
from December 2006, public sector bodies are proactive in ensuring
that disabled people, including those with mental health problems
are treated fairly. Therefore, this very relevant to the European
Union's strategic objective sustain Europe's commitment to solidarity
and social justice.
(2) 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?
Developing a comprehensive EU strategy on mental
health would have many benefits. It would help to increase the
priority given to mental health issues. As the Green Paper suggests
it would constitute a framework for exchange and cooperation between
member states. This would be particularly useful for those issues
with a scope beyond individual countries which are relevant to
many Member States such as the mental health of migrants and asylum
seekers. Furthermore, a Mental Health strategy could play a valuable
role in helping to: ensure consistency of approach and care across
the EU, limit the inequalities in mental health between countries
and highlight the important links between mental health and the
Human Rights Act.
However, Turning Point sees the principle value
of an EU strategy on mental health as building on existing initiatives
both across Europe (eg the WHO Ministerial Conference on Mental
Health's Mental Health Action Plan for Europe, referred to in
the Green Paper) and within individual Member States (eg in England,
the National Service Framework for Mental Health) and in sharing
best practice. It should not reinvent the wheel. The focus and
resources of a strategy should also be on practical applications
and measures which make a tangible, measurable difference to people's
lives.
The EU strategy should also take note of other
international work and initiatives such as The International Initiative
of Mental Health Leadership (IIMHL)[90]
With regard to the priorities listed in section
5, Turning Point welcomes an emphasis on "preventive action"
(2). We would also like to see specific reference to early intervention
once mental health issues have become apparent, to prevent problems
from escalating. Whilst it is important to "promote the mental
health of all" (1) this is potentially such a wide area that
some prioritisation will be essential to focus on areas of greatest
need.
(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?
Turning Point believes that the initiatives
proposed are appropriate. We particularly welcome the Green Paper's
recognition that a person's mental health is profoundly affected
by social care issues such as housing, income and employment which
generally are the responsibility of diverse departments within
Member States. We are also pleased that the Green Paper adopts
a broad understanding of mental health which includes well-being
(WHO definition) and that it mentions specifically reduction of
substance use disorders (section 6.1.2).
It is important that an EU strategy highlights
the value and importance of people who have direct experience
of using mental health services and their carers and families.
The Green Paper makes little reference to finance, although it
will be essential that the Strategy is adequately resourced at
all stages including co-ordination, implementation and review.
Otherwise we fear that the Strategy will have little practical
impact.
With regard to mental health research and policy,
it is key that mental health policy and practice across member
states is evidence-based. Robust, empirically sound research which
compares and evaluates service delivery across the EU would ensure
the dissemination of expertise and best practice. There could
be considerable cost savings if research was better co-ordinated
and conducted across Europe, with less duplication of work in
individual countries. This could be supported by an EU mental
health research body.
It is important that lessons learnt from research
are widely publicised and are made accessible. Research programmes
should include user involvement wherever possible in the research
process.
We note that there is much to be done to improve
data collection within each country and at a pan-European level.
There are many challenges. It will be useful to develop mechanisms
so that data between countries can be compared, but this must
not be at the expense of `losing' important distinct information.
For example, currently in England, for the purposes of data collection,
a learning disability comes under the category of mental health
even though the nature of these conditions and the needs of the
people concerned are quite distinct.
IN SUMMARY
— Turning Point believes that the mental
health of the population is extremely relevant to the EU's strategic
policy objectives.
— There are significant benefits to
developing a comprehensive EU strategy on mental health. It should
build on existing work and its focus must be practical. Its particular
value would lie in researching issues that are beyond the scope
of individual countries.
— Turning Point supports a strategy
which has a broad understanding of mental health and well-being
and which encompasses people of all ages and situations including
children and older people. Priorities will naturally need to be
established within these wide areas.
— From our experience of working with
people who have complex needs, we also welcome the Green Paper's
recognition that mental health should be seen in the wider context
of housing, employment, income and other social care factors.
89 Royal College of Psychiatrists Dual Diagnosis Information
Manual 2002. Back
90
The IIMHL was launched in 2003 by three member organisations-New
Zealand's Ministry of Health, the National Institute for Mental
Health in England and the Substance Abuse and Mental Health Service
Administration in the United States. Canada, Wales, Northern Ireland
and possible Eire are likely to be next to join the IIMHL. Its
Director is Fran Silvestri. Back
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