Following the European elections last month, there is a clear opportunity to influence the new priorities for the work of the European Commission. In this blog ILC Chief Executive, David Sinclair, writes about the key findings so far in our ‘Mental Health Matters’ programme of work that are relevant to European and global stakeholders seeking policy change to alleviate the mental health burden.

Ahead of the European Parliament elections at the beginning of June 2024, we organised a discussion with EU stakeholders to explore what approach European governments and the EU should take to mental health. Our global roundtable in Geneva alongside the 77th World Health Assembly brought a wider range of perspectives to this global problem.

Policies relating to healthcare, the workforce, and welfare systems are all crucial to managing the burden of disease that acute mental ill health presents. Keeping people well is not just important to keep them working. There are certainly socioeconomic benefits to managing the symptoms and burden mental ill health effectively. More importantly, supporting people to remain well and able to do the things they choose is a moral imperative.

We want to understand what needs to happen for mental health to be taken more seriously

Last year we asked ILC staff what the biggest issues they were personally most concerned about. Climate change, worries about families and friends, and mental health were the most common themes. These issues are high on the agenda for individuals and increasingly for governments.

We were pleased that with the support of Boehringer Ingelheim we have been given the opportunity to explore the issue of mental health across the life-course. Our global programme of work will explore:

• The evidence around major depressive disorder, schizophrenia, and PTSD
• The different approaches taken by health systems to diagnose, treat, and manage the symptoms of acute mental health

We’ve started talking to stakeholders and recently held an event in Brussels for European stakeholders.

What have we found so far?

Addressing mental health is a huge challenge for policymakers According to the WHO, “mental disorders are the leading contributor to the global burden of years lived with disability”. In 2019, 970 million people globally were living with a mental disorder, with anxiety and depression the most common.

Prior to COVID-19, 1 in 6 people in the EU suffered from a mental health condition. Since then, COVID-19 pandemic and lockdown measures have taken a significant toll. The global figure is now closer to 1 in 8 people who have a mental health condition – this is a billion people in the world with mental health support needs.

The European Commission is interested: The Commission’s plan for comprehensive approach to mental health was published in June 2023 and set 10 priorities and 20 initiatives. There was a focus on workplace wellbeing, youth mental health, and underserved groups including migrants, refugees, and victims of .

But it’s a challenge most countries are failing to respond to: One article in the BMJ argued that “All countries have failed to achieve universal health coverage for mental disorders, owing to barriers related to budget and stigma”.

Mental health is a life course issue: It impacts us all directly and indirectly form the cradle to the grave. There are a huge range of triggers. Maternal metal health is a significant concern. Perinatal depression is common (1 in 5 women before during or in the first 1000 days). And mental health issues can be passed to children; half of all mental health conditions begin before the age of 14 so it is crucial to take a life course approach beginning in childhood and adolescence. Adverse life events such as natural disasters, crime, and international conflict have significant impacts on population mental health, and this should be a key consideration in government decision-making.

Stigma remains a significant challenge: There remains significant stigma associated with mental health. Some campaigns are in themselves stigmatising and the language around mental health (e.g. “disorder”/”recovery”) isn’t helpful.

The UK Secretary of State for Work and Pensions recently suggested that people with depression and anxiety would lose sickness benefits; this move would require more documentation of a person’s condition, and corroboration from health professionals, before an individual could access welfare benefits.

And we know that ageism is sometimes a barrier to accessing treatment.

We need innovation: We heard that we are reliant on very old medications with significant side effects, particularly for some acute conditions. There is some innovation coming though. Chatbots can provide anonymous 1:1 support. Avatar therapy is emerging. Innovate UK are investing in this space. And the pharmaceutical industry is exploring new medications.

There is a need to focus on those most in need of support: Equality of access is key to making progress on this issue. When it comes to new innovations, we risk them only becoming available to the more wealthy who have access to private routes for treatment. Public health systems can often have significant waiting times for diagnosis and treatment, which is only getting worse with increasing awareness and understanding of mental illness. Equity of access across age, gender, ethnicity, socioeconomic background, and community is vital.

Co-design is important (but): It’s important to engage people who need support with their mental health, but we need to be careful to do this in a way that doesn’t expect individuals to identify their own solutions. Many systems work better if individuals understand how they work. But most users of the system may not.

The needs of the individual should be at the centre of policy and practice change in mental health. And we should take a human rights led approach. There is a clear and important role for patient associations and involvement groups

Bad science may be undermining progress: There is some bad science in the space of mental health. In some cases Governments even reimburse and therapies which don’t have an evidence base for efficacy. Some roundtable attendees and expert stakeholders we have interviewed have highlighted a need for more stringent requirements as to who can use the job title of ‘psychologist’, for example. Clarity around the necessary qualifications and content of healthcare provider training in every country would improve the situation.

The wellbeing economy is an opportunity: Mental ill health is estimated to cost EU Member States over 4% of GDP per year. The indirect costs to the labour market are responsible for an economic cost of €240 billion annually. Addressing mental health at the population level is not only a moral imperative, it’s an economic one too.

Health and care systems aren’t working well: Mental health systems aren’t always integrated, and the care system doesn’t always work well with health services. There are different approaches to the best model for support. The accepted model of talking therapy is one-hour weekly sessions, with only limited contact outside of the sessions to arrange the next. Other patients will have very regular doctor/patient meetings. One doctor said they could see their patient every day if they wanted to. There is much to learn from where systems are working well. Importantly, job satisfaction is higher for clinicians who feel they are able to make a real difference to patients, without being constrained by the system they are working in.

Workplace mental health is important but policymakers should ensure that acute mental health isn’t deprioritised. Work is undoubtedly a source of anxiety, particularly for younger workers. However, we currently use the ability and capacity to work as an informal litmus test for how severe (or not) a person’s mental health condition might be. A more nuanced understanding of what good and poor mental health looks like across a person’s whole life would be beneficial.

There is a major mental health workforce shortage in many countries and support can’t currently be scaled. In some countries there is funding but not enough skilled staff. Many health care professionals are generalist and need specialist support. The sector needs more qualified professionals, not just volunteers and community groups; although these groups are doing some invaluable work to plug the gaps where formalised mental healthcare is not available or accessible.

At the less acute end, community-based initiatives such as social prescribing could, if used thoughtfully, free up some capacity within the system.

ILC’s Healthy Ageing and Prevention Index measures how happy people are in different countries. But we need to be careful about assuming there is a direct relationship between happiness and mental health. There are also a range of cultural and social factors behind mental health acceptance and stigma, and also can affect how individual happiness is valued. Individualistic societies like the USA and UK may prize individual happiness and satisfaction more highly than collectivistic societies do, who might instead focus on community cohesion and overall wellbeing.

We need a focus on prevention: There is a need for a revolution in mental health. We need to tackle the causes and focus on prevention. We should look more at the underlying causes and find ways to facilitate earlier screening. Socioeconomic factors such as poverty and social isolation can be crucial, and we know from our Index that the most equal societies tend to be much happier.

We need political leadership. The EU has invested political leadership and finances into cancer. There may have been a relabelling of existing initiatives but there is no doubt that there has been a significant policy focus on the prevention of cancer and some other NCDs. There is a case for a similar approach to mental health. A comprehensive European Union Strategy on mental health would be worthwhile. The EU could set a bold and radical strategy with clear objectives, measurable indicators, and decent budget and a mechanism for drawing stakeholders together. The WHO work on ageing could incorporate mental health rather than see it as a separate stream of work. A European year of mental health could drive a focus on the topic, and galvanise action on other continents. Mental health is relevant to many other areas of policy but this is not widely-understood amongst policymakers.

What happens next?

In the autumn, we want to set out a series of bold, actionable policy recommendations rooted in the evidence we have gathered over the year. We will be holding events in Japan and in New York to gather the insights of global stakeholders, test our ideas, and share our research. If you want to contribute ideas or thoughts, do get in touch with project leads Patrick Swain (patrickswain@ilcuk.org.uk) and Esther McNamara (esthermcnamara@ilcuk.org.uk).