Mental health policy and practice across Europe: an overview

Housing and employment 281
European Commission’s report on social inclusion (European Commission
2003d) highlights the situation of people with mental illness in the new
member states. In these countries, for example, it appears that those with
mental health problems are among the most likely to live below the poverty
line, to receive inadequate social benefits and to be isolated from the workplace
(European Commission 2003a). There is a lack of measures in place to
combat this deprivation and although, for example, new European Union (EU)
initiatives to combat discrimination will address employment, neither EU
measures nor national legislation, particularly in the new member states,
adequately tackle discrimination in access to housing (European Commission
2003b).
The plans of the new member states to combat social exclusion (Joint Inclusion
Memoranda) all refer to improving the situation of people with disabilities, but
there are few, if any, references specifically to people with mental illness. Only a
few of these countries (e.g. Malta and Slovenia) report special attention being
given to the housing needs of disabled persons and people with mental health
problems. This ‘invisibility’ of people with mental illness is also reflected in
policy documents which have adopted a mainstreaming approach to disability,
shifting away from disability-specific programmes (e.g. European Commission
2003c).
The EU’s strategy to combat social exclusion has consistently put employment
at its centre and in recent years has also emphasized access for all to decent
and sanitary housing. Of course, employment and housing are linked – access to
housing is fundamental to enabling people to take up job opportunities – and,
for example, the support needs of many homeless people can make labour
market reintegration inappropriate.
The Joint Report on Social Inclusion (European Commission 2003d) calls for the
development of a truly multidimensional approach to meet the needs of disadvantaged
groups, and echoes demands for more integrated approaches to
tackling homelessness (Edgar et al. 2002) and unemployment (Pillinger 2001).
The Social Inclusion report gives a new prominence to increasing access to services
for people with mental illness; although deinstitutionalization has been a
common feature of the last two decades and more in the EU, the availability and
quality of support services has been very variable (Quilgars 1998; Freyhoff et al.
2004). Much of the rest of this chapter will be concerned with emphasizing and
illustrating how community-based care services for people with mental illness
must be developed and coordinated with other sectors such as housing and
employment.
Policy and professional perspectives
The Council of Ministers at Nice in 2002 urged policy-makers and service providers
to adapt to the needs of people suffering from social exclusion and to
ensure that front-line staff would be sensitive to these needs (European Council
2003). However, housing and employment have often been seen, if at all, as
marginal to the objectives of health and care services, with a lack of clear
responsibilities for vocational and housing outcomes. Fakhoury et al. (2002)