Elsevier

Health Policy

Volume 85, Issue 1, January 2008, Pages 60-70
Health Policy

The emerging mental health strategy of the European Union: A multi-level work-in-progress

https://doi.org/10.1016/j.healthpol.2007.06.005Get rights and content

Abstract

Policy-making in the European Union (EU) is a complex process that can appear impenetrable and opaque. This paper examines the ongoing process of mental health policy-making in the EU. In 2005, the Health and Consumer Protectorate Director-General of the European Commission published a Green Paper and launched a consultation process aimed at mental health service-users, advocates, providers, business, social services and governments. While there were varying levels of participation between member states, a range of trans-national, national and infra-national actors made contributions. Based on these consultations, a ‘Consultative Platform’ was created and made 10 recommendations centered on the principles of partnership; establishing policy competencies; integrating mental health into national policies; involving stakeholders; and protecting human rights. This ongoing process illustrates many features of EU policy-making: (a) the European Commission generates an initiative; (b) policy focuses on EU standardization, with member states remaining central actors in service-delivery; (c) policy focuses on social inclusion; (d) the European Commission coordinates diverse networks of actors; and (e) there is ‘multi-level’ involvement, with direct interaction between trans-national, national and infra-national actors. An enhanced focus on epidemiological data and ‘evidence-based policy’ would increase rigor and focus further attention on this relatively neglected policy area.

Introduction

Policy-making in the European Union (EU) is a complex process that can appear impenetrable and opaque to onlookers and participants alike. The purpose of this paper is to examine EU policy-making in one specific area: mental health.

While the provision of mental health services in EU states has been indirectly affected by various elements of EU policy in recent decades (e.g. health service regulations, social and employment policy), the EU has never developed an overall strategy in relation to mental health. In January 2005 the World Health Organization's European Ministerial Conference on Mental Health invited the European Commission to contribute to the implementation of a framework for comprehensive action in relation to mental health.

In response to this invitation, the Health and Consumer Protectorate Director-General of the European Commission published a Green Paper entitled “Improving the mental health of the population: Towards a strategy on mental health for the European Union” [1]. The purpose of the Green Paper was “to launch a debate with the European institutions, governments, health professionals, stakeholders in other sectors, civil society including patient organizations, and the research community about the relevance of mental health for the EU, the need for a strategy at EU level and its possible priorities” [1].

This paper aims to:

  • •

    Outline the overall policy-making context in which this strategy is being developed, with particular emphasis on policy modes and multi-level governance within the EU (Section 2).

  • •

    Explore the mental health policy contexts in which this strategy is to be developed and implemented, with particular emphasis on principles of mental health policy and practice across member states (Section 3).

  • •

    Outline the rationale behind the strategy development; the ongoing consultation process; and the current status of the emerging strategy (Section 4).

  • •

    Draw relevant conclusions and outline likely future directions for this process (Section 5).

Section snippets

Policy modes

The emergence of policy initiatives in the EU reflects a range of heterogeneous, evolving and frequently complex processes [2], [3]. A wide variety of institutions, committees and other actors produce, debate and revise policy ideas, resulting in a vast, amorphous policy arena in which there is much activity and interconnectivity—and in which it can be difficult to determine the precise direction of change [3]. The ‘garbage can’ model suggests that decision situations in such ‘organized

Principles of mental health policy

Mental health policy comprises a set of principles, strategic plans and policy measures aimed at reducing the burden and/or incidence of mental illness [15]. Mental health policy is centrally concerned with resource allocation, system capability, care delivery mechanisms and the creation of conditions under which mental illness can be managed (e.g. through mental health legislation). Jenkins [16] notes that a variety of disparate elements are required for the effective implementation of policy,

Rationale behind the strategy development

The development of an EU mental health strategy is rooted in a growing awareness of the personal, social and economic costs of mental illness in the EU. The initial EU Green Paper [1] noted that:

  • •

    Over 27% of EU citizens experience mental illness in any given year [66].

  • •

    By 2020 depression will be the “highest ranking cause of disease in the developed world” [67].

  • •

    Fifty-eight thousand EU citizens die from suicide each year, which is “more than the annual deaths from road traffic accidents, homicide

Summary

The development of an EU mental health policy is a complex, multi-level, ongoing process. The process to date has been largely a consultative one, focusing on some of the perspectives previously identified as important in the development of mental health policy (e.g. economic, political, sociological), while other perspectives (e.g. epidemiological) have arguably received less attention [17].

Regarding the strategy development steps previously identified by Bryson [18] and Jenkins et al. [19],

Conflict of interest

There is no conflict of interest to declare.

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