Mapping the flaws of our European mental health systems

DISCLAIMER: All opinions in this column reflect the views of the author(s), not of EURACTIV.COM Ltd.

Mental health patients are still institutionalised in many EU countries. [Africa Studio/Shutterstock]

Today in Europe, one in four people may experience a mental health problem at some point in their lives. For many they can recover through the right treatment and support. For others, sadly, it will result in years spent living in an institution.

Nigel Henderson is president of Mental Health Europe.

Across Europe tens of thousands of people live in psychiatric and other institutions with little hope. Many of them are deprived of their most basic rights, have little control over their lives and face a loss of their human rights due to violence and coercion in our mental health systems. Although there are some positive changes happening in some European countries, the findings of our recent report Mapping and Understanding Exclusion in Europe highlight some worrying practices in mental health systems across Europe including the overuse of coercion, forced treatments, loss of legal rights and reliance on involuntary hospitalisation of people living with mental ill health.

Our Mapping and Understanding Exclusion report, written by Mental Health Europe and the Tizard Centre at the University of Kent, shines a light on mental health systems in 35 European countries. What is clear is that institutional care, once thought of as a purely Central and Eastern European problem, is still a problem in Western countries, many of which were meant to have deinstitutionalised their mental health services decades ago. Our report indicates that closed institutions are still a feature of the mental health systems in France, Belgium, Ireland, the Netherlands, Portugal, and Germany, where tens of thousands of people with mental health problems are still living.

On a more positive note the challenge of stigma and discrimination experienced by people with mental health problems is being confronted through national campaigns and government policies that focus on the need for more community-based services that enable people to participate and be included in our communities. Public attitudes are changing for the better. We see better reporting and support for mental health in the media and by high profile politicians, celebrities and even royalty.

However, policy and reality are still distant from each other. We know that existing legislation and practices in Europe too often results in people being subject to forced hospitalisation and treatment, seclusion and restraint.

Community-based services and other more modern approaches “should not be considered ‘alternatives’”, writes Dainius Pūras, the UN Special Rapporteur on the Right to Physical and Mental Health. As he explains, coercive services and institutional care should rather be considered unacceptable alternatives that need to be abandoned. Our new reports gathered stories from people who have experienced coercive measures and shows what they can do to a person, how isolating those experiences can feel and how it can impact, often negatively, on their recovery.

The European Commission already plays an important role in protecting the rights of people with mental health problems through investment in the transition from institutional care to community based services in Europe through the use of European Funds. The EU has ratified and is bound by the UN Convention on the Rights of Persons with Disabilities (UN CRPD) which includes people with mental ill health/psychosocial disabilities and has committed to a range of activities following the review of the EU by the CRPD Committee in 2015. The Commission and EU must continue to fund deinstitutionalisation post 2020 and better monitor how its money is spent to ensure it is used in ways that comply with human rights. There is much to learn from European countries sharing knowledge and expertise in this respect. There is also an urgent need for reform of mental health legislation in many countries to bring the law around legal capacity into line with the UNCRPD recommendations.

Engaging and empowering citizens in taking forward changes in legislation and service delivery will be vitally important. People who have used mental health services are ‘experts by experience’ and have much to contribute to ensuring that future services are person and recovery centred and that they respect human rights. The EU can support this by ensuring that funds are available to support research and practice both at a member state level but also by transnational exchanges and learning.

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