This article is the product of a POLITICO Working Group, presented by Janssen.
Europe has some catching up to do when it comes to addressing unmet needs in mental health.
In many places, the surge in demand for mental health care overshadows the available services, with the coronavirus pandemic revealing and exacerbating a critical — and widening — gap in care.
It’s a costly matter.
Worldwide, around 12 billion work days are lost every year due to depression and anxiety, costing almost $1 trillion, according to a report last month by the World Health Organization and the International Labour Organization.
In European countries, the economic costs of mental ill health can exceed 4 percent of gross domestic product (GDP), according to the Organisation for Economic Co-operation and Development. These are driven by reduced productivity and participation in the labor market, as well as direct costs outside of the health system, such as in social security programs.
But for many in Europe, access to mental health care services is a challenge, one that’s on the European Commission’s radar.
Last month, Commission President Ursula von der Leyen announced the Commission is working on a new initiative on mental health, underscoring the importance of having “appropriate, accessible … and affordable support.”
For many Europeans with mental health concerns, it’s a plan that can’t come soon enough.
Big needs
The coronavirus pandemic continues to have a substantial impact on people’s mental health.
The estimated prevalence of anxiety and depression in France, for instance, nearly doubled in early 2020, according to Doron Wijker, policy research officer at the OECD’s Directorate for Employment, Labour and Social Affairs.
More recent figures suggest the situation is not yet back to its pre-pandemic levels, either. According to survey data from May 2022, though self-reported symptoms of depression have been decreasing at a general population level, 15 percent of France’s population still show indications of depression, compared with 10 percent before the pandemic, Wijker said. And when it comes to anxiety, one in four people in France show indications of anxiety compared with 14 percent before the pandemic.
“While estimates of the prevalence of anxiety and depression provide an incomplete window into the mental health and wellbeing of a population, these figures demonstrate the magnitude of the challenge,” Wijker told a recent POLITICO working group on mental health in France.
The mental health of young people across many European countries has taken a particular hit; in many, young people reported symptoms of depression at rates nearly double those of the general population, she said.
The pandemic’s impact on mental health services was a double-whammy: it simultaneously drove up the need for the services, all the while eroding an already short-staffed, burnt-out health workforce.
Many health care workers are leaving the field due to their own poor mental health, said Natasha Azzopardi Muscat, director of the division of country health policies and systems at WHO/Europe, during this year’s European Health Forum Gastein.
Already, countries in the WHO’s European Region are having to deal with insufficient recruitment of health workers in mental health services, according to WHO/Europe.
All this could spell further trouble for patients’ access to care.
Long waits
Backlogs and long wait times for mental health services were already a significant issue long before the pandemic.
Across the OECD, even before the crisis, two out of three people seeking mental health care reported difficulty accessing it, Wijker said.
And within the bloc, mental health care ranks as one of the most unmet health needs, according to an April 2021 report from Eurofound.
These days, the wait time in France to see a child and adolescent psychiatrist, for instance, is between six months and two years, according to Bruno Falissard, psychiatrist and former president of the International Association for Child and Adolescent Psychiatry and Allied Professions.
Though kids and teens make up about 20 percent of the French population, there are only about 500 psychiatrists catering to this group, compared with around 10,000 adult psychiatrists, Falissard told the working group.
The gap in mental health care provision did not arise overnight.
“We have a historical situation of underinvestment, and this is not a French problem — this is a global problem, and the needs are increasing and the offer is decreasing,” said Frank Bellivier, ministerial delegate for mental health and psychiatry at France’s Ministry of Health and Prevention.
Finding ways
The coronavirus pandemic pushed countries to urgently look for ways to try to mitigate care gaps in health care, and some of those may be here to stay.
For one, there was a surge in the use of telemedicine and digital health services, including for mental health.
A key lesson from the COVID crisis, Bellivier said, is that telepsychiatry works.
“We observed a huge development of telemedicine in psychiatry and I think this is a positive experience, both from the health professional point of view but also from the patients’ and families’ point of view,” he said.
But the experience also raised important concerns and challenges, including on the issue of access and the need to train health professionals and users of such technologies on what can be reasonably expected from telemedicine and digital tools, he said.
Digital technologies have the potential to reduce the high unmet needs for care. But in order to ensure their positive growth is sustained, they must be integrated into the broader mental health system, said the OECD’s Wijker.
And with the proliferation of freely-available digital tools and apps, quality assurance is a key issue, she said.
“A number of countries are taking a more proactive role in this space, for example by assessing which digital therapies can be covered under existing psychological therapy programs,” she said.
This article is part of POLITICO’s Evolution of health care series which is presented by Janssen. It is the product of a Working Group and was produced with full editorial independence by POLITICO reporters and editors. Learn more about editorial content presented by outside advertisers.
