The Royal College of Psychiatrists warmly welcomes this Green Paper as a prospective contribution to the World Health Organization (WHO) Declaration and Action Plan. The case for an integrated mental health strategy is well made in the Paper, and the dual emphasis upon promotion of positive mental well-being and the prevention and treatment of mental illness is strongly supported.

The Paper includes two proposals for Council of Europe Recommendations. A Council Recommendation on the promotion of mental health should encourage positive attitudes towards social and family cohesion, and creativity and empowerment within society as a whole. There is a common view that modern lifestyles are becoming less conducive to a sense of well-being and therefore to good mental health. The strategy cannot ignore that view, but should actively investigate these issues when creating a practical framework of mechanisms for change.

A Council Recommendation on the reduction of depression and suicidal behaviour would have the potential to influence the largest diagnostic group, as well as those who are most at risk - and rates of suicide and self-harm are elevated in all mental illnesses. There is now enough reliable evidence upon which to base strategic decisions. As indicated in the Green Paper, new strategies for prevention can be built upon practices that have proven effectiveness, in different States, various age-groups and in diverse settings.

Relevance of mental health to Europe's policy objectives

Mental health is highly relevant to the EU's strategic policy objectives and the European Commission is well placed to make a number of valuable interventions. The need for change is well summarised in Section 1 and the secondary benefits of improved mental health to other policy areas, including economics, are enumerated and clear. We wish to also emphasise the increasing capacity for change, as a result not least of the recent expansion in knowledge about mental health and mental illness: about risk and protective factors, primary, secondary and tertiary prevention, and improvements in a wide range of medical treatments and psychological therapies. This more optimistic view of what can be done to relieve mental health problems and improve recovery is slowly replacing traditional associations with sequestered custodial care. A wide-reaching and authoritative strategy, with an effective means of dissemination, should accelerate the acceptance of this positive view.

Are priorities adequate?

Would the development of a comprehensive EU strategy on mental health add value to the existing and envisaged actions and does the document propose adequate priorities? The College agrees that added value would flow most readily from initiatives that facilitate inter-agency and interstate collaboration, coordinate parallel developments between policy areas, and facilitate the provision of appropriate information for users at all organisational levels.

Satisfactory mental health in a community will depend in part upon economic and political stability and on settings that promote family life, good schooling, cohesion, rewarding work and care of the elderly. The strategy should encourage the richness of local diversity as well as offering standard approaches.

The College also agrees that provision of effective mental healthcare is a first priority, and suggests that the strategy should address the problems faced by all member States in setting realistic threshold criteria for entry to services. Although States are exclusively competent for the organisation of their own mental healthcare and psychiatric services, supportive actions might be taken by the European Commission to promote discussion and understanding of the principles involved. The College strongly supports the plan for a single integrative strategy with a strong coordinating influence.

Are initiatives appropriate?

Are the initiatives proposed appropriate to support the coordination between member States, to promote the integration of mental health into the health and non-health policies and stakeholder action, and to better integrate research and policy on mental health? The proposed initiatives set an ambitious and far-reaching agenda. The WHO Network of Promoting Hospitals and the European Alliance against Depression seem to provide good examples. Coordination between member States should take place at all levels and the proposals in Section 7 seem likely to ensure that.

Integration of mental health into general health and non-health policies would be assisted by a strengthened central mental health presence, rather than the domain being represented by a scattering of unconnected projects and stakeholder champions. Successful implementation of the strategy will not occur without extensive training and retraining as well as public education.

To view the Green Paper see http://ec.europa.eu/health/ph_determinants/life_style/mental/green_paper/mental_gp_en.pdf and for the College's full response see http://www.rcpsych.ac.uk/pressparliament/collegeresponses/parliament/responses/collegeeuresponsemay06.aspx