Between 15% and 20% of adults suffer some form of mental
health problem (European Commission 2003), which range from mild forms of
depression through to complex psychiatric disorders. Depression and
depression-related problems account for more than 7% of all estimated
ill-health and premature mortality in Europe with women twice as susceptible as
men8. Disadvantaged groups face a greater risk of mental illness.
People with mental disorders may face stigma, discrimination and social
exclusion. The impact on the EU economy of mental ill health is estimated to be
equivalent to a reduction of 3% to 4% of the total GDP9.
There are gender-specific risk factors for some common
mental disorders. Women are at much greater risk of experiencing domestic abuse
than men; this can result in high rates of anxiety and depression, symptoms of
post-traumatic stress, and subsequent difficulty in establishing and
maintaining relationships. Women living in poverty and women from minority
groups are at a higher risk for victimisation by violence. Similarly, women
living on a low income for an extended period can experience stress, difficulty
in personal and family relationships and can be left feeling isolated and
depressed. Individuals most at risk of social isolation and anxiety are female
lone parents and retired women living alone10. Moreover, women are more
likely to approach their primary care physician for help. Doctors are more
likely to diagnose depression in women compared to men, even when before
similar scores on standardised measures of depression or identical symptoms.
Female gender is also a significant predictor of being prescribed mood altering
psychotropic drugs. Men are more likely to seek specialist mental health care
and are the main users of inpatient care11,12. Women’s social
roles as primary carers for children and/or other dependants, can result in
“role overload”, where women undertake both employment and
household/childbearing responsibilities. This contributes to social isolation
and further impacts on mental health.
Mental health services in Europe have been identified as a
key policy challenge by the World Health Organisation and the European
Commission. One in four people suffer from mental ill-health in their lifetime,
costing the EU27 countries an estimated total of €300 billion every year in
ill-health and lost productivity. Yet despite this staggering burden, mental
healthcare services are often inadequate, outdated, and highly stigmatised,
despite the availability of modern, effective treatments. Better policies and
provision of services are urgently needed to ensure that people with severe
mental illness are adequately provided and cared for. For example, countries in
the European Region spend on average around 6% of their health budgets on
mental health, while mental ill-health represents 20% of the burden of disease.
The lifetime incidence of severe mental illnesses such as
schizophrenia, bipolar and other psychotic disorders is over 1%, corresponding
to around 5 million people in the EU27. But despite their lower prevalence, the
associated burden of ill-health on individuals and their families is much
greater.
The burden of ill health can be reduced by addressing
factors that have an impact on mental health and wellbeing such as social
relationship, poverty, and discrimination, by raising awareness of mental
issues relevant to older people, such as depression and dementia and by
increasing the provision of psychotherapeutic and psychosocial interventions
for older people.
Some countries support people with severe mental problems
in paid employment, though in most countries economic inactivity remains the
rule. It is estimated that only around 15% of working-age people with long-term
mental health problems are working, a lower number than any other group of
disabled people. Unemployment, a lack of adequate housing and social networks
may result in people becoming seriously isolated and excluded from society.
Some Member States endeavour to protect the rights of
individuals with mental health problems. Countries such as Italy and the UK have moved care into community settings, giving individuals a better chance to
access integrated services while using inpatient beds in general hospitals for
short term treatment. There are still many countries which continue to
incarcerate people for long periods. Care homes or “asylums” accommodate large
numbers of people in some Eastern European countries, but also in Belgium and the Nethe rlands.
Depression: The EURODEP Programme explored
geographical variation of depression in older people, risk factors, detection
and treatment and preliminary evidence showed higher proportions of depression
in women than in men in almost all studies15.
Only cardiovascular disease has a greater toll on
morbidity and mortality than depression. Yet depression remains
under-recognised and highly stigmatised across Europe. Depression affects
10-15% of people over 65. Older people with depression are 2-3 times more
likely to have 2 or more chronic illnesses and 2-6 times more likely to have at
least one limitation in their daily life activities. More appropriate medical training,
increased social awareness and better access to treatment options are necessary
to prevent, diagnose and treat late-life depression. The higher risk of
depression in older women and in people of lower socio economic status requires
particular attention16.
The burden of depression includes a higher burden on
social security systems and brings a loss of quality of life for those affected
and their families, a loss of productivity for firms, and an increased risk of
unemployment for individuals. The Global Burden of Disease Study17,
judged depression in women as the leading cause of disease burden worldwide.
Eating disorders: It is likely that eating disorders
are caused by a combination of psychological, genetic, environmental and social
factors. An individual with a family history of mood disorders such as depression
may be especially affected. Eating disorders are often associated with feeling
of helplessness, sadness, anxiety and the need to be perfect. According to
Makino et al18, the prevalence rates in Western countries for anorexia
nervosa in female subjects range from 0.1% to 5.7%, whilst for bulimia it
ranges from 0.3% to 7.3% in women and from 0.1% to 2.1% in males. There is
often doubt about the reliability of data on eating disorders, particularly as
research is often limited to the under-25s, with older women excluded because
bulimia and anorexia nervosa are considered to be a “young girls” condition.
Dementia: Dementia does not solely affect
older people, but rates increase with age, doubling every four years over 65.
After the age of 85 years rates of Alzheimer’s Disease (AD) increase in women
but not in men19. The EURODEM studies also noted that the rates of AD
were higher among women of lower education, but that education was not a
significant risk factor in men.
Schizophrenia in the EU has a prevalence of about
1% equivalent to some 3.7 million people. The disease usually first affects
young adults. Three-quarters of them continue to experience symptoms throughout
their lives, needing constant treatment. This creates distress for families and
places a huge burden on health care resources. More data on this condition are
not readily available.
Epilepsy: The prevalence of
epilepsy in the EU varies between 3 and 6 per 1.000 inhabitants. Data, though
limited, suggest that the incidence and mortality of epilepsy are declining.
The estimated number of children and adolescents in Europe with active epilepsy
is 0.9 million (prevalence 4.5-5.0 per 1000), 1.9 million aged 20-64
(prevalence six per 1000) and 0.6 million aged 65 or older (prevalence seven
per 1000). Approximately 20-30% of the epilepsy population have more than one
seizure per month .
There is evidence that suicide can be prevented through
adequate treatment of psychiatric disorders and earlier detection and treatment
of psychiatric illnesses in the general population. Treatment with medications
for depression, bipolar disorders, schizophrenia and other psychotic illnesses
can prevent both suicide and attempted suicide. Behavioural therapies have
shown encouraging results in reducing the repetition of suicide attempts.
The Community’s health policy has covered mental health since 1997 through
specific projects and policy initiatives20. The EU 2003-2008 Public
Health Programme provides limited resources for action. Further related
priorities addressed the misuse of drugs and the harm caused by alcohol.
Initiatives under the Community’s social and employment policy targeted the
non-discrimination of people with mental ill health, the social inclusion of
people with mental disabilities and the prevention of stress at the workplace,
including: (i) The adoption of directive 2000/78/EC which prohibits inter alia
discrimination on the ground of disability in the field of employment; (ii)
Actions under the European Year for People with Disabilities in 2003; and (iii)
The adoption of a European Framework Agreement on work-related Stress between
social partners in 2004.
The Community’s Framework Programme for Research has been
and continues to be an important source of funding for European research on
mental health21. An example is the “MHEDEA-2000”-project, which carried
out a European assessment of mental health disability; Information society and
media policy supported the development of Information and Communication
Technology (ICT) -based tools for use in prevention, diagnosis and care;
Regional policy supports infrastructure investments in the health sector that
is beneficial to the regions' structural adjustment; Educational policy
addresses mental health as part of its policy work (e.g. on key competences for
the knowledge society) and through projects; as part of the Community’s
freedom, justice and security policy, the DAPHNE II programme combats violence
against children, young people and women. Such violence can cause mental health
problems.
However, a comprehensive strategy on mental health, which
would link all these activities, does not yet exist at Community level. Such a
strategy would be helpful in strengthening the coherence and effectiveness of
current and future initiatives.
A number of policy documents adopted by the Council of
Ministers since 1999 , signalled a willingness of Member States to use the
EU-level for cooperation in the field of mental health. The Council Conclusions
adopted in June 2005 reinforced this message by inviting Member States to give
due attention to the implementation of the results of the WHO European
Ministerial Conference on Mental Health. The Commission was invited to support
the implementation.
In 2005, the European Commission launched a Green Paper on
'Promoting the Mental Health of the Population' which marked the beginning of
an extensive consultation to develop a EU strategy on mental health. The
document outlined the relevance of mental health for some of the EU's strategic
policy objectives, proposed the development of a strategy on mental health at
Community-level and brought forward possible priorities and suggestions. The
consultation period ended in May 2006; in December 2006 the European Commission
issued a report on the responses to the Green Paper22.
In the meantime, European networks of patients’
organizations (e.g. Mental Health Europe, EUFAMI, EnterMentalHealth,) have
developed programmes which aim at:
·
Protection
of human rights of people with mental ill health
·
Prevention
of mental distress
·
Promotion
of positive mental health
·
Achieving
a continuous improvement throughout Europe in mental health, the quality of
care and welfare for people with a mental illness, and the level of support for
their family and friends.
·
Enabling
member associations to combine their efforts and act jointly at European level.
·
Strengthening
and assisting the member associations in their efforts to improve health
conditions in their own areas.
These organizations are advocating the patients’ needs in
areas regarding the development of policies and programmes; development of best
practice; promoting the empowerment of patients and their families; the
development of training courses for health and social care professionals;
combating stigma and promoting social inclusion.
An internet tool (
www.implementis.eu) has been developed to
help Users, Carers and families touched by severe mental illness, NGOs,
Healthcare professionals and Government policy makers in finding key facts and
evidence base, areas for actions, guidance material and best practice examples.
