Mental health policy and practice across Europe: an overview

78 Mental health policy and practice
A fair share of the pie?
A pervasive policy challenge across most of Europe and across many decades has
been to try to ensure that mental health services and interventions receive a fair
share of available health funding. It is obviously difficult and indeed contentious
to try to define ‘fairness’ in this context, but the historically low level of
funding for mental health in many European countries is surely both inefficient
and inequitable. The assertion of insufficiency follows from the observation
of substantial hidden morbidity – often because of stigma and shame – and
because of the substantial health and quality of life benefits that wider availability
of evidence-based interventions would bring. The argument that present
mental health funding levels are inequitable has similar roots: morbidity is not
well recognized by many health systems, and it is unevenly distributed across
the population. Mental health problems account for nearly 20 per cent of the
total disease burden in Europe and are disproportionately experienced by
people in lower socioeconomic and other disadvantaged groups. Even in countries
such as Norway, with its strong long-term national commitment to mental
health system development, there can be threats to sustainability and consistency
– in this case because most resource allocation decisions are taken at
regional or local level (see Box 4.2).
Box 4.2
Financing mental health services – the case of Norway
Vidar Halsteinli
Norway has a predominantly tax-financed health care system, with only a
modest role for out-of-pocket payments. Mental health services are the
responsibility of five regional health authorities (RHAs), which provide
specialized hospital and community services, and local municipalities
which deliver a range of relevant primary health and social care services,
including GP care, nursing care and housing. RHAs are funded through
grants from central government while municipalities are funded by both
central government grants and local taxes. Local decisions and priorities
on the way resources are allocated to mental health, other health sector
and other public sector interventions may mean that resources intended
by central government to be used for mental health can, in fact, be used
for other purposes, leading to much debate.
For instance, there has been widespread concern that general government
grants to municipalities may mean that a lower share of resources
than intended is made available for mental health. One reason for this
is that other local areas of concern, such as education, may be supported
by strong pressure groups that influence local political decision-making,
while mental health service users are less successful in lobbying for
improved local services.
One solution has been the introduction of earmarked grants for
mental health services, theoretically preventing funds from being used