Mental health in Europe
WHO
European Ministerial Conference on Mental Health
Mental Health Declaration for
Europe Facing the Challenges,
Building
Solutions
Helsinki, Finland, 12–15 January
2005
http://www.euro.who.int/mentalhealth2005
Preamble
1.
We, the Ministers of Health of Member States in the European Region
of the World Health Organization (WHO), in the presence of the
European Commissioner for Health and Consumer Protection, together
with the WHO Regional Director for Europe, meeting at the WHO
Ministerial Conference on Mental Health, held in Helsinki from 12 to
15 January 2005, acknowledge that mental health and mental
well-being are fundamental to the quality of life and productivity
of individuals, families, communities and nations, enabling people
to experience life as meaningful and to be creative and active
citizens. We believe that the primary aim of mental health activity
is to enhance people’s well-being and functioning by focusing on
their strengths and resources, reinforcing resilience and enhancing
protective external factors
2.
We recognize that the promotion of mental health and the prevention,
treatment, care and rehabilitation of mental health problems are
a priority for WHO and its Member States, the European Union (EU)
and the Council of Europe, as expressed in resolutions by the World
Health Assembly and the WHO Executive Board, the WHO Regional
Committee for Europe and the Council of the European Union. These
resolutions urge Member States, WHO, the EU and the Council of
Europe to take action to relieve the burden of mental health
problems and to improve mental well-being.
3.
We recall our commitment to resolution EUR/RC51/R5 on the Athens
Declaration on Mental Health, Man-made Disasters, Stigma and
Community Care and to resolution EUR/RC53/R4 adopted by the WHO
Regional Committee for Europe in September 2003, expressing concern
that the disease burden from mental disorders in Europe is not
diminishing and that many people with mental health problems do not
receive the treatment and care they need, despite the development of
effective interventions. The Regional Committee requested the
Regional Director to:
-
give high
priority to mental health issues when implementing activities
concerning the update of the Health for All policy;
-
arrange a
ministerial conference on mental health in Europe in Helsinki in
January 2005
4.
We note resolutions that support an action programme on mental
health. Resolution EB109.R8, adopted by the WHO Executive Board
in January 2002, supported by World Health Assembly resolution
WHA55.10 in May 2002, calls on WHO Member States to
-
adopt the
recommendations contained in
The world health report 2001;
-
establish
mental health policies, programmes and legislation based on
current
knowledge and considerations
regarding human rights, in consultation with all
stakeholders in mental health;
increase
investment in mental health, both within countries and in
bilateral and
multilateral cooperation, as
an integral component of the well-being of populations.
5.
Resolutions of the Council of the European Union, recommendations of
the Council of Europe and WHO resolutions dating back to 1975
recognize the important role of mental health promotion and the
damaging association between mental health problems and social
marginalization, unemployment,
homelessness and alcohol and other substance use disorders. We
accept the importance of the provisions of the Convention for the
Protection of Human Rights and Fundamental Freedoms, of the
Convention on the Rights of the Child, of the European Convention
for the Prevention of Torture and Inhuman or Degrading Treatment or
Punishment and of the European Social Charter, as well as the
Council of Europe’s commitment to the protection and promotion of
mental health which has been developed through the Declaration of
its Ministerial Conference on Mental Health in the Future
(Stockholm, 1985) and through its other recommendations adopted in
this field, in particular Recommendation R(90)22 on protection of
the mental health of certain vulnerable groups in society and
Recommendation Rec(2004)10 concerning the protection of the human
rights and dignity of persons with mental disorder.
Scope
6. We note that many aspects of mental health policy
and services are experiencing a transformation across the
European Region. Policy and services are striving to achieve social
inclusion and equity, taking a comprehensive view of the balance
between the needs and benefits of diverse mental health activities
aimed at the population as a whole, groups at risk and people with
mental health problems. Services are being provided in a wide range
of community-based settings and no longer exclusively in isolated
and large institutions. We believe that this is the right and
necessary direction. We welcome the fact that policy and practice on
mental health now cover:
-
the
promotion of mental well-being;
-
the
tackling of stigma, discrimination and social exclusion;
-
the
prevention of mental health problems;
-
care for
people with mental health problems, providing comprehensive and
effective services and interventions, offering service users and
carers 1
involvement and choice;
the recovery and inclusion
into society of those who have experienced serious mental
health problems.
Priorities
7.
We need to build on the platform of reform and modernization in the
WHO European Region, learn from our shared experiences and be
aware of the unique characteristics of individual countries. We
believe that the main priorities for the next decade are to:
-
foster
awareness of the importance of mental well-being;
-
collectively tackle stigma, discrimination and inequality, and
empower and support people with mental health problems and their
families to be actively engaged in this process;
-
design and
implement comprehensive, integrated and efficient mental health
systems that cover promotion, prevention, treatment and
rehabilitation, care and recovery;
(1) The term "carer" is used here to describe a family member,
friend or other informal care-giver.
address the
need for a competent workforce, effective in all these areas;
recognize
the experience and knowledge of service users and carers as an
important basis for planning and developing mental health
services.
Actions
8. We endorse the statement that there is no health
without mental health. Mental health is central to the human,
social and economic capital of nations and should therefore be
considered as an integral and essential part of other public policy
areas such as human rights, social care, education and employment.
Therefore we, ministers responsible for health, commit ourselves,
subject to national constitutional structures and responsibilities,
to recognizing the need for comprehensive evidence-based mental
health policies and to considering ways and means of developing,
implementing and reinforcing such policies in our countries. These
policies, aimed at achieving mental well-being and social inclusion
of people with mental health problems, require actions in the
following areas:
-
promote the
mental well-being of the population as a whole by measures that
aim to create awareness and positive change for individuals and
families, communities and civil society, educational and working
environments, and governments and national agencies;
-
consider
the potential impact of all public policies on mental health, with
particular attention to vulnerable groups, demonstrating the
centrality of mental health in building a healthy, inclusive and
productive society;
-
tackle
stigma and discrimination, ensure the protection of human rights
and dignity and implement the necessary legislation in order to
empower people at risk or suffering from mental health problems
and disabilities to participate fully and equally in society;
-
offer
targeted support and interventions sensitive to the life stages of
people at risk, particularly the parenting and education of
children and young people and the care of older people;
-
develop and
implement measures to reduce the preventable causes of mental
health problems, comorbidity and suicide;
-
build up
the capacity and ability of general practitioners and primary care
services, networking with specialized medical and non-medical
care, to offer effective access, identification and treatments to
people with mental health problems;
-
offer
people with severe mental health problems effective and
comprehensive care and treatment in a range of settings and in a
manner which respects their personal preferences and protects them
from neglect and abuse;
-
establish
partnership, coordination and leadership across regions,
countries, sectors and agencies that have an influence on the
mental health and social inclusion of individuals and families,
groups and communities;
-
design
recruitment and education and training programmes to create a
sufficient and competent multidisciplinary workforce;
-
assess the
mental health status and needs of the population, specific groups
and individuals in a manner that allows comparison nationally and
internationally;
-
provide
fair and adequate financial resources to deliver these aims;
-
initiate
research and support evaluation and dissemination of the above
actions.
9. We recognize the importance and the urgency of
facing the challenges and building solutions based on evidence.
We therefore endorse the Mental Health Action Plan for Europe and
support its implementation across the WHO European Region, each
country adapting the points appropriate to its needs and resources.
We are also committed to showing solidarity across the Region and to
sharing knowledge, best practice and expertise.
Responsibilities
10. We, the Ministers of Health of the Member States
in the WHO European Region, commit ourselves to supporting the
implementation of the following measures, in accordance with each
country’s constitutional structures and policies and national and subnational needs, circumstances and resources:
-
enforce
mental health policy and legislation that sets standards for
mental health activities and upholds human rights;
-
coordinate
responsibility for the formulation, dissemination and
implementation of policies and legislation relevant to mental
health within government;
-
assess the
public mental health impact of government action;
-
eliminate
stigma and discrimination and enhance inclusion by increasing
public awareness and empowering people at risk;
-
offer
people with mental health problems choice and involvement in their
own care, sensitive to their needs and culture;
-
review and
if necessary introduce equal opportunity or anti-discrimination
legislation;
-
promote
mental health in education and employment, communities and other
relevant settings by increasing collaboration between agencies
responsible for health and other relevant sectors;
-
prevent
risk factors where they occur, for instance, by supporting the
development of working environments conducive to mental health and
creating incentives for the provision of support at work or the
earliest return for those who have recovered from mental health
problems;
-
address
suicide prevention and the causes of harmful stress, violence,
depression, anxiety and alcohol and other substance use disorders;
-
recognize
and enhance the central role of primary health care and general
practitioners and strengthen their capacity to take on
responsibility for mental health;
-
develop
community-based services to replace care in large institutions for
those with severe mental health problems;
-
enforce
measure that end inhumane and degrading care;
-
enhance
partnerships between agencies responsible for care and support
such as health, benefits, housing, education and employment;
-
include
mental health in the curricula of all health professionals and
design continuous professional education and training programmes
for the mental health workforce;
-
encourage
the development of specialized expertise within the mental health
workforce, to address the specific needs of groups such as
children, young people, older people and those with long-term and
severe mental health problems;
-
provide
sufficient resources for mental health, considering the burden of
disease, and make investment in mental health an identifiable part
of overall health expenditure, in order to achieve parity with
investments in other areas of health;
-
develop
surveillance of positive mental well-being and mental health
problems, including risk factors and help-seeking behaviour, and
monitor implementation;
-
commission
research when and where knowledge or technology is insufficient
and disseminate findings.
11.
We will support nongovernmental organizations active in the mental
health field and stimulate the creation of nongovernmental and
service user organizations. We particularly welcome organizations
active in:
-
organizing
users who are engaged in developing their own activities,
including the setting up and running of self-help groups and
training in recovery competencies;
-
empowering
vulnerable and marginalized people and advocating their case;
-
providing
community-based services involving users;
-
developing
the caring and coping skills and competencies of families and
carers, and their active involvement in care programmes;
-
setting up
schemes to improve parenting, education and tolerance and to
tackle alcohol and other substance use disorders, violence and
crime;
-
developing
local services that target the needs of marginalized groups;
-
running
help lines and internet counselling for people in crisis
situations, suffering from violence or at risk of suicide;
-
creating
employment opportunities for disabled people.
12.
We call upon the European Commission and the Council of Europe to
support the implementation of this WHO Mental Health Declaration
for Europe on the basis of their respective competences.
13. We request the Regional Director of WHO Europe to
take action in the following areas:
(a) Partnership
encourage cooperation in this area with intergovernmental
organizations,
including the European Commission and the Council of Europe.
(b) Health information
ii. produce
comparative data on the state and progress of mental health and
mental health services in Member States.
(c) Research
-
i.
establish a network of mental health collaborating centres that
offer opportunities for international partnerships, good quality
research and the exchange of researchers;
-
ii. produce
and disseminate the best available evidence on good practice,
taking into account the ethical aspects of mental health.
(d) Policy and service development
i. support
governments by providing expertise to underpin mental health
reform through effective mental health policies that include
legislation, service design, promotion of mental health and
prevention of mental health problems;
ii. offer
assistance with setting up "train the trainer" programmes;
iii.
initiate exchange schemes for innovators;
iv. assist
with the formulation of research policies and questions;
v.
encourage change agents by setting up a network of national
leaders of reform and key civil servants.
(e) Advocacy
-
i. inform
and monitor policies and activities that will promote the human
rights and inclusion of people with mental health problems and
reduce stigma and discrimination against them;
-
ii. empower
users, carers and nongovernmental organizations with information
and coordinate activities across countries;
-
iii.
support Member States in developing an information base to help
empower the users of mental health services;
-
iv.
facilitate international exchanges of experience by key regional
and local non governmental organizations;
-
v. provide
the media, nongovernmental organizations and other interested
groups and individuals with objective and constructive
information.
14.
We request the WHO Regional Office for Europe to take the necessary
steps to ensure that mental health policy development and
implementation are fully supported and that adequate priority and
resources are given to activities and programmes to fulfil the
requirements of this Declaration.
15.
We commit ourselves to reporting back to WHO on the progress of
implementation of this Declaration in our countries at an
intergovernmental meeting to be held before 2010.
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More info at:
http://www.euro.who.int/mentalhealth2005
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HUMAN
RIGHTS AND LEGISLATION Stop exclusion, dare to care:
http://www.ruig-gian.org/proj/WHOResourceBook050210.pdf |
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European Declaration on Mental Health [pdf, 375KB] |
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EUR/04/5047810/6 |
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Also available in:
fr[pdf, 408KB],
de[pdf, 406KB],
ru[pdf, 424KB] |
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WHO Mental Health Action Plan for Europe [pdf, 233KB] |
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EUR/04/5047813/7 |
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Also available in:
fr[pdf, 245KB],
de[pdf, 267KB],
ru[pdf, 308KB] |
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Empowerment and mental health advocacy [pdf, 294KB] |
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EUR/04/5047810/B5 |
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Also available in:
fr[pdf, 322KB],
de[pdf, 492KB],
ru[pdf, 510KB] |
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Mental health legislation [pdf, 222KB] |
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EUR/04/5047810/B1 |
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Also available in:
fr[pdf, 254KB],
de[pdf, 402KB],
ru[pdf, 366KB] |
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5.
WHO - HOW CAN
HEALTH CARE SYSTEMS effectively deal with the
major
health care needs
of HOMELESS people? |
WHO
-
How can health care systems effectively deal with the major
health care needs of homeless people?
Twenty
January 2005
ABSTRACT
This
is a Health Evidence Network (HEN) synthesis report focusing
on the evidence of effective treatment
for
the types of ill-health from which homeless people often
suffer.
Homeless people constitute a heterogeneous population
characterized by multiple morbidity (primarily
alcohol and drug dependence, and mental disorders) and
premature mortality. The problems need to be
addressed by many measures, requiring a focused primary
health care system and multi-agency
cooperation.
Keywords
HOMELESS PERSONS
DELIVERY OF HEALTH CARE – organization and administration
HEALTH SERVICES NEEDS AND DEMAND
META-ANALYSIS
EUROPE
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• by post
Publications
WHO Regional Office for Europe
Scherfigsvej 8
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© World
Health Organization 2005
Summary
The
issue............................................................................................................
4
Findings...............................................................................................................
4
Policy
considerations..............................................................................................
4
Introduction..........................................................................................................
5
Sources for
this review............................................................................................
6
Barriers to
health care for the homeless
..................................................................
6
Primary
health care for theless................................................................................
6
Patterns of
morbidity and mortality among the homeless
.......................................... 7
Health care
needs of the homeless.........................................................................
7
Medical................................................................................................................
7
Drug
dependence-related.......................................................................................
8
Sexual
behaviour-related.....................................................................................
10
Alcohol
dependence-related..................................................................................
10
Mental
health-related...........................................................................................
11
Conclusions
.......................................................................................................
12
References
........................................................................................................................
13
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