The emerging mental health strategy of the European Union: a multi-level work-in-progress.

Policy-making in the European Union (EU) is a complex process that can appear impenetrable and opaque. This paper examines the ongoing process of mental health policy-making in the EU. In 2005, the Health and Consumer Protectorate Director-General of the European Commission published a Green Paper and launched a consultation process aimed at mental health service-users, advocates, providers, business, social services and governments. While there were varying levels of participation between member states, a range of trans-national, national and infra-national actors made contributions. Based on these consultations, a 'Consultative Platform' was created and made 10 recommendations centered on the principles of partnership; establishing policy competencies; integrating mental health into national policies; involving stakeholders; and protecting human rights. This ongoing process illustrates many features of EU policy-making: (a) the European Commission generates an initiative; (b) policy focuses on EU standardization, with member states remaining central actors in service-delivery; (c) policy focuses on social inclusion; (d) the European Commission coordinates diverse networks of actors; and (e) there is 'multi-level' involvement, with direct interaction between trans-national, national and infra-national actors. An enhanced focus on epidemiological data and 'evidence-based policy' would increase rigor and focus further attention on this relatively neglected policy area.