The future of mental health. If not now, when?

The future of mental health. If not now, when?

Op-ed by Liuska Sanna, Head of Operations of Mental Health Europe

The COVID-19 pandemic has cast a spotlight on mental health by disrupting our lives in all of its aspects. Several studies have shown how the mental health and wellbeing of whole populations across Member States, and in particular of some specific groups have been affected – young people, the elderly, women, and those already in disadvantaged situations.

One in three adults in the general population had COVID-19 related psychological distress. During the first wave in Europe, 93% of countries surveyed by the World Health Organization (WHO) suffered paralysis in one or more services for people with mental, neurological and substance abuse problems. Almost 40% of participating European countries reported a worsening in the delivery of mental health services. According to a survey that reached young people aged 18–29 (12,000 responses from 112 countries), 50 per cent of respondents was possibly subject to anxiety or depression, while a further 17 per cent were probably affected by it.

Nonetheless, it is important to emphasise that the state of mental health in Europe was a cause for serious concern already before the pandemic: in 2018 it was estimated that mental health problems were experienced by about 84 million people across EU countries and the figures have likely increased since. Moreover, Europe has the highest suicide rate in the world; more than 140,000 people are dying by suicide in the European region each year. The total costs of mental ill-health are estimated at more than 4% of GDP. This is more than €600 billion across the EU27. In addition, poor mental health is associated with unemployment, low income, poor physical health, poor quality of life, stigma and discrimination.

To imagine how the future of mental health in Europe should look like there is no need for a crystal ball. There is sufficient evidence available showing the way forward. A key first feature is placing mental health policies and interventions in the context of a human rights framework. We all have rights as we all have mental health: the two need to be addressed together. Human rights are at the core of Mental Health Europe’s work: we believe in human rights being the drive behind changing how we understand mental health, talk about it and devise policies and practices. MHE’s work is underlined and guided by the United Nations Convention on the Rights of Persons with Disabilities (UN CRPD), which states that people with disabilities, including people with psychosocial disabilities, must fully enjoy their human rights.

Mental health support needs to put the person at the centre of every decision. Promising practices across the world exist and can help pave the way to a system that supports people with mental health problems in ways that respect their human rights. There are for instance alternatives to (forced) institutionalisation and to coercive measures; approaches that enable independent living, access to legal capacity and supported decision-making. If this is possible in some realities it must be feasible also in other contexts with the right commitment from policy makers, service providers and communities.

Communities can play a vital role in ensuring a holistic approach to mental health is taken, where “holistic” is what MHE best describes as a psychosocial model. The biomedical model frames psychosocial disability as an illness mainly caused by biomedical factors and genetic predisposition. The psychosocial model on the other hand, frames psychosocial disability as a human experience. Distress is caused by a variety of factors including wider socio-economic issues (e.g. access to employment, education, living conditions, etc.), and challenging or traumatic life events. With this model, a psychosocial disability is a mental health problem which when combined with barriers in society becomes disabling. In this context, communities are deemed to be better equipped – provided that they are appropriately resourced – to offer an integrated cross-sectoral support that meets the needs of the person. During the most difficult period of the pandemic, communities are those that showed more resilience, flexibility and adaptability to the situation and this capacity should be leveraged, particularly in terms of prevention. It is time to bring mental health to where people are – school, work, leisure – and we should not forget those that are more difficult to reach because they are in a disadvantaged situation.

None of the above however can happen effectively without changing the narrative around mental health and people’s mindsets. Although mental health is becoming more prominent in public discourse, stigmatisation remains widespread. Moreover, misrepresentation in the media adds fuel to misperceptions of mental health issues in the public eye. This kind of discrimination prevents many from getting help, to be vocal about their rights and often contributes to social exclusion. To avoid stereotyping and discrimination against people experiencing mental health problems, national and European policy-makers should invest in mental health literacy and public communication initiatives. These could highlight how mental health concerns us all and the fact that it is just as important as our physical health.

Countering stigmatisation, be it self-stigmatisation or societal, would also contribute to empowering people with lived experience who want to make a reality of the slogan “nothing about us without us”. Too often their involvement in services and policy-making is still a superficial one. MHE values the uniqueness of the insight and expertise brought by people with lived experience of mental health problems and their supporters. Whereas supporting the empowerment of experts by experience is essential, this is not sufficient.  We have to strive to achieve increased capacity of all relevant actors to work together from A to Z in co-creation, valuing each other’s expertise and perspectives whatever their background on an equal basis.

All these ingredients are fundamental requirements to build societies where everyone’s mental health and wellbeing flourish across their life course – it needs to be integral to a Europe that holds among its core values human rights, human dignity and equality. If not now, when?

About Mental Health Europe (MHE)

Mental Health Europe is a European non-governmental network organisation committed to the promotion of positive mental health, the prevention of mental distress, the improvement of care, advocacy for social inclusion and the protection of the rights of (ex)users of mental health services, persons with psychosocial disabilities, their families and carers.

MHE works closely with the European Institutions and international bodies to mainstream mental health in all policies and end mental health stigma. Mental Health Europe represents associations and individuals in the field of mental health including users of mental health services, professionals, service providers and volunteers.

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