The proposed areas of action and health priorities(2)including pandemic preparedness and transformation of accessibility of healthcare systems are undeniably essential. Mental well-being of the citizens of Europe however must not be forgotten. As the World Health Organisation Regional Office for Europe has made clear (3), mental health problems account for 19.5% of the burden of disease in the European Region, and 26% in European Union (EU) countries. About 50% of major depressions are untreated. The cost of mood disorders and anxiety in the EU is about €170 billion per year. Yet the immense economic loss is only one of the consequences.
Mental health problems also impair the lives of a large number of people who are directly and indirectly affected. This creates real challenges for families, friends, at work and in the community where they live.
Mental health is therefore a concern for all European citizens.
In the wake of the pandemic, the need for help for people with mental illness is growing. Fear of COVID-19 illness, stress related from the long – term restrictions imposed on everyone, trauma from the illness itself, and the long-term effects of COVID-19 endanger mental health (4).
This is a public mental health challenge that needs to be met by a combination of further research and public health monitoring to determine (likely differing) specific country needs and evidence based strategies to meet the need, and comprehensive mental healthcare including mental well-being promotion.
As the work programme under EU4Health is developed, EFPA calls for:
Recognition of the need to fund programmes improving the mental health needs of the citizens especially but not solely to respond to the long term implications of Covid-19.
Research is needed but the needs are likely to be greater among the young and people of working age.
A focus on prevention in “building a fairer, healthier world” (5) which is in line with the 10th UN Sustainable Development goal of reducing inequalities (6). Tackling these societal challenges requires a focus on the impact of socialand behavioural determinants of health.(7)Such determinants as lack of healthcare access, risky behaviour and poor working conditions are factors identified across Europe as having a clear impact on physical and mental health. (8)
A shift in the education and training of professionals.
To reduce health inequalities it is important to consider the conditions that contribute to people’s ill health.(9). Health professionals can make a significant difference in advancing health equity. Practitioner education should include the competency in recognising and mitigating social determinants of health (10). This should be extended to the training of psychologists and other mental health and social care professionals. Addressing social determinants of health including inclusion requires great understanding and the skills to deal with these issues appropriately and to support people in their particular circumstances.
A public health approach to mental health service provision.
Given the large number of people suffering mental health problems, the impact of the pandemic on mental health in terms of extra need and disrupted services (11) , and the general underdevelopment of European mental health compared with physical health systems, a public health approach is necessary. The WHO service organisation pyramid for an optimal mix of services (12) for mental health with self-care then informal community care at the base and then progression through tiered services depending on severity of need, is both well-known and well suited to fulfil this purpose. Now is the time for European countries to invest substantially in the development of mental health services, and provide special attention to strategies in developing self-care and informal community care. People need qualified care and help that is low-threshold, close to home and available at all times. They need social support, appreciation and help in their immediate living, home and work environments. These aspects are the least developed but are most promising in reinforcing social cohesion in European society coming out of this dark period of the pandemic.
Tackling stigma related to mental health problems and taking a socially inclusive approach during a European Year for Mental Health.
Together with the MEP Alliance for Mental Health (13)and Global Alliance of mental Illness Advocacy Networks Europe (GAMIAN), EFPA is advocating for a European Year for Mental Health (14) to focus public attention on the special life situation of people with mental health needs. Such a year would provide a focus for a contribution by all of us, lay people and professionals, to take more responsibility in the future to foster social inclusion especially after the pandemic.
(7) Donkin, A., Goldblatt, P., Allen, J., et al. (2017). Global action on the social determinants of health. British Medical Journal Global Health, 3, https://gh.bmj.com/content/3/1/e000603corr1
(8)Huijts, T., Stornes, P., Eikemo, T.A., Bambra, C., & The HiNews Consortium (2017). The social and behavioural determinants of health in Europe: findings from the European Social Survey (2014) special module on the social determinants of health. European Journal of Public Health, 27(1), 55-62. https://doi.org/10.1093/eurpub/ckw231
(10)Siegel, J., Coleman, D.L., & Thea, J. (2018). Integrating social determinants of health into graduate medical education: call for action. Academic Medicine, 93(2), 159-162 https://doi.org/10.1097/ACM.0000000000002054
EFPA contact information.
The European Federation of Psychologists' Associations EFPA aims to promote the development, dissemination and application of psychology in all its forms, and to contribute to shaping a humane society, in Europe and beyond, on the basis of psychology's expertise.
Since July 2019 EFPA has member associations from 38 European countries, including all 27 EU countries. The number of psychologists in the countries represented by these associations is around 350.000.