Life of brain

Can Europe finally bring mental health out of the shadows?

The ongoing permacrisis of underinvestment in mental health services has shone a light on the urgent need to address the growing mental health burden – especially among serious mental health conditions.

In 2019, even before the pandemic, around 84 million people in the EU (one in six) were living with a mental disorder, such as schizophrenia, depression and bipolar disorders, at a cost of EUR 600 billion, or more than 4% of GDP.

Behind these statistics lie millions of personal stories of people doing their best to live their lives while trying to manage the multiple challenges and complexities that come with their condition, including societal stigmatisation, discrimination and struggling to access quality treatment and care.

Since the end of the pandemic, it has been great to see the European Union take decisive leadership in putting mental health at the heart of the policy agenda.

Through a series of initiatives, it aims to bring mental health out of the shadows and is encouraging action from individual EU Member States to put it on par with physical health.

In June 2023, the European Commission published a Communication with a new comprehensive approach to mental health.

The flagship €1.23 billion ambition contains 20 initiatives aimed at improving the region’s mental health through adequate and effective prevention, access to high-quality healthcare and treatment, and reintegration into society after recovery, starting with tackling stigma head-on.

One key area that is critical to delivering long-term success is breaking through the deep-rooted stigma and discrimination associated with mental health.

Mental health conditions, particularly serious mental illnesses such as schizophrenia, bipolar disorder and major depressive disorder, are often wrapped up in misunderstanding and prejudice.

These attitudes can deter individuals from seeking help, exacerbate their symptoms and further isolate them from their communities.

Anti-stigma campaigns, such as Denmark’s ONE OF US national anti-stigma programme, have made some progress in changing public attitudes, but there is still a long way to go in order to challenge the stereotypes and prejudice that exist across society.

The real success of ONE OF US is its foundations in ‘people’s lived experience’.

By employing trained volunteers who understand mental health conditions and the pressures of social stigma, and then creating a system for sharing stories, the programme is transforming healthcare by helping people trust their providers.

The Commission has allocated €18 million to a range of activities aimed at combatting stigma, including developing specific EU guidance on the topic, developing region-wide awareness-raising activities in the fight against stigma and a possible future EU initiative on psychosocial risks at work.

Member States must utilise this guidance and benefit from support in identifying and implementing best practices for addressing stigma and discrimination.

What’s more, it is critical that activities are developed in collaboration with people with lived experience of mental health to have the biggest impact.

Another of the key issues the Commission has set out to tackle is reinforcing mental health systems and improving access to treatment and care.

Mental health services and resources are currently disproportionately distributed within countries and often not properly signposted, delaying vital diagnosis, treatment and care.

Access to services has worsened due to rising demand and chronic healthcare workforce shortages across the sector, with mental health services hit particularly hard.

This means that a central part of the European health agenda – that people can seek support and access high-quality treatment when needed – is currently not the case for many people with a mental health condition in Europe.

On top of this, countries in the WHO’s European Region are dealing with insufficient recruitment of health workers in mental health services.

In Germany, there are currently only 27 psychiatrists for every 100,000 people, while France only fares marginally better with 36 per 100,000 people.

Meanwhile, in the UK, there is an 11.2% current vacancy rate in the mental health workforce and a 19% turnover rate.

As part of its Communication, the Commission encourages investment in training and capacity building at the national and local levels to improve access to innovative treatment and care.

Actions include training and exchange programmes for mental health professionals and technical support for mental health reforms at the national level.

However, simply recruiting more mental health professionals may not be the solution without adequate workforce planning, training, and retention efforts at national and local levels to ensure an appropriate skill mix and levels of experience.

More also needs to be done to encourage greater collaboration between mental health professionals and general health professionals to create more integrated, holistic approaches.

For example, a majority of psychiatric medication prescribing takes place in general practice, which in general is poorly integrated with mental health professionals.

While primary care providers are trusted by their patients, it is unrealistic to expect them to be able to provide personalised care for specific mental health patients, given the time constraints that they face and the huge variety in their clinical workload.

As part of its early initiatives, the Commission has sought to bring researchers and stakeholders together as part of an ecosystem to facilitate and coordinate activities that could maximise EU and Member States’ research investments in brain health, including on mental health.

While still in its emerging stages, this ecosystem is a great step forward and could encourage innovation in mental health, particularly in the areas of personalised and patient-centred care, becoming more common practice.

Greater commitment towards personalisation is sorely needed in mental health, particularly in ongoing treatment and management of conditions.

Unfortunately, current therapies focus on the overarching diagnosis rather than the tailored management of the symptoms and individual experiences.

Furthermore, these medications are only effective in certain groups of patients, and clinicians do not have the tools to predict in which cases they will be effective.

That’s why it was great to see progress in this area, with projects such as the ‘Virtual Brain Twin for Personalised Treatment of Psychiatric Disorders’ project, initiated in January this year.

The project aims to generate virtual brain twins for schizophrenia patients through an ecosystem using neurological simulation, data analysis, innovative AI tools and insights from psychiatric care.

Those together with clinical studies should help guide clinicians in making decisions on medication type and dosage alongside exploring alternative treatments like brain stimulation and lifestyle changes.

The scale and success of the Commission’s mental health ambition will rely on the ability of Members States to effectively prioritise and implement mental health plans with appropriate resources.

While mental health has been climbing the agenda, the amount spent on mental health remains very low, with only approximately 3.6% of their healthcare budgets currently allocated to mental health.

This is likely to remain the case as many Member States continue to struggle with competing funding priorities in the aftermath of the COVID-19 pandemic and the ongoing cost of living crisis.

Considering the multiple drivers and determinants of mental health, a holistic, cross-sector approach is undoubtedly the right one.

However, any real success will depend on the ability of European and national policymakers to invest properly in mental health services and drive integration across multiple other policy areas.

This was echoed by MEPs in their own report on mental health, who have called for a long-term, integrated mental health strategy that encourages corresponding national strategies with concrete targets and indicators.

With many countries going to the polls this year, success and progress will also very much depend on the agenda of any incoming government.

Is the European Commission’s ambition to take mental health out of the shadows going to be successful? It might still be too early to say but the signs are certainly encouraging.

The programme has already made good progress, with increased funding, cross-border collaboration and awareness campaigns. Moreover, there appears to be a clear recognition of the problem throughout Europe and a collective will to enact change.

However, we must not mistake early progress for a mission accomplished. A lot of the low-hanging fruit has been targeted; the hard work is still yet to come.

There is a definite need for legislative ‘teeth’ and measurement in order to mitigate the inevitable roadblocks and temptations for national Governments to defer or dilute action.

Building on the Commission’s lead, there is also a clear role for both the public and private sector, working closely alongside patient associations and special interest groups, to co-design solutions and campaigns.

Ultimately, this will normalise conversations around mental health, particularly serious mental health issues, so that people feel supported and able to contribute to the communities they live in.

There is a long way to go, but Europe has a genuine opportunity to lead the way and show other nations that investment in mental health is an investment into a better life.

Nedim Pipic is the Therapeutic Area Head for Central Nervous System, Retinopathies and Emerging Areas at Boehringer Ingelheim. Go to boehringer-ingelheim.com