The European Commission’s communication on a comprehensive approach to mental health, adopted in June 2023, aims to place mental health on an equal footing with physical health and ensure a new, cross-sectoral approach to mental health issues.
The EU and its Member States must act swiftly to achieve this. The post-COVID-19 pandemic momentum is fading, even as poor mental health continues to inflict substantial monetary and non-monetary costs on individuals and on wider society. Europe must prepare for the mental health impact of the next crisis, whatever form it may take. Crucially, solutions must be sought not only narrowly within mental health care, but also in improving living and working conditions and facilitating social and economic inclusion.
Social and economic drivers
The Great Recession in Europe, the economic downturn that began in 2008, resulted in job and income loss, which demonstrably contributed to a rise in poor mental health among those affected. The COVID-19 pandemic, and the measures put in place to contain the virus, similarly caused a spike in the prevalence of poor mental health due to job and income insecurity. Moreover, this crisis negatively impacted mental health through other factors, notably social isolation and the deterioration of working conditions in sectors such as care.
The dramatic impact of these two crises on mental health demonstrates two key points:
- Firstly, that everyone can suddenly be exposed to factors putting them at risk of poor mental health. For instance, during the Great Recession, individuals in previously well-paid and secure finance jobs suddenly faced unemployment and the risk of losing their homes, causing great mental stress for their households. During the pandemic, socially active elderly and young people with good mental wellbeing suddenly faced isolation, leading to poor mental health.
- Secondly, that the increase in poor mental health was not without reason; it was clearly caused by factors such as financial strain and social isolation. While short-term mental health support is vital, a sustainable solution requires addressing these underlying factors.
As detailed in new Eurofound research, these crises heightened the prevalence of social and economic exclusion, worsened working and living conditions, and, consequently, increased poor mental health. Even in periods without such crises, groups of people are affected by these issues and suffer poor mental health as a result, albeit on a smaller scale. Furthermore, other factors contribute to poor mental health regardless of crises, including facing discrimination based on gender, sexual orientation, or migration background, or having experienced poor mental health in the past.
Worrying trends
While the surges in poor mental health during the two crises were evident, longer-run trends in prevalence are harder to measure. Changes in survey data and (especially) mental health service usage are difficult to interpret:
- Increased usage of mental health services may be caused by improved access, for instance due to reduced stigma and discrimination, enhanced entitlements, greater availability of services, or increased quality of and trust in available services. Thus, increased service usage does not necessarily mean that poor mental health has become more common.
- When poor mental health is measured by surveys, some of these issues are overcome. However, the survey measurement is still influenced by stigma around reporting poor mental health. Moreover, certain groups especially vulnerable to poor mental health are usually excluded from samples—including children, people in residential care, and the homeless—or they may be under-represented, such as those with particularly low incomes and in precarious employment situations. Lastly, survey results vary widely, depending significantly on the precise measures of poor mental health used.
Overall, however, indicators point towards some growing groups of people with poor mental health. These include a rising prevalence among young women, and a growing cohort of people aged 80 and over at elevated risk. Certain risk factors for poor mental health are also increasing. These relate to the digitalisation of work and life (e.g. problematic social media usage), growing workforces with greater mental health challenges (e.g. care), and persistent concerns about housing, the cost of living, the natural environment, and armed conflicts.
Conversely, other factors are more favourable, such as relatively low unemployment and certain aspects relating to digitalisation (e.g. the work-life balance facilitating impact of telework, and some forms of social inclusion via digital communication).
Suicide deaths decreased for decades, with the largest drops seen in post-communist EU Member States. This represents a significant achievement, likely driven by improved working and living conditions, enhanced access to mental health support, and decreased stigma and discrimination.
However, this decrease has stalled since 2017. Suicide death rates have increased among certain groups, notably young girls and men aged 85 and over. Suicide is the most common cause of death among young people (ahead of traffic collisions), but remains more frequent among older people.
Moreover, over the past few years, there have been increases in suicide deaths at the EU level, even after adjusting for ageing societies. While small compared to the drops of past decades, the largest year-on-year increase was from 2021 to 2022, the latest year for which data are available. This is a worrying development.
A system under strain
People in the EU are generally entitled to mental healthcare at low or no cost. In practice, however, these entitlements are often void. Stigma and discrimination against people with poor mental health discourage individuals from seeking support.
Furthermore, capacity limitations render entitlements meaningless for many. Timely access to care for mild or moderate needs, such as psychotherapy, usually requires out-of-pocket payments, which are often unaffordable for people on a low income and without supplementary insurance.
Moreover, people may not be made aware of their entitlements and face difficulties identifying appropriate support. Many do not trust available support or find it inadequate. In the EU, 46% of people with emotional or psychosocial problems score the quality of mental healthcare services below 5 on a scale from 0 (poor) to 10 (excellent).
Access to high-quality mental health support must be improved. Services need to be trustworthy, human rights-respecting, and person-centred. This can be achieved by involving those who have experienced poor mental health in the design of mental health policies and services.
Europe must learn from its crises. It must improve the mental health of its population by enhancing living and working conditions and boosting social and employment inclusion, while simultaneously ensuring that support services are fully able to meet the needs of the EU’s population.
Hans Dubois is research manager in the social-policies unit at Eurofound in Dublin.
