Second Thematic Consultation Meeting: Social Inclusion and Fundamental Rights in Mental Health

The second of three formal consultation meetings on the Green Paper was held in Vienna in March 2006. The SUPPORT project acted as rapporteur for these meetings, producing a summary report of key points discussed.

Key Messages

 

  • Recognition that social exclusion in relation to mental ill health was significant, and the stigma and social exclusion detrimentally affect people’s willingness to engage services and health promotion.
  • Ending social exclusion is a function of civil society, and not solely a function of health policy and health services.
  • A range of initiatives is in place in Member States to address social exclusion, and the stigma associated with mental ill health. These originate in health and health promotion, but also through rights based activities. NGOs play an important role both in setting and delivering this agenda.
  • In addition to the concern about the effect on individuals in society, there was concern about the rights of individuals with mental health disorders whilst receiving treatment, on a voluntary or involuntary basis.
  • The meeting felt strongly that there was a role for the emerging Fundamental Rights Agency in addressing social exclusion and affirming the human rights of people who experience mental ill health.

Summary of Discussion

There is an urgent need to find a global strategy in view of needs associated with mental ill health. In this work, social inclusion and promoting fundamental rights are key.

How the EC can contribute to improved quality of life for people affected by mental illness or disorder through social inclusion and through respect for dignity and fundamental rights? Social inclusion and protection of people with disability are responsibilities for Member States (MS) but also fall within EC jurisdiction.

 

1.   Social Inclusion

Current situation in relation to the social inclusion of people with mental health problems

Social exclusion is a major public health risk that affects the mental health of a very large number of people across the EU. 

People with mental ill health or disability meet fear and prejudice from others, often based on misconceptions about mental ill health. Stigma increases personal suffering and can prevent help seeking. Social exclusion and discrimination can impede access to services and resources such as housing and employment.  Article 13 of the EC Treaty sets out a legal basis for community level action to combat discrimination based on disability.

Social exclusion can be considered in terms of the loss or reduction of rights and participation in society.  Social exclusion takes many forms: subtle stigmatisation and social distancing; self-stigmatisation; territorial exclusion; and discrimination.  It is important to address all aspects, through actions at different levels. 

The relationship between mental health and social exclusion is bi-directional and multidimensional. This raises challenges about how to prevent negative events or protect against their consequences.  Social exclusion has both economic and social consequences, leading to increased, sustained costs to public services, negative social and personal effects in terms of quality of life, and lost capacity in the labour market.

Promoting social inclusion can help the EC promote economic growth and flourishing societies, as set out in the Lisbon agenda. 

Key Challenges

  • Respecting the rights of service users and achieving closer co-operation with service users groups and with professionals 
  • Tackling negative attitudes and stereotypes about mental health problems/ mental illness that give rise to negative behaviour.  Social inclusion requires a change in the view point of professionals, society and service users themselves
  • The inadequate development of sustainable community based mental health facilities across MS and the lack of adequate professional standards and competencies in community based systems of care
  • Access to employment is a key area for development, to assure income, social identity and contribution to community life. Promoting and supporting re-integration into the labour market is crucial in seeking to eliminate the prejudices and stigma associated with mental health problems
  • Mental health problems account for a sizeable proportion of expenditure on disability benefits and there is a need to ensure that benefit systems support the integration of people with mental disorders
  • NGOs play an important role in promoting the social inclusion of marginalized groups and are a key resource in pursuing the objectives of the Green Paper, although are often under funded.

Areas for Action

There is scope for the Green Paper to act as a catalyst to promote social inclusion through the actions of a wide range of stakeholders:

  • Early interventions in childhood
  • Support for employment
  • Promotion of social networks
  • Flexible funding and use of (EC) structural funding to assist reform and promote inclusion and non discrimination
  • Empowerment through consumer-directed use of resources
  • Legislative measures to ensure conformance

Possible initiatives at Community level could include promoting the exchange of best practice to promote social inclusion and protect the rights of people with mental disorders:

  • To develop common indicators
  • To work in collaboration with other main bodies: WHO (strategy), EC (implementation) and Council of Europe (Human rights)

 

 

2.    Fundamental Rights

Current situation in relation to the fundamental rights of people with mental health problems in the EU

There are a number of elements in place and in development that create a supportive framework for the promotion of human rights in the EU. Article 6 of the treaty of EU and the Charter of Fundamental Rights to affirm rights and make them more visible to the public. A Network of Independent Experts on Human Rights, established in 2002, proofs the Commission’s legislative proposals to ensure compatibility with human rights. There are proposals for a Fundamental Rights Agency to provide assistance and expertise and to raise awareness of the Charter. In addition, the EC Department of Justice, Liberty and Freedom has developed a range of guidelines and tools.

The Green Paper signals a change of paradigm, in line with human rights.  But with a move away from institutional care, there is a risk that needs become less visible. There is a need to develop proactive community services and to ensure that money follows the patient. 

Key Challenges

There is a high degree of variability of practices in the use of involuntary admission to psychiatric hospital, the duration of which can vary 40-fold between countries.  This suggests that culture, tradition and values may be strongly implicated. It would be useful to have a shared foundation of common principles in all legislation.

Looking at equal rights and responsibilities of people with mental disorder raises issues of non discrimination. Different standards may apply to people with mental disorders compared with other groups e.g. those with communicable diseases. The present paradigm tends to presume legal incapacity and deprives people of liberty often without appropriate safeguards.

 Fundamental rights need to include rights of access to treatment for those in need, including migrants and asylum seekers. Pressures on services can limit access for this group.  Rights to treatment should be broadly defined to include psychological and vocational / occupational interventions.

De-institutionalisation should not be seen as an end in itself but as a means to develop the support required for someone to live and participate in their community.

 There are measures that would enhance the protection of fundamental rights such as: access to independent advocacy; the use of trained psychiatrist and professional diagnostic terminology in decisions about compulsion; the harmonisation of time frames for compulsory placement; and distinguishing between detention and treatment.

 Areas for Action

Work is required to review and expand the paradigm within which we are working. The EU can assist by supporting more research and involving the whole population in discussion and debate on issues of rights and ethical and legal frameworks.

  • There are considerable variations in the use of compulsory measure in different MS and this need to be monitored.
  • An EU mental health strategy would be useful in promoting the development of community based services and the rights of people with mental health problems and their families.
  • The EU could assist by mapping of Human Rights legislation and structures across member states, defining concepts: rights, obligations and structures
  • The Fundamental Rights Agency: should have a supervisory role to uphold minimum level of rights

 

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