Mental health policy and practice across Europe: an overview

Financing and funding 87
of further short- or long-term difficulties in recruiting appropriate personnel,
represent the reality of such resource insufficiency as experienced by people
with mental health problems. Such shortages must surely energize both new
training initiatives and the search for alternatives to face-to-face treatment
modalities. Is it possible to develop effective self-administered, manualized
or computer-based psychotherapies that can reduce the demands on clinical
psychologists, psychiatric nurses and psychiatrists and can be delivered costeffectively?
Will there be developments in pharmacological treatments that will
alleviate symptoms, reduce rates of relapse and improve quality of life, without
unacceptable side-effects? And will they be affordable across the world? Will
there be genetic or other breakthroughs that could revolutionize preventive
strategies as well as symptom alleviation?
An issue less often focused on when thinking of the mental health system is
workforce capacity within the primary care sector. National mental health plans
and strategies increasingly recognize the importance of primary care, but is capacity
sufficient? In addition to looking at the function and need for specialist
personnel working in the primary care setting, another staffing issue involves
knowledge and skills. To what extent do primary care staff have sufficient training
to recognize mental health problems and to interact effectively with other
agencies? Chapter 9 discusses a number of primary care training strategies.
There are, of course, training needs for individuals working in other front-line
areas such as social care, schools and prisons.
Available services are often poorly distributed, being available in the wrong
place and at the wrong time relative to population needs and preferences. They
may be concentrated in large cities or available only to certain groups of the
population (usually those with higher incomes), or – as we noted earlier – tied
up in large, old asylums. This resource distribution challenge is not at all easy to
resolve, as it is often related to the very fundamental precepts of a health system
or society. The difficulties encountered in trying to redistribute resources away
from the large hospitals illustrate the embeddedness of many resources. Of
course, it is inevitable and proper that countries will exhibit marked differences
in their patterns of service provision. Many examples could be given:
• Italy famously passed legislation to close its psychiatric hospitals, and the
Italian health system today relies much less on inpatient care than, say,
Germany’s or Belgium’s.
• The Netherlands and Finland have invested heavily in psychiatric social
work whereas Denmark has given proportionately much greater emphasis to
clinical psychology.
• Patterns of medication use reflect different licensing and reimbursement
arrangements (see Chapter 7) as well as local cultures of prescribing, professional
education, marketing and research. For example, France has a threefold
greater rate of psychotropic utilization than the Netherlands (Alonso et al.
2004a).
• The family is generally seen to be a more important source of support to
people with mental health problems in Mediterranean societies than in
northern Europe (see Chapter 16).
• The position and role of primary care is also rather different from one health