14TH REPORT: "IMPROVING THE MENTAL
HEALTH OF THE POPULATION": CAN THE EUROPEAN UNION HELP?
Letter from Ivan Lewis MP, Parliamentary
Under Secretary of State, Department of Health to the Chairman
We were grateful to receive the Inquiry Report
of Sub-Committee G on their scrutiny of the European Commission's
Green Paper on mental health; I have pleasure in submitting to
you the Government's response.
I would like to take this opportunity to express
our appreciation of the constructive and thoughtful approach that
the Sub-Committee adopted.
GOVERNMENT RESPONSE
Introduction
1. The Government welcomes the Committee's
report of its inquiry as a thoughtful and constructive contribution
to the debate. This response follows the order of the Committee's
report, addressing the main points in turn.
2. We feel the Committee's main conclusions
are broadly consistent with our positive response to the European
Commission's Green Paper on the potential value and content of
an EU mental health strategy. In brief, this was that an EU strategy
could add value by supporting delivery of the World Health Organisation's
action plan—for example, by promoting cross-sector activity
in ways that a single-subject body like the WHO cannot.
3. However, we also expressed the view that
a strategy should be flexible enough to accommodate Member States'
own priorities for delivery and their different starting points.
We still believe that the EU should encourage particular developments
by disseminating information and facilitating local developments
rather than by attempting to set EU-wide priorities that are significantly
more closely defined than those in the Green Paper.
4. The Commission's consultation exercise
ended in May 2006, and at the time of writing the adoption of
a Commission Communication on Mental Health—ie the strategy—is
scheduled for the summer of 2007. We have no firm information
about the nature of the strategy other than the Commission's comment
in May 2007 that it will "open up opportunities for exchange,
cooperation and co-ordination at EU level on key aspects in mental
health and it will also announce a number of specific initiatives."
5. Clearly, with the strategy's publication
imminent our scope for influencing its content is now limited.
However, we expect Member States to have discretion in how to
use the strategy, and the Committee's report will help us to frame
our reaction to the strategy when it appears. We respond to the
report largely on that basis, while recognising that we are discussing
a mental health strategy intended to benefit the EU as a whole,
not the UK alone.
Chapter 1: setting the scene
6. The first chapter of the Committee's
report accurately describes the scale and variety of the challenges
that mental illness presents to society, and to government. In
some ways those challenges are common across EU Member States,
but in others they are not—suicide rates vary widely, for
example, as do the systems and services in place for providing
care and promoting good mental health. It is relevant to the discussion
of an EU strategy to note that the UK is considered by the WHO
to be one of Europe's strongest performers in this field, with
a comparatively low suicide rate, significant increases in investment
and work force over recent years, and a greatly strengthened emphasis
on treatment within communities rather than in hospitals.
7. That is not an excuse for complacency,
of course, which is one reason why the UK Government is a signatory
to the 2005 WHO Helsinki Declaration and action plan for mental
health in Europe. We continue to share the Committee's support
for that plan and believe we can demonstrate real progress against
all its key points.
8. In our response to the European Commission's
Green Paper, and in our evidence to the Committee we expressed
support for the idea of an EU strategy designed to facilitate
the implementation of the WHO plan rather than add to it or rival
it in any way. That remains our position and, so far as we know,
that of the Commission.
Chapter 2: defining mental well-being and mental
health problems
9. The vocabulary used to discuss these
issues is not a trivial matter. We prefer to remain flexible,
and to use language appropriate to the context and audience. What
matters is that the meaning is mutually understood, and therefore
we normally employ the current most widely accepted and conventional
terminology.
10. In our 1999 National Service Framework
we defined mental health as:
"An individual's ability to cope with
the stresses and challenges of life."
11. "Mental illness" is a very
broad concept, and liable to be misunderstood if used in isolation
to describe something more specific. The NSF definition is:
~"[A] range of diagnosable mental disorders
that excludes learning disability and personality disorder."
12. Taken together, we feel that in most
ways these definitions are close enough to the terminology of
the Green Paper to allow meaningful communications with the Commission.
13. There is a consensus that mental illness
is common and sometimes serious, and that its impact—on
individuals, the economy or society as a whole—can be correspondingly
significant. When discussing the prevalence of mental illness
in the UK, we normally quote an Office for National Statistics
survey of 2000 which indicated that, at any one time, about a
sixth of the adult population are experiencing symptoms of mental
disorder. It does not follow that clinical intervention would
be necessary or beneficial in all those cases, any more than it
is in every instance of physical illness.
14. We can accept that the five observations
of the EU made by the Committee in paragraph 30 of its report
apply to at least some extent in the UK. We are not certain of
the precise meaning of the fifth—that there is not sufficient
or good enough treatment for most mental health problems—but
we recognise that care for the most common disorders needs to
improve, for example through the programme now underway to increase
access to psychological therapies.
15. We agree that it would be inappropriate
for a strategy to attempt to address mental illness and learning
disability jointly. They are, as the Committee points out, distinct
conditions that require distinct approaches. In England we set
out our intention to improve the life chances of people with a
learning disability in the 2001 White Paper Valuing People.
We would consider carefully any proposal for a European learning
disability strategy.
16. To avoid any risk of confusion, we should
note here that mental illness itself can be classed as a "disability"
under the Disability Discrimination Act 2005, so that the protection
the Act provides can extend to people with mental health problems.
Chapter 3: the social and economic impact of mental
health problems
17. We believe the Committee's report presents
a comprehensive and accurate summary of the evidence, and there
is little to add. The UK Government response to the Green Paper
made similar points.
18. We welcome, and share, the Committee's
recognition of the indispensable role played by the families and
other carers of people with mental health problems. In 1999, the
year that we published the mental health National Service Framework,
we also published the first National Carers' Strategy. The NSF
itself includes a standard for carers which states that they should
be offered an assessment of their own needs, and there are now
almost 800 dedicated mental health carer support workers in post
nationally. We agree that it would be appropriate for a European
Union mental health strategy to offer support to Member States'
own efforts to strengthen support for carers.
Chapter 4: the added value of an EU mental health
strategy
19. The report describes the rationale for
an EU strategy that the Commission's Green Paper presented. We
feel that the Committee's conclusions are positive and consistent
with our own.
20. The EU's role in promoting good mental
health and preventing mental illness is, as the Committee notes,
complex. This is because an effective EU strategy could extend
beyond health care into sectors such as employment. We agree that
this opportunity for cross-boundary working makes an EU strategy
an attractive option, and one that can genuinely complement WHO
activity. We do, however, recognise that Member States have exclusive
competence for the organisation of their health services.
21. We share the Committee's view of the
potential value of the "platform" approach that the
Commission suggested as a method of engaging stakeholders and
spreading information and ideas. We await the final proposals
on this, and on the wider governance arrangements for the strategy.
Chapter 5: human rights issues
22. The Committee recognises the significance
of human rights issues for mental health care policy, and how
the challenges they present vary across Member States. As the
Committee notes, the UK is recognised as having made great strides
in the transfer of care from long-stay institutions to communities,
although there remain times when a period of care as an inpatient
is the most clinically appropriate and safe course of action.
An EU strategy should not neglect the needs of these inpatients.
For the small proportion of patients who need to be subject to
compulsion in treatment to avoid harm to themselves or others,
we have strong safeguards enshrined in mental health and human
rights legislation. As we have already noted, the protection of
the Disability Discrimination Act extends to people with a mental
disorder both in hospital and in the community.
23. Like the Committee, we hope that an
EU strategy for mental health can—alongside the WHO action
plan—help all Member States to offer care that respects
human rights, and is provided in an appropriate and minimally
restrictive environment that fosters recovery.
Chapter 6: social exclusion, stigma and discrimination
24. We welcome the emphasis that the Committee
has given to these issues. We acknowledged the problems in our
response to the Green Paper and, like the Committee, believe that
the strategy has a potentially important part to play in providing
encouragement and support to Member States as they attempt to
address them.
25. Tackling the social exclusion, stigma
and discrimination still suffered by people with mental health
problems is a priority in the UK and we have already discussed
with the Committee some of the action we are taking through the
"Shift" campaign against stigma, our social inclusion
action plan and the provisions of the Disability Discrimination
Act, for example.
26. On social exclusion, we accept that
we have some way to go. We recognise the particular problem of
mental health in prisons that the Committee highlights, and are
responding with investment in training for prison staff and in
specialist "inreach" services that every prison in the
country now has access to.
27. On stigma, the Shift campaign is actively
promoting changes in attitude and behaviour—for example,
through its recent guidance to employers and its work with the
media on how mental illness is portrayed. Despite that, we accept
that public attitudes to mental illness can still reflect a degree
of fear and ignorance, which is disappointing given the proportion
of the population that has either first hand experience of a mental
disorder or experience as a friend or relative of someone with
a mental health problem.
28. Much of our work in this area (and others)
involves, or is addressed at, employers—including small
employers. We share the Committee's recognition that one of the
principle benefits of an EU strategy is its potential to reach
beyond the health sector into areas such as employment, and we
also accept that there will need to be a meaningful way of measuring
the strategy's progress: We are not, however, convinced that this
should require any new obligation on Member States to supply additional
information.
Chapter 7: promotion and prevention
29. Promoting good mental health and preventing
mental illness are two of the four priorities that the Commission
have proposed for a strategy. Like the Committee, we have endorsed
this approach and look forward to a strategy that facilitates
the exchange of ideas, evidence and good practice.
Chapter 8: mental health issues for population
subgroups
30. The development of policy and practice
in the UK increasingly recognises the varying needs of different
subgroups of the population. We have distinct strategies in place
for each of the four groups that the Committee's report considers
(children and adolescents, older people, Black and minority ethnic
groups and women) and new policy is now guided by equality impact
assessments that examine how the policy might affect different
groups.
31. We share the Committee's analysis of
the issues. In our response to the Green Paper we stressed the
importance of addressing inequalities in mental health, and in
mental health services; we look forward to seeing the strategy's
proposals for taking that forward.
Chapter 9: setting minimum standards or promoting
principles
32. We agree that it is impractical to attempt
the imposition of uniform minimum standards across Europe, for
the reasons the Committee have described in their report.
33. The Committee's proposal for a set of
principles to guide mental health policy across Europe is interesting.
Reaching agreement between Member States on what those principles
should be may not be straightforward. Domestically, we are not
immediately convinced that the UK administrations would find such
principles useful.
34. Assuming the EU strategy resembles the
Green Paper, it is possible to infer clear principles from it,
and from the WHO action plan, even if they are not explicitly
presented as such: for example, the need to respect human rights,
tackle stigma, reduce inequalities, abolish discriminatory practice,
and the other matters that the Committee identifies.
35. The Committee may have something more
explicit and direct in mind; we are aware that the Council of
Europe has addressed some of these issues in the past and may
be doing so again, in which case we shall consider their proposals
carefully. We will, of course, also remain open minded about any
related proposals from the EU, but we do not feel able to argue
positively for a set of principles that goes further than we expect
the strategy itself to.
Chapter 10: information needs
36. Like the Committee, we recognise the
value of comprehensive and reliable statistics to the development
and monitoring of mental health policy. Much data is already available
in respect of the UK, and we hope the strategy will help us to
exchange useful information with Member States across the EU.
37. Sharing data, good practice and research
findings in this way was an important strand of the Green Paper
and one that we explicitly supported in our response to it. We
believe there is untapped potential to spread useful information
more quickly and avoid wasteful duplication of effort. Individual
Member States have their own systems for gathering data; we believe
that the strategy will need to respect that, exploit the existing
information and offer support and guidance to Member States seeking
to improve data collection and reporting.
Conclusion
38. We are grateful for the Committee's
interest in mental health and the issues that the Green Paper
raised. We await the strategy, and the Committee's consideration
of it, with interest and hope to play a full part in making it
work for the benefit of people across the European Union.
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