The broad social determinants of poor mental health demand a holistic, Europe-wide approach.
‘It was not depression, it was capitalism’—an image with these words recently appeared on a banner in a student demonstration in Santiago de Chile, linking the mental-health problems that trouble us with their systemic roots.
The pandemic has highlighted the importance of mental health for the quality of life and wellbeing of citizens, as well as the structural deficits in care among public-health systems in Europe. Since March 2020, according to the Organisation for Economic Co-operation and Development, the prevalence of anxiety and depression has increased and, in some countries such as Belgium and Spain, even doubled.
These deficits however existed before the pandemic and we cannot deny their links with the austerity policies which swept across Europe after 2008. The virus has simply reflected back to us, as if in a frosty mirror, a reality that has been holding us back for years, in which political factors should not be underestimated.
Anxiety, depression, suicides and other mental disorders are mainly associated with unemployment, low income or a poor standard of living. In all countries, the mental health of unemployed people and those experiencing financial insecurity is worse than that of the general population, a trend which predates the pandemic but appears to have accelerated in some cases.
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There are also deeper wellsprings, to do with the processes of disembodiment accelerated by the digital revolution, causing a feeling of alienation at the individual level—uneasiness with one’s own identity, fragmentation of the subject and loss of vital meaning.
In The Burnout Society, Byung-Chul Han describes fatigue as a disease of a neoliberal society focused on performance. In his view, we willingly and passionately exploit ourselves in the belief that we are fulfilling ourselves. What exhausts us is not external coercion but the internal imperative of having to perform more and more.
This self-exploitation goes hand in hand today with the use of digital tools. The digital revolution has changed rules, personal relationships, business, communication and the way we spend our days. It is bringing profound changes which can have an impact on our mental wellbeing, as we exchange spaces of sensitive human perception and interaction for screens.
We are, therefore, at a crucial moment, when the urgency of strengthening mental-health systems needs to be recognised. A European-level strategy, with a holistic, cross-cutting, multidisciplinary approach, integrated into the public-health system, should foster co-operation between countries, identifying and addressing practical solutions to ensure that mental-health problems are better diagnosed and treated.
Such a strategy shoud begin with its first pillar—education. One of the greatest challenges today’s society must face is care of emotional health, from childhood and adolescence. More and more countries are investing in active-pedagogy projects or incorporating such methods into traditional education, to integrate emotional with academic competences and promote personal, affective and communication skills, while also attending to the mental health of teachers. It is also important to invest in children to break the cycle of disadvantage and, in this sense, the Child Guarantee plays a fundamental role in Europe.
The second pillar would be the natural world. Environmental initiatives, in line with the European Green Deal, are a priority. Research has shown that those exposed to certain air pollutants are more likely to suffer mental-health problems. Poorly planned urban environments, with unsustainable transport systems and lack of green spaces, increase air pollution, noise and heat and reduce opportunities for physical activity, negatively affecting individuals’ physical and mental health. It is necessary to move to a life-centred perspective that draws inspiration and learns from nature.
There are many ways to do so—from making our cities and schools ecological and using materials obtained from nature in a sustainable way, to innovative solutions based on imitating elements present in nature. The Bauhaus programme of the European Commission introduces a novelty in the institutional discourse—the importance of beauty in shaping our urban plans. It is no longer just about building functional spaces and accessible and efficient homes but also making them beautiful, harmonious and capable of promoting the health of their occupants—refuges supporting physical, mental and social wellbeing.
Moreover, in the same way that we are part of nature and need to relate to it, we are also social beings, in need of human contact and social interaction. For this reason, a third pillar to take into account in a European mental health-strategy is the impact of digitalisation on different life contexts.
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Digital tools for work purposes must be used appropriately and with care, to avoid any violation of workers’ rights and possible psychosocial risks derived from the application of automation, surveillance or artificial-intelligence systems. The right to disconnect is definitely an important step towards substantial improvements in the balance between work and family life, thus contributing positively to better mental health for all EU workers.
We also need to do more research on the effects of technology on human health. A recent study from the European Parliament research service warns of the health risks of 5G radiation in certain cases. We need stronger regulation to protect human health from all the impacts of digitalisation. Chemical companies are required to collect information on the properties of the chemicals they handle and record the information in a central database at the European Chemicals Agency; technology companies should have to do something similar.
Finally, health systems, the fourth pillar of the strategy, must provide good mental-health care for all individuals and promote comprehensive models including access to psychology and psychiatry services. Currently, the path to these in most European countries is long and expensive, although with wide differences in the starting point.
For example, in Spain there are 11 psychiatrists per 100,000 inhabitants, yet in Norway, France, Sweden and Germany there are more than twice as many and in Switzerland five times more, according to Eurostat. The same is true of clinical psychology: in Spain there are six psychologists in the public-health system for every 100,000 inhabitants; across the EU, on average, there are 18.
Demand is growing throughout the EU and there is a lack of professionals. Although serious disorders, such as psychosis, major depression, suicide attempts or eating disorders, do tend to receive preferential treatment in the care circuit in most member states, the same does not happen with mild psychiatric symptoms and minor emotional disturbances. These disorders—the most common among the population—do not receive the necessary attention in the primary-care system to be diagnosed and treated early, so they risk becoming aggravated or chronic.
Among the 407 million people living in high-income European countries, mental disorders, along with self-harm, account for 30 per cent of disability-affected life years—compare cancer (17.1 per cent) or cardiovascular disease (16.0 per cent)—without including several common ones. Yet, despite the impact and cost of mental disorders and various means to treat and prevent them, fewer than 10 per cent of people with mental disorder in the EU receive adequate treatment.
Good mental health is a cross-sectoral issue with an impact on the inclusiveness, productivity, wellbeing, quality and sustainability of our society and our economy. A European strategy should not only focus on the widest possible provision of care but also on the social and economic impacts of mental wellbeing.
Many European countries have begun in the last couple of years to draw up national strategies and to strengthen their policies. According to a report from Mental Health Europe, 20 countries have recently taken important steps to improve or update their national legislation or policies related to mental health; Spain has just joined, with an ambitious plan announced by the government.
The Finnish presidency and the Employment, Social Policy, Health and Consumer Affairs (EPSCO) Council called on the commission at the beginning of this parliamentary term to present a comprehensive mental-health strategy for the EU. The socialists in the European Parliament have supported this initiative.
There is no time to lose. Europe must take care of the mental health of its citizens or, to put it another way, urgently strengthen the welfare state. Mental-health treatment involves a series of services, ranging from health and social care to employment, education and housing. The stronger the public investment, the greater our wellbeing and the better our physical and mental health will be.