It’s time to move mental health to the top of the European Union policy agenda.
June 2023 will be an important moment for those advocating that the European Union prioritise mental health. The first comprehensive approach to mental health will be presented by the European Commission, putting it at the heart of EU policy-making.
The pandemic has been a catalyst, having a widespread impact on mental health, particularly for young people: half of all young Europeans now report unmet health needs and depression among them has more than doubled. Covid-19 has also increased inequalities in mental health.
In July 2020, the European Parliament recognised mental health as a fundamental human right. There is now a consensus that member states must bring it to the fore, to ensure a sustainable recovery and build a more resilient Europe.
Health inequalities have a stark social gradient: income inequality increases the risk of mental ill-health, particularly for those experiencing socio-economic disadvantage. Not only are young people and women in general at greater risk but the at-risk include those on low incomes, unemployed people, children, elderly people, health and care workers, LGBT+ individuals, people with disabilities, migrants and refugees, as well of course as people with pre-existing mental-health problems.
Extensive literature correspondingly demonstrates that policies that address the social determinants of increasing health inequalities are key to improving mental health. It is also crucial that mental health be nurtured ‘upstream’, in the schools and workplaces of European citizens, for example—not only when symptoms present in clinical settings.
Exacerbating inequalities
Some changes since the pandemic have been seen as positive for mental health—prioritising family and personal life over work through better work-life balance, for example. The opportunity to work from home has however a social gradient too, so it may exacerbate inequalities in the labour market.
There is indeed a growing body of research on the negative effects of home working, including a blurring of work/home boundaries, exploitation, overwork and stress. Elevated psychological distress has been found among women working from home, which needs to be understood within the context of social pressures and norms, particularly the disproportionate responsibility they have for unpaid care work. The pandemic has also been associated with increased loneliness and isolation, intimate-partner violence, job precarity and forced exit from the labour market (due to illness and longer-term disability).
Despite growing recognition of the prevalence of mental-health issues, the policies needed at an EU and national level to enhance support face challenges. One is social stigma—regardless of media attention and growing willingness among young people to discuss their wellbeing. Public education campaigns are needed as part of developing mental-health literacy. A second challenge, as our recent study of France, Ireland and Poland shows, is overcoming the effects of long-term underinvestment in mental-health services, especially in a workforce which suffers from low status and pay.
A third is to integrate mental health across policy areas, a prerequisite of addressing the social determinants of mental health and its unequal manifestations. Failure to recognise this has led to a medical focus on hospital treatment, at the expense of locally provided, quality primary care and services supporting people with common mental-health conditions.
Cost incontrovertible
The economic impact of growing mental ill-health yet weak provision is incontrovertible. Its cost in 2015 stood at more than €600 billion—more than 4 per cent of gross domestic product—across the then 28 EU member states. The Organisation for Economic Co-operation and Development estimated that much of this was due to lower employment and productivity among individuals with mental-health issues, as well as greater spending on social security and the direct spending on healthcare involved.
At both member-state and EU levels, politicians and policy-makers are now signalling that mental health is about to move far higher up the political agenda. An EU-wide mental-health strategy would improve quality of life, strengthen cohesion and build resilience among EU citizens and their communities within and among member states.
In May last year, the Socialists and Democrats group in the parliament called for a comprehensive and ambitious mental-health strategy at EU level and a ‘broader and more holistic discussion with the objective of addressing and mitigating mental health issues and the related socio-economic burden throughout the EU’. The president of the commission, Ursula von der Leyen, focused on mental health in her State of the Union speech last September, committing to a comprehensive approach incorporating consideration of mental health in all member-state and EU policies. The commission is expected to present an action plan in June.
Whole-of-government strategy
The EU and campaigners are clear that the transversal nature of mental health means the strategy must be whole-of-government and multi-sectoral, with a better understanding of gaps in services and sharing of data between sectors. For instance, promoting wellbeing at work, including through training in psychosocial risks, must be integral to all EU health-and-safety legislation. Fair teleworking legislation and directives on the ‘right to disconnect’ and the use of artificial-intelligence technologies—protecting workers from mental health risks such as hyper-connectivity and continuous surveillance—would also help.
Just as crucially, any EU strategy must actively address misconceptions, discrimination and stigma. It should remind member states of the cost of underinvestment in mental health, the unaddressed need and the associated inequalities. At the same time, mental-health services should be integral not only to health policy but also, among others, social security, education, employment, housing, environment and migration.
The EU should promote a multi-stakeholder, cross-sectoral approach, including international organisations, governments and non-governmental organisations, social institutions and service providers, community and voluntary groups, as well as the private sector. Finally, the strategy should incorporate mental-health interventions into mainstream care pathways and/or enable blending with traditional forms of care, making available local, high-quality care. This would entail investing in improving diagnosis, early intervention and clinical treatment and care for those with complex conditions, while promoting non-pharmacological interventions and involvement of family and relatives in individual pathways where possible.
Dr Gerry Mitchell is a social-policy researcher, most recently having worked for Compass, the Foundation for European Progressive Studies, the Friedrich Ebert Stiftung and TASC. Her research interests include inequality, frontline experience of social policies and democratic reform.
Dr Shana Cohen is director of TASC. She has taught at George Washington University, the University of Sheffield and Cambridge University—where she was deputy director of the Woolf Institute—on global social policy, globalisation and human services. She has worked with NGOs and community-based organisations in Morocco, the US, the UK and India.