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WHY WHEN YOU KNOW THE TRUTH SILENCE ABOUNDS
JUST A TEENY EXAMPLE OF THE FUCKIN EU BUTTIN IN WHERE THEY DIDNT OUGHT TO
COMMISSION OF THE EUROPEAN COMMUNITIES
Brussels, 14.10.2005
COM(2005) 484 final
GREEN PAPER
Improving the mental health of the population.
Towards a strategy on mental health for the European Union
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TABLE OF CONTENTS
1. Introduction.................................................................................................................. 3
2. Mental health – central for citizens, society and policies ............................................ 4
3. The situation – mental ill health, a growing challenge for the EU .............................. 4
4. Developing responses: Policy initiatives on mental health.......................................... 5
4.1. The European Community, its mandate and activities in the field of mental health ... 5
4.2. Mental health in Member States .................................................................................. 6
5. The need for an EU-strategy on mental health............................................................. 7
6. Seeking solutions – options for action ......................................................................... 8
6.1. Promoting mental health and addressing mental ill health through preventive action 8
6.1.1. Promoting the mental health of the population ............................................................ 8
6.1.2. Addressing mental ill health through preventive action .............................................. 9
6.2. Promoting the social inclusion of mentally ill or disabled people and protecting their
fundamental rights and dignity................................................................................... 11
6.3. Improving information and knowledge on mental health in the EU.......................... 12
7. A consultation process for the development of an EU-strategy on mental health ..... 12
7.1. Creating a Dialogue with Member States on Mental Health ..................................... 13
7.2. Launching an EU-Platform on Mental Health ........................................................... 13
7.3. Developing an interface between policy and research on mental health ................... 13
8. Next steps................................................................................................................... 13
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GREEN PAPER
Improving the mental health of the population.
Towards a strategy on mental health for the European Union
1. INTRODUCTION
The mental health of the European population is a resource for the attainment of some of the
EU’s strategic policy objectives, such as 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 citizens1.
However, the mental health of the EU population can be considerably improved:
• Mental ill health affects every fourth citizen and can lead to suicide, a cause of too many
deaths;
• Mental ill health causes significant losses and burdens to the economic, social, educational
as well as criminal and justice systems;
• Stigmatisation, discrimination and non-respect for the human rights and the dignity of
mentally ill and disabled people still exist, challenging core European values.
Improvement is possible. Many initiatives have already been taken. Further development and
consolidation of the existing actions is required. The January 2005 WHO European
Ministerial Conference on Mental Health established a framework for comprehensive action,
and created strong political commitment for mental health. It invited the European
Commission, a collaborating partner of the conference, to contribute to implementing this
framework for action, in line with its competencies and the Council’s expectations and in
partnership with the WHO.
This Green paper is a first answer to this invitation. It proposes to establish an EU-strategy on
mental health. This would add value: by constituting a framework for exchange and
cooperation between Member States; by helping to increase the coherence of actions in the
health and non-health policy sectors in Member States and at Community level; and by
allowing involvement of a broad range of relevant stakeholders into building solutions.
The purpose of this Green Paper is to launch a debate with the European institutions,
Governments, health professionals, stakeholders in other sectors, civil society including
patient organisations, and the research community about the relevance of mental health for the
EU, the need for a strategy at EU-level and its possible priorities.
In accordance with the provisions made in Article 152 of the EC Treaty, some of the
proposals for action in the field of public health made in this Green Paper fall under
Community competence. Further proposals will be the exclusive competence of Member
States. For proposals for action in other policy fields, the appropriate legal bases will apply.
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The Commission’s intention is to publish the results of the consultation process together with,
if appropriate, its proposal for a strategy on mental health for the EU by the end of 2006.
2. MENTAL HEALTH – CENTRAL FOR CITIZENS, SOCIETY AND POLICIES
There is no health without mental health. For citizens, mental health is a resource which
enables them to realise their intellectual and emotional potential and to find and fulfil their
roles in social, school and working life. For societies, good mental health of citizens
contributes to prosperity, solidarity and social justice. In contrast, mental ill health imposes
manifold costs, losses and burdens on citizens and societal systems.
Mental health, mental ill health and its determinants:
The WHO describes mental health as: “a state of well-being in which the individual realizes
his or her abilities, can cope with the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to his or her community”2.
Mental ill health includes mental health problems and strain, impaired functioning associated
with distress, symptoms, and diagnosable mental disorders, such as schizophrenia and
depression.
The mental condition of people is determined by a multiplicity of factors (annex 1),
including biological (e.g., genetics, gender), individual (e.g., personal experiences), family
and social (e.g., social support) and economic and environmental (e.g., social status and living
conditions).
3. THE SITUATION – MENTAL ILL HEALTH, A GROWING CHALLENGE FOR THE EU
The health dimension
More than 27% of adult Europeans are estimated to experience at least one form of mental ill
health during any one year (see annex 2)3.
The most common forms of mental ill health in the EU are anxiety disorders and depression.
By the year 2020, depression is expected to be the highest ranking cause of disease in the
developed world4.
Currently, in the EU, some 58,000 citizens die from suicide every year (annex 3), more than
the annual deaths from road traffic accidents, homicide, or HIV/AIDS5.
Mental and physical health is closely inter-related. One implication: Integrating mental health
into the provision of general hospital care can significantly shorten hospitalization periods,
thereby releasing economic resources.
The impact on prosperity, solidarity and social justice
The implications of mental ill health are manifold:
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Mental ill health costs the EU an estimated 3%-4% of GDP, mainly through lost
productivity6. Mental disorders are a leading cause of early retirement and disability
pensions7.
Conduct and behavioural disorders in childhood incur costs for the social, educational as well
as criminal and justice systems (see annex 4)8.
Further intangible costs concern how society treats mentally ill and disabled persons. Despite
improved treatment options and positive developments in psychiatric care, people with mental
ill health or disability still experience social exclusion, stigmatisation, discrimination or the
non-respect of their fundamental rights and dignity.
4. DEVELOPING RESPONSES: POLICY INITIATIVES ON MENTAL HEALTH
The growing perception of mental ill health as a problem has triggered policy makers, health
professionals and other stakeholders to look for solutions, most recently at the January 2005
WHO European Ministerial Conference on Mental Health9.
There is agreement that a first priority is to provide effective and high-quality mental health
care and treatment services, accessible to those with mental ill health10.
However, although medical interventions play a central role in tackling challenges, they alone
cannot address and change social determinants. Therefore, in line with the WHO strategy, a
comprehensive approach is needed, covering the provision of treatment and care for
individuals, but also action for the whole population in order to promote mental health, to
prevent mental ill health and to address the challenges associated with stigma and human
rights. Such an approach should involve many actors, including health and non-health policy
sectors and stakeholders whose decisions impact on the mental health of the population.
Patient organisations and civil society should play a prominent role in building solutions.
4.1. The European Community, its mandate and activities in the field of mental
health
The mandate for action at Community level in the field of public health is defined in Article
152 of the EC-Treaty. It stipulates that “a high level of human health protection shall be
ensured in the definition and implementation of all Community policies and activities”11.
Community action shall complement national policies for improving health, preventing illness
and disease, health information and education, as well as reducing drug-related damage, and
shall encourage cooperation between Member States in these fields. Member states are
exclusively competent for the organisation of health services and care. For other Community
policies the appropriate legal bases apply.
Based on these competencies, mental health is an issue for the European Community through:
• The contribution that good mental health of the population can make to some of the EU’s
strategic policy objectives;
• The role of the Community to encourage and support cooperation between Member States
and to address inequalities between them; and
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• The obligation for the Community to contribute to a high level of human health protection
through all its policies and activities.
Over the past years, several specific initiatives have been developed in different Community
policies:
– The Community’s health policy has covered mental health since 1997 through specific
projects and policy initiatives12 (annex 5). The EU Public Health Programme 2003-200813
provides the legal basis for action. Further related priorities addressed the abuse of drugs
and the harm done by alcohol.
– Initiatives under the Community’s social and employment policy targeted the nondiscrimination
of people with mental ill health, the social inclusion of people with mental
disabilities, and the prevention of stress at the workplace, including:
– The adoption of directive 2000/78/EC which prohibits inter alia discrimination on
grounds of disability in the field of employment14;
– Actions under the European Year for People with Disabilities in 2003; and
– The adoption of a European Framework Agreement on work-related Stress
between social partners in 2004.
– The Community’s Framework Programmes for Research have been and continue to be
an importance source of funding for European research on mental health15. An example is
the “MHEDEA-2000”-project, which carried out a European assessment of mental health
disability16
– Information society and media policy supported the development of Information and
Communication Technology (ICT) -based tools for use in prevention, diagnosis and care17.
– Regional policy supports infrastructure investments in the health sector that is beneficial to
the regions' structural adjustment.
– Educational policy addresses mental health as part of its policy work (e.g. on key
competences for the knowledge society) and through projects.
– As part of the Community’s freedom, justice and security policy, the DAPHNE IIprogramme
combats violence against children, young people and women18. Such violence
can cause mental health problems.
However, a comprehensive strategy on mental health, which would link all these activities,
does not yet exist at Community level. Such a strategy would strengthen the coherence and
effectiveness of current and future initiatives.
4.2. Mental health in Member States
There are significant inequalities between (and also within) Member States. One example is
suicide rates, which range from 3.6 per 100,000 population in Greece to 44 per 100,000
population in Lithuania, the highest in the world19. The proportions of the health budgets
dedicated to mental health are also highly variable across Member States (see annex 6).
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The 2004 report “The state of mental health in the European Union”20 found that the status of
mental health is not uniform across Member States, instead, reflecting a diversity between
countries, their situations, traditions and cultures.
Country stories compiled in the 2005 publication “Mental health promotion and mental
disorder prevention across European Union Member States: an overview”21 present
challenges, policies and structures across Member States.
Given the diversity between Member States, it is not possible to draw simple conclusions or
to propose uniform solutions. However, there is scope for exchange and cooperation between
Member States and the opportunity to learn from each other.
A number of policy documents adopted by the Council of Ministers since 199922 , signalled a
wish of Member States to use the EU-level for cooperation in the field of mental health. The
Council Conclusions adopted in June 2005 reinforced this message by inviting Member States
to give due attention to the implementation of the results of the WHO European Ministerial
Conference on Mental Health. The Commission was invited to support this implementation on
the basis of its competencies.
5. THE NEED FOR AN EU-STRATEGY ON MENTAL HEALTH
The establishment of a strategy on mental health at EU-level would add value by:
(1) Creating a framework for exchange and cooperation between Member States;
(2) Helping to increase the coherence of actions in different policy sectors;
(3) To open up a platform for involving stakeholders including patient and civil society
organisations into building solutions.
The consultation should identify in which way the Community’s policies and financial
instruments, for instance the Framework Programmes for Research, contr
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