FEAM Statement on Mental Health Policy Issues
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FEAM Statement on Mental Health Policy Issues Statement November 2010 The Federation of the European Academies of Medicine (FEAM) FEAM was founded in 1993 in Brussels with the objective of promoting cooperation between the national Academies of Medicine and of extending to the political and administrative authorities of the European Union the advisory role that the Academies exercise in their own countries on matters concerning medicine and public health. As an umbrella organisation, it brings together national Academies of thirteen European member states (Austria, Belgium, Czech Republic, France, Germany, Greece, Hungary, Italy, Portugal, the Netherlands, Romania, Spain and the United Kingdom) and aims to reflect the European diversity by seeking the involvement of additional Academies and experts in its scientific activities and by collaborating with other European-wide networks on scientific matters of common interest. Published by Psychiatrické centrum Praha - Prague Psychiatric Center 2010 ISBN: 978-80-87142-11-0 © Federation of the European Academies of Medicine FEAM Statement on Mental Health Policy Issues A FEAM Statement November 2010 Content Summary 4 1. Introduction 5 2. Health and socio-economic impact of mental ill-health in the EU: what is the size of the problem? 6 3. EU mental health policy at the crossroads 8 4. What should be covered in a broader mental health strategy? 9 5. Conclusions 18 6. References 19 Appendix: FEAM procedures and contributing individuals 21 This Statement was endorsed by the FEAM member Academies 22 Acknowledgements 23 3 Summary The high burden of mental illness has been Our recommendations focus on the needs relatively neglected in EU policy. The cur- (i) to achieve better understanding of rent practice of psychiatry is undermined the psychosocial and biological factors by insufficient biological understanding of in mental disorders, together with their mental health disorders, under-recognition, interactions; (ii) to capitalise on scientific stigmatisation, a lack of effective thera- advances so as to develop more effective peutic interventions and of access to care recognition, classification, diagnosis and delivery. therapy; and (iii) to share best practice to optimise the delivery of health services. The present report draws on discussion Achieving a more productive linkage from a Prague meeting organised in 2009 of research with clinical care requires by FEAM (Federation of European Acad- improved epidemiology, increased emies of Medicine) to review some of the investment in basic, clinical, translational critical issues in contemporary psychia- and multidisciplinary research and its try and is intended to provide advice to supporting infrastructure, and new decision-makers at the EU and national approaches to networking of centres of levels in developing a more coherent policy excellence and public-private partnership for mental health. We cover policy priorities to translate scientific advances into relating to research and public health for innovation. major contributors to the disease burden, including depression, bipolar disorder, Developing this coherent strategy for men- schizophrenia, and their co-morbidities. We tal health requires increased commitment also address cross-cutting issues for mental from the European Commission and Parlia- health policy, including stigma, suicide, ad- ment. The biomedical community also has a diction, workplace stress and the challenges major responsibility to engage with policy- of adolescence and ageing. makers and the general public to com- municate about mental health disorders, their determinants, triggers, risk factors and management. 4 1 Introduction Mental ill-health is a major public health problem for Europe, bringing challenges for patients and their families. It also creates an economic burden on society. Mental illness also brings an ethical challenge when it leads to stigmatisation and social exclusion. While the promotion of mental health has received increasing attention in the European Parliament (Brepoels, 2010) and European Commission, there is much more to be done. Both Member States and the EU must invest more in mental health services and research. FEAM convened a scientific meeting in Prague in 2009 to identify some key issues for policy makers at the EU level. 5 Health and socio-economic impact of mental ill-health in the EU: what is the size 2 of the problem? A report by DG Sanco (2004) noted the It is important to do better in understanding and historical difficulty in collecting standardised quantifying the broader impact of mental illness epidemiological statistics across all the Member on European society. There are additional public States in mental health, partly because of health burdens when mental illness presents variability in survey techniques and definition. with co-morbidities (in particular, cardiovascular Without standardised data, it is difficult to disease, diabetes and cancer). A comprehensive assess impact but, in aggregate, the cost of review of the various attributes of physical mental health problems in the EU was estimated health of patients with schizophrenia (Höschl conservatively to be 3-4% of GNP (pre-2004 2010) has provided practical recommendations data, with health care costs accounting for 2% for changes in clinical practice to manage of GDP). Depression is one of the most costly such patients. mental disorders because of the large number affected and the impact on work. European There are considerable, indirect, socio-economic estimates suggest a cost of perhaps 1% of costs of mental disorders, for example relating to GDP. Depression has also now overtaken heart lost productivity, additional social care and the disease in the EU as the major health problem impact of increased crime. There is an important in terms of disability-adjusted life years (DALY), research objective to be pursued in collecting accounting for more than 9% of all DALY in the cross-sectional and longitudinal data, to assess EU (Murray and Lopez, 1996; Spinney 2009). these impacts, evaluate causes and monitor trends in prevalence. The currently available Further information on socio-economic impact data are relatively limited and mostly obtained is available from a study by the European from outside the EU. It will also be necessary to Brain Council, which estimated the total costs give more thought as to whether mortality is a of brain disease in the EU plus EFTA countries good indicator for the burden of mental illness. in 2005 to be approximately 390 billion euros (covering health care costs, costs outside of Good longitudinal data are also particularly medical care and indirect costs, including loss of valuable in forecasting disease trends. Without work) but this comprises costs of mental health the long-term collection and analysis of data, it disorders including costs of neurodegenerative is difficult to know whether apparent increases disorders. One-third of the total burden of in prevalence are real or can be attributed to disease in Europe is caused by brain diseases better awareness and detection of disease. (Olesen and Leonardi, 2003; Olesen et al. 2008). However, whether or not the prevalence Approximately 27% of the EU population (18- of depression, for example, is increasing, 65 years) was affected by at least one mental it can be predicted that demand on health disorder in the preceding 12 months. Although services across the EU will grow because many mental disorders are widespread, the main depressed people do not currently visit their burden occurs among a smaller proportion of doctor (Alonso et al. 2004) and because of the the population suffering from severe depression, increasing prevalence of ageing populations bipolar disorder, schizophrenia or drug particularly concerned by mental health dependence. problems. 6 Investment in mental health research by the public and charitable sectors brings economic benefits. A study, supported by the UK Academy of Medical Sciences (Health Economic Research Group et al. 2008) formally compared the economic benefits (both health gains and productivity gains, direct and indirect) accruing to the UK, with the cost of research. While there are many methodological uncertainties and assumptions inherent in such a comparison, the best estimate from this initial study, allowing for time lags, of the annual rate of return on the medical research investment in mental health is 37% per year (compared with 39% for cardiovascular diseases). 7 EU mental health policy at 3 the crossroads European mental health policy is perceived to to: (a) What is already known - the evidence be at a crossroads (Höschl, 2009) in terms of base to be used to better inform policy the need to develop a strategy to tackle the development; and (b) What is not yet known, increasing disease burden at a time when there but should be – the gaps in the evidence base. is a multiplicity of different health management practices in Member States, an underinvestment As a starting point, it is relevant to note and fragmentation of research, and the need the public health priorities in mental health to think about the promotion of mental health identified by the European Commission. (Box 1). and well-being in the general population as well as provision for those with mental Box 1: European Commission designated illness. Our report focuses on the latter and priorities for mental health while much of health care delivery remains a responsibility for the individual Member • Mental health in youth and