First, the story so far…
The European Regional Office of the WHO adopted the Helsinki Declaration and Action Plan at a special Ministerial Conference in Helsinki in 2005. Both these documents set the agenda for action to support rights for people with mental illness and to develop community based services.
Global Mental Health Action Plan and the European Mental Health Action Plan
The European Union launched its own Pact on Mental Health and Wellbeing in 2008 and has now established a Joint Action on Mental Health and Wellbeing starting in 2012. The Scottish Government collaborates with both the European Commission and the WHO Europe office in developing and taking this work forward and will be involved in three of the work strands of the EU activity – depression and suicide, community services and mental health in other policy areas.
We were in Oslo for two consultations – one on the Global Mental Health Action Plan, and the other on the European Mental Health Action Plan. These documents will set the international agenda for the next few years. We in Scotland have already been involved in the expert group preparing the European document.
WHO experts – Oslo
WHO Europe expert meetings are generally hosted by one of the member countries and meetings tend to follow better economic conditions, which explains why we were in Oslo. The group met in Edinburgh a few years back. Part of the purpose is to hear a little about what is going on in the host country with a couple of the sessions being given over to briefing sessions. We had an interesting presentation on how services had responded to the Brevik murders and lessons to be learned that we will be feeding into our national resilience work.
Thor, our host for the evening also explained that the building was located on land that was in the background of the Munch picture The Scream.
Mrs Ragnhild Mathisen, State Secretary at the Ministry of Health and Care Services opened the meeting and gave her take on the 4 elements needed to take forward strategy and policy
- (1) political will;
- (2) funding;
- (3) consensus on aims; and
- (4) dialogue with users and carers.
There was much to agree with there, though I will come back to funding to show how the issues apply differently across countries.
Global Mental Health Action Plan
Dr Shekhar Saxena, Director of Mental Health & Substance Abuse at WHO HQ in Geneva introduced the Global Mental Health Action Plan. He described it as a return to mental health after 10 years and a great opportunity. The event in Oslo, with around 50 countries represented (Europe is quite a large place), was the largest consultation event on the document.
The resolution commissioning the plan was agreed in May and set out a requirement for a comprehensive, coordinated response from health and social sectors at the country level, supported by an action plan that sets out the global mental health context, the vision, cross-cutting principles, goals, objectives, targets and key areas for potential action.
Commitment – 5% of health spend should be on mental health
The plan identifies a number of key change areas and suggests 8 overarching targets. These are necessarily broadly drawn as they need to be able to apply to countries right across the development spectrum. So the commitment that 5% of health spend should be on mental health would be stretching for some, but significantly below performance for others. As background, the WHO analysis is that around 13% of all illness is related to mental illness, but globally only around 3% of spend is allocated to mental health. In Scotland the figure is closer to 10%. The Irish delegate suggested in some areas it might produce disinvestment – they currently estimate 7% of their health spend goes on mental health. Dr Saxena explained that the target was global rather than country specific.
A key focus of the work is closing the treatment gap as key indicator of progress and using that approach to address the burden of disease. The treatment gap is the difference between the number of people with a particular illness and the number who are receiving treatment. A good health system should increase diagnosis and treatment, but this can often be confused with an increase in an illness. Generally, the prevalence of most mental illnesses is remaining fairly constant.
Service user and family involvement
There was also a strong focus on rights and on service user and family involvement. Some of the proposals seem very process focused – specific mental health legislation to be no more than 10 years old, for example – and there was a good discussion on being able to take the debate on to outcomes. Dinesh Bhugra, who will be Chair of the World Psychiatric Association from 2014, made the case for better focus on the physical health of those with illness. There was also an interesting debate on the interaction between promotion and prevention and treatment services, and agreement that the debate needed to become more illness specific.
The discussion is always interesting, not least for the diversity of perspectives from the different countries. Also those representing countries will have quite often very different responsibilities, with some delegates being psychiatrists in lead clinical roles and others policy officials. My sense is that few have the ability to take back ideas and put them into implementation, but that the WHO and EU work gives them an opportunity to indirectly make the case for services in their own country. Similarly, outside those areas where WHO has staff on the ground, they and the EU have relatively little power, though their expertise is clearly valued and sought.
The consultation started in May and continues to 19 October 2012. If you want to read the full document you can find it and respond to the consultation at
http://www.who.int/mental_health/mhgap/consultation_global_mh_action_plan_2013_2020/en/index.html I already warned Dr Saxena to expect a few extra responses from Scotland. The document is be agreed in early 2013.
European Mental Health Action Plan
Matt Muijen, the Director of the WHO Europe Office, presented on the European Mental Health Action Plan. It covers similar ground to the Global Plan, with a similar range of challenges across the geographic area with mental health systems in various stages of development. He presented 3 large scale changes
- (1) deinstitutionalisation;
- (2) marginalised groups; and
- (3) empowerment of service users.
The timetable is a little more relaxed and we will get the next draft of the European Plan in October.
On the Wednesday we had presentations on the some of the country based work of the WHO, notably in the Stability Pact countries of South East Europe where mental health had been a key development area in promoting collaboration during the post conflict period, with significant improvements being made. There was a somewhat harrowing account of developments in Greece, where mental health services are being severely reduced as part of the fiscal measures. The presentation from Kristian Wahlbeck from Finland on the evidence on what do to during a recession to protect mental health would suggest a different approach, but one that is currently beyond their means.
Finally, while it was clear from the discussion that not all ideas translated easily across borders, there was a clear indication that some did …
@GeoffHuggins is Head of Division in the Scottish Government: Reshaping Care and Mental Health Division
Next week’s blog is a first for #ayrshirehealth, our first ‘double header’ featuring @corinnewatt:
Next week my first blog for #ayrshirehealth - Marching to the beat of the same drum - looking at synchronicity in Integrated Care Pathways—
Corinne M Watt (@corinnewatt) September 21, 2012
Doing double header for #ayrshirehealth blog, in two weeks - The Neurosequential Model of Therapeutics for traumatised & maltreated children—
Corinne M Watt (@corinnewatt) September 21, 2012