Mental health policy and practice across Europe: an overview

Tackling social exclusion 43
and Sweden. The general prison population has risen in all six countries.
Priebe et al. suggest one reason for the increasing size of the prison population
is the growing tendency towards ‘risk containment’ in twenty-first-century
European society. In this sense, the rise in prison numbers and in compulsory
institutionalization of people with mental health problems are part of one
risk-averse trend. Although a citizenship approach requires equal rights and
responsibilities for people with mental health problems – including taking
responsibility for crime whenever someone is mentally competent – it seems
that investment in incarceration is taking the place of investment in support for
participation in social networks and civic opportunities.
Setting priorities
A key question is: what practical, policy and legislative changes need to be
introduced in order to eliminate this unfair experience of social exclusion by
people with mental health problems? As dimensions of social exclusion are
broad and ‘interactive’, responses must also be diverse and multi-agency. The
recent policy recommendations from the United Kingdom’s Social Exclusion
Unit (2004) included a 27-point action plan for major government departments:
health, work and pensions, finance, education and employment. At
the international level, the World Health Organization’s (WHO) European
Ministerial Conference on Mental Health in Helsinki in January 2005 prioritized
tackling stigma, discrimination and inequality, and the empowerment and
support of people with mental health problems, as well as stating social participation
and action against discrimination as major action points (WHO 2005).
The European Declaration on Mental Health and its Action Plan for Europe was
endorsed by the 52 member states of the WHO European region.
Both the Action Plan for Europe and the United Kingdom’s Action Plan
address a range of issues including discrimination, poverty alleviation, access to
appropriate services and support, and finding and sustaining employment.
Housing, education and inter-agency cooperation also feature prominently in
the Action Plan. However, while such documents may state that they are targeting
stigma and discrimination it is possible to question how high a priority this
actually is, and how it is best achieved. As this chapter addresses social exclusion
from the perspective of a lack of basic or enforceable rights due to discrimination,
the following sections focus on why this should be the major priority,
and discuss practical methods of achieving it.
Improving the bottom line and human rights
It might seem intuitively sensible to begin the challenging task of overturning
exclusion by improving the ‘bottom line’ of life and human rights. There are
opportunities: as European Commissioner for Employment and Social Affairs
Anna Diamontopoulou put it, ‘the European Union was born from the ashes of
the holocaust’ (speech to the Italian Presidency Conference, Milan, 2003). The
determination to avoid a repetition of past abuses is reflected at EU level in the