Ensuring implementation of the Joint Action on Mental health and Well-being:

 Proposal for an EU-level Action Plan

 1       Introduction

This document contains the rationale and draft framework for a future EU level Action programme on Mental Health and Well-being.  It was developed by GAMIAN-Europe to ensure that the recommendations that have been developed as part of the recently finished Joint Action on Mental health and Well-being will be implemented and put to concrete use. It outlines why there is a need for such an Action Plan and makes the case for the added value of an ambitious EU-level initiative in this area, building on the valuable work that has already been done.

2       Some facts on mental health in the EU

• Mental disorders cause immense suffering for individuals, families and communities. They put pressure on health, educational, economic, labour market and social welfare systems across the EU
• Mental disorders are highly prevalent and increasing in the EU: 50 million citizens – about 11% of the population – are estimated to experience mental disorders.
• Depression is the most prevalent health problem in many EU-Member States, with suicide remaining a major cause of death: in the EU, there are about 58,000 suicides per year (75% are committed by men). Nine of the ten countries with the highest rates of suicide in the world are in the European Region.
• According to estimations of WHO mental health problems affect every fourth citizen at least once during their life. Neuropsychiatric disorders are the second leading cause of disability-adjusted life years (DALYs) in the WHO European Region, accounting for 19.5% of all DALYs.
• Only 50 % of those affected by depression receive treatment
• There is a link between mental health problems and losses of productive human capital: the surveys revealed that there are substantial costs associated with mental disorders, such as higher presenteeism and absenteeism or significantly reduced earnings among those with a mental disorders, which also are the leading cause for people receiving work disability benefits.
• Stigma, prejudice and discrimination unfortunately are widespread and have an impact on those affected seeking or receiving help and support
• In European countries, at least 30% of people with severe mental disorders do not have access to mental health care, and the majority of the populations don’t benefit from the interventions that have proved to be effective in prevention and promotion.
• On a more positive note, there is increasing data proving that positive mental health and well-being is a key factor for social cohesion, economic progress and sustainable development in the EU – so the need to prevent mental illness and promote mental health is increasingly recognised by policy makers.
• In many or most cases mental ill health can be prevented, cured, treated and managed. A more widespread understanding of this fact might help to combat stigma.

3       An EU-level Action Plan on Mental Health: rationale

Given the facts and figures outlined above, it is clear that there is an urgent need for action to address and ensure mental health and well-being. Member States are all facing the same issues in relation to tackling mental ill-health, both with respect to prevention and mental health promotion as well as the development
and implementation of effective and sustainable care provision models. For instance, the current trend towards community health care requires clear strategies and policies to ensure quality of and access to care.

Many countries are struggling with this development and Member States can (continue to) benefit from cooperation, mutual learning and the exchange of good (and bad) practice.

European action to date

Over recent years the Commission has already taken various steps to ensure a place for mental health on the political agenda:

• The 2004 Commission Green Paper ‘Improving the mental health of the population: Towards a strategy on mental health for the European Union’, which makes the case for the added value of an EU-level mental health strategy by:

• Creating a framework for exchange and cooperation between Member States;
• Helping to increase the coherence of actions in different policy sectors;
• To open up a platform for involving stakeholders including patient and civil society organisations into building solutions.

In this Green Paper, the Commission proposes for an EU-strategy to focus on promoting the mental health of all, addressing mental ill health through preventive action, improving the quality of life of people with mental ill health or disability through social inclusion and the protection of their rights and dignity and developing a mental health information, research and knowledge system for the EU.

At that time, the idea of a concrete strategy did not meet with sufficient support from the Member States so instead, the Commission came forward with:

• the 2008 European Pact for Mental Health and Well-being, which concentrated on 5 themes, i.e. prevention of depression and suicide, mental health in older people, mental health in youth and education, mental health in workplace settings and stigma and social inclusion. A number of high level conferences took place, leading to:

• the 2011 Council conclusions on ‘The European Pact for Mental Health and Well-being: results and future action‘, which recognised mental well-being as an essential constituent of health and quality of life, and a prerequisite for the ability to learn, work and contribute to social life. The Conclusions invited Member States to make mental health and well-being a priority of their health policies and to develop strategies and/or action plans on mental health including depression and suicide prevention. The Council also invited Member States and the Commission to put in place:

• the 2013 Joint Action on Mental health and Well-being, building on the findings of the Pact, aiming at building a framework for action in mental health policy at U level, which should contribute to the promotion of mental health and well-being, the prevention of mental disorders and the improvement of care and social inclusion of people with mental disorders in Europe. The five areas addressed were

• promotion of mental health at the workplaces;
• promotion of mental health in schools;
• promoting action against depression and suicide and implementation of e-health approaches;
• developing community-based and socially inclusive mental health care for people with severe mental disorders;
• promoting the integration of mental health in all policies.

Other relevant actions:

• The November 2015 Opinion on ‘Access to health care in the EU’ by the Expert Platform of Effective Ways of Investing in Health specifically addresses access to mental health care;
• The 2013 WHO European Action Plan on mental health, focusing on well-being, rights and services, linked to seven main objectives, such as equal opportunity for people to realize mental wellbeing throughout life, rights of people with mental health problems, accessible mental health services and the right to respectful, safe and effective treatment;
• The European Parliament runs an active Interest Group on Mental health and well-being; action is taken to ensure relevant references to mental health in EU proposals, such as the recent Directive on Health and Safety in the Workplace.

Future EU-level plans:

In order to provide a follow-up to the Joint Action, the Commission has announced the ‘stronger involvement’ of the EU-Compass for Action on Mental Health and Well-being. This is a mechanism to collect, exchange and analyse information on policy and stakeholder activities in mental health.  This will disseminate the ‘European Framework for Action on Mental Health and Well-being’ as developed by the Joint Action and it will monitor mental health and wellbeing policies and activities by Member States and non-governmental stakeholders. It will:

• Identify and disseminate European good practices in mental health;
• Collect data on stakeholders’ and Member States activities through three annual surveys;
• Organise three annual reports and forum events;
• Hold national mental health workshops in each Member State and Iceland and Norway.

The EU Compass will also support the work of the EU-Group of Governmental Experts on Mental Health and Well-being through the preparation of four scientific papers.

The need for a more concrete and ambitious approach

While GAMIAN-Europe warmly welcomes the planned work of the Compass, some critical questions remain as to how the Compass will effectuate practical change and good policy and practice development. Concrete policies and strategies now need to be put in place, and while useful, it is doubtful that the work of the Compass will be able to stimulate and ensure this. The actions foreseen seem rather ‘theoretical’: while reporting and developing scientific papers are useful activities as such, the work carried out so far merits to be taken to a slightly more ambitious level.

In addition, it is not clear how countries will actually be engaged in this monitoring and reporting process. The role, composition and remit of the EU-Group of Governmental Experts on Mental Health is also unclear. How will the priority topics of the events and scientific papers be determined? Who will be involved with that process? What is the ultimate aim of the exchange of good practice and how can sound and robust policy and practice be distilled from this process?

GAMIAN-Europe believes that, through the various actions already that have already taken place, the foundations have been laid for more ambitious and structured actions, which will actually engage the relevant policy makers as well as other stakeholders (e.g. patients). There are EU-level precedents for more ambitious actions in specific health areas, for instance in fields of cancer and rare diseases, where the Commission has put a great effort into ensuring concrete national action plans. These plans are developed with the input from all relevant stakeholders, who are also involved with their implementation.

A more ambitious approach would also be in line with the expected outcomes of the Joint Action, which aimed to ‘build capacity of national mental health leaders and other stakeholders in mental health policy development and the creation of mechanisms supporting a structured collaboration between key actors in the implementation of mental health policies in Europe’.

 4       Areas for action: building on the Joint Action on Mental Health and Well-being

Much is now known about what works in mental health promotion, prevention, care and treatment of mental disorders. The challenge is how to implement this knowledge and concrete national action plans can stimulate progress and change. As the impact of mental health problems can be felt in many different areas and at different times of life and work, a comprehensive EU level action plan should be multi-dimensional and longitudinal. The areas which were addressed by the Joint Action remain highly relevant and recommendations for action have already been developed as part of this initiative.

Some of the actions listed below are already part of the future work of the Compass. But others can add extra value to what has already been done to ensure that the efforts made to date are not lost.

1. Inclusion of mental health as a priority in health and social policy development: mainstreaming

The Joint Action specifically refers to the need to explicitly include mental health in all areas that have a direct or indirect bearing on mental health. To make this more concrete, GAMIAN-Europe proposes a number of current and future EU-level programmes and policy priorities which could (and should) have a mental health focus such as, such as:

• The Health Programme
• Joint Action CHRODIS
• The European Social Fund
• The disability strategy
• The social Open Method of Coordination (accessible, high quality and sustainable health and long-

term care systems

• Horizon 2020 (research)
• The European Semester Process
• Actions on Corporate Social Responsibility
• Health and safety in the work place
• The Employment Strategy
• Actions in the field of long term care

GE would welcome an opportunity to discuss, engage and elaborate on how the mental health dimension could be strengthened in each of these initiatives.

Awareness-raising and good practice exchange: mutual learning and exchange

The EU action programme could ensure and coordinate an effective exchange of information, experience and good practice between relevant stakeholders and Member States in relation to the 5 work streams already identified by the Joint Action. In this context it is important to highlight the crucial role of employers to implement good mental health at work policies, promoting good mental health and having flexible policies for those with mental health problems.

Another option to raise awareness would be to consider designating one of the coming years as the European Year of Mental Health and Well-being.

1. Stimulate the development of national action plans on mental health and well-being

As already referred to in the 2011 Council Conclusions, national action plans on mental health could be put in place, taking the 5 themes of the Joint Action as their basic work streams, and using the existing national actions plans on cancer and rare diseases as models: these plans should be established to explore appropriate measures for mental health in order to ensure that patients with mental health problems have access to high-quality care[1], including diagnostics, treatments and rehabilitation. They should aim to guide and structure relevant actions in the field of rare diseases within the framework of national health and social systems and integrate current and future initiatives at local, regional and national levels into their plans or strategies for a comprehensive approach, using the recommendations developed by the Joint Action as guidelines. National plans can also be useful for mutual learning and exchange: they are an ‘effective tool for the communication of the decisions and the plans identified and chosen by a Member State and the evidence supporting and influencing them in a transparent fashion both to public within the Member State and also with and between other members of the European Union’[2].

The EU Expert group of Governmental Experts on Mental Health could act as a coordinating mechanism for a structured and effective exchange and mutual learning.

1. Financial support

A number of the above initiatives hold the potential for funding (e.g. the Health Programme, the Structural Funds, Horizon2020). This funding could contribute to capacity building of mental health organisations in relation to provision of support (e.g. emotional support, exchanges, information) and advocacy (e.g. policy development, practical solutions). It could also support the exchange of information, research and networking.

1. Data collection and monitoring

The Horizon2020 programme could issue specific calls for research projects addressing mental health in future calls for proposals under the action ‘Tackling Societal Changes’, section ‘Health, demographic change and well-being’. The EU-funded ROAMER project has developed a sensible and inclusive roadmap for research in this area, which could provide guidance on priority setting and the most pressing issues.

1. Inclusion of people affected by mental health problems in relevant EU consultations, fora and

Advisory boards

 Any strategy of policy addressing mental health should be developed as a joint efforts by all key stakeholders from societal and policy sectors concerned; government agencies, departments and Directorates General should work together as involvement by health, social services, housing, employment, education and training sectors is crucial in holistic care.  Representative organisations active in the field of mental health should explicitly be included in social and health consultations as well as in relevant fora and advisory boards (for instance the EU-Expert Group on Mental Health) as a relevant stakeholders. This could help assess proposed policies and initiatives for their impact on people affected by mental health issues (and their carers). GAMIAN-Europe welcomes the growing recognition of the fact that people who have experienced mental Health problems have valuable expertise and need to play an active role in planning and implementing actions.

6       Conclusions

It has already been recognised that ‘complementary action and a combined effort at EU-level can help Member States tackle these challenges by promoting good mental health and well-being in the population, strengthening preventive action and self-help, and providing support to people who experience mental health problems and their families’. This recognition is based on the existing evidence on the magnitude of mental health problems in European countries. The Joint Action has laid the foundations for a more sustained and structured effort at both EU as well as national levels. The momentum of the Joint Action should now be put to use as a useful starting point for a more ambitious effort to ensure sound policy development, with the ultimate aim to improve the quality of life of those affected by mental health problems.

[1] The four cornerstones of treatment should be borne in mind i.e. medication, psychotherapy and counselling, psycho-education and self-help initiatives.

[2] Stated by the Commission in relation to the national action plans on cancer