Introduction
by Dr. Andraž Teršek.
Mental healthcare and the prevention of suicide are highly important problems of contemporarily society. Mental health is considered to be one of the biggest and most serious health problems in Europe, according to the statistical data of the WHO and EU Commission. During the 2020 Coronavirus pandemic this health problem of the society as a whole has even deepened and expended. The purpose of this essay is to address these, too often forgotten or neglected problems, at least according to the
media agendas, public attention, and the focus of daily political debates on other, completely different issues. My intention is to make a small contribution to raise the recognition of the existence and importance of both problems in the EU member states and at the global level. By appealing to the international community there is a compelling societal urgency to raise common awareness of the importance of mental health and suicide prevention. Especially after the 2020 Coronavirus pandemic (or, as many doctors, medicine scientists and WHO emphasize, after its “first wave”).
Mental Healthcare and Suicide Prevention Are Important Legal Matters
These are not only medical problems. And these are not only questions for philosophical, ethical and social deliberations. These are also, quite strongly and deeply, legal problems: problems to be addressed by law, with thoughtful legal policies. Even more, the State’s legal obligation is actively to exercise the responsibility for public mental health and the prevention of suicide.
Such responsibility of the State (each EU and Council of Europe member State) is its positive legal obligation, founded in the international and constitutional law. This positive legal obligation of the State surpasses the mere protection of rights, freedom and other legitimate interests of people with different kind of mental disorders against the intrusions in these rights (the negative character of human rights). First, this positive obligation covers the existence of quality programs for the effective prevention of the risks for mental illnesses or disorders, but also – or even especially so – for the prevention of suicides per capita in each EU member state, or rather – in the EU as a whole. By other words, this positive legal obligation of the State demands the institutionalisation of effective assistance to individuals with different mental disorders. Second, the State has to realise the goals and commitments which are determined by national programs for mental health effectively, with emphasized determination and, above all, with high degree of political and ethical responsibility for human life, health, liberty and dignity. By doing so, the State must assure the proper legislation, sufficient funds for medical institutions and research centres, but also the employability of the professionals in this field. Third and above all, it has to develop quality, effective and available public health system as such.
This positive obligation of the State must be constitutionally evaluated as a very important, but still just the first step in fulfilling positive legal obligations of the State from the view of public health. The safeguarding of the minimum standards doesn’t exhaust the legal responsibility of the State in this context. While the Judiciary, an equally important and at the end of each legally relevant story also the most important “constitutional player”, should be stricter when evaluating the exercise of legal obligations, the State is to regard public mental health in the systemic manner.
The 2020 Coronavirus Pandemic Experience
In Europe, living conditions during the Coronavirus pandemic were hard to bear. Quite expectedly they were causing anxiety, sadness, feelings of loneliness and similar sensations of the organism. Those living circumstances were especially damaging for people with depression, depressive disorder or other mental health problems. Such evaluation, even if secular on the first glance, was undoubtedly confirmed by doctors, medical scientists and other medical staff who addressed the public through media.
The main reason was self-evident: constitutional rights for freedom of movement and socializing were limited by government decrees in all of the EU member states, in some states slightly more (Spain, Italy, Hungary, Slovenia…) and in other states a little less. Even though “the state of emergency” was not officially declared in most of the EU member states (the Slovenian Constitution explicitly determines the conditions for such declaration in Art. 92 and those conditions were not fulfilled) the “exceptional” circumstances of public life had an effect as if it has been declared. In the EU member states people were living in de facto “state of emergency” and in quarantine (inside the national borders, in Slovenia also within the boundaries of municipalities). In the first part of the officially declared pandemic, people were not even able to visit doctors and hospitals (due to other common diseases other than COVID-19), psychiatrists and psychotherapists included. That was for two months, more or less.
Frightened People Will Remain Being Frightened
It was obvious – according to media reports, discussions on internet forums and on Facebook web sites – people were very frightened. And they will remain to be frightened, even when the end of the pandemic will be officially proclaimed. In EU member states who proclaimed the end of the official pandemic first (Slovenia being the first, Austria and Hungary being the second), this fear, deeply rooted inside, was obvious. Many of them, especially the elderly, were still avoiding public life and the contact with other people and not a small number of them remained determined to wear masks. This image of the current social situation in Europe and the feelings of the people is not negligible, less worthy of ridicule. This serious matter, a serious consequence of a pandemic, must be faced with maximum seriousness, responsibility and empathy.
It is quite reasonable and legitimate that for most of the time politicians were the ones addressing the public. They took up most of the space and time in media. Doctors, other medical staff or medical scientists were publicly less exposed. But a side effect was expected and can’t be denied in its legitimacy and importance. When people are frightened, the possibility and predictions if they will behave in accordance to the directions and official demands is higher. But, and there usually is an additional “but”, in such living circumstances more fear results not only in a higher percentage of obedience and respect for the rules, it also results in increased percentage of anxiety, immune system failure and in a final consequence of deteriorating general public health, mental and / or physical.
Besides that, politicians all over Europe, even representatives of the WHO were using words such as “we are combating the coronavirus.” And how did people emotionally and psychologically react? With an emotional and physiological response as if it were a state of war. Such a response additionally increased mental health problems. By their daily addressing of the public, politicians and PR representatives of the governments were mostly citing statistical data: how many people have been tested for COVID-19, how many of those were positive and how many people have died daily –presumably from the Coronavirus. Such was the nature of the message and with a few exemptions, no broader context was offered to the public, neither a detailed information about the age of those who were infected, nor other about previous diseases and possible terminal illness. Pure statistics communicated to the general public did have expected and logically an effect of further increase of the fear, especially for the elderly. As already mentioned, this fear didn’t go away with the officially proclaimed end of the pandemic in the EU member states who were the first to officially proclaim it. This fear won’t go away soon and easy. So, the legitimate concern that it will become a new epidemic must be taken seriously and with high level of socio-political responsibility.
It doesn’t seem superfluous to repeat, especially with the elderly still refusing to go out without masks. Even though the WHO does not recommend wearing masks and even though quite a number of doctors publicly expressed their strong objection to wear masks with an explaination of the medical reasons – why masks don’t efficiently protect individuals against possible infection and why wearing those masks can even be quite dangerous and damaging for the health of individuals. But – people are still scared and so they do it.
The Priorities of the Legal Policies Within and of the EU
By searching through the internet, one can easily and quickly conclude EU member states having their own national programs or resolutions for facing mental health and suicide problems. Although the EU Commission has its own resolution for coping with these two problems, it is not enough. I have reviewed the situation in EU Member states and inquired how the forecasts and commitments written in such documents were realised in social practices before the pandemic. I came to the conclusion that in most EU member states those forecasts, commitments and “promises” given by the daily politics remained unrealized, with modest effectiveness and determination, not to say responsibility for their quality and effective systemic execution.
The same applies t0 the Republic of Slovenia. The special Act on Mental Health was enacted in late 2008. It was publicly introduced as appropriate legal framework covering the problems of mental health and suicide prevention. But as far as Slovenia is concerned this statute alone is nothing special. Most of the provisions concern general principles already known and written elsewhere in other documents, such as the general doctrine of the medical profession and the Code of Ethics for the work of physicians. With addition of the provisions transcribed from the Constitutional Court’s judgement determining fundamental rights of individuals who are posted by doctors or by a court decree to the Psychiatric Hospital for compulsory and involuntary treatment. Therefore, I consider such legal act as a general guideline for the protection of the fundamental constitutional rights of this type of patients, without the added value, which would be worth special mention.
Concluding this matter, the systemic arrangements of the mental health problem and the problem of suicide prevention remain insufficiently effective in the practice. Additionally there is a traditionally existing problem: the deficit of professional staff, the deficit of funds guaranteed in the budget and the deficit of special capacities. Those deficits remain a fact. Inside the frame of public health systems and institutions, which I strongly consider to be an absolute legal and political priority in the short-term future, this problem must not be ignored or taken for less important.
Necessary Legal Deliberations for the Short-Term Future
In my opinion, in not more than three to five years, special concern should be given to the analysis and research of legal, specifically, constitutional questions and solutions regarding mental healthcare and suicide prevention. Mental healthcare and suicide prevention must be fully recognized as legally relevant phenomenon. These challenges must be fully and publicly addressed as matter of ethical responsibility, moral lucidity, medical priority and constitutional necessity. A constitutional principle of “social state,” which is one of the institutional features of constitutional democracies in all of the EU member states, must (not only “should”) be politically and legally strengthened not weakened. The socially, ethically, politically and legally responsible political community, as the EU is supposed to be, may not disregard this issue. Substance and scope of fundamental rights and freedoms regarding mental healthcare and the suicide prevention represent a very special, a most intimate relationship between the state and the people/general public. In this context, the positive nature of constitutional rights must be safeguarded with more effort of the EU member states and their institutions in the field of public health systems. Fundamental rights and freedoms, directly or indirectly connected to health issues, must be given more protection. And the judiciary must be stricter when deciding cases on legal acceptability of statutory solutions and the sufficiency of legal policies. Usual and well known excuses of daily politics referring to “insufficient funds” for effective confrontation with the problem of mental healthcare and public health in general shouldn’t be easily accepted by courts – as an escape from the political, constitutional and ethical responsibilities of the State.
Appeal to the Legal Community
Legal and especially constitutional aspects of mental healthcare and suicide prevention represent a subject with rather much deficit in terms of scientific research and evaluation. This is my personal evaluation based on my review of information on this subject available on the internet. This presents us (or faces us), citizens of the EU member states, with an obvious and persuasive necessity, to take determined and efficient steps forward. The modern social constitutional democracy, which is highly emphasized as fundamental feature of the EU as a whole, and the constitutional doctrine of the positive obligations of the State, enable and demand updated approaches to legal aspects of mental healthcare and suicide prevention. Expectations towards legal policies and positive legal obligations of the EU member states have to be increased and strengthened.
I emphasize and repeat once again: the mental healthcare problem and the suicide prevention problem is a serious and too big of a problem in Europe. That is a fact and this fact opens the door for most serious, determined and permanent analytical scientific approach very widely – also from a legal perspective. The law must be used for the purpose of reducing the number of cases of suicides per capita in EU member states and for reducing the problem of different, but very present mental illness issues of the European population. This problem is present in current social life, it is very real and most serious.
Therefore, the legal community should and must engage in the process of reducing this problem, for the purpose of improving mental health of citizens of the EU member states. The EU must show its capability for the development of progressive and evolving institutionalised plans and programs of psychiatry, psychotherapy, suicidiology, nursing and, last but not least, palliative care.
The EU Commission and European legal community should be deeply involved in forcing the member states to do much more in this context as it has been done in previous years. The EU Administration plays an important role in the process of putting the member states under an effective control of responding to their political, legal and ethical duties regarding mental healthcare and suicide prevention. It is not only a matter of “some of the” human rights and freedoms. And it is not only a matter of “human dignity.” It is a matter of life and death, living and dying. It is a matter of HUMANITY. Who dares to argue against that?
Interesting websites
- University of Primorska: Faculty of Health Science
About the author
Dr. Andraž Teršek is a university professor of constitutional law and a constitutional scholar, employed at the Faculty of Education and Faculty of Humanities (University of Primorska, Koper) and at the European Faculty of Law (New University, Ljubljana & Nova Gorica). He lectures and publishes primarily on constitutional law, human rights and freedoms, law and ethics in education, freedom of expression and political philosophy. He has published numerous professional, scientific and newspaper articles, several professional books and scientific monographs, as well as a novel and a book of poetics.
Citation:
Teršek, Andraž: An appeal to raise awareness of the importance of Mental health care and suicide prevention (In: Polak, G. [ed.]: GI-Mail 07, ISSN: 2312-0827 Going International, Vienna 2020)
Here you can download this publication.
Published in GI-Mail 07/2020 (English edition).
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