On 5 July 2022 during its annual event, the NPCE has agreed on a policy paper calling on EU decision makers to take measures to secure mental health of refugees and migrants in Europe:
Key priorities in securing mental health of refugees and migrants in Europe
Health is a human right - including mental health. Yet care for refugees and migrants with mental illness is not sufficiently assured across Europe. Access to appropriate levels of care must be secured for refugees and migrants with mental illness in Europe, early on, even from the very first day of their arrival. Any mental health care provision should consider individuals’ specific needs.
Humanitarian crises, such as war and terror, can endanger mental health. Experiencing war and fleeing trigger psychological stress that can lead to negative consequences in individual’s mental illness. Refugees and migrants have a higher risk of developing mental illness than the host community (WHO, 2021). Among refugees and migrants, there are also people with existing mental illnesses whose treatment needs to be continued.
Securing the provision of care for refugees and migrants with psychological distress and mental illness is central, since without good mental health and well-being, an appropriate integration, ability to go to school and work, and social participation are limited. The investment in provision of mental health care and respective interventions have shown to be cost-effective (WHO, 2022).
The NPCE calls on the EU and Member States to:
- Acknowledge that mental health is a basic human right and that there is no well-being without mental health;
- Acknowledge the return of invest in mental health and the importance of treating mental disorders as a basic parameter to facilitate the integration of migrants and refugees;
- Finance and ensure access to mental health care for refugees and migrants regardless of their origin and legal status. Mental health services should include prevention, psychological first aid, psychological and psychotherapeutic treatment, as well as language mediation;
- Assure quality standards, quality of care and training of professionals in all Member States;
- Promote interdisciplinary approaches in treatment for refugees and facilitate the development of guidelines among professionals involved in mental healthcare services for refugees to ensure coordination and common standards;
- Foster the identification and implementation of best practices in mental health care for refugees and migrants across Europe;
- Facilitate the development and implementation of digital solutions in mental health care for refugees and migrants, e.g. digital applications such as phone/web-based, which make it possible to ensure psychological support even in the event of a high influx of refugees;
- Establish public reporting to benchmark mental health services for refugees across Europe;
- Make finances available to react to crises
- Set up mental health crisis plans and involve mental health professionals like clinical psychologists, psychotherapists, and psychiatrists, in the development of crisis plans to address mental health issues.
The policy paper can be downloaded here.
On 24 June 2021 during its annual event, the NPCE has agreed on a policy paper calling on EU decision makers to take measures to strengthen mental health and ensure access to psychotherapeutic care for patients with mental disorders since the COVID-19 pandemic has also overwhelmed people’s mental health:
CALL FOR ACTION: Strengthening Mental Health in the COVID-19 Pandemic
The COVID-19 pandemic has been ongoing for more than a year and is affecting everyone’s daily life. Social distancing and lockdown measures, home schooling and work at home, compatibility of work and childcare, as well as existential fears, short time work, and unemployment, can overwhelm psychological resistance and regeneration.
As a result, depressive disorders, anxiety disorders and stress disorders, alcohol dependence and substance abuse, and suicides increase. It becomes clear that the pandemic poses a serious threat to mental health and subsequently, the need of early diagnosis and adequate treatment must be met to strengthen wellbeing and the ability to work, and to prevent early retirement.
The EU-wide availability of welfare state support services will have a decisive influence on whether the health and economic consequences of the pandemic and its psychological effects can be absorbed. Although the negative impact of the COVID-19 pandemic on mental health is part of political discussions, concrete political actions are still scarce.
The NPCE calls on the EU to:
- Improve data collection on mental health issues and mental disorders associated with the COVID-19 pandemic by extending the ECDC mandate.
- Establish an Ad-hoc Task Force at the ECDC analysing data on mental health and writing a report on mental health during the COVID-19 pandemic in the EU, including prognoses on the development of the prevalence of mental health disorders.
- Establish a Joint Action on mental health during the COVID-19 pandemic, assessing the EU-wide challenges and developing recommendations on the prevention, treatment and rehabilitation of people suffering from mental disorders, including the specific needs of people with post-acute COVID-19 syndrome.
- Ensure sufficient funding for (psychotherapeutic) research on the impact of the pandemic on mental health, the prevention and treatment of mental disorders, and rehabilitation of people with mental health disorders and post-acute COVID-19 syndrome.
Furthermore, the NPCE calls on the Member States to:
- Ensure timely access to and funding for psychotherapy services for all people in need of psychotherapeutic support and increase the psychotherapeutic service capacities.
- Facilitate the use of digital tools embedded in psychotherapeutic treatment, such as video treatment or effective digital applications.
- Be aware of the special needs of people with mental disorders during the pandemic when implementing hygiene and safety rules, ensuring access to and availability of social and healthcare services, as well as timely access to vaccination, and providing free face masks and COVID-19 tests.
- Develop, implement, and strengthen specific (psychotherapeutic) support services and prevention programs for vulnerable groups, such as healthcare professionals, children and adolescents, families in socioeconomic hardship, the elderly, and homeless people (with mental disorders).
The policy paper can be downloaded here.
Tobacco taxation – excise duties for manufactured tobacco products
The EU Commission plans to revise the directive on excise duties for manufactured tobacco products. The NPCE has submitted a statement as part of the EU Commission's public consultation:
The Network for Psychotherapeutic Care in Europe (NPCE) welcomes the initiative of the European Commission to update the directive on excise duties for manufactured tobacco products. Tobacco consumption is a main health determinant in the EU. On average 30 percent of men and 22 percent of women smoke daily or occasionally according to the Eurobarometer survey in 2017 (European Commission, 2017). Taxation is a strong and effective measure to prevent smoking and stop tobacco consumption. However, higher taxation must lead to a noticeable price increase of tobacco products to become effective in reducing tobacco use in the general population. Therefore, the minimum excise duties should be significantly increased. To prevent smoking and achieve a stop to consumption, a tax increase of 10 percent per year is recommended (DKFZ, 2003). Especially among children and adolescents, high tobacco prices prevent smoking. Besides this, also e-cigarettes and liquids must be taxed.
Moreover, the EU should call on the Member States to finally ban tobacco advertising, marketing, and sponsoring. All types of advertising counteract tobacco prevention. Tobacco dependence is among the mental health conditions with the highest somatic morbidity and mortality risk. For people suffering from tobacco addiction, the access to psychotherapeutic care, e.g. behavioural treatment, must be ensured and should be refunded by sick funds. Overall, tobacco prevention measures must be intensified, both in the EU and in the Member States, to combat tobacco use and to reduce the number of deaths from smoking.
The NPCE would be delighted if the EU Commission would take these aspects into consideration.
Green Paper on Ageing
The EU Commission has adopted the Green Paper on Ageing. The NPCE has submitted a statement as part of the EU Commission's public consultation:
The Network for Psychotherapeutic Care in Europe (NPCE) welcomes the EU Commission’s engagement to improve the well-being and health of the elderly in the EU. Following the EU Commission’s green paper on ageing, the NPCE would like to spot the light on the need to strengthen mental health among the elderly.
Loneliness and social isolation, chronic illnesses, and care dependency, as well as substance abuse, as well as low pensions and related financial distress, can affect one’s mental health and lead to mental health illnesses. A study by Andreas S. et al (2017) found out that among 65–84-year-old people, 50 percent suffered from a mental illness during their life, 30 percent during the last year, and 25 percent were mentally ill at the time of the study conduction. Moreover, the study revealed that anxiety disorders, affective disorders and substance dependency were the most prevalent mental illnesses among the participants.
Therefore, the prevention of mental illnesses among the elderly, health promotion and early detection and diagnosis of mental illnesses are required to improve access to healthcare like psychotherapeutic care. Especially people in retirement or nursing homes have limited access to mental health care, such as psychotherapy and other psychiatric interventions, due to limited mobility, deficit healthcare provision in the facilities and agreements with health insurers. Also, with regards to the elderly people living in their own homes, outreach healthcare needs to be in place in order to give them access to diagnosis and treatment. The prevention of suicides among elderly must be strengthened. Next, research is necessary to improve psychiatric care, including psychotherapy, for the cognitively impaired such as in people with dementia. Psychotherapists are experts of mental health and should contribute to and be included in the development of adequate measures on how to maintain, improve, and regain mental health among the elderly. The more as psychotherapy in general has been shown to increase resilience and may hence turn the accelerated ageing process associated with many mental health problems.
The NPCE would be delighted if these aspects are taken into account.
Strategic Framework: Health and Safety at Work 2021-2027
The EU Commission plans to revise the Strategic Framework on Health and Safety at Work. The NPCE has submitted a statement as part of the EU Commission's public consultation:
The Network for Psychotherapeutic Care in Europe (NPCE) warmly welcomes the initiative of the Commission of the European Union to renew the Strategic Framework on Health and Safety at Work.
The individual ability to work and employment are relevant factors influencing health. Poverty and unemployment lead to a higher risk of mental illness. Sick leave due to mental illnesses are a huge individual and societal burden. Safe and healthy workplaces must be assured for all workers in the EU, as well as the rehabilitation of workers after sickness and the inclusion of workers with chronic diseases or disabilities.
In view of the NPCE, the Strategic Framework on Health and Safety at Work 2021-2027 should therefore amplify the scope of measures to protect workers’ mental health in the EU.
In times of high workflows and work compression, but also in times of increased home office due to the corona pandemic, it must be assured that workers are sufficiently protected from work-related mental health threats which can lead to mental illnesses. Therefore, the strategic framework should also include measures that identify mental health threats at work and in home office, and measures to prevent workers from subsequent risks.
The International Labour Organization (ILO) underlines that the burden of stress originates yearly losses for 3% of the world general product. Protecting and promoting mental health at work, addressing psychosocial determinants, and fostering resilience at work are cost effective. With significant positive results if the programs are well managed by competent mental health professionals.
The Covid-19 pandemic is a worldwide trauma, not only those that have been affected by the pandemic suffer mental health traumas but the whole population is affected, therefore we need to deal effectively with mental health issues where people live and work as the WHO Ottawa charter on health promotion prescribes (WHO, 1986). There is abundant research about the costs of trauma but also how trauma-informed and person-centred approaches can prevent trauma, minimize the dangerous damages and favour post traumatic growth and prevent vicarious trauma and personnel burn out.
A large body of research show that there is no health without mental health, expenditure for promoting and promoting mental health, wellbeing and resilience are cost effective, so they are an investment and since citizens are the most important natural resource for a workplace, protecting and promoting individual, workplace, community and national health produce individual and social health and prosperity.
Besides this, some professions have a higher risk experience traumatic events during their worktime, such as e.g. police officers, first aid workers or train drivers. In times of the corona pandemic health workforce in hospitals is also affected by a high number of patients dying from Covid-19 and by managing the treatment of a high number of patients while facing limited healthcare capacities. Besides measures that prepare workforce for dealing with such situations and that strengthen their resilience, traumata due to work-related events should be acknowledged as occupational illnesses.
In addition, psychotherapists, as experts in mental health, have competencies that qualify them for greater involvement in the prevention of mental illness in occupational health and safety, in workplace health promotion and in workplace health management. Therefore, Member States should consider to further involve and anchor psychotherapeutic expertise in occupational health prevention, promotion and occupational health management as well as rehabilitation, e.g. by including psychotherapists in expert panels and committees which define guidelines, list of occupational diseases, develop prevention measures etc, as well as further develop the cooperation with statutory sick funds and pension funds.
The NPCE would be pleased if the EU Commission takes the abovementioned aspects into account.
EU Commission’s Regulation Proposal on the extension of the ECDC’s mandate
The EU Commission has published a regulation proposal on the extension of the ECDC’s mandate as a measure to establish the EU Health Union and combat the COVID-19 pandemic. The NPCE has submitted a statement as part of the EU Commission's public consultation:
The Network for Psychotherapeutic Care in Europe (NPCE) welcomes the initiatives of the European Union to jointly combat the COVID-19 pandemic. In this context, the NPCE strongly support the proposed regulations on serious cross-border health threats and on the extension of the mandate of the ECDC.
However, one aspect that has not yet been sufficiently addressed in the proposed regulations is mental health. The reinforcement of the crisis preparedness and response mechanisms proposed for the EU requires mental health to be integrated and imbedded in the transformation foreseen in the health and social services. Within the ongoing pandemic, the risk increases for mental health disfunctions, both individually and socially. The COVID-19 pandemic and the associated measures to prevent the spread of the virus place an extraordinary psychological burden on citizens in Europe. It is known from psychotherapy research, that the longer a crisis, a conflict, and a life-threatening event last, the more likely it is that the psychological resistance and regeneration will be overwhelmed and the more likely it is that mental illness will result. This risk can increase significantly by the occurrence of other risk factors. It is likely that the COVID-19 pandemic will exacerbate or even trigger mental illness when psychological vulnerability already exists. In addition, existential fears, unemployment, and short-time work can also endanger mental health in the long term. Depressive disorders, anxiety disorders and stress disorders, alcohol dependence, suicides, obsessive-compulsive disorders, and psychoses may also increase. It is yet uncertain what long-term health consequences are associated with a SARS-CoV-2 infection which include not only physical problems but also psychological suffering and neuropsychological consequences. The EU-wide availability of welfare state supportive services will have a decisive influence on whether the health and economic consequences of the pandemic and its psychological effects can be absorbed. A strong need of extra resources to cope with the long-term mental health consequences will be required at national and EU level. We all agree that mental health is relevant and will be a key factor in overall response, recovery and resilience within crisis. We know and believe that regulations are essential to move from strategic intentions at EU level to operational transformation at country level.
Therefore, a greater consideration to mental health impacts should be given within the proposal, foreseeing technical mental health expertise to support early detection and assessments of events as well as providing support on prevention and control of potential psychological disfunctions.
This would create the basis for collecting data that would be helpful in setting up health and social systems, strengthening preventive measures, and providing sufficient care services for people with pre-existing mental health conditions and illnesses, mitigate and reduce the impact of the ones resulting from the events. This is particularly important because mental illness affects the ability to work, is the biggest factor in early retirement, and thus, poses a significant threat to productivity in the European Union. To achieve this aim, a definition of 'other special health issues' could be included in the proposed regulations: "'other special health issues' means any effect on physical or mental health associated with communicable diseases or with any other cross-border threat to health;". This would allow data collection to identify an increase in mental illness during and as a result of a pandemic and facilitate resulting research and allows the ECDC to make recommendations on prevention and healthcare capacity towards the Member States.
The NPCE would be delighted if this proposal is taken into account during the legislative process.
NPCE signs Joint Statement calling for more action on mental health in Europe
Much more discussion and action at European level are needed to underline the importance of mental health as well as the link between mental and physical health. Evidence shows that physical and mental health related problems are closely related. Mental health is central to the lives and well-being of all people, their work, the societies and the economy.
21 European organisations, including the NPCE, have signed a Joint Statement calling for more action on mental health in Europe. The signatories urge the European Institutions to ensure parity of esteem, the principle by which mental health must be given equal priority to physical health, to take a life-course approach to mental health, to pay stronger attention to mental health in the workplace and to improve mental health treatment in primary care settings.
You will find the full statement here: Joint-statement on mental health for the EU Health Policy Platform
Proposal for a revision of the Professional Qualifications Directive
There is an ongoing discussion at the European level how Europe can meet the demand for highly skilled people in the health care sector in future and how it can become easier for professionals to find skilled jobs across Europe. The Professional Qualifications Directive sets the framework for professionals to start a new business or to find a job in another Member State. On 19 December 2011 the Commission has adopted a proposal for a Directive of the European Parliament and of the Council amending the Professional Qualifications Directive (Directive 2005/36/EC). The proposal is expected to be agreed by the European Parliament and Council by end of 2012. Deadline for amendments is 15 October 2012.
Key elements of the proposal
- Introduction of a European professional card. The card aims to facilitate temporary mobility and to provide the possibility to easier and quicker recognition.
- Reduction of the deadlines for obtaining the recognition of qualifications.
- Information in one place about the documents required for recognition and online recognition procedure.
- Possibility of partial access to a profession, where the activities covered by a regulated profession differ from a country to another.
- Introduction of an alert mechanism between competent authorities to detect and avoid abuse.
- Introduction of common training frameworks and common training tests.
Proposal for a decision of the European Parliament and of the Council on serious cross-border threats to health
On 8 December 2011, the European Commission adopted a legal proposal to better protect European citizens from a wide range of serious cross-border health threats. These can be biological, chemical or environmental in nature. Existing rules on preparing for and managing health emergencies will be strengthened and the Health Security Committee will be given a stronger mandate to react in a crisis. The main measures proposed include to extend the existing co-ordination mechanism for communicable diseases to all heath threats caused by biological, chemical or environmental causes and to agree on European wide emergency cross border measures when a crisis results in large scale mortality and national measures fail to stop the disease from spreading.
The ENVI adopted an amendment, amendment 68 to Article 4 - Preparedness and response planning – paragraph 2 – point I with the following extension to the text of the commission: these shall also relate to preparations in the field of psychosocial emergency care.
The first reading in the European Parliament is expected in December.