Committee on Public Health Ordinary meeting
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SANT European Parliament
Follow its sittingsAbdirahman Mahamud
Next. And mostly we rely on information coming from what we call the epidemic intelligence from open source that looks in social media, media. Those are signals. Those are not confirmed cases. And we go to the Member States to verify.
Next slide. I just want, because it's attracted a lot of media and questions, how does WHO try to triangulate every signal? We look at the relevance, the credibility, the context it's happening, and then triangulation. And then we make a decision where we discard that signal or we report and go back to the Member States. Next slide.
And that's just an example how we communicate via email to the NFP. This was somewhere in another region. And there was also a misunderstanding that the case has to be a public health event of international concern. What we worry a lot is the international disease spread where there's a human case, vector, or goods that can be contaminated. So a lot of the communication between us, it doesn't have to be a public health emergency of international concern.
Next slide. And then from there, once we verify, we inform the Member States, State Parties, through password-protected platform called EIS. Next slide. And for the last 25 years, we've been informing also the public in our website called Disease Outbreak News. So this is how the system works.
And I know you are not interested how the system works, but I just wanted to give you the legal mandate and how we do the business on a daily basis. So, next. Coming to the main event is, as Chair you have alluded, on 2nd October we detected media report, as you alluded, the lab worker had onset of symptoms on 29th, hospitalized and died of 2nd October. On 3rd and 5th, we sent a verification request under IHR Article 10. Next slide.
From there, we received a feedback telling us they have tested, no test of high-threat pathogen was detected on 6th. And 7th and 8th, because of the media report of a second alleged case, we also sent another verification request.
So at this time we got a detailed report from our Russian Federation NFP. They have conducted 5,500 cases for testing for virology, bacterial, all the common and uncommon diseases. And from those 5,500 they were only able to pick small cases of COVID, rhinoviruses and the flora. Contact follow-up up to October 9th has not revealed any linked secondary cases. Next slide.
I think you all know and we provided those information on our disease outbreak news issued on September. We to say the least we offered our support to them and a five Rospotrebnadzor organization have conducted three research and involved the measures so a lot of extensive work done in the field. Next slide. So, in summary what we feel the green part is the reassuring that no plague, the lab worker was vaccinated and had the personal protective so it's reassuring that all the contact tested have not detected any high-threat pathogen. We have not found or the government has not reported any additional linked if someone died had onset on 29th September and died the second today is 15th October.
If there were respiratory pathogen we'll have found either in Russia or the neighboring countries if this was a new disease of unknown etiology. However, a big red, we still don't know what that lab worker died of. We can't determine if the seven days is enough. We don't know the occupational setting that this patient the worker was exposed and we have limited confidence on the source and mode of exposure remain uncertain. So it's not all green but we have a number of reds that still following up with the Russian Federation.
Next slide. And just to just a summary of what how we communicated from DG statement social media to all the you have been following this event and WHO's fully applied the international health regulations. So I stop here, happy to answer your questions and thank you once again for inviting us.
Adam Jarubas
Okay, dear colleagues we're starting with the discussion and first round of coordinators as a first Mr. Gerald Hauser, please.
Gerald Hauser
Danke Herr Vorsitzender, Herr Direktor, ich habe eine konkrete Frage, das ist ja nicht der erste Laborunfall, denke an Wuhan, wo auch Viren freigesetzt wurden. Das Problem der Gain-of-Function-Forschung ist ja, dass Organismen genetisch verändert werden und damit potenzielle Risiken verbunden sind und deswegen die Frage an Sie: Wie weit geht diese Forschung? Gibt es, gibt es da nicht notwendige Grenzen, dass man sagt, wegen auch wegen der vielen Gefahren, auch möglicherweise der tödlichen Gefahren, muss diese Gain-of-Function-Forschung auch limitiert und begrenzt sein? Wie sieht das die WHO?
Aurelijus Veryga
Dėkoju pirmininke, na Rusija nėra ta šalis, kurios pareiškimais ar informacija reikėtų tikėt ir pasitikėt.
Nei žmonės, nei jų gyvybės ten niekada niekam per daug nerūpėjo ir mes galim prisiminti Černobylio katastrofą, kiek kiek laiko buvo slepiama informacija, kiek per tą laiką žmonių nukentėjo. Todėl į šią situaciją, nepaisant to, ką Rusija pasakoja ir kokius duomenis teikia pati, reikėtų žiūrėt ypač rimtai, todėl kad šaltojo karo metu Rusija turėjo visą laboratorijų tinklą, kurios dirbo prie bakteriologinio ginklo ir maras, maro sukėlėjas buvo vienas iš tų, kuris buvo tyrinėjamas ir tas tinklas iki šiol egzistuoja. Tai mano klausimas yra tiek Pasaulio sveikatos organizacijai, tiek aišku Europos Sąjungos institucijom, kurios yra atsakingos už infekcinių ligų kontrolę, ką galima padaryti kartu bendradarbiaujant, kad daugiau sužinot ir valdyti situaciją negu tiktai tai, ką Rusija pati pateikia ir kaip teisingai buvo pastebėta Pasaulio sveikatos organizacijos atstovo pranešime, daug klausimų lieka neatsakyta. Ką mes galim padaryti kartu, kad šitą riziką suvaldyt?
Olivier Chastel
Merci Monsieur le Président. Alors chers collègues, moi je veux évidemment d'abord remercier le représentant de l'OMS pour sa présence aujourd'hui parmi nous, pour le temps qu'il nous consacre. Et je prends la parole au nom de mon collègue, coordinateur du groupe Renew, Vlad Voiculescu. Donc soyons francs, les informations concernant ce décès inexpliqué en Russie ravivent inévitablement, d'aucuns l'ont déjà dit, les inquiétudes que nous avons connues pendant d'autres périodes et notamment la période COVID. J'ai évidemment pris connaissance du communiqué de l'OMS sur cette situation et toutefois nous savons à quel point les incertitudes entourant ce type d'événement peuvent alimenter les rumeurs, la désinformation et notamment via les réseaux sociaux.
Et dans ce contexte, j'aurais voulu savoir quelle était la stratégie de communication de l'OMS. Qu'est-ce qu'elle a mis en place pour lutter contre cette désinformation et garantir au public un accès rapide à des informations fiables et transparentes. D'autre part, six ans après le début de la pandémie de COVID-19, pouvez-vous nous donner un exemple précis d'une mesure que l'OMS prend aujourd'hui face à ce cas en Russie et qu'elle n'aurait d'ailleurs pas prise en janvier 2020. Merci d'avance.
Ignazio Roberto Marino
Thank you very much Chair and thank you to the Director General of the WHO for his presentation today. I am really concerned about what happened and the fact that WHO learned about this serious accident first from the media and then after pushing the Russian authorities got more details. I don't know how many in this room know that that Russia as well United States are still keeping vials of smallpox in their lab because when the smallpox was eradicated by our, you know, treatment with the vaccine and so disappeared from the planet, these superpower country decide to keep sample of live smallpox because maybe they need to use it for some kind of war.
And I wonder if we have this lack of transparency is really is really bad. And and I also know that these two labs where the smallpox is kept are authorized by WHO. I wonder why WHO does not ask to Russia and United States to destroy these viruses because if that via would be broken will be a disaster because all the people born after 1975 has zero antibodies against smallpox. Thank you.
Catarina Martins
Muito obrigada, senhor presidente. Queria agradecer muito ao diretor-geral da Organização Mundial de Saúde o tempo para nos prestar esclarecimentos. Acho que, enfim, estamos todos muito preocupados com esta com este surto de peste o que sabemos na Rússia, é uma coisa que nenhum de nós esperava que pudesse estar a acontecer. Estamos ainda mais preocupados por percebermos que a informação está a ser escondida. Eu tenho a certeza que a Organização Mundial de Saúde está a fazer tudo o que pode para dar o melhor conhecimento à saúde pública de todos os países para podermos agir.
E eu se calhar centrava a pergunta no que é que nós podemos fazer enquanto União Europeia. Nós sabemos que a Organização Mundial de Saúde tem estado sobre ataque, a administração Trump mas não só tem retirado meios à Organização Mundial de Saúde e talvez neste momento seja importante perceber o que é que a União Europeia de um modo muito prático pode fazer para reforçar a Organização Mundial de Saúde, por um lado, e por outro lado também o que é que pode fazer para quebrar este bloqueio de informação da Rússia sobre o que está a acontecer. Porque seguramente não podemos só ficar à espera, temos de saber ser os parceiros de que a Organização Mundial de Saúde neste momento precisa para proteger a vida de todos nós. Muito obrigada.
Ondřej Dostál
Děkuji, pane předsedo, biologické zbraně byly za studené války vyráběny na obou stranách a po rozpadu Sovětského svazu zůstaly na území nástupnických států jak ty zbraně samotné, tak vědci a laboratoře schopné je vyvíjet a není jisté, zda se přes veškeré úsilí podařilo dostat je přes kontrolu. Na rozdíl od jaderných zbraní je poměrně snadné ty biologické zbraně přenést do rukou teroristů či nestátních aktérů. Chtěl jsem se zeptat, existuje nějaký kanál, kterým by bylo možné ze strany WHO zjistit, když nějaký stát má podezření, že byl napaden biologickými zbraněmi, ale nechce to říkat veřejně, aby nešířil paniku, aby tato informace byla včas WHO předána a případně zda pro to můžeme udělat i my něco na území Evropské unie. Díky.
Adam Jarubas
Thank you, is there anyone who wants to take the floor? If not, Dr. Mahamoud could you answer the question posed by the MEPs please?
Abdirahman Mahamud
Thanks so much, honorable members for that informative questions. Some of them are beyond WHO as the secretariat. We are the secretariat of the member states and we implement your wishes. So we have the World Health Assembly that passes resolutions what us as a secretariat is implement is is what the member state have agreed secretariat. So a lot of the points you have raised will be addressed through the resolutions of the member state.
As the secretariat we don't have, we implement what the member state has empowered us to do. And unfortunately some of the points you raised whether it's related WHO implementing or policy the IHR we don't have that power. IHR relies on the verification from the member state but as I said earlier, we do triangulate.
We don't rely on only one information. We try to triangulate from all the contacts we have from the neighboring regions, from the neighboring Republic within and from other. So this is WHO is trying to find a needle in a haystack of misinformation. And I like the question you have asked, how do we keep the world safe and informed without causing unnecessary panic? It can easily WHO can come out and say, oh, this is the next pandemic or that.
So what we do to answer your question about how we handle infodemic and what we have learned is communicate in a transparent way. This is what we know, that's what we don't know, and this is the uncertainty. People are adults. You are policy members, you represent states. So you can make informed decisions based of rather than us summarizing this is our risk assessment and we believe based on the information provided by one member state is say, here is the what was provided, here is what we think it is and these are the remaining questions.
Unless we answer those questions we cannot have confidence on the information. Thanks to the member state, some of the amendment to the IHR in 2024 has slightly empowered us. If you can remember the IHR 2005 has really relied tightened WHO's hand as the secretariat. So we heavily relied on what the member state only reported us whether in the COVID. Based on the lessons learned during COVID, those amendment happened 2024.
But we need the pandemic accord. So I call for your support as EU representative, as the parliamentarian, can we ensure because the next pandemic we don't know when it's going to happen, but unless the whole world come together and approve the annex to the pandemic accord we will be struggling. Let's say if this was the next pandemic. So I just wanted to reiterate again as a secretariat we implement what the member states give us through a resolutions or the amendment to the IHR. The uncertainty remains on the smallpox is a WHO resolutions where WHO secretariat we do monitor, but it's you as the member state to decide what the world needs.
We really don't want public health to be geopoliticized and it end up to the Cold War era where every member state rather than coming in a dialogue, transparency and science being used the secretariat we have seen now. And as you remember in previous Cold War several countries left WHO. The world needs WHO, we need your support and advocacy based on science rather than geopoliticizing. If it's geopoliticized, unfortunately what's going to suffer is the world population and us as the secretariat. In terms of relying the gain of functions, we do believe WHO we issued a guidance on biosafety and biosecurity and there's a World Health resolution to address that.
But we don't have the enforcement. WHO is not the police to enforce. We issue the normative guidance and what's the best to implement. It is you the member state who needs to implement. So it's not the lack of resolutions whether it's the gain of functions or misuse or the biosafety and biosecurity of the lab.
We have not been equipped and we don't want. We want member state to collaborate and remove politics from public health. And I know the two cannot be separated when there's an active going conflict where thousands of civilians are dying, but for us is empower us to do the work we do and please and please support the mandate of WHO. We are under attack where we can last time we went through a massive cut 25% of WHO workforce have been had to let go because of the financial.
So my three message is really good questions, but we need to be empowered. Help us in finalizing the pandemic accord and the IGWG and support WHO. I thank you.
Adam Jarubas
Thank you Dr. Mahamud for your time and presentation on that case. Dear colleagues, let's move on to the next point, point four, presentation of the policy department study on in-depth analysis on the use of data for AI in public health. I'd like to ask our guest speakers for taking your seats on the podium. Dear colleagues, this study explores some of the AI technologies applied in the healthcare sector, examines essential EU legal frameworks which facilitating the use of data for development of medicinal AI, and examines some of the key concerns arising in this context. Finally, it presents policy recommendations to address these issues.
The policy department has invited Mrs. Daniela Spajic, sorry for my pronunciation, to present the study. Mrs. Daniela Spajic is a postdoctoral researcher focusing on data protection, privacy and confidentiality issues related to health data spaces, e-health and data sharing at the KU Leuven Centre for IT and IP Law. I will now give the floor to our speaker for her presentation and after to the members for the Q&A session. If you want to take the floor please indicate to me and the secretariat. Mrs. Spajic, the floor is yours for eight minutes please.
Daniela Spajic
Thank you very much. Honorable members of the SANT committee, thank you very much for having me today. The report investigates the possibility to access and use or reuse data under the current EU legal framework for the development of AI in medicine. Artificial intelligence has the ability to transform healthcare for the benefit of both healthcare providers and patients, and therefore implementing a framework that facilitates the reuse of data is pivotal to its advancement. The development and deployment of AI face various challenges and for the purpose of this analysis, the official definition laid down in the AI Act has provided the ground for the analysis, including machine-based systems with varying levels of autonomy.
In the healthcare sector, various AI tools are being applied, considering the potential that AI has to optimize resource allocation, workflow and accuracy in medical diagnosis, as a study on the deployment on AI in healthcare shows. In particular, the evaluation of AI supporting the detection of diseases in medical images presented promising results. For instance, AI-driven medical image analysis can be used for lung cancer screening. Medical image analysis which identifies patterns in medical data such as X-rays can improve accuracy in diagnostics while also reducing the workload for clinical staff. Furthermore, AI facilitating personal medicine and predictive analysis could also support healthcare in the future.
For instance, predictive AI tools can assist in evaluating the risk for patients to develop for instance diabetes or cardiovascular disease, or assessing the demand for services by detecting patients who are likely to need immediate medical assistant or intensive care.
Additionally, AI can be based on the use of data from electronic health records to develop clinical best practices for medical research and more personalized care. Here, the use of large language models can extract medical information from patients' records, help summarize and structure that information. Yet, despite its potential to support better medical and prediction-based diagnosis, it seems that the specific degree of deployment is currently difficult to estimate, given the lack of reliable data. An overarching survey performed with healthcare professionals, healthcare professionals' associations, and hospital representatives showed that the majority of the survey respondents were using AI solutions, though the results seem to incorporate different stages of AI deployment. Some actually deployed AI in their clinical practice, while others used AI in the piloting phase for clinical trials, or the AI system was still under development.
At the EU level, there are multiple frameworks governing the use and reuse of health data. The General Data Protection Regulation has been the key regulation regulating the processing of personal data of individuals. With the creation of the European Strategy of Data in 2020, an important key action outlined therein is the establishment of multiple legislative initiatives aimed at fostering the availability of both personal and non-personal data through common European data spaces. Important frameworks following the strategy include, amongst other things, the Data Governance Act and the European Health Data Space Regulation. The Data Governance Act adopts cross-sectoral governance rules for data intermediaries and also transposes the so-called data altruism concept, which supports the use of data for the common good.
And this mechanism should also be supported under the European Health Data Space Regulation. The European Health Data Space Regulation constitutes the first sector-specific data space regulation in the EU. The aim is on the one hand to improve individual access and control over personal electronic health data in the healthcare sector, and on the other hand to foster the so-called secondary use, including for instance healthcare-related research, policymaking, and personalized medicine. With these objectives in mind, the European Health Data Space Regulation has become the leading framework driving the secondary use of data. In more recent legislative processes, the proposal for a Digital Omnibus has been established to support AI development and simplify the EU's data acquis.
The Digital Omnibus is composed of two proposals: the Digital Omnibus on AI, which as the name suggests is specifically about the AI Act and includes targeted changes.
The digital omnibus on AI entered into force in July this year. The second part of the digital omnibus covering data rules is still under negotiation and seeks to accelerate the availability of data for the development of AI by repealing multiple EU legislations. These include the free flow of non-personal data regulation, the data governance act and the open data directive. These legislations should be migrated with its essential provisions into a new refined data act. Additionally, certain provisions under the general data protection regulation should be amended.
The European health data space regulation has the possibility to enable access and use of electronic health data for the development of AI as it incorporates legal grounds for accessing data amongst which one is explicitly dedicated to AI development. However, challenges occur concerning different aspects. In particular, legal uncertainty remains concerning the interplay between the EHDS regulation and the general data protection regulation such as on the legal basis applicable to AI requires clarification. The data governance act with its data altruism consent seems to introduce a new different standard for scientific research by requiring scientific research purposes in the general interest. Furthermore, to ensure privacy and safety of patients, securing anonymity will be an important aspect under the EHDS.
And to foster trust in the EHDS, securing a proper standard of security for both the data infrastructure and AI is pivotal. So based on the issues identified, the digital omnibus proposal constitutes a possibility to address certain issues. For instance, by clarifying the scope of what scientific research should entail. In that vein, the suggested change to the notion of personal data under the current digital omnibus proposal can increase the problem of defining when personal data can be considered anonymous. It is important to tackle this aspect to ensure that support on proper data anonymization standards can be provided.
The digital omnibus foresees repealing the creation of a rulebook and a European data altruism consent form for data altruism organizations. These organizations require support and a consent form can create alignment across countries to ensure that the standards for consent are maintained throughout the European Union. Additionally, attention needs to be paid to the balancing of interests in intellectual property and trade secrets versus the sharing of health data for the benefit of healthcare. Therefore, devoting efforts to creating legal, organizational and technical safeguards can help in the balancing act whilst ensuring that the spirit of the EHDS is maintained. Finally, allocating responsibilities proves to be difficult in the context of AI.
There are multiple actors involved with diverse backgrounds. Also, physicians may be held liable in particular where treatments may not meet the necessary professional medical standard. A focus on creating reliability of such AI systems that benefit healthcare professionals whilst ensuring that they maintain their medical skills is essential to foster trustworthy artificial intelligence. Thank you very much for your attention.
Adam Jarubas
Thank you, Mrs. Speit.
I open the floor to MEPs, and Aurelijus Veryga as the first, please.
Aurelijus Veryga
Dėkoju, pirmininke, ir labai dėkoju už pranešimą. Išties labai svarbi tema ir labai ačiū už jūsų paminėtus pavyzdžius, kaip dirbtinis intelektas gali prisidėti prie geresnės vaizdų analizės, diagnostikos. Bet sveikatos laukas yra platesnis negu tik medicina ir gydymas. Tai yra ir visuomenės sveikata, ir tos srities tyrimai, ir čia dirbtinis intelektas tikrai galėtų labai labai padėti, nes visuomenės sveikatoj mes nagrinėjam, kaip įvairūs aplinkos veiksniai, gyvensena ir kiti dalykai yra susiję su sveikata ar ligomis. Tai kas jūsų požiūriu čia šitoj srity šiuo metu labiausiai gal trukdo ar trukdytų įgyvendinti tokį tikslą, tai yra pasitelkti dirbtinį intelektą analizuoti įvairius rizikos veiksnius ir jų poveikį sveikatai, nes tikėtina, kad pasitelkus metaduomenis būtų galima nustatyti daugybę dalykų, kurių gal mes net neįtariame egzistuojant poveikį žmogaus sveikatai.
Gerald Hauser
Danke, Vorsitzender. Danke für die Präsentation. Für viele Menschen ist der Schutz der personenbezogenen Gesundheitsdaten so wesentlich und wichtig. Das wurde ja heute auch mehrmals angesprochen. Wie schaut das jetzt in der Praxis aus?
Ich beziehe mich auf eine Anfragebeantwortung von Kommissar Várhelyi vom 27. Februar, wo er mir mitteilt, dass auf nationaler Ebene über die nationalen Rechtsvorschriften die Möglichkeit besteht, Einspruch gegen die Weiterverwendung, Weiterverbreitung der höchstpersönlichen Gesundheitsdaten einzulegen. Das ist also national geregelt. Wie schaut das aber im europäischen Gesundheitsdatenraum aus, wo also Gesundheitsdaten grenzüberschreitend ausgetauscht werden? Und hier teilt mir der Herr Kommissar mit, ich zitiere: "Die EHDS-Verordnung, also die Verordnung zum Gesundheitsdatenraum, ermöglicht auch die Weiterverwendung bestimmter Kategorien von Gesundheitsdaten für Forschungszwecke und bestimmte andere Zwecke. Eine solche Weiterverwendung erfolgt nur bei pseudonymisierten oder anonymisierten Daten und mit Hilfe strenger Schutzmaßnahmen."
So, und jetzt meine Frage: Wenn eine Person Einspruch erhebt zur Weiterverwendung seiner höchstpersönlichen Gesundheitsdaten im europäischen Gesundheitsdatenraum, kann er da hundertprozentig sicher sein, dass seine persönlichen Gesundheitsdaten auch anonymisiert nicht weiterverwendet werden, oder werden die Daten anonymisiert auf jeden Fall weiterverwendet? Sie wissen ja, KI hat ja durchaus die Möglichkeit, aus anonymisierten Daten auch irgendwann einmal personifizierte Daten herauszuschälen. Das ist ja für viele Menschen auch die große Gefahr. Deswegen ganz konkret: Wenn jemand Einspruch erhebt zur Weiterleitung auch seiner höchstpersönlichen Daten im europäischen Gesundheitsdatenraum, ist er sich sicher, dass diese Daten auch anonymisiert nicht weitergeleitet werden?
Stine Bosse
Thank you very much, and thank you for a very interesting presentation. I am a true believer that AI is a fantastic tool also in the health area, so don't get me wrong, I really think it's both necessary and we will benefit from it.
But we live in very, very different times and difficult times. So my question would be around security. And that goes from physical security, I mean where the data is entered, the areas of, you know, is there a safe space idea in this thinking? It's through hacking. You know, what happened if something was hacked and these are sensitive pieces of data and they would influence a lot of people.
It sort of it has a big effect if something happens. And then of course onto the pure mistakes. Wrong things in big IT models is devastating. So do you see that in the regulatory framework that we're now trying to modernize, are we also having our security thinking on board and please let us know in which way. Thank you.
Ignazio Roberto Marino
Thank you for this really interesting presentation. I have a couple of comments. First of all, I do not share the same enthusiasm about AI in reading, as was presented in the slides, reading X-rays and making the health worker job easier because AI reads in place of a health worker and make the diagnosis. I'm not, personally I was thinking like that until a few months ago when a number of studies started to show that AI, when does not know the answer, invent the answer. And this was, for example, a study done at Stanford on thousands of mammograms showed that when AI did not recognize the presence of a tumor, you know, made up a diagnosis.
And this phenomenon has been called AI hallucination. And you know, obviously you don't know when AI is telling the truth or is hallucinating. And therefore I think the supervision of the human being is absolutely important. The second is I really am very happy about this enthusiasm that I share about using AI to share and analyze scientific data to make progress. But you know, yesterday discussing about in this committee about data sharing in outcome of organ transplantation, a significant number of members said that these, you know, are national data that cannot be shared outside of the member state.
So it is wonderful to think that we can analyze this data not only with the humans but also with the help of AI. But if the representative of the member states that they don't want to share the data, what is the answer?
Marie-Luce Brasier-Clain
Merci Monsieur le Président. Merci de votre présentation qui soulève de vrais points de vigilance sur les incertitudes juridiques autour de l'articulation des textes européens, les risques sur le secret médical et le partage des responsabilités.
Comme partout, une mauvaise utilisation de l'IA entraîne des risques, tout comme une utilisation raisonnée s'avère bénéfique. Et n'oublions pas que l'IA n'est pas une technologie fiable à 100 %. Un cas de mauvaise utilisation, c'est par exemple celui qui entraîne des pertes de compétences par manque de réflexion critique et de recul. Les conséquences peuvent être graves puisque la qualité des soins en pâtit ainsi que la confiance dans le corps médical. Cela soulève aussi la question de la responsabilité.
Quand un médecin suit une mauvaise recommandation venant d'une IA, où se situe la responsabilité entre lui, l'établissement de soins et le fabricant du logiciel ? Il en va de même pour le respect de la vie privée et la protection des données. Comment éviter que la réutilisation des données ne porte atteinte au secret médical ? Et si par exemple une IA permet de retrouver l'identité d'un patient, qui doit en assumer la responsabilité ? Votre étude recommande enfin une approche européenne uniforme en raison des différentes interprétations entre États.
Mais la solution doit toujours être de privilégier non pas une harmonisation européenne mais une reconnaissance des règles nationales avec des garanties communes.
Ivan David
Já budu mluvit česky. Už před více než 30 lety existovaly poměrně vyspělé expertní systémy, dokonce samoučící, které byly schopny s dat určovat pravděpodobnou diagnózu. Já jsem ovšem velmi skeptický, protože samozřejmě to všechno záleží na množství a kvalitě těch primárních dat, které jsou analyzovány, a na ty se nelze stoprocentně spolehnout. Pak je tady ještě důležitá otázka, a sice otázka subjektivního pohledu na informace, které z toho expertního systému a například umělé inteligence vycházejí, protože hrozí naprosto nepřiměřené spoléhání se na ty informace, které z toho vycházejí, bez jaksi další kontroly. Připomeňme si jenom, k čemu vedlo, a já nejsem proti, ale k čemu vedlo zdokonalování laboratorního vyšetření nebo automatického hodnocení rentgenových snímků, případně dalších zobrazovacích metod, kde často dochází k falešně negativním závěrům se všemi z toho plynoucími důsledky.
Takže já jsem velmi skeptický a je třeba, aby se od počátku zdůrazňovalo, že tady musí být i expertní vyhodnocování živého člověka, aby nedocházelo k tomu, že se někdo podívá jaksi do papíru, do výsledků a pacienta vůbec nevyšetří nebo nebere v úvahu jeho anamnézu a podobně.
Adam Jarubas
Thank you. Thank you, colleagues. And last question from my side, in the context of data usage, how we can simplify the administrative processes for health professionals, if you can to refer to the question posed by MEPs, please.
Daniela Spajic
Yes, thank you very much for your questions.
They are really interesting and also very, yeah, very valuable for me to clarify some things and also maybe shed some light onto some aspects. So, it is very correct that not only health data is important in order to enhance healthcare provision, but also other data potentially, such as environmental data that can be used to indicate or help identify certain risks or potential health issues. In that sense, the European Health Data Space regulation actually seeks to, yeah, you could say extend the notion of health data that we originally had under the General Data Protection Regulation. It includes, so the European Health Data Space regulation includes amongst other things, determinants related to health. So in that sense, there are more aspects also in terms of, yeah, the social environment or aspects that go beyond the physical health of a patient should form part of the data categories.
Now, beyond that also, the interoperability of the different data spaces, such as the environmental data spaces that is also being worked on, will also play a pivotal role in facilitating the sharing of data between the different health data spaces so that it can also benefit the European Health Data Space. The patients' rights considered under the European Health Data Space are of course not to be neglected. The EHDS regulation considers for patients the possibility to opt out from the secondary use of data. The opt-out mechanism is left to be implemented to the Member States. And however, as it was indicated correctly, there should still be possibilities to process data, but only for a specific, for very specific reasons if a person has opted out.
And this could for instance be for public health reasons that the data could still be reused even though the patient has opted out from the secondary use in the first place. However, these are very strict exceptions that need and specific strict requirements that need to be fulfilled under the EHDS regulation. To however to foster trust into the European Health Data Space regulation from the side of citizens and patients, security, as I tried to highlight, really plays an important role. Under the EHDS regulation, a secured processing environment is supposed to be set, will be set up. Within that secured processing environment, it should be possible to process the data and more specifically in general only anonymous data.
So any data that should be shared as a general rule under the European Health Data Space regulation should be anonymous. And only if it is not possible to achieve the purpose for which the data has been applied, then pseudonymized data could be used. However, anonymization is the general rule and it will be left to the health data access bodies to take care of that. How they are going to do that, we will need to see whether they are going to assess that themselves or potentially even outsource that. However, it will be their responsibility.
So and also maybe to clarify as well, in the secured processing environment, it should not be possible to download any personal data.
In terms of AI hallucinations, absolutely, they currently still exist. So it is very important to take and acknowledge the status quo of the AI development in which technical partners find themselves. And in that sense, it is also very important to ensure that healthcare professionals maintain their medical skills and that they keep up the training to be able to detect potential anomalies in these datasets or the output created by artificial intelligence. That is also very important because it can obviously create liability issues also for healthcare professionals, which is why also creating better and more reliable AI should be a focus point in making the AI really valuable for the healthcare sector. To ensure that AI creates proper outputs that can be used, the quality of the primary data will play an important role.
I think data intermediaries within data intermediaries will here play an important role to facilitate on the one hand the collection of data and also the categorization and the anonymization of data to help AI developers to receive the data that they need. So human oversight also will play an important role. Here I would like to refer again to the medical skills that I believe we need to ensure that healthcare professionals maintain. Yeah, I hope I have answered the question as far as possible.
Adam Jarubas
Thank you so much, Ms. Speit, for your presentation, excellent presentation. Thank you, colleagues, for your discussion. Safe use of data is becoming a key issue in that time. On the one hand, we know that AI creates a lot of opportunity for innovation, new technologies, but on the other hand, makes more and more threats. I'm 100% sure that it wasn't the last time when we raised this issue in the meeting of our committee.
Thank you for your time today. Let's have a two-minute break and we will start in a moment with our voting. Thank you so much.
Dear colleagues, please take your seat. Dear colleagues, please take your seat, we will start in a moment. Point five, the impact of US pharmaceutical policies to the availability and pricing of medicines in Europe, vote on oral question to the European Commission and vote on oral question to the Council of the EU. The SANT committee coordinators have decided to put forward written questions for oral answer to the European Commission and to the Council of the European Union in response to US pharmaceutical policies with focus on safeguarding patients' access to essential innovative and life-saving medicines. The coordinators have approved the text of this oral questions in their meeting of 28 September.
Both questions are entitled European response to US pharmaceutical policies safeguarding patients' access to essential innovative and life-saving medicines. The coordinators have appointed Stine Bosse from the Renew group to act as a sponsor, meaning that she will present these questions on behalf of the SANT committee in the plenary at a later stage, if they are put on plenary agenda by the Conference of Presidents. Today we have two single votes: first, the adoption of the question for oral answer to the Commission, and second, the adoption of the question for oral answer to the Council. Let me announce the replacement for both votes. I know that Nikos Papandreou is replaced by Nikolas Farantouris and Christophe Clergeau is replaced by Matjaz Nemec.
Before proceeding with the vote, I will give the floor to Stine Bosse for a two-minute statement, please.
Stine Bosse
Thank you very much. So, dear colleagues, today we vote on an oral question from our committee. One to the Commission and one to the Council. The questions are short, but the stakes are not. America's most favored nation pricing and the section 301 investigation into Germany are not a distant trade quarrel.
They go to the heart of our European public health model. When a European drug price can pull down an American price, companies will delay launching in Europe. It is already happening.
Within 10 months, new medicine launches in Europe fell by 33%. Patients in smaller, lower-priced member states are hit the hardest. Today it is Germany, tomorrow it could be any of us. So this is not left or right. If you are about patients, this is your concern.
If you are about public budget, this is your concern. If you care about European jobs and industry, this concerns you. It is a pity the Commission cannot lead on this issue. Pricing and reimbursement belongs to member states, but indeed that makes this a catalyst for change. I want the Parliament's voice to ring loud and clear.
Member states must now work closer together than ever before on joint clinical assessments, on pricing and reimbursement, on making Europe the best place for research, investment, and clinical trials. We are 450 million people. Divided, we accept others' terms. But united, we set the terms. Parliament must now speak up for citizens, for patients, and we must push the Commission and the Council to act.
Postponing action and waiting for the effects of the US administration policies to become even more devastating is not what citizens expect from us. The clock is ticking. We must act before patients pay the price. This is the moment to finally work together, yes, to defend our European way of life and to make the decisions today that ensure our way of life still works tomorrow. That's exactly what these two questions seek to do.
Thank you very much.
Adam Jarubas
Thank you, Stine. Thank you for your presentation. Dear colleagues, first let's do a testing vote by roll call vote. I open the vote. Are we ready?
Okay. Mr. Ivan, yes, go ahead please.
Speaker 30
It's okay. Okay, we've got it. We take note. Yeah, we note that. Okay, let's do a testing vote.
I open the vote. I close the vote. Okay, thank you so much. Let's proceed to the roll call vote on oral question to the European Commission. I open the vote.
Adam Jarubas
I close the vote. Adopted. We will now move to the vote on the question for oral answer to the Council of the European Union. I open the vote. I close the vote.
Adopted, thank you so much. Okay, dear colleagues, let's move on to the next point now. We're starting with workshops on mental health. Now I would like to ask Professor Ignazio Marino for leading this part of the meeting. Ignazio, please take the seat on the podium.
Ignazio Roberto Marino
Good morning again. Our last point this morning is the workshop on mental health. Last Saturday, October 10, marked the World Mental Health Day, a reminder that mental health is an essential part of our overall health, shaping how we live, work, and connect with others. Across Europe, an estimated 84 million people experience mental health problems, while 46% report emotional or psychosocial difficulties, such as anxiety or depression.
Yet 54% of those affected do not receive professional support. This is why we must strengthen prevention, ensure access to quality mental health care, and pay particular attention to children and young people, including the impact of social media on their well-being. Protecting mental health is not only a health priority, but a shared responsibility for a healthier and more resilient Europe. This workshop has been organized by the policy department to support our work on the own-initiative report on mental health. The policy department has invited three experts.
Professor Martina Rojnic Kuzman, MD, PhD, member of the board and executive committee of the European Psychiatric Association, EPA, and Secretary General of the Croatian Psychiatric Association. Cassie Redlich, technical officer at World Health Organization, WHO, Regional Office for Europe in the Mental Health and Well-being Office. And Dion Russ, member of the executive committee of the International Association of Youth Mental Health, IAYMH, and member of the advisory group for Global Mental Health Action Network. First, Professor Martina Rojnic Kuzman will give a presentation on the clinical and scientific foundation of youth mental health. Second, Ms. Cassie Redlich will give a presentation on the public health and policy perspective of youth mental health.
At last, Mr. Dion Russ will give a presentation on the youth perspective of youth mental health. After these presentations, I will take the floor as rapporteur for this file and afterwards to the shadow rapporteurs. After the intervention, I will give the invited experts the possibility to react for comments and questions. All other members will have the possibility to take the floor in the second round of intervention. As usual, our discussion will be based on catch-the-eye.
I invite members who want to take the floor to indicate it to me or the secretariat. With no further delay, I give the floor now to the speakers and so I invite Professor Rojnic Kuzman to take the floor for 10 minutes. Thank you very much for being here today.
Martina Rojnic Kuzman
Thank you very much for the kind invitation and I'm here representing the European Psychiatric Association, which is the largest association of psychiatrists in Europe. We represent roughly 78,000 members psychiatrists and do many of the activities, but most importantly, we also collaborate with many of the partners, some of them such as GAMIAN and EUFAMI, who represent patients and families who sits on the board of the EPA. Some facts about mental disorder what we think now is true. We know now that mental disorders are not genetic disorders, rather they result for a cumulative effect of different exogenous or environmental factors. We also know that most psychiatric disorders start in childhood or in adolescence and also can shape or change their manifestation throughout their life, so sometimes it can happen that it occur like conduct disorders and afterwards it changes into anxiety disorders or personality disorders or substance use and so on.
But they are lasting throughout the life. This is a very recent review which tried to encompass all the known risk factors and associated with 10 psychiatric disorders.
And basically what you can see here is that major psychiatric disorders, that is almost all of them, are associated with five groups of risk factors. The first one is maternal and perinatal health, so health of mothers during pregnancy and afterwards. The second is childhood adversities, that is for instance physical abuse or sexual abuse, any kind of abuse of children which contributes to schizophrenia, PTSD, autism, substance use disorders and many other disorders. Then it's somatic disorders, which is basically physical conditions such as chronic physical conditions also contribute to mental disorders. Then it's lifestyle and substance use, for instance the use of smoking or the use even of marijuana is contributing to some of the psychiatric disorders.
And finally it's social and environmental factors, for instance being excluded or having not access to health services or social isolation or inequity or pollution also contributes to mental factors. If we are talking specifically of digital environmental risk for youth, we know that early excessive use of digital smartphones is the one who contributes to the poor cognitive development of children, academic development of the children, poor verbal development of children, poor emotion development of the children and also contribute to the children's symptoms sometimes of psychiatric disorders. However, it does not affect all children equally. It affects more those children who anyhow are at risk because of these cumulative factors that I was telling you before. Since we know which are the risk factors and how they grouped, we also know which should be the areas of prevention.
If we want healthy children, we have to have healthy mothers and secure fathers. We also have to have children's safety and child who is protected throughout the childhood and adolescence. We have to have treated somatic disorders, which means physical disorders. We have to have healthy living and also reduced risk for substance use. And finally we have to have communities which have community cohesion, which are nicely designed, which have infrastructure, which have social inclusion and equity.
This latter risk or group is usually taken care of by the governments. This is an example from Canadian government, but basically most European governments also have different policies which are quite wide and actually have strategies that shape the whole community to be healthy. However, not all of them or actually rarely these policies are implemented in practice, so we need to work on here more. This is a just a step that Canada took, which not only that set priorities and priorities areas, but also they defined measures, so how we measure where we want to go in the good direction. Ah, sorry.
Martina Rojnic Kuzman
Ah, okay, sorry, I'll slow down a little bit. I have this time, ten minutes.
Enough time.
Enough time.
Martina Rojnic Kuzman
Okay, fine, thank you. And the final thing is also to have output measures, but also to report them in a clear way that the policy maker can also use it. If we are talking about interventions who are evidence based, which means what works really when children who are at risk, which means that children who have some problems in behavior or problems at school, this here I'm showing you is the selection of evidence based interventions. So if we want to have healthy children up the age of six, so preschool children, what works are the interventions who are directed towards parents.
That is this four types of interventions. The first is psychotherapeutic approach, usually cognitive behavioral therapy or or mindfulness approaches. The second is physical activity. And the third are family interventions or parenting interventions for parents. In the age when the child is from the year six until the 18, those strategies that works are the ones directed to children and also the same strategies work.
So again, psychotherapy of type of cognitive behavioral therapy, mindfulness directed to children, physical activity again directed to children, again parental intervention directed to parents of teenagers and adolescents, and also the the fifth one is social and emotional learning programs which are delivered in schools by the school personnel, school teachers and other personnel. In adults, which means the young adults, what work is again psychotherapy and this kind of interventions. Then is again mindfulness and the third thing is physical activity. For them also what works again is parenting parenting interventions directed to young parents. The other thing that you also can see here is promising digital interventions.
And promising digital interventions are the ones who actually deliver this kind of psychotherapy on digital mode or they deliver it instead of not instead but it's it's therapy is given them online but not in person or the ones who connect the services, which means they my screen for instance the the the person's symptoms and then connect it to a certain services. So these are the digital interventions that currently seem to work. If we are seeing this intervention especially for digital environmental risks in youth, the three which are the one effective previously for overall mental health are also the one which are effective when it comes to digital risks. So intervention interventions targeting children again with psychotherapeutic note. The second is again physical activity, at least as they say 45 minutes three times per week.
And the third is parent focused intervention. So basically the interventions are the same because the output is the same, so to enhance the mental health of children and adolescents. If we want to see which are the status or where we now. So if we want to have healthy mothers, there are these services which are called the perinatal mental health services. These are services which connect psychiatric and gynecological care for mothers who had symptoms or will develop them in a postnatal area.
And you can see here that basically only the countries which are dark violet are the ones who have these services developed to a sufficient manner. The others are somewhere to go but not really developed fully. The second thing is the as I said family interventions which are well evidence-based measures. It's also developed in these countries so similarly to these countries where in the rest of the Europe it is rather underdeveloped. When it comes to programs which are delivered in schools, so for age for children age from six to 18, according to the ESRP report, we have major countries which actually have this kind of programs.
So school-based promotion but not psychotherapeutic services, community youth hubs delivered by peers, digital tools, social prescribing and digital regulation, that is for instance banning the use of mobile phones in schools.
This is just a kind of a sketch when I wanted to point out when seeing whether these countries have universal prevention programs by the state, whether these programs are implemented or not, whether they implement all these measures that I said that they are evidence-based. Those countries who have them are in green, where the majority of countries are in yellow, which means that the majority of countries have it to a certain degree, but not really to the form that it should have. So what are the recommendations or what to do? So first again focusing on different periods of life, if we want to increase mental health of children in preschool children, we need to focus on mothers and parents. So we need to invest in making effective perinatal mental health services that we don't have.
We have to have parenting interventions which are already existing, so there are very well and very good programs in some of the countries, some of Scandinavian countries, so we need also to transfer it in other European countries. When it comes to school age, we need to have these programs, but we need to have evidence-based programs in schools because what I hear often is that school teachers are overwhelmed, they are overburdened and overstressed and that when there is a magnitude of these programs and they do not know which one to use, then it is seemed that it doesn't work. So we need to have to tell them which programs are effective, to educate them, to make them also stay in schools and to also support them not to be burnt out. Then we need to also have these youth centers, but providing that they have evidence-based treatment. We need also to have more sports in schools.
There is some initiative for instance in Finland, all over the Finland they have this kind of interventions and they seem to work. And also parenting intervention should be available in school age. In adulthood, again we need parenting interventions and all these different evidence-based psychotherapeutical approaches that could be also delivered at work. In order to do so, for some times we need staff, for instance there is definitely a shortage of child and adolescent psychiatrists, possibly also teachers. Sometimes we need more education of staff, but also thirdly, but not less important, in many instances we have services but they are disconnected.
So we have very good services in one place of prevention, in one part of one region, but they are disconnected from the other services making it all inefficient. And finally, I would like to say that actually there is very good data cost analysis which says that prevention in psychiatry, all these programs that I was telling you about, here on the left you have seen an analysis which is from 2011, but from the right there are some of the interventions which are also cost-effective for 2026, which means that every euro you get into prevention, you get a return of investment at least several euros back. So I think this is a good case also for being very active in this area. Thank you very much for this attention. Thank you.
Ignazio Roberto Marino
Thank you Professor Rojc-Kuzman and now I give the floor to Ms. Redlich for ten minutes. Thank you.
Redlich
Thank you very much. It's a pleasure to be here this morning on behalf of WHO Europe and I work within our mental health and well-being unit. I think it's important to say that we recently went from mental health unit to a mental health and well-being unit, which really shows how we're trying to shift ourselves towards thinking much more holistically about mental health but also young people's mental health and well-being. I think you'll find that these presentations are quite complementary and hopefully you'll get from my presentation that we want to think about policies that actually enable some of these interventions to actually be implemented successfully in the member states.
So why prioritize youth mental health? I think we probably don't need to be convinced of this anymore but briefly the burden of poor mental health in our region is high and it's rising. The consequences of poor mental health and untreated mental health in young people is great. Untreated mental health conditions in young people can have long-lasting effects. It pushes young people off their developmental trajectory.
It affects all manner of areas of their life from relationships, transitions from school to employment. Also we know that investment pays off. As you heard we have numerous studies showing that investment in youth mental health and well-being and particularly promotion prevention activities gives a good return on investment. So from some of our WHO modeling that was done with partners in around 2022 we found that for every dollar invested in adolescent in a sort of package of adolescent mental health interventions that it could yield approximately a 24-fold return on investment over an 80-year span. Unfortunately I think for all the talk of how important investment is in young people's mental health and well-being we're seeing mental health outcomes for young people in decline across the region.
So these data are from our most recent report on child and youth mental health in the WHO European region. So these are data for 53 member states so an expanded Europe. And we saw that prevalence of mental disorders increased between 2010 and 2021 across all age groups. It was a 40% increase for 15 to 19-year-olds. That's the top line that you can see there.
And for the WHO European region suicide is another leading cause of death for young people aged 15 to 29 years of age. And when we look more broadly at mental health and well-being indicators we also see many of these in decline. These data here are from our health behavior in school-aged children survey, the most recent one that compared the indicators over time. It's a study of 44 countries across Europe and Canada and is conducted every three years. So for this most recent survey we saw a decrease in a number of indicators of well-being across life satisfaction, self-rated health, social support.
We saw an increase in reports of multiple health complaints. An increase in the rates of problematic social media use. So that's addictive-type behaviors related to social media. One in five adolescents reported a lack of support from either their family or friends. And one in four girls at age 15 reported feeling lonely most of or all of the time.
So it's not a great picture. And it leaves us in a situation at the moment where demand for care and support is high. It's as high as it's ever been and rising it seems.
Specialist services cannot meet the demand across any of the countries that we speak to in the region. It doesn't matter the income level, all countries are struggling to meet demand. Wait times are increasing, over a year or more in some countries to actually access specialist assessment and treatment. And half of young people in the EU report some amount of level of unmet mental health care need. And even when there are services, there are many barriers.
I won't go into detail here, but they span from still low levels of mental health literacy in the community and stigma, which stops people from actually being supported into care and to and accessing care at an early stage. We don't have a great supply of acceptable, appropriate services that young people actually want to go to, that are youth-friendly, that are designed by young people themselves. We have a lack of inclusive services. Often young people are kept out of services because they're either too complex for the services or they are not unwell enough yet for services. And the coordination of services across a system can be exceptionally frustrating and complicated for people to navigate, especially family and parents.
So we believe that actually from a policy and a practice perspective as well, change is needed. This is not a problem that we can solve simply through more services, more investment in more specialists, greater specialist workforce. We need specialist services, but we also need to be thinking more broadly, moving towards earlier upstream action to address all the risk and protective factors that we saw in the previous presentation. We need greater investment in promotion of mental well-being and prevention of mental disorders, thinking about place-based approaches, the settings in which young people are living and working and getting their education. And we need to think about the transformation of services towards lower threshold, earlier intervention, so models that can actually provide access to young people when they want to receive services.
So the first time they say there's something wrong, I want support, that they can actually walk through a door and get that support. So I wanted to just provide some examples of some of the areas of policy work that we have been undertaking recently, really with the aim to broaden our work to address the drivers of mental health and well-being and certainly thinking about a life course approach, but also thinking about a mental health in all policies approach, which is increasingly driving the work that we do. Many of these drivers sit outside the health sector. It cannot be that the health sector alone is responsible for fixing this problem. This is our newest report.
It was released last week on adverse childhood experiences across the EU, Iceland and Norway, supported by the European Commission. ACEs or adverse childhood experiences are potentially traumatic events that occur in childhood, things like abuse, neglect, household dysfunction. They're important to measure and to address because they have strong association with outcomes in later life. From our report, we found ACEs were far too common across the country. So we surveyed over 26,000 young people across 29 countries.
We surveyed them between the ages of 18 and 30. So these are young adults who should be in the prime of their lives. We found two-thirds of those young adults that were surveyed reported at least one ACE.
One in five had experienced four or more ACEs. So that's a significant amount of adversity in childhood. There are strong, consistent associations between ACEs, or the experience of ACEs in childhood, and all the outcomes that we examined in early adulthood. So that's mental health, but also physical health, quality of life, education outcomes, employment outcomes, financial outcomes, violence, community connectedness, trust in community. And the more, it was a cumulative impact.
So the more ACEs young people had experienced, the greater the risk of poor outcomes, the poorer those outcomes were, and the higher the societal and economic costs. In the report, we provided three areas of evidence-informed policy action for tackling ACEs. So one being about preventing ACEs from ever happening in the first place. And that really needs to address root causes: poverty, violence, family dysfunction, family separation, substance use. The second is building resilience.
So we know that building resilience can support, can mitigate some of the impacts of experience of ACEs. And that's thinking about promotion of positive relationships, strong social networks around young people, social-emotional learning embedded in schools, and then trauma-informed systems of care. So making sure that we're building care systems that can actually support people with a history of trauma. Another area we've spent a lot of time working on, continue to work on, is promotion, prevention, particularly for adolescence. These types of policy actions are ones that enable mental health-promoting environments.
So making sure that we have environments around young people that promote their mental health and well-being, that allow for caregiver support not only in early childhood, but also into adolescence and young adulthood. Access to appropriate psychosocial and psychological interventions when young people need them and want them. We have a number of guidelines across WHO and UNICEF publications, but I also wanted to highlight that last week we also had the UNICEF mental health promotion toolkit that was launched, again supported by the European Commission, incorporating a number of EU best practices. So that's a really good resource there alongside these other ones, Helping Adolescents Thrive and our Health Promoting Schools initiative. Another area of work we've been focused on because so much member state interest over the last couple of years is the impact of social media and digital technologies.
So this is a policy brief we published almost two years ago now, in partnership with Ministry of Health in Poland and Digital Transformations for Health Lab. It outlines eight priorities for policy action. It's really intended to support member states to think about how they balance the risks, but also the great benefits that come with social media and digital technologies and environments for all of us, but also particularly for young people. You can see here, I won't go through them all, but really the aim was to develop a broad set of actions targeting different actors, different levels of the system. It reflects the range of factors that impact young people's mental health and well-being, but also all the actors that need to play a part in making digital and online spaces safer for young people, and a balance between empowering people who are using these spaces, but also holding industry to account for the risks and the harmful features embedded in those systems.
And finally, transforming mental health systems.
And finally, transforming mental health systems, we're increasingly looking at policy actions that can support shifting our focus from specialist services, which at the moment are overwhelmed and overloaded with young people who don't necessarily need to be on those waitlists, to models of care that allow for low-threshold, brief, accessible early interventions. And you can see some of the best practices around the world and around the region in these two publications here: service guidance for mental health of children and young people from WHO headquarters and also the OECD report on promoting good mental health in children and adults. A few examples here: we're starting to see many of these low-threshold services pop up in many countries across Europe. They are not the same, they're very much context-specific, but there are some common components which are really exciting and are allowing young people access to services that they would otherwise not have. They tend to be open access, there's no threshold that they need to meet, they don't need a diagnosis.
They're staffed not necessarily by specialists, by trained non-specialists, many different types of workforce, from peers, from volunteers, an expanded set of allied health professionals that don't usually work in our mental health service in the region. They have connected support, so it doesn't mean that young people can't get specialist support, but they can walk in the door, they can speak to someone as soon as they want support, and then they can be directed to other services if they need more intensive support. And importantly, they have meaningful youth participation and engagement and leadership built into the service models. And you can see here a number of the examples: we have Headspace Denmark, there's also Iceland and Norway are running Headspace centers, @ease in the Netherlands, which Dion here knows a lot about, the Adolescent Resource Centre in Latvia, Soulspace is sitting in Berlin in Germany, and Youngle, which is a web-based service in Italy. So that was a whirlwind tour through many of the public health approaches that we're taking at the moment.
I thank you so much for your time and look forward to your questions.
Ignazio Roberto Marino
Thank you, Ms. Redlich. And now I give the floor to Mr. Ras. Mr. Ras, the floor is yours for ten minutes. Thank you very much.
Dion Russ
Thank you so much, Mr. Moreno. Ladies and gentlemen, honorable members of the Parliament, I'm Dion Ras and I'm here on behalf of the Global Mental Health Action Network, which is the world's leading network for mental health advocacy with over 10,000 members representing 170-plus countries. Honorable members, in a recent report from the United Nations Human Rights Office on the needs of young people with regards to their mental health, inputs from around 4,000 young people has made the following very clear: we need to move from institutional forms of care to community-based forms of care, and we also need to involve young people in all processes that affect them. These topics, alongside the digital environment and positive mental health promotion, are what I will discuss today. Now, let's start with the point on moving from institutional to community-based care.
Institutional care is, as defined on my slide, a general term for psychiatric hospitals and institutions providing custodial care implying long-stay care and the potential for restrictive practices and exclusion.
As for community-based care, that is a model of care focusing on the integration between health and social services and the fostering of social inclusion as compared to exclusion with regards to institutional care. Now, what does it mean to move from institutional care to community-based care? Well, that would therefore mean to reallocate resources from long-term psychiatric care that takes place in psychiatric institutions to community-based services. But it also involves support with housing, employment, and education. Now, there are several reasons as to why we might want to do something like that.
Institutional care often involves the loss of autonomy and exclusion from the community, like a young person I know that was not allowed contact with their family or friends for support. It can involve unsuitable care or aggravation of symptoms, like when I was in a psychiatric institution at 19 years old, placed amongst adults closer to 50 after I had made an attempt to end my life. But unfortunately, it does not end there. There is a historic risk of emotional, physical, and sexual abuse of patients from the people that are supposed to treat us, like a friend who had professionals make sexual advances and gossip about their dossier right in front of them. Young people in those institutions are at their darkest point in their lives, and yet they are isolated and with conditions not much better than those in prisons.
Now, we know that institutional care alone is insufficient to support the enormous burden of mental health, but one in four countries still lack community-based mental health care services. Additionally, we see that data collection on community-based services is poor, and these services are sometimes accompanied by little regulation or basis in research. They struggle to receive long-term funding and experience vast quality differences. These differences sometimes manifest as a lack of clinical supervision, when I, as a young peer supporter, had experienced complex cases involving physical abuse, sexual assault, suicidal ideation, you name it. I have been in a position like many peer supporters where there was no professional who could take over and no suicide prevention specialist to refer the young person to.
And as I've mentioned before, I wanted to end my own life at some point in my own life, and I was not going to send this person off with zero support. And so I took it upon myself at 17 years old. Now, if what I have mentioned before are examples of how it should not be done, honorable members, what are good examples then, I ask you? Well, I can answer that question, and I would like to direct your attention to @ease in the Netherlands, as Cassie already mentioned, and Headspace in Denmark. I believe these are two very, very amazing services.
They're very much research-based, and they offer physical walk-in centers to expand a bit on what Cassie was saying, and a chat for youth where they receive psychological support from trained volunteers. They are free, anonymous, and supervised by clinicians, and there are referral mechanisms in the event of crisis situations, mitigating a lot of the difficulties I myself have experienced as a peer supporter with other organizations. Now, there are also other interesting forms of care. There are things like integrated youth services like All Cove in the US, as well as Foundry in Canada. These are amazing examples of community-based care.
These methodologies provide young people with centers that have psychologists, doctors, peer support workers, and employment specialists, all in the same building, leading to a singular access point to care and very smooth coordination of care.
Now, we also have some other interesting examples that focus more on the side of things of increasing mental health literacy. We see Spunout in Ireland as well as Jack.org in Canada providing initiatives that increase mental health literacy through articles, online courses, and resources for mental health promotion in classrooms. And so my recommendations for this particular point are as follows. We need greater financial investment in and longer funding cycles for research-based community-based care, and we need EU-level quality standards for community-based care. Finally, we also need a task force that will determine how integrated youth centers can be set up in the European context.
To move on to my second topic, youth participation, let's start by underscoring its importance. When involving young people in developing and implementing mental health policies and services that affect them, they are more responsive and relevant to the needs of youth when they are involved. It supports young people's personal and professional development, and of course it serves as a sort of preparation for the future labor force. And finally, it upholds the child's right to express their views and to be taken seriously in matters that affect them. But what makes participation meaningful?
Well, this means that it follows certain principles, ensuring that young people feel safe and motivated to participate. Principles like inclusivity through non-jargonistic language and safeguarding protocols, and transparency about outcomes, expectations, remuneration, and so on. It also means that young people should be involved from agenda-setting to implementation and evaluation. Now, these principles that I have just mentioned to you are taken from and further discussed in these very successful guidelines for youth participation. And very conveniently, I might add, all these examples I mentioned earlier on in the section on community-based mental health services are also great examples of meaningful youth participation.
EASE, for instance, has participation embedded into its policy and governance through its youth advisory group, which I co-founded. Spunout, Headspace, and Alcove also have youth advisory groups, ensuring that young people always have a say in its organization. A lot of organizations listed here are also what designed with young people from the start, and that includes the names, the services, as well as the centers themselves and their design. I'd also like to quickly mention the organization that I represent, which is the Global Mental Health Action Network. It serves as a great example of meaningful youth leadership.
Young people are a massive part of its leadership. As for my policy recommendations for this particular topic, I have experienced that youth participation is not always facilitated in a meaningful manner, and so I recommend that EU minimum standards should be established for youth participation in EU-funded mental health initiatives, standards in line with the current best practice frameworks. They should require youth to be involved at all phases of the project, include fair remuneration, safeguarding, as well as accessibility measures, and finally also include feedback mechanisms. As for the last two topics, let's first go over the positives and negatives of the digital environment.
The negatives are quite extensive in my personal experience as a young person growing up in the digital age. We see cyberbullying, the problematic use of social media, gaming addiction, easy access to gambling through online casinos, crypto meme coins and prediction markets, as well as illicit substances. We see it's quite easy to get exposed to very dangerous people, also through online gaming for instance. Additionally, the digital environment shapes our views on what is normal, and there are already many young people online that believe drug use and plastic surgery are necessary and normal for entering a romantic relationship. And I think we can all agree that that is quite a warped view.
Now, the positives of the digital environment overlap very much so with my reflections on positive mental health promotion. Social media and gaming can foster a sense of community, and it has in my personal experience kept me in contact with my best friends after moving away from England for over a decade. So where it isolates, it can also very much connect people. But it is not necessarily a replacement for in-person contact. And despite how important young people find a sense of community to be for their mental well-being, as found in the UN report I shared earlier, community spaces for young people are under constant threat of closing and not receiving enough funding from municipalities.
All of the examples that I've listed actually on community-based mental health initiatives also organize activities for young people, allowing support to be just a step away from community spaces. And so my recommendation for these final two points are quite interlinked with one another. They are as follows. I believe that school and community spaces need programs to increase digital literacy rates and safe usage of social media, video games and the internet. EU funding also needs to be made free for peer support contingent upon activities being set up such that a direct path is made from mental health support to socially connecting activities.
Now, we can't snap our fingers and make war, pandemics or economic downturns disappear, but we can make sure that whatever we face, we face together. And so I thank you all very much for your attention.
Ignazio Roberto Marino
Thank you for this wonderful presentation that are very inspiring to us. And actually, before starting, I would like to ask to each of you a favor. If at the, you know, in the next several days, each of you can send, you know, just a short email to the secretariat with the two or three bullet points indicating in your view what is the most important, are the most important topics that we need to cover in the INI that we on mental health that we are going to write because obviously your experience and the academical work will be very, very useful if you can do us this, this favor. The, I as a rapporteur of the INI on mental health, I will take the floor for a few questions to each of you and then we will be happy to give the floor to the shadows and the other people that would like to intervene. I have been listening and taking notes to each of you and I want to ask to Professor Rogenie Kuzman a couple of, of things.
First, I noted that in the paper that you presented by Arango and others published in 2021, there was something about COVID-19 and maternal and perinatal health. I believe, and I've said this a number of times, that we did an experiment that we never did with the Homo sapiens. We isolated our kids, our teenagers, and even the adults for almost a couple of years. So personally, I don't know what the consequences could be, but I would like to know if you think, beyond what we have seen in the slides, what you think could be the consequence of that isolation and what we should do to prevent further disease. And then I think what do you think that we should do to introduce primary prevention, which is lacking in most, as you have shown, of the European member states?
And we know that there are states where the primary prevention basically does not exist. Then I have a question to Ms. Redlich from the WHO. You know, that figure that you showed about suicide leading cause of death is something that really astonished all of us when we read that in the study that we recently completed. And also I appreciated your financial slide saying that every dollar invested has a return of eighty dollars in increasing mental health and particularly in young people. So I believe, and I don't know, maybe I'm just daydreaming, but I believe that, and obviously the WHO played an important role, that we did a terrific job with breast cancer in Europe and in many other continents.
And because we knew that one out of nine women may experience breast cancer in their life. The statistics that you have shown are even worse for mental health, particularly in teenagers. What should we do, because here we are legislators, to, and to you make sense to launch some kind of campaign similar to the prevention and screening of breast cancer in mental health? Because I think that from your presentation is clear that we know what the problems are, but what is the solution to these problems? And I think that we need some kind of strong action like we did in other disease that, you know, are physically evident while mental health is less physically evident in some cases.
And then I have a question for Mr. Ross. We had another meeting on mental health care with a number of psychiatrists yesterday here in the Parliament. And there is a topic that they covered and none of you covered, and I think in a number of countries in Europe and also in England, that is not Europe anymore but is close by, is the role of electroconvulsive therapy for major depression in teenagers. I know that is a very controversial topic, but a number of psychiatrists yesterday told us that is very effective, and I wanted to know if you have an idea and a position about that. I stop here and listen to you, and then we will give the floor to the shadow rapporteurs.
Martina Rojnic Kuzman
Should I start? Okay, thank you very much for these very important questions. So the first question was about social isolation, doesn't matter really whether it's related to COVID or not. We know that social isolation is really a risk factors for many disorders, so not only mental health disorders, but also cardiologists also say that there is social isolation is one of the risk factor for cardiovascular disorders. And we increasingly knows that this is one of the risk factors for many disorders.
So social isolation per se is a risk disorder. So basically what we should do regarding social isolation, first I would like to say that social isolation, so we as children we learn how to communicate with others through our parents in the beginning. So basically this is a place where we learn. So children who are upbrought or who are brought up in a families where there is absence of parents or where the families are dysfunctional are obviously prone to social isolation and they do not cannot learn it properly. So therefore in this perspective I would definitely argue for parental services which as I said proved to be very efficient in a sense of mental improving mental health but also cost-effective in a sense of return on investment.
The second thing for social isolation is now that there is increasingly this intervention which is called social prescription. And social prescription basically means that for instance if the for it's for adolescents but also for adults for for even older people, so basically it means that because of loneliness people are at risk of many disorders. And when a physicians sees that person is lonely, either being adolescents or or older person, he prescribes social activities, which means that he connects this person with different activities within the community which provide communities and they work on art or craft on sport. So this is basically social prescribing and I think this is one method to go as well, but we need to have this connection of services.
The people come because of illness and then have this in community. We have to have organized services provided by different youth centers or NGOs and so on where these activities can be can be done. So we need to connect them. Regarding the primary prevention, if you're referring to prevention on a primary level, which means that these services are accessible to all, again, these services are the ones which should be again provided from the start. I think from parents, because we can start in school age and so, but I think it's too late.
So it's too late and then we have more problems to go. So we need these services which are accessible and available even to parents. There is one of these programs which is called the Triple P, Triple Parenting Program, or the Positive Parentship, which is a program which is available, was available in Australia, but now it's available also in many of the European countries, which basically has different layers of intervention, starting for layer of universal prevention of education for parents who are have to who will have children, to those who have very risky behavior toward the children when they offer different types of interventions which are more intense. So these kind of programs which are run by the NGOs, so it's not run by a health sector, is something which is very affordable and can be definitely provided. And the same also goes for for different other periods of life, such as youth, youth or or even adulthood, as for instance this kind of youth centers could also provide or be a very good centers for primary prevention because they are accessible more to youth regarding the other centers.
They are affordable, which means that they are not so costly, and people can they are not stigmatizing, so people can approach. So I think we should also try to invest in these kind of services.
Redlich
Thank you for those questions. I think they're the big questions that we have to answer. I mean, you are correct that we have a a large measurable problem that seems to be getting worse. We know to a certain extent what we should be doing and what more investment we need, yet when we're not doing it. I think unfortunately mental health is a bit different to breast cancer and other physical illnesses, and because of that we struggle with how to invest properly, to to resource the work properly, and and to implement actions in a consistent and scaled way.
Mental health is not one thing. We're we're not thinking about just one condition, and we've certainly seen the the spectrum of what we talk about when we talk about mental health grow recently, and in particular I think sort of since COVID and since we've had much more of an aware in many countries, not all countries, a better better mental health literacy. But that means that we're all thinking about and talking about mental health all the time, and we can't possibly have service systems that can manage all people who feel they need some level of support. It also has an impact for data and evidence because we're not talking about one intervention and one outcome that we're heading for. We're not just wanting to eliminate cancer.
We there's a range of different outcomes that that work for people in terms of their recovery journey across, you know, sort of symptoms, but also across their connectedness with community and education outcomes and all these different things that are important for people within their recovery journey.
So, and the time horizon is different because mental health and mental ill health affects us across our life course, and investment made in early childhood, for example, might not be, the benefits might not be seen for many, many years. That's an issue for government and for finance departments, and it's also that it's cross-sectoral. So the, the costs and the benefits and the impacts are felt in different sectors. So it's a difficult one. I think part of this is probably better advocacy to say why is it that we're not, a young person who has cancer will be treated straight away in the best hospitals with the best clinicians, but a young person who has, who seems to have perhaps a diagnosis of autism may not even get that, that diagnosis and an assessment for years in some countries at the moment.
So that's just the inequity there is extraordinary. The stress on the parent is the same dealing with those young people with serious difficulties. So part of it is raising awareness about this inequity in the way that we think about these disorders and, and difficulties. I think the other is bringing action sectors together for action. So, you know, there's been great activities within some of the joint actions supported by the European Commission, DG SANTE.
It tends to be health sector actors. Maybe we need to be starting to bring in different sectors to think about how do we take sort of a, a broader joint accountability for some of these outcomes and also to have investment then across different sectors. So I, I also want to just add a caveat that suicide is the leading cause of death at the moment. That is not to say that we haven't done great work in, in reducing suicide over many years now, the last few decades. But it's not consistent.
So part of this is because we've been able to reduce communicable diseases, road accidents, things like that, which were other leading cause of death amongst young people. But suicide is still remains a huge problem and increasingly a problem, self-harm and suicidal behaviors in young women. So we need to keep our eye on the ball even though we're doing a lot of good work in that space.
Dion Russ
Thank you so much. It's a very important question, the, the question on electroconvulsant therapy, but I, I think I, I'm afraid I will have to disappoint you because as far as I am aware, we do not have a position on this particular topic. But it's still a very much a very interesting question. So if you would be interested, we could remain in contact and I could go back to my team and ask this question and see what they think and get back to you.
Ignazio Roberto Marino
Thank you very much for these very clear answers. And now I, I give the floor to the shadow rapporteur of the INI on mental health, first to Vytenis Andriukaitis from S&D. Vytenis, no?
Vytenis Povilas Andriukaitis
No, I am not shadow. I just ask question about as, as in Q&A. I will ask questions.
Vytenis Povilas Andriukaitis
Thanks a lot for very brilliant presentations, really. I am very happy, you know, now you just proposed a lot of improvements when we are speaking about our INI reports, you know. But today morning I participated in very important event, which round table event, exploring common priorities across neurological and mental health. I am always raising questions about mental and neurological, brain and mental health as as holistic picture, as picture of two sides of one coin. Now we are going into separate strategies and separate and of course excluding from our attention comorbidities.
Because neurological disorders, neurological diseases are very sometimes interlinked together with mental problems or vice versa. My question is, are we capable to to go into more holistic understanding about necessity to explore common priorities between neurological health and mental health starting from newborns, finishing with with you know adults.
Speaker 45
Thank you Vytenis, so the floor is yours who would like to take the question.
Martina Rojnic Kuzman
Well then thank you very much for for this question. I agree with you completely. So basically what is my understanding now is that these two parts, neurology and psychiatry are increasingly coming together in a in a mission of brain health. So basically and as you rightly said they are really interconnected. So if someone has problems with brain circulation it will affect both psychiatric illness and both neurological illness.
And so as the EPA, as the European Psychiatric Association, we have many memorandums of understanding with the neurologist and so we try to be together in this brain policies and advocate together. Of course sometimes because it seems that we are fighting because they want to have more on let's say circulation and we would like to have more on psychiatric, but basically as you right as you said it's it's a holistic approach that should be advocating and basically we are advocating for a holistic approach. So there are is one brain. Yes.
Ignazio Roberto Marino
Thank you. Now I give the floor to Viktória Ferenc, she is a shadow rapporteur. Thank you.
Viktória Ferenc
Yes, thank you Mr. Marino and thank you for the secretariat and all the panelists who organized this wonderful workshop on mental health. And I would like to open the discussion towards a specific theme, namely the mental health in times of crisis, particularly in the context of war. And this highlight is not accidental because I am a member of the European Parliament originally from Transcarpathia, Western Ukraine, and I am deeply concerned about the impact of the war on people of all ages, including national minorities like my community, the Hungarian community in this part of Ukraine. So unfortunately the war does not end at the front line and in Transcarpathia and in all Ukraine women, elderly people and young people face the psychological consequences of war every day, unfortunately since almost five years.
Disturbing footages, news of casualties and constant uncertainty place an enormous emotional burden on them. And as people usually or often said in Ukraine, life cannot be put on hold. But how can people continue living as they did before when war has become part of their everyday life? So out of concern for these communities, I believe it is essential to ensure that mental health support is accessible to everyone, including in everybody's mother tongue. Language is not only a means of communication, but also a source of emotional security and trust.
And this brings me to two questions. Do you have research findings or quantitative evidence showing how much more effective psychological support is when provided in the person's mother tongue? And does mother tongue mental health care simply improve communication, or does it also significantly improve treatment outcomes, particularly in case of war-related trauma? Maybe you have some evidences or research findings. Thank you.
Ignazio Roberto Marino
Thank you Viktória for this very important question. I mentioned the COVID isolation, but obviously there is a much worse isolation going on in our continent right now, and it's very important that you brought that up. Thank you. The floor is yours again.
Martina Rojnic Kuzman
Okay, thank you very much for this. Unfortunately, I would really agree with you that the war is, well, cumulative effect of many, many things together. And its effect does not last only as the war lasts, but also they last for decades and also may be switched to a second generation. So it's something that truly changes the society. So it's not that one intervention will be necessary, but a whole system of mental health services and community services together will be important to be built throughout the decades, I would say.
I also come from Croatia, we also had these experiences many years ago, but still this topic is somehow alive. So it's, we have consequences still now. So this is something which is really should be taken into consideration and we also should learn one from each other what to do and what not to do in this instance. Regarding your question of whether language is important, it's very important because many of the persons who are from Ukraine or whatever, they do not speak fluently English. So they speak in their native language.
So if you cannot speak, it's very difficult to have any kind of intervention, meaningful intervention. What seems to work is first of all to have those people who are not professionals, but they are the people who are actually helpers, who are helpers of the same nationality, they speak the same language or similar language, and they may provide a first-time help. So they may provide soothing, they may provide activities. So they are the first-line helpers and they are usually not professionals. And then when there is a need to link these services with non-professional in the same language with professional, then we need translators or we also need, and there is an initiative to have many of the Ukrainian specialists within other mental health systems, like for instance in Netherlands they have a very extensive help and network where they actually are trained and psychiatrists, but they are Ukrainian psychiatrists and Ukrainian psychologists and they speak with Ukrainian and even Russian and other people who need, yeah, who need help.
So basically, it is very important because otherwise you can give just a very reduced help in terms of mental health. Yeah.
Redlich
Yes, thank you. I think this is an incredibly important point. I think we've done a great job over the last decade or so, but certainly in the last four or five years of making sure that we see the importance of embedding mental health interventions in any emergency response setting, in any setting of war and conflict. This is something that's well embedded now within WHO and our emergency response programs. In Ukraine in particular, I was working in Ukraine and started our mental health work in 2015 and through '16.
That has grown to be one of the biggest, in fact the biggest mental health team and response anywhere in the world at the moment. And what that's taught us is that actually we need to think about not just helicoptering in mental health support in these times, but actually building a system that can then go on to sustain that support for people over time. So what we've seen happen there is that we've had a massive amount of capacity building in this sort of training of helpers and non-professionals. We've also seen a huge effort to train and build capacity amongst all primary healthcare workers. So we have GPs, we have nurses, we have allied health professionals who now can support in identifying mental health problems, trauma, being able to respond with brief psychological interventions, knowing where they can refer people for ongoing support.
We're supporting the improving the quality of specialist services. There's been massive reforms in the health system in Ukraine and so that's been an opportunity to make sure that mental health is taken along with those reforms and improved. It's now, I think, something that we can hold onto as best practice really in terms of how we make sure that mental health is well embedded in any of these responses and particularly with these protracted emergency situations and ongoing conflict because we know that it will have impact on the population for many years. And in terms of, you know, the issue of having care and support and treatment in mother tongue, I mean, I think beyond having solid evidence, it's best practice really. You know, we would follow best practice guidelines in making sure that any treatment and support is in a language that is accessible and comfortable for the people that, for the person that is receiving that support.
Speaker 47
Sometimes that might not be the case, but that would always be what we would strive to provide.
Dion Russ
I think I'd like to add to what my fellow co-panelist Ms. Roznik-Kuzman said about producing a holistic system of care and with both general and community-based forms of care by sharing a bit of my experience as a peer support worker. I think most if not every time I have had a conversation with a young person from a conflict zone or a person that was displaced or otherwise displaced by war, I think almost every time they mentioned that they did not feel comfortable going through the sort of general healthcare system or the general standard pathways to mental healthcare.
So I would be talking about a psychologist or a psychiatrist, but they felt much more comfortable talking to people of their own age, perhaps not with similar experiences in terms of war, perhaps sometimes yes. We have very diverse body of volunteers at At Ease, for instance. But they always felt more comfortable talking to someone at least of a similar age as opposed to someone that was quite a bit older, like a psychologist or a psychiatrist. So I can only attest to what you said on making sure that there is a holistic care system for these people and young people displaced by conflict and war.
Ignazio Roberto Marino
Thank you, thank you very much. And now I give the floor to Aurelijus Veryga from ECR. Thank you, Aurelijus.
Aurelijus Veryga
Thank you, Ignazio, and I would like also to thank all the participants for your brilliant presentations. Thank you so much for bringing this broad perspective of mental health, which is really very broad, and from the questions coming from the colleagues, we can see we are trying to touch different parts of it and even connect with the neurological health, which I believe is truly a good way to go. And thank you for highlighting the new risks for both younger and older parts of generation. You have mentioned the impact of the social networks and also colleagues had a question about the pandemic measures, the impact of these. But my question is more associated with the field that I feel is a bit left outside and a bit neglected because we are taking new and new things on board, which is okay, it's good, we have to follow the new things, new risks.
But my question is more associated with older problems like illegal substance use. And you definitely know the famous Swedish study that proved the causal relationship of marijuana use and schizophrenia. And today we have a reality when those marijuana plants that are planted now to use have much higher concentrations of THC. And we have even unknown number of synthetic cannabinoids that are spreading through the use of vapes and they are illegally sold to minors and they are used. So to your knowledge, is there any research ongoing or already maybe finished to discover those new links with those new plants and new synthetic cannabinoids, especially in relation to acute psychotic events and especially in the minors?
So that's the one question. And then the second question, colleagues already asked very correctly about the war and possible impact of that. But my question would be more even more specific, having in mind COVID, the pandemic, and also the war in the context of PTSD. Because I believe this COVID, the pandemic itself was a very traumatic event, not just the war, and not just an isolation had an impact. So how do you see that from the PTSD perspective as a specialist?
Martina Rojnic Kuzman
Thank you. Well, regarding the, the first question, it is correct that we know that the use of marijuana, and especially the ones that you said that with higher percentage of THC, is the one which is relating directly to psychosis and schizophrenia. And what we also saw that wherever there is a country where there is available, which means that it's more legal, then we have this increase of admittance to psychiatric ward due to psychosis. Well, relating to synthetics drugs, it's a different topic because what we know, actually, that these drugs are very, very easily synthesized. And in one country, for instance, I know that in Croatia, there was at, in one year, it was about 140 new substances on the street, new synthesized drugs.
So, what, and what we see here is now that actually many people use many drugs all together. They sometimes or many often don't know what they're using. And what we see in a clinical practice is this clinical presentations which do not resemble to anything. So, they're actually very severe clinical presentations with altered consciousness which may last for days, and we struggle with that. I'm not aware of any paper which connects different types of drugs with different outcomes, but what I can say from the practice is that actually they cause a lot of damage and, and they are often used more of them together and this damage is very hard to treat.
So, it is really, I would say, public alert for, for this. We would need definitely to do much more on, on the way how to stop the, the, the increase of the availability of these drugs. And this is more maybe a question for the regulatory policies. And regarding the impact of trauma, we know that war as well as COVID, and sometimes when they occur together, it's called like double disaster, it increases not only PTSD, but basically, I think according to the WHO report, it increases the percentage of any mental health disorder in a country. So, basically, we know that schizophrenia, it's occurs around 1% in a country, and when there is affected to war, it increases.
So, basically, each of the psychiatric disorders and also PTSD. PTSD is just the one which is related, but basically all of them increase. So, in, in that instances, we actually would need to have, as I said, and, and my colleague already said, we need to have a whole system in place and we have to expect the, the all psychiatric disorders just to raise, as PTSD, of course. With regards to the PTSD, I also have to say that as opposed to other psychiatric disorders, the PTSD treatment for PTSD might be quite variable across Europe. And we also need to work here more in terms of to standardize the kind of treatment.
Speaker 51
Somewhere it is more treated pharmacologically and some other parts of Europe are more treated psychotherapeutically. So, we need as psychiatrists to set our standards and say this is treated in that way. So, yes, I think I have responded, but I'm not sure. Thank you.
Redlich
I mean, just to say that, you know, I think that these questions are valid and important, and it actually does, through the questions that you're asking, it highlights the problem that we have because we have so many areas that we need to tackle. We think about different determinants, different outcomes. That has impact for clinical spaces. We need to have strong mental health systems that actually treat people who are experiencing these disorders, but we also need to think about how do we get all the sectors on board. So thinking about sort of regulation, thinking about having law enforcement and all the mechanisms required to be reducing the sort of the access to new cannabinoids and other drugs.
Thank you, Ms. Riderich.
This is beyond the health sector. We really need to be bringing people together to tackle this in a holistic way. So thank you for all the questions. I think it's incredibly valuable, this discussion to have.
Dion Russ
Absolutely. Speaking from the community-based mental health perspective, I'm not aware if there's any literature on this, I don't think there is, but I suppose from my own experience as a peer supporter, we do also see a lot of, and I mentioned this during my presentation very briefly, a lot of complex cases of mental health struggles, and that also includes post-traumatic stress disorder. And I suppose I would only, I feel it's important to use this moment to stress again what I was mentioning in my presentation with regards to quality standards for these community-based mental health initiatives, because in the past with another organization I won't name, but in the past I have encountered or I've had many conversations with young people with PTSD, some officially diagnosed, some, you know, you might suspect it, or otherwise sharing very, very detailed and horrible and tragic accounts of trauma. And in the case of this organization that I won't name, I unfortunately had no way of referring them on to anywhere. And so, I suppose, yeah, again, I find it very important that the young people that experience PTSD that might not seek out formal care and that then go to community-based forms of care, that they have some sort of pathway towards formal care that is suitable towards their issues.
Ignazio Roberto Marino
Thank you very much. Now I'll give the floor to Ivan David from ESN for his question. Thank you very much.
Ivan David
Budu opět mluvit česky. Já jsem psychiatr, zabýval jsem se historií organizací psychiatrické péče, navštívil jsem desítky institucí, které se zabývají duševním zdravím a duševními nemocemi.
Já bych chtěl především zdůraznit, že v naší společnosti existuje velmi nebezpečná tendence, a to je medicinizace společnosti, psychiatrizace společnosti, kdy celá řada problémů, které nejsou primárně duševními poruchami, jsou hodnoceny jako duševní poruchy. Já se musím postavit velmi skepticky k těm číslům, která zde zazněla, protože často neexistují diagnostická kritéria, která by byla společná a existuje deklarovaná nemocnost a nedeklarovaná nemocnost, takže čím více odborníků, kteří diagnostikují, tím více diagnostikovaných, takže ta čísla jsou zkreslující. Z jistého hlediska mohou být jaksi podhodnocena, mohou být nadhodnocena. Vždycky péče o duševní zdraví podléhala ideologii už od osmnáctého století, možná už od starověku. Je tomu tak i dnes, tedy až po antipsychiatrii.
Já bych se rád pozastavil nad tím, že se tady často hovoří o tom, co udělat pro to, aby se lidé stali klienty nějaké odborné péče, a my bychom se měli především starat o to, co udělat pro to, aby se nestali klienty té péče. To znamená velký důraz tedy na prevenci primární, sekundární, terciární. Víme, že je problém s výchovou k rodičovství. Já bych tady chtěl velmi zdůraznit to, co tady okrajově zaznělo, a to je budování odolnosti, to znamená důraz na tělesné aktivity, sport a také kontakty, protože víme, že sebevražednost velmi úzce souvisí s izolovaností, že společnosti, kde lidé žijí izolovaně, kde je vysoké množství jednočlenných domácností, lidé se nenavštěvují, nekomunikují, je tam mnohem vyšší sebevražednost než v těch zemích například na jihu Evropy, jako je Řecko, Itálie, Malta, kde prostě jsou zvyky vzájemně komunikovat, navštěvovat se, tak je tam daleko nižší sebevražednost. Takže na to bychom...
Dneska totiž děti vyrůstají izolovaně. Naše generace chodila na hřiště, měli jsme různé kroužky. Dnes velká část dětí prostě sedí u počítačů, dívají se na monitor, komunikují prostě se vzdálenými osobami velmi formálně. V důsledku toho neumějí navazovat sociální vztahy, partnerské vztahy. Často se na to poukazuje, kdy vidíme, že jdou na schůzku chlapec s dívkou a sedí vedle sebe a oba se dívají na monitor, na displej, prostě nekomunikují spolu.
Čili naše společnost je tímto způsobem značně deformována, na to bychom se především měli zaměřit. Pokud se jedná o tu institucionální péči, ať už se nazývá komunitní nebo nenazývá komunitní, tam je velké riziko, že ty osoby samy sebe začnou vnímat jako osoby, o které je pečováno, mají takzvané sekundární zisky z té sociální role jaksi nemocného nebo pečovaného a přesunou odpovědnost ze sebe na tu pečující osobu, což je velmi nebezpečné a je potřeba se tomu zásadně věnovat.
Pokud se tady jedná o ty investice, tak se zdůrazňuje už historicky, že každá koruna, euro, dolar prostě věnovaný prevenci, že se několikanásobně vrací. Já jsem k tomu velmi skeptický, protože jsem se setkal s celou řadou naprosto neefektivně investovaných prostředků do takzvané prevence. Rovněž jsem skeptický k té péči, která je organizována amatéry, osobami, které jaksi nejsou vyškoleny, protože často to vede k tomu, že ta potřebná kvalifikovaná péče se tím oddaluje, čili s tím je problém. Já jsem se chtěl zmínit jen o některých těch záležitostech, které vnímám jako důležité, jinak tady toho zaznělo velmi mnoho. Tento téma je obrovsky široké, čili problém postihnout ho jaksi najednou nesystematicky samozřejmě vede možná k tomu, že většina osob zde v tomto sále se také dívá do monitoru a neposlouchají, i když pak tedy všichni zatleskají, že si všimli, že vystoupení skončilo.
Speaker 54
Thank you very much. And now I give the floor back to Ms. Redlich or Professor, who wants to go first? Okay.
Redlich
Thank you for the questions and comments. I think these are valid concerns and certainly I would like to try to address some of them. I take your point. I think that we look at different in terms of looking at prevalence of mental health conditions versus the self-reported distress and other challenges to mental health and well-being. We separate the two, but they are both meaningful in terms of how mental health systems function and cope.
We have high rates and I think the data that I quoted in our health behavior in school-aged children surveys, they're representative samples of school-aged children aged 11, 13, 15, and we collect that every three years. It is self-reported and it's asking young people what they experience. And it might be that that is changing and increasing over time because there is more discussion about mental health, they're more aware of their mental health, perhaps it's being talked about in schools more than before. But it doesn't change the fact that it's important information because those young people, if they experience themselves as mentally unwell or having challenges, that they will go and try and seek help somewhere. And I think if the only places that they're able to access are settings which are designed to treat mental health conditions and staffed by psychiatrists and psychologists and other professionals with a lot of training who cost a lot for our system, then that's not an appropriate response.
And that's why I think we're advocating for thinking about how we can create settings where if we have large numbers of young people who feel they need something, then can we provide something that is appropriate for their needs at the level that they require and delivered by people who can effectively, uh, uh, provide the level of service they need? And we know that we would never advocate for untrained professionals in, uh, low-intensity services, for example, but we certainly know, um, and much of our work in, in the lowest-income settings relies on trained community and lay workers to deliver appropriate interventions for the level of training they've received. Um, we know that that can be just as effective as, as someone with more professional training. So it's, uh, making sure that we have a tiered or stepped care approach as is appropriate for the context so that we can focus on people with the most acute, um, level of need in the most specialized environments. Um, I agree that, I mean, one of the, the strong recommendations within our, um, policy brief on addressing digital determinants of, of young people's mental health and well-being, and which came directly from consultations with young people themselves, was if we want to get people off screens, then we need to provide alternative environments, that we need to provide good, um, activities for young people that are in the real world.
That requires investment in sports clubs, in other activities. We need to ask young people what they would like to do so that we're not investing in things which actually young people don't want to engage in. Um, and young people do have lots of ideas about where they would prefer to be spending their time and, and would, often when you ask, would like to be doing other activities if they were available in their community. So I absolutely think that thinking about how we create safe, mental health-enabling offline environments to balance the, the, um, the time spent in those environments, also acknowledging that there are opportunities for connection online, but it, it can't be all the time and at the expense of other health-promoting activities. Um, the return on investment data, again, it often relies on modeling and that relies on things being implemented well and being sustained and at a scale that makes a difference.
So I think I take your point that we actually need more, um, data and evidence on, um, real-world action that's, that we know is implemented to good fidelity with the things that we know work, and then we can see whether we do get a, an, a return over time. Unfortunately, those evaluations are few and far between, but I, I think it's something, um, to aim for. Okay. Well, uh, thank you for the questions. You actually tackled several points.
Martina Rojnic Kuzman
Uh, so first, regarding the, I would agree with you that maybe we tend to have medicalization of some things which maybe should not be medicalized. Uh, and maybe when we are, uh, reading these reports, we see that the anxiety has grown and the depression has grown, but it's true that these are estimates from questionnaires. So basically, uh, the level of symptoms which is usually measured by a person, uh, like self-reflecting or by others, and it's not a diagnosis which is medically made by psychiatrists, and that's correct. So basically, we made some, some thing estimation about, and whether the, how is mental health is made out of the questionnaires.
However, what is also true is regardless of how this estimation is made, we have much more demand from the field of youth and and these youth comes and asks for help. So even regardless there may be not an increase in diagnosis which are given by psychiatrists, we have much more demand. So basically I think we should somehow find a way to resolve this demand. With that being said, I also would say that I agree with you that some basic stuff works. As I as I showed also in in the presentation, we showed and what is well evidence-based is physical activity, which is basic stuff, parenting intervention.
So of course if parents are well and make good parenting, then a child will have every chance to also have mental wellness. So we need to invest in those two. And the third which also seem to work is when people are at risk to give them psychotherapeutic help. Psychotherapeutic help means that this help is provided by those who are trained. And to be trained in psychotherapy, so not everybody can call themselves psychotherapist.
To be trained in psychotherapy, regardless which is your which is whether you are medical doctor or you are even peer or you are a lawyer, doesn't matter. But if you are psychotherapist means that you have passed at least several years of training, then making or working under supervision with patients and also some of the psychotherapeutical training means that you yourself has undergone to training, it means that you are treated as a client. And this is this takes several years. And so whoever makes this as psychotherapist, psychotherapist, I would say is qualified. So what it seems to be working is that psychotherapists are doing this intervention regardless of who are the psychotherapist.
So I would definitely argue to have the investment in this that seem to be working. And I think that this thing should definitely pays off. But also there is one aspect which I actually learned from from a community-based mental health, which is something which is a I would say a movement maybe from the last 30 years, which was actually taken on by the patients. As far as I know, it took also from Netherlands where they say this idea that nothing about us without us. Which means that the patient take on the movement of changing the way how psychiatrists practice and move from the hospital-based practice in terms of where I as a physician tell a patient what is good for him to also give them a voice.
And for me, it actually seems that it improved the care because the also we learned as psychiatrists from them, but for me is also easier because the responsibility is now shared. It's not my responsibility, it's our shared responsibility for the patient mental well-being. So I think that this is is improvement overall. This improvement of this community mental health have been developed differently in different as you may probably know in different countries, but overall it seems to me that it's improvement. And from this perspective, I would say the inclusion of those who are peers and have their own experience in the field of mental health as as therapist is also can be producing a very good effects, but also it should be noted that peers also are trained.
So if they're not trained that it's depend they're trained as other therapists should be trained. So then you get educated therapist and I think it will work. And and in that way, the what you do and what you invest, if it's well evidence-based, it will return investment.
If not, probably is not going to return the investment. But also when we are talking about return of investment, I would argue that basically when we compare the cost, for instance, of mental disorders to any other disorders, let's say let's take dementia, for instance. So if we are calculating the cost for dementia, we are calculating the cost of a person not working and having medical problems for 10 years and the cost of medical treatment and the cost of family involvement. But when we are talking about cost of a person with mental disorder, which starts at the childhood or adolescent year, we have the cost of mental illness and medical treatment, the cost of family treatment, but also the cost of a person not working, not going to school. So basically these are all these costs where this productivity is lost.
And also then the cost of social services which have to give this person a social security. So basically my point is that any investment would probably pay off in a long term, but it's very wise from us to give it to those to those interventions which are evidence-based and work and then of course to evaluate them.
Ignazio Roberto Marino
Thank you, thank you very much. I now give the floor to Andre. Oh, you have some, okay, sorry, sorry about that.
Dion Russ
No worries. I wanted to comment on two aspects of your remarks, one being the shifting of the responsibility of care to the carer. It is said, and do correct me if I'm wrong of course, but I believe you said this almost with the underlying implication that this is attributable to the young person. I would argue that the responsibility of care being shifted towards the carer is not just attributable to young people, it's also attributable to the way that care is organized. Institutional forms of care often take away autonomy from the young person and that manifests, for example, in not being able to make decisions about their own care, for example, involving support systems, receiving therapy, being able to go outside, being able to even leave their room, things like that.
And so when there is a call for community-based mental health care, I think it might be important to know that underlying a lot of, if not most of these methodologies of community-based mental health care is this encouragement of young people being involved in making decisions about their own care. So to use At Ease as an example, when we have a conversation with a young person and we feel like it would be appropriate to include a professional clinician within this conversation and to invite them in, as they are usually there present on site, we always ask the young person whether this is something that they would prefer. And so I would hope that there is more investment in these kinds of services. And then the second remark that I wanted to respond to was this sort of general sentiment, as I understood it, of the fragmentation of households and communities as people are more mobile than ever and moving around as compared to countries that might have stronger communities, I believe you mentioned Italy if I'm not wrong. I think here it's important to mention that young people, also as per the United Nations Office for Human Rights report that I previously in my presentation cited, young people want community.
I think even though it it might paint a very harrowing and lonely picture to mention that young people are on dates and looking at their phones, not talking to one another, these I would say the majority of young people want a sense of community. And to make up for that in countries where communities are so fragmented is very difficult. But what I see personally is that young people are very motivated to make up for that because they want to have community and so they organize clubs of their own initiative and take time out of their busy study schedules and their work schedules in order to do this. The problem is just there is a lack of funding. It's always the same story where I come from in that the cultural spaces for young people that there are that are in the vicinity of where I live, they're under a constant threat of being closed down by the municipality and they don't receive enough funding in order to provide young people with this sort of communal space.
So I would say that there is the motivation is there, it's just the lack of seemingly political will and funding from larger institutions in my perspective.
Ignazio Roberto Marino
Thank you very much Mr. Ras, now I give the floor for the last intervention to Ondřej Dostál and I would like to say thank you to the translation service because they will stay for another few minutes so we can have translation if needed. Thank you.
Ondřej Dostál
Děkuji pane předsedo, já na rozdíl od váženého kolegy Davida nejsem psychiatr, ale zabýval jsem se organizací a financováním zdravotnictví. Vy navrhujete určitý soubor iniciativ, ale není mi zcela jasné, kdo je bude vykonávat, jak budou personálně zajištěny a kdo je zaplatí. To je domácí úkol, který by měl odpracovat každý, kdo s něčím přijde do Evropského parlamentu. Zdravotní péče a sociální péče jsou organizovány na úrovni členských států. To znamená, pokud máme dostat užitečné odpovědi, potřebujeme na úrovni každého z nich vědět, které z těchto činností budou zajištěny z veřejného zdravotního pojištění či jiného systému zdravotní péče, kolik to bude stát a kdo to v rámci toho systému zajistí.
Jaké činnosti budou poskytnuty v rámci systému sociální péče, případně jaké činnosti budou provádět a financovat municipality, města, obce, kraje, případně zda si představujete, že některé z těchto aktivit zaplatí rozpočet Evropské unie. S tím, že peníze nejsou všechno. Větší problém, alespoň v naší zemi, je otázka personálních kapacit. Tu péči nemůže poskytovat dobrovolník nebo neziskovka, má-li se jednat o medicínskou péči. To je regulovaná profese a lidí z té regulované profese v tento moment nemáme dostatek a i kdybychom dnes investovali do jejich profesní přípravy, ta bude dokončena třeba za pět, za osm let.
Takže se ptám, zda tady a teď máte představu, co z navržených iniciativ může být v jednotlivých členských státech realizováno, případně kým a za kolik. Děkuji.
Martina Rojnic Kuzman
Well, of course we don't have a proposition here and now for who is going to pay and who is going to have this budget. What is, it's, it depends on, on every member state of EU and they have different legislation. So, usually what I've seen that it works well and good, that when there is a certain agreement on European level how a policy should be made, then each ministry of a certain country is then appointing the funds and also appointing and then after the funds also some of the training. Many of these activities cannot be, do not imply new training, but just imply system reorganization. But also is true that many of the initiatives are funded by the EU and sometimes new initiatives are funded by the EU, they are piloted and then if they are piloted, they are then undertaken by the governments.
These are basically, for instance, the community mental health was done in such a way for Croatia. So first we have a project which was funded by the EU, then we tested it in Croatia whether it works or not, and then we try to model it according to our needs and then it got into our legislation. We are now in a phase where we are fighting with the legislation because this legislation allowed it to be performed in Croatia, but it's not allowed the payment yet. But we will get there. And once we get there, then it will be paid from the, from our ministry, Health Ministry and social work.
So since these are strategies which are novel strategies, I think one way would be to fund it through the projects and then allow it for the nations to have the fund and then make it as a sustainable practice within the country.
Redlich
I mean, I would completely agree that we've seen that that model and that pipeline seems to work well, that many of the, certainly the reforms moving countries towards community-based mental health services and setting up community-based teams have been funded in that way. I think there's, it's important for those funding efforts to go into effective models that we know are likely to work and there's support for adaptation and implementation and then, and from the outset thought about how these new models of care or services or interventions are actually going to be sustained. And that needs political commitment at the national level, but it certainly helps, I think, to have and it's seen, we've seen that it helps to have demonstration of positive impact. I think we're also not naive enough to think that we need to think about reforms and activities which are cost-neutral and so with a focus on restructuring and, and moving funds from things that are not working to things that potentially will address the challenges that are being faced in the particular context, building on platforms and activities that are already there. Agreed that the diversification of the workforce is a huge issue.
And I think this is something that all countries are struggling with, that we have a very limited workforce for mental health in most countries. I don't personally, and I think our organization doesn't believe that that needs to be the case, that there are more people within the systems that can be providing different types of psychosocial interventions, psychological support, but it does require a regulatory environment that allows for that.
Dion Russ
Just a very brief comment from my end. I think it might warrant some clarification that when people in the field of community-based mental health talk about deinstitutionalization or the move from the institution to the community level of care, it's not, even if there's mention of reallocation of resources, it's not trying to get to a sort of extreme scenario where general mental health care is entirely replaced by community mental health care. Community mental health care is set up first and foremost as a means of addressing the gaps left by general mental health care so that they can work in tandem with one another.
Ignazio Roberto Marino
Thank you very much. I really want to express my personal gratitude to our speakers, Professor Roy Nir-Kuzman, Ms. Redlich, and Mr. Russ. It was very, very important for us to have your input. I, in closing, I just want to say that again, that if you'd be kind enough to send us some bullet points that you think are critical and should be in the INI that we are going to write in the next several months. Finally, I want to tell to the audience and particularly to the MEPs that our speakers have been kind enough to share their PowerPoint, so each of us will get the PowerPoint in the mail that will probably be useful to summarize what they have told us today.
So we close our session of the SANT Committee and, okay, the closing the meeting, I need to say that our next SANT meeting will take place on November 9 and November 10. Thank you very much and have a good rest of your day. Thank you, bye-bye.