BMJ  2006;333:210-211 (29 July), doi:10.1136/bmj.333.7561.210

Editorial

Europe's mental health strategy

Responsibility extends beyond health authorities

Many countries in western Europe are experiencing increasing numbers of sickness spells and early retirements due to mental disorders and problems.¹ However, the importance of good mental health is still not acknowledged universally. In the era of the information society, mental stressors are public health threats of increasing magnitude.

A recently presented green paper by the European Commission on mental health promotes discussion on the relation between the European Union's strategic policy objectives and the mental health of Europeans.² The paper builds on the Helsinki Action Plan of the World Health Organization's European Ministerial Conference on Mental Health 2005.³ The potential adoption of a union-wide mental health strategy later this year could signal an upgrade in the status of mental health issues within the union and within each member state.

The paper acknowledges the need for European action on mental health. Each year, about 60 000 European Union citizens die from suicide, more than the total annual deaths from road traffic accidents.⁴ Meanwhile, many countries still have no suicide prevention policy,⁵ even though evidence based measures for suicide prevention are effective and available.⁶ The economic consequences of mental health problems—mainly in the form of lost productivity—are estimated to be 3-4% of gross national product.⁷ In any given year a quarter of Europeans are likely to be affected by mental disorders,⁸ while only 25% of these will have contact with formal health services.⁹

The new mental health strategy proposed by the green paper should focus on the promotion of mental health, preventive actions, social inclusion, and the protection of the rights of people with mental disorders, as well as on developing a European mental health information system. The lessons of the successful control of infectious and cardiovascular diseases indicate that the road to improved mental health among populations lies not in investment in mental health services but in promotion and prevention activities. Yet these remain challenging, as individual, familial, and societal determinants of mental health often lie in non-health domains such as social policy, education, and urban planning. Promising new evidence has, however, indicated that effective interventions exist¹⁰: interventions in local communities,¹¹ home visiting programmes,¹² and school programmes¹³ are some examples of effective interventions for improving mental health.

Mental health is a marginal issue in existing European Union health infrastructures, and there is no specific unit devoted to mental health either in the European Commission services or at the European Centre for Disease Control. Though the need for a mental health information system is acknowledged in the paper, it does not suggest any sustainable European infrastructures for monitoring and information dissemination. There is an obvious need for new European institutions to complement and support national activities; such structures could include a European clearinghouse for evidence on mental health interventions, an institute providing guidelines on mental health practice, and an observatory for mental health. None of these activities exist today on a sustainable basis in spite of the achievable European benefits that would be gained.

The European Commission has been given the chance to take a lead and contribute to the introduction of progressive national and regional mental health policies in Europe. Many countries have neglected the need for a comprehensive mental health policy for too long.⁵ For the most part, mental health is seen as a matter for health authorities only, and many existing policies focus on the development of services. The commission can change this pattern by advocating the inclusion of mental health not only in European public health policy but also in social and employment policy; research policy; and freedom, justice, and security policies. Such a shift would likewise transform the alcohol policy of the European Union, in which mental health considerations have so far been notoriously overshadowed by trade considerations.

The commission's green paper is open for consultation by member states, organisations, and individual citizens (http://europa.eu.int/comm/health/ph_determinants/life_style/mental/green_paper/consultation_en.htm). Input into the consultation will help shape the future mental health of Europeans. The European Parliament's response to the green paper is scheduled for September and is an opportunity to raise awareness and political commitment for mental health issues.

Mental health is a major challenge for European health policy. Good mental health contributes to prosperity, solidarity, and social justice, and cannot be achieved by the health sector alone. All sectors have to be involved in the promotion of mental health.

STAKES National Research and Development Centre of Welfare and Health, PO Box 220, Helsinki 00531, Finland
(kristian.wahlbeck{at}stakes.fi)

STAKES National Research and Development Centre of Welfare and Health, PO Box 220, Helsinki 00531, Finland

---

Competing interests: None declared.

References

1. Järvisalo J, Andersson B, Boedeker W, Houtman I, eds. Mental disorder as a major challenge in prevention of work disability. Social security and health reports 66. Helsinki: Social Insurance Institution, 2005.
2. European Commission, Health & Consumer Protection Directorate-General. Green paper. Improving the mental health of the population: towards a strategy on mental health for the European Union. Luxembourg: EC, 2005. (http://europa.eu.int/comm/health/ph_determinants/life_style/mental/green_paper/mental_gp_en.pdf.)
3. WHO Regional Office for Europe. Mental health: facing the challenges, building solutions. Copenhagen: WHO Regional Office for Europe, 2005. (www.who.dk/document/E87301.pdf.)
4. WHO Regional Office for Europe. European health for all database (HFA-DB). www.euro.who.int/hfadb (accessed 24 Feb 2006).
5. European Commission, Health & Consumer Protection Directorate-General. Mental health promotion and mental disorder prevention across European member states: a collection of country stories. 2nd ed. Luxembourg: EC, 2006. (www.imhpa.net/fileadmin/imhpa/Country_stories/FINAL.pdf.)
6. Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, et al. Suicide prevention strategies. A systematic review. JAMA 2005;294: 2064-74.[Abstract/Free Full Text]
7. Gabriel P, Liimatainen M-R. Mental health in the workplace. Geneva: International Labour Office, 2000.
8. Wittchen H-U, Jacobi F. Size and burden of mental disorders in Europe—a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 2005;15: 357-76.[CrossRef][Web of Science][Medline]
9. Alonso J, Angermeyer C, Bernert S, Bruffaerts R, Brugha TS, Bryson H, et al for the ESEMeD/MHEDEA 2000 Investigators Scientific Committee. Use of mental health services in Europe: Results from the European study of the epidemiology of mental disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004;(420): 47-54.
10. Doughty C. The effectiveness of mental health promotion, prevention and early intervention in children, adolescents and adults. A critical appraisal of the literature. NZHTA Report 2005;8(2).
11. Hawkins D, Catalano R, Arthur M. Promoting science-based prevention in communities. Addict Behav 2002;27: 951-76.[CrossRef][Web of Science][Medline]
12. Olds DL. Prenatal and infancy home visiting by nurses: from randomized trials to community replication. Prev Sci 2002;3: 1153-72.
13. Patton GC, Glover S, Bond L, Butler H, Godfrey C, Di Pietro G, et al. The Gatehouse project: a systematic approach to mental health promotion in secondary schools. Aust N Z J Psychiatry 2000;34: 586-93.[CrossRef][Web of Science][Medline]

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