MEP ALLIANCE FOR MENTAL HEALTH

THE EU AND MENTAL HEALTH – PRIORITIES AND POSSIBILITIES FOR ACTION

REPORT

16 October 2019 , Brussels

www.gamian.eu MEP ALLIANCE FOR MENTAL HEALTH

MEETING AGENDA 16 October 2019 European Parliament

WELCOME AND INTRODUCTION Tomas Zdechovsky MEP Maria Walsh MEP 14:00 - 14:15 Hilkka Karkkainen, GAMIAN-Europe THE EUROPEAN COMMISSION John F Ryan, European Commission, DG SANTE AND MENTAL HEALTH ACTIVITIES 14:15 - 14:30 HEARING: STAKEHOLDER Short interventions: Frédéric Destrébecq -European Brain Council PRIORITIES AND THE POTENTIAL Philip Gorwood - European Psychiatric Association FOR EU LEVEL ACTION Koen Lowet - European Federation of Psychologists 14:30 - 15:30 Associations Claudi Bockting - European Association of Clinical Psychology and Psychological Treatment Claudia Marinetti - Mental Health Europe Miia Männikö - EUFAMI Andrea Bilbow - ADHD Europe Owen Miller - Alzheimer Europe Marc Hermans – UEMS Psychiatry Section Nick Morgan – Euro Youth Mental Health Usman Khan – European Patient Forum Eef Verschaeve – OPGanG Hilkka Kärkkäinen - GAMIAN-Europe POLICYMAKER’S MEPs: Tomas Zdechovsky MEP, Maria Walsh MEP, Rory Palmer MEP, MEP, MEP, Tomislav Sokol MEP, RESPONSE Stelios Kympouropoulos MEP, MEP, Radka Maxova 14:55 - 15:15 MEP, MEP

Council of Ministers Pasi Mustonen, Permanent Representation of Finland to the EU AUDIENCE DEBATE: DEFINING THE NEXT STEPS 15:30 - 16:00

CONCLUSIONS AND CLOSE Tomas Zdechovsky MEP Maria Walsh MEP 16:00 - 16:10 Hilkka Karkkainen, GAMIAN-Europe

The MEP Alliance is coordinated by GAMIAN-Europe 2 MEP ALLIANCE FOR MENTAL HEALTH

WELCOME AND INTRODUCTION

Tomas Zdechovsky MEP opened the meeting, welcoming colleague MEPs, speakers and participants. He stated that this was the first meeting of the MEP Alliance for Mental Health – which was active as the Interest Group on Mental Health, Wellbeing and Brain Disorders in the two previous Parliaments. This group will celebrate its 10th anniversary this year and still has the same mission, i.e. to advocate the development of sound EU policies which contribute to prevention of mental ill health and ensure good services, care and empowerment for those affected by mental ill health. Tomas Zdechovsky MEP then announced that 26 MEPs have already agreed to support the Alliance and its work and that MEPs Maria Walsh, Alex Agius Saliba and Rory Palmer have come forward as co-chairs of the Alliance. He warmly thanked all supporters and co-chairs for their interest and commitment and expressed his intention to intensively work with them over the coming years. The panel of co-chairs will be expanded to include MEPs from the other political groups over the coming weeks; this is work in progress. The Alliance will be also deciding on a work programme soon and the information gathered in today’s meeting will serve as input. Tomas Zdechovsky MEP also noted the large number of participants in the room - this means that the importance of good mental health is recognised and that the sector is vibrant.

In her opening statement Hilkka Kärkkäinen (GAMIAN-Europe), thanked Tomas Zdechovsky MEP for his continued support and interest. She recalled that GAMIAN-Europe worked with Antonya Parvanova MEP in 2009 to set up the Interest group on Mental Health, Well-being and Brain Disorders. A number of other MEPs joined the Interest Group, but most of them - unfortunately - have not returned to the European Parliament for this term. GAMIAN-Europe is very thankful of their support and commitment. Over the last 10 years the Interest Group met some 35 times on a wide variety of topics and was one of the most active groups in the Parliament. For the current Parliamentary term, it was agreed to change the name of the Group to make it shorter and more dynamic –but its mission and its activities will be the same. Hilkka Kärkkäinen expressed her appreciation for the fact that 26 MEPs have already enlisted as active supporters, with 11 present in the room today. GAMIAN-Europe will continue to coordinate the MEP Alliance, but views it as a platform for all those that want to strengthen the mental health sector and who want to cooperate to amplify its voice. Today’s meeting is a very clear example of this openness, as the ‘hearing’ format provides mental health stakeholders with a platform for speaking their mind, to share ideas and where possible, to align activities and come forward with their views and ideas for action at EU and national levels.

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THE EUROPEAN COMMISSION AND MENTAL HEALTH ACTIVITIES

Tomas Zdechovsky MEP then gave the floor to John Ryan (European Commission, DG Santé), who underlined that mental health is critical to individual wellbeing, as well as to social and economic participation. According to recent estimates, more than one in six people across EU countries had a mental health issue in 2016. The total costs of mental ill- health are estimated at more than 4% of GDP – or over EUR 600 billion – across the 28 EU countries. The heavy individual, economic and social burdens of mental illness are not inevitable. Many European countries have in place policies and programmes to address mental illness at different ages. However, much more can be done to manage and promote mental health. The European Commission has been quite active on mental health. Since the adoption of the 2005 Green Paper 'Improving the Mental Health of the Population', a number of important initiatives have been carried out, such as the 2008 'European Pact for Mental Health and Wellbeing' and the 2013 EU-funded Joint Action on 'Mental Health and Wellbeing'. These actions have paved the way to build solid networks of experts, civil society, and policy makers who contributed to the development of the 'European Framework for Action on Mental Health and Wellbeing', agreed in 2016. To implement the 'Framework’ the Commission created the EU Compass for Mental Health, a cross-cutting' data base of policies and good practices, which has collected examples of good practices. The Commission continues to support Member States in this task through the Steering Group on Promotion and Prevention and Management of non-Communicable Diseases, which has set mental health as a priority for the identification of best practices and implementable research for 2019.

The best practices presented during the marketplace, which are now available on the webpage of the Steering Group, have address depression, suicide prevention, mental health care delivery systems, stigma, mental health and well-being at work, community treatment, and mental health in children. EU countries will indicate before the end of October which of these practices are interested in implementing or scaling-up, and the Commission then will identify the best ways to support the implementation of these policies, using all available instruments at the Commission's disposal. In this way the activities of the Steering Group will facilitate the implementation of evidence-based best practices by EU countries, in order to ensure that the most up-to-date findings and knowledge are being put into practice according to the needs and priorities expressed by the Member States. 4 MEP ALLIANCE FOR MENTAL HEALTH

The Steering Group's work will be supported by online resources on health promotion and the prevention of non-communicable diseases. A special challenge concerns the mental health and well-being in children and adolescents as 50% of mental health disorders begin at a young age and during adolescence. It also needs to be recognised that mental health and well-being are cross-cutting issues that are dealt with by other sectors – including education, culture, transport, and communication technologies. The latter presents opportunities for children, but also risks to their wellbeing, development and mental health.

The Commission is also committed to addressing dementia and Alzheimer’s disease and activities in this area will follow the same process under the Steering Group on Promotion and Prevention of non-communicable diseases.

Tomas Zdechovsky MEP thanked John Ryan and invited him to stay in touch over the coming 5 years; the MEP Alliance for Mental health will be actively pushing for EU-level action and a greater commitment on mental health.

Maria Walsh MEP took over the chair and asked John Ryan for the best way to convince the Commission to put in place a European Year of Good Mental Health.

John Ryan stated that several European Years have already addressed health themes; in addition, the Commission organises awareness weeks with respect to health issues (e.g. AMR Awareness Week, planned for November). This is being organised in cooperation with the WHO. Moreover, the WHO has agreed mental health action plans that will come to an end in 2020; it could be interesting to work with this body on an awareness activity, as mental health is not only a European challenge. Responding to other questions, John Ryan agreed that risk assessment of the impact of technology would be a useful exercise. Participants were also invited to comment on the multi-annual strategic workplan for Horizon Europe, which is currently under consultation. Some 6000 responses have been received so far. He also advised participants to join the Health Policy Platform, which is the place where stakeholders meet and plan cooperation on certain cross-cutting issues and bring together ideas, which can then be taken forward in discussions with the Commission.

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HEARING: STAKEHOLDER PRIORITIES AND ANDTHE POTENTIAL FOR EU LEVEL ACTION

Fred Destrébecq – European Brain Council Mission: promote brain research with the ultimate goal of improving the lives of the estimated 179 million Europeans living with brain conditions, mental and neurological alike. EBC’s first priority is to make brain research – both in terms of neurology as well as in terms of mental health - a priority for the EU research agenda. Horizon Europe in its last phase of negotiation. EBC has advocated for a larger budget in general as well as for the specific health research cluster; EBC also advocated on the inclusion of a mission on the brain and a specific partnership on brain health. This would also be an opportunity for the EU to reinstate its leadership in the field of brain health. A second priority is the encouragement of prevention and promotion strategies in the field of mental health. EBC’s Value of Treatment study, which includes specific strands on autism and depression has clearly shown that strategies of early detection and timely intervention have positive patient outcomes and positive economic benefits. EBC would like to have these recommendations recognised at EU-level.

Philip Gorwood - European Psychiatric Association Mission: representing psychiatry in Europe, addressing the interests of psychiatry in academia, research and practice throughout all stages of career development. It focuses on the improvement of psychiatric care for mental disorders as well as on the development of professional excellence. In 2023 depression will be the greatest challenge (in terms of DALYs): other important psychiatric disorders - bipolar disorder, psychosis (schizophrenia), anxiety, eating disorders, substance misuse disorders, child psychiatry – will also be highly prevalent. The main priority for the EPA is to help facilitate a single voice for European mental health care, bringing together all relevant stakeholders, including different medical specialties, different organisations as well as patients and family members. Related to this, EPA is advocating for the creation of national quality label of care for mental health would be a clear added-value. MEPs could help to transform this into an official European label. Second, a mapping of the state of mental health care across the EU would be useful; we cannot address care gaps if the current situation is unclear. Third, it would be good to develop and (e-training) platform for health care professionals, as that would offer a cost-effective opportunity to reach and engage organisations with specific skill sets. 6 MEP ALLIANCE FOR MENTAL HEALTH

Koen Lowet - European Federation of Psychologists Associations. Mission: EFPA is about information: we inform the general public, policy makers and stakeholders about psychology. It is also about collaboration, stimulating its member associations to meet and exchange knowledge and expertise. EFPA is also about quality, agreeing training standards for practicing psychology. EFPA’s first priority is prevention, promotion and early intervention. Early, appropriate and high-quality support and care will facilitate treatment and lead to better treatment outcomes. Its second priority relates to creating better access to psychological services. Throughout Europe people affected by mental ill-health have difficulty to obtain psychological services. It is much easier to receive pharmaceutical treatment or to be admitted to psychiatric hospitals. However, psychological treatments have shown to be equally effective as any medical treatment, without the negative side effects. Health economists have made a strong case to invest heavily in psychological services performed by a well-trained and supervised workforce as the return on investment will be high – which is important, given current strained health budgets. The EU level can help facilitate collaboration and exchange of knowledge and expertise in the area of mental health.

Claudi Bockting – European Association of Clinical Psychology and Psychological Treatment Mission: promotion and development within Europe of empirical and theoretical research in and applications of clinical psychology and psychological treatment, and the interchange of information relating to this subject between the EACLIPT and similar associations throughout the world towards an international achievement of these objects and purposes. EACLIPT’s two main priorities relate to a. the need for European dissemination of evidence based, effective and cost-effective psychological interventions and b. the need to invest in research on treatment in those individuals that do not or only partially respond to treatment or experience relapse. As for the first, current research is showing that a wide range of interventions exists and that many of these treatments are effective as well as self- empowering. There is also increasing knowledge about the sustainable effects of psychological interventions; they can contribute to good mental health and well-being years after treatment. This is also important in the context of sustainable health systems. Increasing use of technology will also be important in that respect; but a certain level of well-being is required to actively make use of it. A focus on interventions for those individuals that do not or only partially respond to treatment is important, as these individuals should not be left by the wayside. EU-funded research can make a contribution in this area. 7 MEP ALLIANCE FOR MENTAL HEALTH

Claudia Marinetti – Mental Health Europe (MHE) Mission: to advocate for positive mental health and wellbeing and for the rights of people living with mental ill health, and raising awareness to end mental health stigma and discrimination. Key for mental health is a psychosocial model that goes well beyond an outdated biomedical approach. Instead of defining mental ill-health as a ‘disease’ caused by purely biological factors, we should look at a person’s life and social environment, treating these factors as equally important in understanding well-being and mental ill health and recognising people who have experienced mental distress as experts in their own lives. MHE also works to ensure the best possible transparency in the interactions between the pharmaceutical and related industries and the mental health sector, including HCPs, HCOs, and patient organisations. The first main priorities for the future of mental health is the need to strengthen a paradigm shift towards a human right based psychosocial approach to mental health and disability. The second would be the need for increased transparency in the mental health sector to ensure the best possible care and recovery options. In order to address these priorities, MHE feels that there is an urgent need for a European Mental Health Strategy and will work with our Coalition for Mental Health and Well-being, which will operate in parallel to the MEP Alliance for Mental Health, coordinated by GAMIAN-Europe. MHE is open to have constructive discussions with stakeholders and hopes that stakeholders can all join forces to work towards a fair, transparent, mentally friendly Miia Männikkö - EUFAMI Europe. Mission: to represent all family members of persons affected by severe mental ill health at European level so that their rights and interests are recognised and protected. EUFAMI is ”the voice” at European level of family members of people affected by severe mental illness. The upcoming Finnish Presidency Conclusions invite the Commission to come forward with an EU Mental Health Strategy. International organisations such as the WHO and OECD increasingly focus on mental health and wellbeing; the time is right for the EU level to the same. Therefore, the main priority for EUFAMI is to ensure the adoption of this EU-level Mental Health Strategy, which would also take account of the support needs of family carers. In addition, it should facilitate the exchange the good practices that exist to support families and family carers and monitor the health and well- being of carers. Only then can a Mental Health Strategy fulfil its aim, i.e. to contribute to more social cohesion, well-being and economic growth in the EU. A second priority relates to gender equality and work/life balance. The carers leave and flexible working conditions, as stipulated in the Work/life balance Directive are a good start as this underlines the recognition of the specific needs of carers. However, there should be a specific programme which would focus on concrete support services for family carers, e.g. respite, work/life balance tools and financial support. As 75% of carers is female, of which 54 % reduces work time in order to care, this is clearly a gender issue which needs attention. 8 MEP ALLIANCE FOR MENTAL HEALTH

Andrea Bilbow – ADHD Europe Mission: to advance the rights of, and advocate on every level throughout Europe for people affected by AD/HD and co-existing conditions in order for them to reach their full potential. ADHD has a strong genetic and neurobiological basis and has a huge impact on mental health. It could be considered as one of today’s biggest mental health crises: 5% of children and 3% of adults across Europe have ADHD - many of whom are still not diagnosed or treated. Untreated/poorly managed ADHD can have serious consequences (e.g. traffic accidents, criminal behaviour and drug abuse). Research confirms causal links with other major health issues such as obesity, depression and other serious psychiatric disorders and also suicide. Effective treatments do exist; these can prevent more severe problems and enhance educational and occupational outcomes. ADHD-Europe’s first pressing issue is the lack of knowledge on ADHD among professionals, policy makers, media and other public services. There needs to be obligatory education and training on ADHD for mental health professionals and GPs in all EU countries, with clear guidelines and quality standards. People should not need to seek treatment for mental health care in other countries. The second issue is lack of equal access to early diagnosis, and proper treatment for children and adults with ADHD. The main current issues relate to awareness and provision of sufficient medical and psychosocial treatments and support. ADHD-Europe would like to see the development of ADHD (lifespan) clinics throughout Europe, with uniform rules on the use of medication. Minimum quality standards must be set and properly resourced so that patients received the same exacting standards of diagnosis and treatment, wherever they live.

Owen Miller – Alzheimer-Europe Mission: to ensure that the voice of people with dementia is heard at a European level, ensure a rights-based approach is taken in relation to dementia policy, ensure dementia is prioritised at in European dementia policy, as well as meaningfully contributing to both policy development and research in relation to dementia. Alzheimer Europe’s first point relates to patient organisations , which play a unique and vital role in the policy development process at an EU level. These organisations add value to policy making, contribute to research and act as a two-way conduit sharing information, knowledge and experience between national and European levels. Patient organisations need support to do this, including funding through the Health Programme of the EU – this must continue with the health component of ESF+. A second point relates to the need for more research into dementia. Over 9 million people over 65 have dementia, with no cure and no disease modifying treatment available. Some pharmaceutical companies have stopped research into the condition. The societal cost of dementia is high; yet, like mental health, it is significantly underfunded in terms of research budgets. The Horizon Europe programme is uniquely placed to address the condition, using its resources, networks and expertise to support and prioritise research into dementia.

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Marc Hermans – Union Européenne des Médécins Spécialistes – Section of Psychiatry Mission: not for profit umbrella organisation representing all medical specialists in Europe, to increase safety and quality of care for patients through promoting the quality of postgraduate training, continuous medical education (CME) and continuous professional development (CPD), and of specialist practice in Europe. A first priority is quality of training as described in the European Training Requirements (ETRs), developed for each medical specialty. This document addresses requirements for trainees, trainers, training environments and their quality assessment. Through its European Accreditation Council for CME (EACCME), UEMS can accredit scientific events, in Europe, the USA and Canada. The second priority is quality assessment of qualified doctors in Europe. Many of the UEMS’ Sections have developed EU-wide examinations through their European Boards. Within the Section of Psychiatry, the preferred term is ‘Standing Committee for Training’ since such an examination does not yet exist. For the purpose of quality improvement of assessments and the possible implementation of an EU wide examination, the Section has sought collaboration with the European Psychiatric Association (EPA) and the European Federation of Psychiatric Trainees (EFPT). A Task Force on Education in European Psychiatry is working on this, an international survey is currently ongoing. Both priorities need the involvement of other stakeholders, such as GAMIAN-Europe and EUFAMI as well as other professionals from the field of mental health.

Eef Verschaeve - OPGanG (B) Mission: OPGanG represents the common interests of its members, who work together in solidarity, exchange knowledge and join forces for better mental health care. According to OPGanG, patients in mental health • have more knowledge (than often considered) • have more capacities (than often expected) • can recover and deliver a valuable contribution to society • can actively be part of the health care system • add a significant value by participation in the health care system One of the organisation’s missions is to increase the interest and commitment of politicians for deployment of experts by experience in Belgium and all other member states of the EU. Expertise by experience in Mental Health care has proven to be a strong support to the recovery of persons with mental health illness. It is important that experts by experience are recognised as a fully- fledged professional group in the mental health care and become a recognised part of the standard staff in health care. National legislation should be adopted to better facilitate the implementation of experienced experts as volunteer worker as well as an official and paid job. Uniform recruitment and remuneration system for paid experienced experts should become the norm, taking into account their health situation. In a few other EU countries (e.g. The Netherlands) ‘good practices’ of involvement of experienced experts exist. 10 MEP ALLIANCE FOR MENTAL HEALTH

Nick Morgan – Euro Youth Mental Health Mission: create a Europe that enables young people to access support and talk openly about their mental health and well-being. By encouraging collaboration across services, sharing of best-practice and ensuring that young people are empowered to have a voice in all matters that affect them around the promotion of mental health and preventing the impact of mental illness. There are many pressing issues in relation to youth mental health, such as how health budgets are split between physical and mental health, suicide prevention and education, youth unemployment and de- institutionalisation; selecting only 2 is not easy. But one of the most important issues relates to the need to ensure that young service users are at the heart of decision making at all levels, i.e. treatment, services, care and policy. Young people should have non-coercive freedom of choice on the care and services they receive, to work with social media to educate peers and health care professionals on the importance of mental health. The second issue is related to the need to train all non- medicinal professionals who work with young people; they should recognise that mental ill health is currently classified as a disability; appropriate support should be on offer where and when required. The EU could earmark more budget for mental health. But the Commission could also look for ways to support innovation and share ideas and good practice in the support and engagement of young people, for instance by means of cross-European service user forums; ideas and discussion from these forums could then be taken back to the respective countries. As resources are scarce, we need to put these to the best possible use and encourage mutual sharing and learning.

Usman Khan – European Patients’ Forum Mission: to be the collective influential patient voice in European health and related policies and a driving force to advance patient empowerment and equitable patient access to care in Europe. Within EPF, both mental as well as physical health are represented and it is recognised that mental health should have equal parity with physical health; a significant proportion of patients with long term physical conditions are also dealing with a mental health condition. Equally, close to half of all patients with a mental health condition also have a long-term physical condition. According to EPF, the EU institutions can best support the patient perspective and voice in the following ways:

1.Support mental health patient advocacy education and training 2.Support mental health patient advocacy organisations 3.Provide opportunities for patient organisations to be meaningfully involved in mental health policy making 4.Continue to support investment in patient centred mental health research 5.Promote and support improved mental health literacy 11 MEP ALLIANCE FOR MENTAL HEALTH

Roger Broadbent- Dyslexia Society (UK) Mission: community interest company that delivers dyslexia training packages to businesses and community organizations; aims to break down the stigma of dyslexia and implement systematic change. The latest NHS report on the impact of learning difficulties, dyslexia, ADHD etc. leads to significantly higher mortality rates and poorer health than the population without these conditions. As 20% of the population is affected by dyslexia related conditions (dyspraxia, dysgraphia, dyscalculia, dyscopia), this is a serious issue. Funding to recognise and support these conditions is tiny in comparison to the real need. Poor mental health can be a result of these conditions, i.e. high suicide rates, anxiety, depression, low self-esteem etc. This is reflected in a recent report of the German Society of Child and Adolescent Psychiatry, stating that 60% of dyslexic pupils had poor mental health (cited in the European Dyslexia Charter); only 1% of dyslexics across Europe have been diagnosed. The only realistic way to address this is for the National Health Services in all EU states to provide free testing and psychological support for the individuals affected. Proposals within the European Dyslexia Charter to ensure individuals are properly supported in education and their workplace should be adopted across the board.

Hilkka Kärkkäinen – GAMIAN-Europe Mission: non-profit patient-driven pan-European organisation, representing the interests of persons affected by mental illness and advocating for their rights. GAMIAN-Europe is currently working on many different themes with a number of other organisations, such as depression. In cooperation with 8 other leading mental health organisations we have developed a policy paper, called ‘Words to Actions’, outlining actions that should be taken in a number of different areas. The main policy message here is for policy-makers to act boldly, ensuring adequate resources for the prevention, management and care of depression and seeking more effective ways of allocating them. One concrete step forward it would be for the EU level to put in place a European Action Programme on Mental Health, which would also stimulate the development of national action programmes. Such Action Programmes are already ongoing in other areas (such as cancer and rare disorders); it would make great sense to do so in the area of mental health as well, in view of the prevalence and impact of mental ill health. There are limits to what the EU level can do in legal terms. But it can help disseminate good practice, pay attention to the impact of all its policies on mental health. It can mainstream mental health into health and social policy development. It can provide financial support to relevant initiatives. It can support data collection and research. An action Programme could address many of the priority topics and issues mentioned here today as well as stimulate cooperation between the EU and national levels and between relevant stakeholders. Any strategy or policy addressing mental health should be developed as a joint effort by all key stakeholders from societal and policy sectors concerned. Involving patients and other representative organisations in the development of policies and initiatives is key to ensure their relevance. 12 MEP ALLIANCE FOR MENTAL HEALTH

POLICYMAKER’S RESPONSE

Maria Walsh MEP invited MEPs present to indicate why they are supporting the MEP Alliance on Mental Health, what they think should happen in the area of mental health at EU level and how that could be achieved.

Alliance co-chair Rory Palmer MEP stated that, despite the fact that there are many people who passionately care about mental health and truly want to bring about change, progress has been slow. He therefore urged participants and colleagues to be as strategic as possible, and approach the Commission and Council with the clearest set of asks and demands possible. The next Health Commissioner, Stella Kyriakides, is a clinical psychologist by training; we should not waste the opportunity of having a Commissioner who understands the issues and knows what is required; we will be pushing an open door. He also underlined the importance of the voice of patients; this can never be overestimated and involving and engaging with patients is just as important as doing so with other health stakeholders. As a final point, Mr Palmer MEP stated that the European Parliament, as a place of work, is doing pitifully and embarrassingly little to take account of the stigma and discrimination which are often related to mental health. The training and awareness raising of mental health related issues amongst politicians and support staff should be improved. It will be impossible for the Parliament to take action on mental health as long as it does not have its own house in order. Alliance co-chair Alex Agius Saliba MEP welcomed today’s opportunity to meet with stakeholders in order to push forward the EU mental health agenda. He underlined the importance of joining forces to support actions that will lead to progress. His interest in mental health is the clear need to improve the quality of life and mental health of those affected, their families and loved ones as well as society as a whole. Mental ill health on the rise in a majority of countries; however, it is not yet considered a priority area across the board. This lack of recognition is counterproductive as there can be ‘no health without mental health’. As an example, he noted that suicide is the second leading cause of death among young people. Mental health ill amongst young people can have devastating effects and all the tools we have at our disposal should be put to use to support our young people who are struggling with mental ill health. This needs to be addressed as a matter of urgency. Policy and practical solutions will need to be identified in order to ensure that mental health problems are better managed identified and treated: a holistic approach across all relevant areas across society is required. Employment is such a field: the workplace can cause stress and damage mental health. This is why Mr Agius Saliba MEP has proposed a recommendation on ‘the right to disconnect’, which would be a major step forwards in restoring the balance between work and family life. Also, we need exchange of good practice between member states to effectuate better management of depression and define concrete ways of addressing mental health at national level. Stakeholders like those present today must be seen as an integral part in consultations and the policy development process in order to better understand the needs faced by patients. Policy attention for this topic is increasing, but is insufficient. Meetings like today, where stakeholders share priorities and potential solutions is a positive response. 13 MEP ALLIANCE FOR MENTAL HEALTH

As a psychiatrist, Stelios Kympouropoulos MEP is very much concerned by the topic; therefore, committing to and engaging with the MEP Alliance for Mental Health is a natural fit. He underlined the great need for more awareness across society of the prevalence and impact of the many dimensions of mental ill health as well as of the various conditions. Similarly, people affected by mental ill health and their loved ones need more support; both in terms of services as well as in terms of social support, in order to avoid that they get isolated. He expressed his strong support for the MEP Alliance for Mental Health and assured the audience that he would do his very best to support concrete and positive action at EU and national levels.

Professor Tomislav Sokol MEP emphasised the need to put mental health higher on EU and national policy agendas. There are positive signs that health in general is getting more policy attention (e.g. cancer) so that may be a hopeful sign. Mr Sokol MEP has a background in health law and therefore, public health is close to his heart. Events like this, bringing so many stakeholders together, are very useful as they can create platforms to influence and strengthen EU level initiatives as well as the EU itself. MEPs, working with stakeholders can bring the topic of mental health much higher on the ‘Brussels bubble’s’ policy agenda – Parliament, Commission and Council. The area of cancer is a good example of how this would be possible for mental health as well. Mental ill health is an increasing problem; we need to work to raise awareness of its impact and bring it closer to European citizens. In order to do so, we need to make use of the existing EU-level tools to address this issue, such as the Cross-border Healthcare Directive and the proposal for a Directive on Health Technology Assessment. It is important to realise that concrete instruments do exist beyond the exchange of best practice, such the European Semester and its country specific recommendations. These can truly effectuate changes in health policies and force Member States to take action.

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Radka Maxova MEP is all too aware of the difficulties and challenges faced by people who are affected by mental ill health. This is a topic which has been important for her for a long time; she provided examples of her earlier involvement and commitment, e.g. a conference organised in the Czech Parliament on stigma in mental health care. This event aimed to put mental health on the national policy agenda and to improve psychiatric care and organised with financial support from the EU. One of the general mental health aims should be to enable people affected by mental ill health to live at home, in their own environment, with supervision. Early diagnose and appropriate formal care should be available to all who need it. Population ageing is another big issue, not only because of the increasing prevalence of mental health issues amongst older people, but also because of the challenges to meet increasing care needs. As a first time MEP, Mrs. Radkova stated her intention to be an active supporter of the Alliance and to work with all those involved to make a change.

As a medical doctor, Juozas Olekas MEP has a great deal of experience in health care; and from his experience, he is aware that it is impossible for stakeholder to reach their goals individually. Cooperation and ‘silo-breaking’ is urgently required. The voice of patients is indispensable in this respect. Now is a good time to launch an initiative like the MEP Alliance for Mental Health; there are many new MEPs and this is the start of a new term, when much support can still be found. Working together at national and international level, making strategic use of existing tools, can indeed make a difference. As important topics Mr. Olekas MEP referred to the need to address stigmatisation and the possibilities of new technologies to support families in their caring role – as well as for their potential to create new jobs. These topics should be discussed and further explored and Mr. Olekas MEP voiced his strong commitment to making progress in this area.

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Josianne Cutajar MEP underlined her belief in the importance of addressing mental health in all its aspects and the need to for collective action to ensure progress. The European Parliament has already demonstrated its interest in and recognition of the importance of good mental health by means of specific initiatives, such as the Work/life balance directive, which clearly recognises the importance of well- being. One of Mrs Cutajar’s main interests relates to technological innovation, which provides possibilities for greater flexibility at work. However, it would be interesting to analyse these new technologies for their impact on (the mental health of) workers. New technologies, e.g. robotics, can lead to redundancies; workers will need reskilling. We need to think of this impact in advance as it can put pressure on individuals and therefore, impact on mental health. This is an important topic for the short term.

Brando Benifei MEP underlined his interest in and involvement with mental health issues, e.g. as former chair of the European Parliament’s Disability Interest Group. He welcomed the involvement of so many stakeholders as this is crucial to fully understand the issues at stake. MEPs have been and will be an ally in taking a bottom-up approach, as this is the only way that real needs and gaps can be addressed. Listening to stakeholders – patients, carers, health care professionals - will be a precondition to make meaningful change. It is important to stress that mental health is as important as physical health; there should be parity of esteem. Mental health is under threat – and there are new challenges too, such as the increase in work-related stress, cyberbullying; these need to be analysed and taken into account, also for their impact on future health systems. As one in four persons is affected by mental ill-health during the life course, this topic is needs to be taken seriously. This is an issue where a real EU programme action programme, involving all EU institutions, should be considered. This should be discussed in the framework of the Multi-annual Financial Framework. The EU can support research and project but we need a broader programme on mental health that can support action at member state level as well.

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Co-chair Maria Walsh MEP underlined her strong commitment to engage with and support citizens. Politics and policies have to change; without involvement of the communities and the people concerned, nothing will change. Mental health is part of the foundations for all policies, both at EU as well as at national level. The stigma attached to this topic makes it even more important to take effective action. It is heart-breaking to note how many people on the ground do not feel appropriately supported – if they have access to support at all. Often, the focus is on those people that are most at risk; those less at risk are forgotten. But all people should be enabled to make use of their full capacity. One of Mrs. Walsh MEPs main interests is mental health in young people; mental health in older people – e.g. retired people that all of a sudden lose the structure in their lives provided by work and do not quite know how to take the next step – is another key issue. Health literacy, appropriate interventions, training and awareness – all of these are important. But maybe the most important is that we should listen to those concerned more and be guided by dialogue. A European Year for Good Mental Health would be a useful and concrete initiative, and this is one of the aims the MEP Alliance for Mental Health can set for itself. In terms of mental health, we should not just focus on people who display symptoms of mental health but have an overall focus on well-being in daily life, in a preventative way.

Co-chair Tomas Zdechovsky MEP reiterated his support for the MEP Alliance for Mental Health, as mental health is one of his priority policy interests, also from a personal point of view. He reminded the audience of a Written Declaration he launched in the European Parliament in 2016, addressing the mental health of migrants. While this unfortunately did not get the number of signatures required, it did help to raise awareness of this topic in the Parliament and beyond. According to Tomas Zdechovsky MEP, one of the reasons for this lack of attention to mental health issues is the stigma attached to mental ill health. If this stigma could be addressed effectively and lessened, mental health would get the attention it deserves. Unfortunately, this situation is still a long way off as even at EU level the interest in mental health issues is decreasing. This will lead to a decrease in the visibility of mental health and the need to address it where the opposite is needed; the EU level should take more action, rather than less. Mental health is about access to mental healthcare and services, about continuity of care and about avoiding that young people get left behind. It is about equal opportunities and about ensuring that individuals have the best opportunities to fulfill their capacities and lead the lives they want to live. 17 MEP ALLIANCE FOR MENTAL HEALTH

Maria Walsh MEP then gave the floor to Pasi Mustonen (Health Counsellor, Permanent Representation of Finland to the EU), who emphasised that, for Finland’s EU Presidency, mental health is a top priority. The Presidency is advocating a new, horizontal policy approach, the Economy of Wellbeing. This highlights the relation and interaction between wellbeing and economic growth. The primary claim is that while people's wellbeing is a value in itself, it is also vital for ensuring sustainable long-term economic growth and societal stability. Investing in both physical and mental health should be seen as an investment, not a cost. The Economy of Wellbeing builds on the European Pillar of Social Rights and supports the implementation of the Sustainable Development Goals. Like in the case of SDGs, the Economy of Wellbeing requires better cross-sectoral understanding and co-operation to be successfully implemented. The EU needs to get out of its sectoral silos. In the Presidency’s view, the EU simply cannot reach sustainable economic development without untapping the potential of more horizontal and cross-sectoral policy development. Mental health is viewed as an integral part of the Economy of Wellbeing as it is rapidly becoming one of the defining health challenges of our time. Even when looking at the health sector alone, mental health problems are the biggest cause of disease burden in high income countries – not only in terms of health costs, but also for many other sectors. At the same time, we are living at a time of major transformations in work life. As a consequence of these changes, human capital is becoming more and more important factor in the labour market. Good mental health is the foundation of human capital. Strong mental health is the capital we will build on in the future. Despite the above, mental health has been somewhat neglected at EU level. The Finnish Government strongly believes that we should invest more in mental health skills, promotion of mental health as well as prevention and good care of mental health problems. In order to intensify the EU’s action in this field, we are convinced that a broad European Mental Health Strategy should be developed. The Council Conclusions on the Economy of Wellbeing, to be adopted at EPSCO Council meeting on 24 October, will invite the Commission to propose such a Strategy, which should be comprehensive and – in the spirit of Health in All Policies approach launched during the previous Finnish EU Presidency in 2006 – it should cover all relevant sectors beyond health: social, employment, finance, education, etc. The aim of the EU mental health strategy should be to facilitate the shift from fragmented actions to cross-sectoral long-term policies and actions that are based on research findings and impact assessments. Needless to say, the messages from Health Commissioner-designate Ms Kyriakides regarding her willingness to do her utmost to put mental health back high on the EU agenda are very welcome. Pasi Mustonen finished by underlining that by promoting good mental health, the impact will be big – in terms of human impact as well as in terms of labour market, economic growth and development. The EU should do much more in this field. We should put people at the centre of policy- and decision-making. Finland is committed to take part and contribute to this action. 18 MEP ALLIANCE FOR MENTAL HEALTH

AUDIENCE DEBATE

In the audience debate the following issues were raised:

• This meeting has brought together all main stakeholders and many ideas have been floated and put forward, and new connections made. The number of participants and MEPs has never been so high. There is a lot of enthusiasm in the room. But it should not stop here. We should use the momentum of this meeting to make progress, to keep working together. One suggestion would be to draft a joint statement on where we want to go with mental health and share this with policymakers at the highest level. • MEPs were asked to reflect on how stakeholders can help the MEPs help the stakeholders. • Questions were raised about how to engage those stakeholders and people concerned that do not live in Brussels; how to engage people outside the ‘Brussels bubble’? • A broader look should be taken beyond mental ill health per se; there are many other factors that are important for patients besides treatment. As mental health is relevant in many different areas, how can we bring a mental health dimension in other areas of policy development and services provision? • A mental health strategy for the EU is urgently required. Our focus should be on advocate to secure this strategy and ensure that the EU will take up this up in the next years. This meeting has helped to bring together the associations, which should pool resources to get this done. • It was remarked that the people affected by mental health issues have problems getting their voices heard. Even in this positive meeting, the number of patients in the room is limited; patient organisations are usually underfunded and therefore, underrepresented. They heavily depend on volunteers; this lack of resources is unsustainable; ways and means need to be found to structurally involve and engage with patients. • There is no specific action on mental health – the focus is on communicable diseases. At this point in time there is no dedicated EU official in charge of mental health, this should change at the very least. • Better education on mental health is also required. This education should include patient and carer experience, and should not only target health care professionals; policy makers should also be educated. This education should be publicly funded. • MEPs supporting the MEP Alliance for Mental health should make sure to push forward to mental health agenda in their respective Committees. They will be open to tabling amendments and consider Own Initiative reports and Written Questions to the Commission. 19 MEP ALLIANCE FOR MENTAL HEALTH

CONCLUSIONS

In conclusion, Maria Walsh MEP underlined the large number of organisations that had come forward to share their views on what they would like to see happen and how the EU level can help. This means that the potential for strong and coordinated advocacy exists and needs to be capitalised upon. A wide range of topics and themes has come to the fore, as well as a number of ways to make these become a reality. While the priorities may of course be different for the various stakeholders, common ground can be defined, i.e. the will and urgency to ensure appropriate policy attention for mental health, in order to change and improve the lives of those affected by mental ill health as well as their families and carers. Obviously, governments will need to allocate sufficient and adequate resources in this area. More support and tools are needed for an EU-level platform to share good practices among member states, for an increase of participation from experts-by experience in EU research projects for mental health in the Horizon Europe programme and more focus on mental health in the EU Health Programme. It was very positive to hear that the Finnish Presidency is inviting the Commission to come forward with a dedicated and comprehensive mental health strategy. This clearly is a useful ‘hook’ for joint advocacy as well as a great opportunity to effectuate progress. The MEP Alliance will take careful note of what has been shared here today and try to develop a common and strong agenda for action. Those that have not had the opportunity to speak were invited to send their priorities to GAMIAN-Europe – the coordinators of this meeting - so that they can be taken up in the event report. This will be prepared and shared in the coming weeks. Last but not least, Maria Walsh MEP stated the intention to continue to build the Alliance internally and create a strong, vocal and representative support base in the European Parliament. this first meeting is a step in the right direction.

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