14TH REPORT: "IMPROVING THE MENTAL
HEALTH OF THE POPULATION": CAN THE EUROPEAN UNION HELP?
Letter from Margot Wallström, Vice-President
of the European Commission to the Chairman
Thank you for your opinion on the Green Paper
Improving the mental health of the population dated 25
April 2007.
In line with the Commission's decision to encourage
national parliament to react to its proposals to improve the process
of policy formulation, we welcome this opportunity to respond
to your comments. I enclose the Commission's response. I hope
you will find these a valuable contribution to your own deliberations.
I look forward to developing our policy dialogue
further in the future.
12 September 2007
COMMISSIONS RESPONSE
The Commission would like to express its appreciation
for the support expressed to its activities expressed in the House
of Lords European Union Committee's Inquiry Report Improving
the mental health of the population: can the European Union help?.
Mental health problems have become a major public
health challenge in Member States. They also impose significant
burdens on the European economy and its social welfare systems.
These challenges are increasingly recognised. Also increasing
is the will to respond to these challenges and the interest in
learning from good practice available across the EU.
The Commission welcomes the concluding statement
in the House of Lords Inquiry Report that there is an important
role for the EU for promoting better mental health and delivering
better services.
The position of the House of Lords is in line
with the general outcome of the consultation of the Commission's
Green Paper Improving the Mental Health of the Population.
Towards a Strategy on Mental Health for the EU.[6]
For your information, please find attached a summary report about
the open consultation. All contributions are publicly available
on the Commission's public health website,[7]
and the House of Lords Inquiry Report has been added to it.
As a follow-up to the consultation, the Commission
is at present finalising a Communication, which will set out a
strategy on mental health. In line with the House of Lords recommendations,
this strategy will be designed in a way to allow Member States
to cooperate in promoting mental health, preventing mental health
problems and improving the situation of people with mental health
problems, under involvement of the relevant policy areas which
can make contributions.
As regards a possible role for the EU in delivering
better services, matters of competence are indeed complex: Article
152 of the EC-Treaty states that Community action in the field
of public health shall fully respect the responsibilities of the
Member States for the organisation and delivery of health services
and medical care. In their contributions to the Green Paper consultation,
several Member States have stressed that a strategy on mental
health for the EU would need to respect this existing distribution
of responsibilities. This being said there are many supporting
actions that the EU can take (such as facilitating comparison
and cooperation, investing in health infrastructure and skills
through the structural funds, facilitating networking and exchanges
of best practice, research).
In following, please find more detailed responses
by the Commission to the conclusions and recommendations presented
in chapter 11 of the House of Lords Inquiry Report.
CHAPTER 2: DEFINING
MENTAL WEN-BEING
AND MENTAL
HEALTH PROBLEMS
The extent of mental health problems
Point 339. The Commission supports the principle
of the recommendation. At the same time it draws attention to
the fact that Article 152 of the EC-Treaty states that Community
action in the field of public health shall fully respect the responsibilities
of the Member States for the organisation and delivery of health
services and medical care.
Learning or intellectual disability
Point 340. The House of Lords' position is in
line with the Green Paper consultation outcomes. The Commission's
mental health strategy will not group together learning disability
and mental health problems.
CHAPTER 3: THE
SOCIAL AND
ECONOMIC IMPACT
OF MENTAL
HEALTH PROBLEMS
Summary of impacts
Point 341. The comment by the House of Lords
is in line with the Commission's approach. The Commission is,
as part of the development of a Communication setting out a strategy
on mental health, considering options to promote the wider public
recognition of the social and economic impact of mental health
problems. The Commission also supports the statements in the House
of Lords' Report on the role of families and the need to give
support to formal and informal carers. These issues will be integrated
into future work with Governments and further stakeholders.
Point 342. The comment by the House of Lords
is in line with the Commission's approach.
Point 343. The Commission confirms that the
Green Paper consultation signalled much support for an inclusive,
transparent and engaging way of cooperation on mental health involving
policy areas, other relevant stakeholders and service users. The
Commission's mental health strategy will include announcements
to put such mechanisms in place.
How the EU's role differs from that of the WHO
Point 344. The Commission intends to design
its mental health strategy as an inclusive one.
CHAPTER 5: HUMAN
RIGHTS ISSUES
Deinstitutionalisation
Point 346. The comment by the House of Lords
is in line with the Commission's approach.
Point 347. The comment by the House of Lords
is in line with the Commission's approach.
Compulsory treatment
Point 348. The comment by the House of Lords
is in line with the Commission's approach.
Community care
Point 349. The comment by the House of Lords
is in line with the Commission's approach.
Point 350. The comment by the House of Lords
is in line with the Commission's approach.
CHAPTER 6: SOCIAL
EXCLUSION, STIGMA
AND DISCRIMINATION
Social exclusion—need for action
Point 351. The Commission will include into
its mental health strategy actions to address social inclusion,
building on the analysis that social exclusion can be both a cause
or a consequence of mental health problems.
Point 352. The Commission intends to design
its strategy in a way that it will allow concerted action by Member
States as suggested by the House of Lords, based on identified
best practice.
Point 353. The Commission is aware of the specific
health challenges in prisons and addresses them through a number
of initiatives. It will also consider these settings in its mental
health activities. However, the provision of treatment and care
services in prisons, like elsewhere, is a matter falling under
the responsibility of Member States.
Action to tackle negative attitudes and discrimination
Point 354. The comment by the House of Lords
is in line with the Commission's approach. The Commission is considering
possible actions which could be suitable to raise public awareness
about mental health and mental health problems.
Point 355. Commitment by Member States in the
sense proposed by the House of Lords does already exist. It has
been created, for instance, through Conclusions by the Council
of Ministers of 2-3 June 2003 on mental health,[8]
and also by the WHO Mental Health Declaration for Europe, which
was supported by Ministers of Health from all EU Member States.
The role of the strategy will primarily be to strengthen the implementation
of such commitment.
Point 356. Disability based on mental health
problems comes within the scope of EC Directive 2000/78/EC, which
aims to combat discrimination on the grounds of disability (and
of religion or belief, age, and sexual orientation), as far as
employment and occupation are concerned.
According to the European Court of Justice, for the
purposes of the Directive, the concept of "disability"
must be understood as referring to a limitation which results
in particular from physical, mental or psychological impairments
and which hinders the participation of the person concerned in
professional life (judgment of the Court of 11 July 2006 in Case
C-I3/05, Chacon Navas, paragraph 48, emphasis added).
According to Article 5 of the Directive, employers
shall take appropriate measures to enable a person with a disability
to have access to, participate in, or advance in employment, or
to undergo training, unless such measures would impose a disproportionate
burden on the employer. This burden is not disproportionate when
it is sufficiently remedied by measures existing within the framework
of the disability policy of the Member State concerned, like appropriate
state funding.
It should be stressed that, although the Directive
aims at combating discrimination in employment and occupation;
however, according to its recital 17, it does not require the
recruitment, or maintenance in employment of an individual who
is not capable to perform the essential functions of the post
concerned. This is without prejudice to the obligation to provide
reasonable accommodation for people with disabilities.
All 27 Member States of the European Union have
adopted national legislation to transpose this Directive. Now
the Commission is analysing whether the national laws transpose
correctly and completely the Directive—notably as far as
discrimination based on disability is concerned.
The Commission will engage infringement procedures
against all Member States who have not done so. These procedures
may end up in the European Court of Justice, which may judge that
a Member State has made an incorrect or incomplete transposition
of the Directive. If a Member State persists in its eventual lack
of proper transposition, the European Court of Justice, at the
request of the Commission, can impose a financial penalty.
Action to address employment problems
Point 357. The Commission intends to invite
Social Partners to contribute to the implementation of the EU-mental
health strategy.
Point 359. The Commission intends to develop
together with Member States and partners a format which could
be used to invite reports from them on their mental health activities
(see also response on point 373).
CHAPTER 7: PROMOTION
AND PREVENTION
Mental health promotion and prevention
Point 360. The comment by the House of Lords
is in line with the Commission's approach.
Point 361. The Commission's strategy will respect
the responsibilities of Member States for the organisation and
delivery of healthcare and medicals services. It will put in place
mechanisms to work together with Member State Governments, nongovernmental
stakeholders and to coordinate work across Commission.
Examples of good practice
Point 362. The comment by the House of Lords
is in line with the Commission's approach. The Commission is already
identifying good examples and will increase its efforts to give
more visibility to them.
Sharing good practice
Point 363. The response to point 362 applies.
CHAPTER 8: MENTAL
HEALTH ISSUES
FOR POPULATION
SUBGROUPS
Children and adolescents
Point 364. The Commission supports the principle
of the recommendation and intends to make the needs of children
and adolescents a priority of its mental health strategy. At the
same time, it draws the attention of the House of Lords to the
fact that Article 152 of the EC-Treaty states that Community action
in the field of public health shall fully respect the responsibilities
of the Member States for the organisation and delivery of health
care and medical services.
Older people
Point 365. The Commission supports the principle
of the recommendation and intends to make the needs of older people
a priority of its mental health strategy. At the sametime, it
draws the attention of the House of Lords to the fact that Article
152 of the EC Treaty states that Community action in the field
of public health shall fully respect the responsibilities of the
Member States for the organisation and delivery of health care
and medical services.
Ethnicity
Point 366. The comment by the House of Lords
is in line with the Commission's approach.
Point 367. The comment by the House of Lords
is in line with the Commission's approach.
Women
Point 368. The comment by the House of Lords
is in line with the Commission's approach.
CHAPTER 9: SETTING
MINIMUM STANDARDS
OR PROMOTING
PRINCIPLES
Sharing good practice
Point 369. The comment by the House of Lords
is in line with the Commission's approach.
Point 370. The Commission agrees that it could
be useful to develop a set of "principles", which could
also be described as "objectives", to guide mental health
policy and practice in the EU.
Point 371. The WHO Mental Health Declaration
for Europe does already establish an agreed set of principles.
However, as the WHO's Declaration also covers aspects not falling
under EU-competence, there could be value in developing a set
of objectives, which a focus on areas of EU-competence.
CHAPTER 10: INFORMATION
NEEDS
Statistics on mental health systems
Point 372. Together with Member States, the
Commission is considering measures to improve the integration
of mental health into the EU Health Information System, which
includes information on health care systems (for the statistical
information see Commission's response to point 373). The Commission
draws the attention of the House of Lords to the fact that other
international organisations such as the WHO or the OECD have been
mandated to analyse health care systems and their outcomes.
Point 373. As already mentioned in the Commission's
response to point 372, together with the Member States the Commission
is considering measures to improve the integration of mental health
into the EU Health Information System.In line with the mandate
for action at EU level, the focus of these activities is on providing
better and more comparable information about mental health in
the EU. The statistical element of the EU Health Information System
is being developed—as part of social statistics—through
the Community Statistical Programme. Statistical indicators and
data collections encompass the various aspects of health status,
health determinants, such as including socio-economic aspects
and life styles, and health care, whereby also attention is given
to mental health and its determinants. Several indicators related
to mental health are already part of the European Community Health
Indicators (ECHI). As part of a mental health strategy, the Commission
is considering the possibility of inviting periodic reports on
mental health, which would provide information about the situation
at EU-Ievel and in Member States.
Information on policy andpractice
Point 374. The Commission's response to point
373 applies.
Research
Point 375. The Commission is willing to take
forward research on mental health. Mental health-related aspects
have been already been addressed through a considerable number
of research projects under the 5th and 6th Framework for Research.
Also, the 7th Framework Programme for Research, Technological
Development and Demonstration Activities (2007-13) includes a
specific reference to mental health in a life-course perspective
under its Health Theme.
Sharing good practice
Point 376. The comment by the House of Lords
is in line with the Commission's approach.
6 COM (2005) 484 final of 15 October 2005. Back
7
http://ec.europa.eu/health/ph_determinants/life_style/mental/green_paper/consultation_en.htm Back
8
http://ec.europa.eu/health/ph_determinants/life_style/mental-020603_en.pdf Back
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