A recent study shows that almost 165 million people suffer from mental health problems in Europe, but only about one-third receive necessary therapy or medication. E&M investigates the declining trend of mental health across the continent.   

Millions of Europeans suffer from mental health problems such as clinical depression, eating disorders and schizophrenia. Apart from the direct mental and physical effects, these conditions can impact negatively upon an individual’s social life. Given this, it is essential for societies that their citizens have access to adequate mental health services and education – as well the conditions that achieve mental well-being in the first place.

Socio-economic factors and the internet cause distress

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Unemployment can cause mental health problems. | Image: rhodes Licence: CC BY – SA 2.0

According to a 2010 Eurobarometer survey, since 2006 there has been a downward shift in Europeans reporting positive emotions. The World Health Organization (WHO) states that nearly 124,000 people die by suicide in Europe every year. In addition, a survey carried out by the European Commission found that one in every seven citizens surveyed had sought professional advice for an emotional problem and seven per cent had taken antidepressants during the previous 12 months.

This is a problem that must be tackled now. The economic cost of poor mental health can be a huge burden on society – let alone the social and psychological problems. According to Karol Balfe, Amnesty International Ireland’s mental health campaign coordinator, in countries such as Ireland, the bulk of this cost “occurs outside the health sector, particularly in the labour market as a result of lost employment, absenteeism, lost productivity and premature retirement as well as in premature mortality.”

So, what are the causes of poor mental health? A 2010 UK study revealed that almost half of unemployed young people believed joblessness caused them mental health problems such as self-harm, panic attacks or insomnia, while 41 per cent of young people not in work, education or training claimed to have felt suicidal. According to Mary Van Dievel, director of Mental Health Europe (MHE), young people with mental health problems “are less likely to gain meaningful employment because of stigma and discrimination, while unemployed young people are more prone to developing mental health problems themselves.”

The increasing ubiquity of the internet has also been harmful for young people. Gaming, although not recognised in the International Classification of Diseases, can cause attention deficit disorder, according to one mental health specialist. For young people, sitting in front of computer and television screens for long periods may result in the neglect of their social relationships, which can be quite harmful for their mental well-being – something most of us are guilty of.

“People, and these includes policy makers, also believe that mental health problems are rare, while in reality one in four Europeans will have some sort of mental health problem during the course of their lives.”

Van Dievel points out the detrimental effect drugs and alcohol can have, as well as socio-economic circumstances, education and even what someone eats. “Living in a poorer area of a city can decrease someone’s life expectancy by 10-15 years,” says Van Dievel, “and of course, make them more prone to health problems of any kind.”

Stigma and funding obstruct policy reform 

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Across Europe, there are different styles of treatment for mental illnesses. | Photo: reuben Licence: (CC by NC 2.0)

Van Dievel also says there is still a lot of stigma attached to mental health problems across Europe. “People, and these includes policy makers, also believe that mental health problems are rare,” she says, “while in reality one in four Europeans will have some sort of mental health problem during the course of their lives.”

John Dalli, European Commissioner for Health and Consumer Policy, says the diversity in health systems across the EU means that there are different national approaches and traditions when it comes to mental health – with reforms of mental health services more advanced in some countries than others. Speaking to Europe & Me, Commissioner Dalli said, “A key element of reform in mental health services … is the advancement of community-based mental healthcare – moving towards out-patient rather than in-patient care as far as possible.”

A researcher in the Central Institute of Mental Health (CIMH) in Germany says countries across Europe have different approaches to the “common label” of mental health. “The Southern and Eastern European countries spend less on mental health services than, say, central Europe or Scandinavia, but there is more of a family-oriented approach to the post-discharge period,” the researcher says. “In countries like Spain and Greece, the patient lives with their family after they are discharged (out-patient), who support them. We do not have this in countries like Germany or Switzerland where the patient will stay in a rehabilitation centre (in-patient).” Many European countries have an overreliance on medication and hospitalisation.

Another big problem is involuntary admission to psychiatric wards, where mentally ill people are kept against their will – an act many believe denies those individuals their human rights. Commissioner Dalli would not comment on whether involuntary admission to psychiatric wards violates the European Convention on Human Rights.

The stigma associated with mental health is one of the main obstacles in tackling the problem Europe-wide, along with the problem of funding. Commissioner Dalli said, “Indeed, providing quality care is an ever-present challenge to the budgets and resources of the Member States. This is accentuated even further by the economic crisis. In addition, the stigma associated with mental health problems means that sufferers often do not seek help.”

“In countries like Spain and Greece, the patient lives with their family after they are discharged […] We do not have this in countries like Germany or Switzerland where the patient will stay in a rehabilitation centre.”

Europe needs to reform mental health policy 

However, a 2008 WHO report found that activity in European mental health legislation has flourished in recent years. “Since 2005, 57 per cent of countries have adopted new mental health policies or updated existing ones, and 47 per cent have introduced new legislation or updated existing legislation. Azerbaijan, Estonia, Georgia and Moldova were listed as the only countries that have still not adopted any form of mental health legislation.

At the intergovernmental level, the EU has ratified and adopted the Convention on the Rights of Persons with Disabilities (CRPD). Commenting on the CRPD, Karol Balfe says the EU’s ratification of the convention represents “a significant commitment to raising awareness of the human rights violations experienced by persons with disabilities, mainstreaming disability rights across all areas of EU competency and taking concrete steps towards ensuring that the rights of persons with disabilities are respected, protected and fulfilled.”

However, this is just the first step, says Karol. “Each individual EU country needs to ratify the convention and the EU should also ratify the Optional Protocol to the CRPD to enable individual complaints to the Committee of the CRPD by victims of alleged non-compliance.”

E&M’s source in the CIMH says, “The EU institutions play an important role in both prevention and promotion. Mental health is neglected on the national level, so the EU organises a lot of activities that includes NGOs – where it invites representatives to talks and even research activities.”

Commissioner Dalli believes that while EU policies can play a role in helping to narrow the gaps in mental health services across Europe, “it is, however, up to Member States to define their own mental health policies and to organise and deliver care. The Commission does not have a mandate to impose sanctions for the type of care offered by each Member State.”

NGOs work effectively with young people

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Social media campaigns have played an important part in helping young people deal with mental health prejudice and discrimination. | Photo: Carmen Kong

NGOs are also taking an important role in campaigning for adequate mental health legislation. Commissioner Dalli believes NGOs play a key role in promoting mental health awareness. “A project on ‘user empowerment in mental health services’, completed this year by the Commission and the WHO, highlighted the crucial role NGOs and patient organisations play as partners of governments and health professionals.

The Commission works closely with various mental health NGOs, and provides Mental Health Europe with some financial support for awareness raising activities since their work is focussed on the promotion of mental health knowledge and overcoming stigma.

Figures for young people involved in promoting mental health awareness are hard to come by. Mary Van Dievel says MHE’s members work extensively with young people. “Our member Mental Health Ireland has a project called ‘Young Mental Health Ireland’ which both caters to and involves young people, and our Croatian member Sto Koluri has another very interesting project, where highschool children are taught to work with other children with developmental disabilities and mental health problems.” However, E&M’s source in the CIMH says most of the research and director positions are mainly staffed by older people – experts, parents and former patients.

Social media campaigns which challenge mental health prejudice and discrimination can be quite effective. With the growth of social media, both governments and NGOs can utilise online space to raise awareness of the problems associated with mental health – particularly among young people.

So, what can young Europeans do to improve the mental well-being of citizens across Europe? Commissioner Dalli believes the onus is on all sections of society. “During the past two and a half years the Commission has, through the European Pact for Mental Health and Well-being, organised conferences on mental health. As a follow-up, we are discussing with Member States how to put in place an EU-level exchange and coordination process to identify and disseminate the most effective policy and stakeholder approaches and actions.

“We need to find solutions that go beyond medication and psychotherapy, which are costly and often address illnesses that could have been prevented earlier. We must find ways to reduce the stigma associated with mental health problems. We must involve schools, workplaces and society as a whole.”

Commissioner Dalli says, “Member States, the EU institutions, NGOs, educational settings, social partners, medical health services and citizens all have a role to play. It is by working together that we can achieve the best results.” So, get active, Europe!

Cover image: Neil Moralee Licence: CC by ND-NC 2.0

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