The European Union and its member states must accord a much higher priority to the suffering caused by mental ill-health.
On World Mental Health Day on October 10th, the World Health Organization launched an awareness campaign to promote mental health as a universal human right. Human rights are inherent to all, regardless of nationality, sex, national or ethnic origin, colour, religion, language or any other status. It is therefore our responsibility, as policy-makers, to ensure that mental health—the state of mental wellbeing that enables people to cope with the stresses of life, realise their abilities, learn and work well and contribute to their community—is rendered accessible, affordable and universal.
This is however far from the reality in Europe, where over 150 million people live with mental-health conditions. Around the world, more than half of those suffering from such conditions are never diagnosed or do not gain access to timely or appropriate treatment. In the European Union, this treatment gap has an economic cost amounting to over 4 per cent of gross domestic product (€600 billion per year), with enormous consequences.
Unique to each individual
Further analysis of the disaggregated data reveals that belonging to certain vulnerable groups creates additional challenges, which should be independently addressed. Many characteristics that contribute to one’s identity sediment additional layers on the personal experience of mental (ill-)health. These overlap into mutually reinforcing, ‘intersectional’ combinations, unique to each individual.
Hence the key message of the report on mental health drafted for the sub-committee on public health of the European Parliament, which will be voted on by the Environment, Public Health and Food Safety Committee today. Mental health should be a priority for everyone and any person at any point in their life can become susceptible to poorer mental health.
Intersectionality allows us to interpret vulnerability as the result of social stratification, through which individuals are marginalised based on socio-demographic factors. Access to mental-health services can thus be compromised. The systemic deficits in society which create inequalities must then be remedied to guarantee mental health and wellbeing to the whole population. A mental-health-in-all-policies approach best addresses these inequalities and engages a variety of sectors in together pursuing an ideal state of wellbeing.
Take the gender pay gap in the EU, which stands on average at 13 per cent. Implementing the ‘equal pay for equal work’ directive adopted in the spring will not just be beneficial for women’s financial status—it will also enhance their ability to prioritise their mental health and wellbeing.
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Since individuals can have complex needs and policies often transcend one sector, intersectoral collaboration is essential to corral their outcomes effectively. This is especially so considering the social determinants of mental health—how the circumstances in which people live and work shape their health outcomes. Thus, focused policies and programmes are required in education, workers’ rights, justice, transport, environment, housing and welfare to prevent mental-health conditions and promote health and wellbeing.
Another extremely important aspect is recognition of children, adolescents and young people as a vulnerable group. Global threats such as the pandemic, energy crisis, war and conflict, economic instability, the ever-more-pressing climate-change and pollution crises and the side-effects of other stressors, such as job competition and unaffordable housing, mean they are confronted daily with a world apparently intent on making it difficult for them to live a healthy life. The report adopts a holistic perspective, underlining protective factors such as physical activity, movement and play, reinforcing the role of schools and youth organisations in prevention and early detection of mental-health conditions and recommending policies to strengthen child and adolescent services.
Once again, a mental-health-in-all-policies approach is beneficial in this context, as policies implemented in education can be crucial for the next generation to recognise adversities and develop coping strategies to protect their mental health. Proper guidelines, teachers with mental-health training and school-based psychology services can promote an environment where students are supported and cared for, rather than laden with pressure to meet expectations. Evidence-based parenting programmes can also promote responsive caregiving and child development, fostering positive relationships and supporting the mental health of parents and caregivers—all determinants of good mental health throughout the life course.
Mental ill-health, compounded by its enduring stigmatisation, is further exacerbated by inhibiting sufferers to seek help. For this reason, at the European level the involvement of communities, public figures, politicians, public institutions, governments and citizens in contesting the stigma associated with mental-health conditions is critical—as is the lived experience of those who have been so tainted, who should be included in all stages of policy-making.
Integration does not however stop with societal recognition and an end to discrimination against individuals with mental-health conditions. Society must realise that those with such conditions and psychosocial disabilities have the right to lead full and meaningful lives and participate in all spheres. This includes the workplace, where the majority of working adults spend much of their time. Employers are known to discriminate against people with mental health conditions and, at the same time, the workplace can be the site of mental-health risk factors.
European Union key
The European Union is key, as it can urge member states to implement structural policies supporting those with mental-health conditions and national plans promoting reintegration and adaptation into the labour market, including support for workers on leave and those seeking re-employment, while ensuring a flexible work-life balance. The EU can also help reduce psychosocial risks at work by prioritising workers’ rights, including to compensation and social benefits.
Further steps include revision of the European framework directive on safety and health at work and the recommendation concerning the European schedule of occupational diseases, to incorporate work-related mental-health conditions—in particular depression, burnout, anxiety and stress. This is essential for member states to recognise mental-health conditions as a multifactorial consequence of individuals’ environment, including the workplace.
As this is the first report on mental health drafted by the European Parliament, it sets the tone for future initiatives. It is ambitious and plans to leave a legacy, stressing the increased importance that should be ascribed to mental health. A European strategy for mental health must go beyond the sharing of best practices among member states. While expectations are high for the European Health Union, these will not be fulfilled unless mental health is placed centre-stage.
Sara Cerdas is a Portuguese medical doctor and a member of the European Parliament for the Socialists and Democrats Group. She is the main rapporteur for the parliament's own-initiative report on mental health.