Gezonde samenleving, gezonde mensen!

PLATFORM TEXT (December 2006)

Healthy Society, Healthy People!

Humanistisch-Vrijzinnige Vereniging vzw
Sarah Beweging (Sarah Movement)
Holebifederatie (LBG Federation)
Netwerk Psychiatrie en Samenleving (Network Psychiatry and Society)
Els Ooms, assistant Psychoanalysis Dept. (UGent)
Prof. Ronald Commers, ethicist (CEVI, UGent)
Prof. Filip Geerardyn, psychoanalyst (UGent)
Prof. Fred Louckx, health sociologist (VUB)
Prof. Walter Vandereycken, psychiatrist (KUL)
Prof. dr. Jan Vranken, sociologist (OASeS, UA)

Although the majority of people in Belgium lead prosperous lives, 15% of the population live below the poverty line. The prescription of antidepressants has almost doubled in the last ten years. Still, the number of people with mental complaints remains high. Many people call themselves happy, and yet there are seven suicides a day. Mental health in our country seems to be deteriorating fast. Research has shown that many individuals and groups are structurally excluded. The quality of many people’s lives is undermined by a sickening logic. With ‘Healthy Society, Healthy People!’ HVV and its partners are campaigning against these tendencies. Belgium finishes 9th on the Human Development Index. Good news, one would think. Unfortunately, scoring high on the public health, knowledge and standard of living lists does not necessarily result in high scores on mental well-being.

Our mental health is endangered! One in six Belgians have suffered from depression. 6% are chronically depressed. One out of twenty-five have tried to end their lives. There are more than 200 suicide attempts a day. In Flanders three people a day commit suicide. In Belgium there are seven suicides a day. It is estimated that 10% of adolescents have tried to maim themselves, usually with the intention to end their lives. One in eight Flemings suffer from serious mental problems. The figures are depressing, to say nothing about the people with sleep problems (20%), anxiety disorders (6%) or somatic complaints (8%).

All over the world states try to reduce their health budgets. The latest OECD-figures show that public financing of health care in Belgium was reduced from 78.5% in 1995 to 71.1% in 2003. As a result, private financing increases and some groups are excluded. Mental health improvement has been part of the objectives in the Flemish government agreement since 1999. And although important measures have been taken in the past few years, they remain insufficient. Nearly all initiatives have been aimed at the individual, psychological level. Much attention has been paid to patients and therapists, relatives, suicide attempters and general practitioners. The increase in jobs at the Centres for Public Health and the recent ‘Fit Mind, Fit Body’ campaign are valuable examples, which, unfortunately, only promote an individual approach.

This humanist platform believes that an inclusive welfare policy cannot ignore the social dimension of our mental health! Extensive research has shown that structural and social factors that exceed the ‘influence of the individual’ co-define mental health (disorders). What is my level of schooling? Do I live above or below the poverty line? Am I married or single? Do I live in the north or south of the country? What is my lifestance? What kind of family was I born into? What kind of values and feelings belong to my environment? Am I employed or unemployed? What kind of job do I have? All these factors may influence our mental health. What is more, social expectations of success are so high these days that many people are filled with a constant sense of failure. The same pattern can be found in mental health care. A person who ‘feels bad’ is identified as a ‘sickly person’. The pharmaceutical industry benefits from this situation, of course. The stress economy, which all of us, with or without jobs, are caught in, closes the circle.

The humanist platform wishes to break through the dangers of this creeping culture and demands sustained attention for the following social factors and tendencies:

Welfare does not automatically mean (mental) well-being. The economic rat race has made all aspects of our lives extremely stressful. Flexibilization and restructuring take their toll: depression, burnout, anxiety and panic attacks, chronic fatigue syndrome (CFS), are clearly stress-related and their social dimension cannot be denied. Making money has replaced giving meaning.
Imagine being a fifteen-year-old lesbian... In spite of the emancipation of LBGs, heterosexuality is still considered to be the only ‘normal’ sexual orientation. You are a heterosexual until the opposite is shown. As a result, LBG adolescents are still the largest high-risk group for mental health problems, especially girls and low-schooled individuals. The rate of depression among LBGs is twice as high as among other groups of youngsters. Between 33 and 45% of LBGs have suicidal thoughts. 25% of lesbian girls attempt suicide. People judge normality and abnormality without realizing they are setting themselves or their group as the standard, with all its consequences.
The pharmaceutical industry does not only produce pills, it also invents new diseases! The propagation of and trading in new diseases has taken on alarming proportions. Under the guise of information and education the pharmaceutical companies try to influence the media, the general public and the medical world by promoting the use of ‘their’ medication for those ‘new’ diseases. Their aim is to scare the general public. “So you thought you were healthy? Wrong! Statistically speaking, the chance you are suffering from ‘our’ disease is X per cent.” The so-called erection problems among 40-to-50-year-olds are a typical example. It was a hype started by the manufacturer of ... Viagra. And have you noticed how social anxiety disorder or ‘social phobia’ is highlighted?
In biopsychiatry the patient is often considered to be a thing that does no longer function and needs to be ‘repaired’ because of the economic and social order. In this kind of psychiatry the patients as specific individuals, with their own history and clearly defined symptoms within a concrete context, have ceased to exist. So has the former biopsychosocial model. Tinkering with someone’s neurotransmitter system has become more important than listening to the patient. Forcing people to accept this new model affects their dignity and reduces their mental health to a chemical problem.
All things of value are fragile and defenceless. How much do values matter within the neoliberal model? True values are being sold out while market ‘values’ are colonizing our environment: the labour market, sports, leisure, the media, our circle of acquaintances, the world of cyber games. Winning is what counts, at all costs. Compassion is for softies, fair play for losers. Cooperation only serves individual interests. Giving means taking. Interhuman relations have become networks that can further your career. I consume, therefore I am. Loving someone is foolish. Those who do not follow this harsh logic will get crushed under the ‘steamroller of values’.
Poverty and mental problems often go together. People with mental problems can easily sink below the poverty line. Poor people will easily develop mental health problems. The link between poverty and depression is obvious. Below the poverty line, the average of depressive complaints which prevent normal functioning in society is 9.9%: a percentage significantly higher than the average above the poverty line (6.9%). Below the poverty line, the risk of depressive complaints among women is 40 to 370% higher than among men. The number of depressive complaints among unemployed people living in poverty is considerably higher than among impoverished workers. People with little job security and little or no control over the planning and execution of their tasks suffer from depression more easily. People who have missed the economic boat can easily be submerged in physical and mental distress. By disregarding the social and structural factors which affect our mental health, the exclusion of large numbers of people is perpetuated. We sacrifice them to the harsh logic of neoliberalism. Ignoring these factors condemns our mental health policy to ineffectiveness. But sitting down to meditate amongst the ruins of the social and mental health care system is not an option! Judging by our Gross National Product, our society is perfectly capable of redistributing wealth so that more people will be able to enjoy the benefits of our welfare state.

The signatories of this platform advocate the creation of psychosocial well-being within a socio-economically just society. The present policy is far from firm. Measures are fragmented. Resources for a broad and thorough approach are insufficient. Therefore we recommend:

That public health policy should take more account of supra-individual, social factors. Psychological well-being always has social dimensions.

Need for more intersectorial/departmental consultation (e.g. Mental Health Centres - LBGs; health care - welfare).
Working conditions: less flexibilization; reduction of stress factors; limitation of night work.
Loneliness: more investment in civil society and its organizations; more democracy at the basic level and increase in citizen involvement in policy development.
Ensure accessibility and affordability of mental health care (e.g. recognition and reimbursement via RIZIV of psychological and psychotherapeutic treatments, preservation of diverse therapeutic models)
Sensibilization and breaking taboos around normality/abnormality, adequate/inadequate behaviour, being different ... outside the psychiatric environment (eg through media campaigns).

That more resources should be allocated to scientific research.

More research into factors influencing the higher prevalence of suicidal thoughts, suicide attempts and suicides among specific groups (LBGs and the poor).
More independent, government-funded research.

That the subject should be given the central position in society and in health care relief.

No indirect health care circuits of experts, but immediate attention to the patient. Paying more attention to some kinds of self care and psychosocial assistance.
Increasing the duration and quality of therapeutic relationships. Critical analysis of the use of ‘forced confinement’.
Independent investigation into the application of biological methods of treatment (medication, ECT).
Putting a stop to social and ethnic prejudices in mental health care.

That a just society free of poverty should become one of people’s fundamental rights.

No one must live below the European poverty line of € 777.
Ensuring the affordability of health care, e.g. by putting an end to the increase in the patient’s financial contribution.
No privatization of health insurance to avoid exclusion.
An integrated prevention policy which shows concern for the problems and opportunities of the weakest socio-economic categories.
A substantial increase in the income that a disabled person’s domestic partner is entitled to.

That more attention should be paid to the relationship between health care, the pharmaceutical industry and the academic world. Education and in-service training:

Introducing a critical attitude and social dimension into the education and in-service training of doctors.
Providing the experts involved with objective and independent information.
Introducing laws and ethical codes related to the sponsoring of training, meetings, congresses etc. for all professional categories involved. Introduction of regulation for possible conflicts of interest between the pharmaceutical industry and the health care sector (e.g. at lectures).

Research:

Institutions such as FWO and IWT should be allocated more resources to be able to do more independent research.
Stricter norms for the registration and promotion of medication. Recognition of new medication must be linked to the added value of each product.
Ties to the pharmaceutical industry must be exposed. Financial interests of researchers and clinicians must be regulated.
The pharmaceutical industry must be obliged to allocate part of its profits to independent research and in-service training.

Translation: Paul Massant