John Bowis, President of Health First Europe details how community care can support better mental health services in Europe.
My first involvement with mental health on the European stage was working with the 1999 Finnish Presidency initiative on mental health promotion. Later, as the rapporteur of the European Parliamentary Report on improving the mental health of the population – towards a strategy on mental health for the EU, l had the opportunity to open the European debate on mental health and mental illness. Since then, several initiatives have been carried out at the European level to promote services for mental health, raise awareness and minimise the stigma of mental disease.
However, despite recent actions at European level, such as the Joint Action Plan on Mental Health and Well-being, many European countries continue to neglect mental services by under-resourcing the sector. For example, between one-third and one-half of people with disorders do not receive treatment1. One of the major reasons behind the gap between the needs of citizens and the availability of these health services is the lack, or inadequate provision of, community services.
Where we can improve mental health services
In 2006, Members of the European Parliament agreed with my Parliamentary report 2 that while health has continued to be prioritised on European and national agendas, European healthcare systems have not been able to overcome 5 key flaws elevating mental health as part of the public health agenda. Namely:
- the inadequacy of community services;
- the failure to listen to service users and their carers;
- the inability or unwillingness of different agencies to work together;
- serious underfunding; and
- a policy for mental health promotion that is in most countries notable by its almost complete absence.
To tackle these obstacles, there is a clear need for improved community care policies that are aimed at re-organising care around the patient. For mental healthcare, this is especially important because many common conditions such as depression and anxiety are often highly treatable, but too often patients must fit into a system that does not offer adequate funding for these healthcare services, does not have the appropriate staffing to treat common mental health conditions, and does not provide easy access for patients to specialised services.
Strengthening mental healthcare services
Europe’s role in promoting mental health services is often controversial, given the principle of subsidiarity on health related issues. However, the EU can play an important role in supporting the expansion of these health services by sharing best practices in community care, strengthening anti-discrimination rules where applicable, and by supporting employment policies which incentivise private companies to adopt internal policies to support employees affected by mental-illness3 and promote the mental wellbeing of all their workforce.
Additionally, the EU should continue to drive the shift of national health systems towards primary care by incentivising care in the community. To achieve this, Health First Europe developed a model which provides a road map for Member States to the substantive changes required to release the value and power of community care services for all citizens, including those suffering from mental health conditions. As Honorary President of Health First Europe, I believe that this model provides a strong basis for generating EU action on mental health and supporting Member States to find ways to better support primary care professionals to diagnose, treat and manage mental illness.
The Health First Europe Model outlines 6 areas of needed reform, all applicable to the provision of mental health services:
1. Community Care Policy: Establishment of a dedicated community care policy and political leadership to implement the policy;
2. Patient-Centric Care: A system designed in response to citizen health needs;
3. Innovation and Value: Incentivising innovative solutions involving key actors (citizens, carers, technology) across the health system of value to improve health outcomes for the well-being of citizens and society;
4. Access and Reimbursement: Flexible funding to increase access to innovative community care solutions including community care products, treatments and services;
5. Care and Treatment: Creating a mobile and flexible health and social care workforce bound to the citizen, not the system;
6. Quality Care and Standards: Generating quality of care assurance in the community. The implementation of needed reforms should begin at EU level under the new Commissioner designate for Health, Vytenis Andriukaitis. By creating a dedicated policy on community care at EU level, the EU can take the lead with Member States to develop best practices on community care services which better support mental health services.
After almost 15 years of closely following EU developments on mental health, I believe it is time to support significant changes to health organisation and help citizens receive the treatment they need and deserve for mental health conditions.
1 Making Mental Health Count, Organisation for Economic Co-operation and Development (OECD), 8 July 2014
2 European Parliament resolution on improving the health of the population. Towards a strategy on mental health for the European Union, http://www.europarl.europa.eu/sides/getDoc.do?pubRef=-//EP//TEXT+TA+P6-TA-2006-0341+0+DOC+XML+V0//EN&language=EN
3 YouTube Video – John Bowis, MEP talks about discrimination and making people with a mental disability more included in society.
Health First Europe