Mental health services are characterised by under-investment, a focus on hospital treatments and a lack of primary and community services; workforce crises and barriers to access that include stigma. They fail to acknowledge the social determinants of mental health or address mental health inequalities. As such they lack resilience and do not have the capacity to respond to the rise in demand resulting from the increasing prevalence of mental health conditions. This crisis existed long before Covid. These are the findings from interviews with respondents working in the mental health sectors in France, Ireland and Poland interviewed for Is an EU-wide approach to the mental health crisis necessary?, a TASC study conducted in partnership with the Foundation for European Progressive Studies into the need for an EU-wide mental health strategy.
When asked about the role of the EU in making mental health systems more resilient, some respondents, having seen the way in which EU governments had worked together during the pandemic, were optimistic that they could do the same to address the crisis in mental health. Given what long term evidence has shown about the relationship between a person's socio-economic situation and their mental well-being, the EU has a key role in starting a call to action to member states that begins with recognising that all EU social policies have an impact on mental health. And that improved collective mental well-being will improve educational outcomes, lead to healthier lifestyles, decrease health risk behaviour, increase productivity at work, reduce missed days off work, raise incomes, improve social relationships, and cut anti-social behaviour and crime. As such, the EU needs to facilitate member states adopting a ‘whole government’ cross-sectoral ‘mental health in all policies’ strategy to address the social determinants of mental health; invest in community and primary services; improve the working rights and conditions of staff in the mental health sector; build the knowledge and mental health literacy of employers in all sectors; and promote the importance of activities that encourage social contact and build confidence and trust in communities in order to reduce the risk of further mental health inequalities.
Respondents saw the EU as best placed for setting standards for mental health provision, regulation, guidance, exchanging best practice, and strengthening research collaboration and innovation of mental health provision - particularly digital. With those elements in place, it is more likely that member states will be able to deliver high performing mental health systems to meet the challenges of increased demand. They talked about the need for a platform that would enable them to cooperate, share and coordinate knowledge and best practice.
However, the study also revealed some underlying tensions that would need to be examined in both member state and EU-wide strategy. Foremost of these is the difficulties that arise from the term ‘mental health’, which lumps together many different conditions and experiences in one homogenous entity. On the one hand,
policymakers and many practitioners were keen to move away from the biometric focus on mental illness, disorders, hospital treatment and related stigma. They advocated much greater emphasis on prevention, early treatment, services in the local community, and not just health services, but also a co-creation approach rooted in society and about relationships between, for example, employers and their employees, and housing providers and their tenants. On the other hand, other respondents emphasised the need to be clear that mental health policy encompasses provision for those with a range of conditions, both in terms of severity and how long they are experienced. They cautioned against the danger of strategy conflating the promotion of well-being in every life context (through further development of public health policies and improved policy for addressing the increased prevalence of milder mental health conditions) with strategy developing investment in clinical provision for conditions such as schizophrenia. Similarly, while the EU was best placed to improve EU-wide public awareness and mental health literacy and thereby reduce discrimination and stigma - a huge barrier to improving mental health, any strategy also needed to include targeted provision for the most vulnerable in the EU. This included EU-wide level focus on how to improve the institutional framework of mental health policy for those moving between members states, whether that be reducing health inequalities for those migrating to work in key roles in our economy and society or improving the experience of the most vulnerable and at-risk groups escaping trauma and seeking asylum for example.
Another tension emerged from the increased digitalisation of the economy and society during the Covid-19 crisis. On the one hand, increased use of on-line services had opened up access to some who would not otherwise have been treated by the mental health sector during the pandemic. On the other hand, some vulnerable groups, including those with serious mental health conditions before the pandemic, became digitally excluded during the pandemic. The expansion of remote working has led to greater insecurity, exploitation and blurring of home-work boundaries, which have resulted in the increased prevalence of some mental health conditions that the health sector has struggled to cope with.
Without addressing the welfare system challenges across the EU illustrated by this study of mental health provision, it is clear that economic convergence is unlikely to be maintained. The cost of not addressing, treating, and preventing mental health disorders and mental ill-health has been illustrated by the Covid-19 crisis. The cost extends well beyond the individual impacted by illness. Combined with the economic downturn and cost of living crisis, the war in Ukraine, the climate emergency and associated eco-anxiety and the likelihood of further pandemics, inequalities are likely to perpetuate across generations, with long-term negative consequences and the increased risk of further inequalities, increased mental health problems and less cohesive societies. With all that in mind, the EU can’t afford for mental health to remain an isolated Cinderella service. Pressure is building to move it to the centre stage of EU policy making.
Dr Gerry Mitchell is a social researcher, writer and political activist. With degrees from Cambridge and LSE, she was a PhD Associate at LSE's Centre for Analysis of Social Exclusion and a Research Officer in its Department of Social Policy. Gerry’s research has focused on inequality (she was a contributor to and editor of the FEPS-TASC's report Inequality and the top 10% in Europe); the delivery of welfare to work and working tax credit programmes and the impact on those using them. Her policy experience includes working with Compass; the Houses of Parliament; the New South Wales Government Department of Training and Education and in frontline roles with disabled and long-term unemployed people; children in mainstream and special needs settings and in the NHS. Gerry is an active member of the Labour Party and stood as Parliamentary Candidate for Woking, Surrey in the 2019 General Election.