Mental health policy and practice across Europe: an overview

90 Mental health policy and practice
and productive inefficiencies, because they make it harder for services to respond
to the needs and preferences of service users. Possible steps to address these
challenges will not be applicable or appropriate in every country. Each needs
to be considered for its local relevance and to assess its potential for improving
the level, distribution, appropriateness, flexibility, coordination and ready
availability of resources in meeting mental health needs.
Fundamental to any action is the need to improve awareness of mental health
issues and to address stigma and discrimination. Some members of the general
public may believe that mental illness is self-inflicted and less deserving of attention.
They may believe that problems are difficult to treat. They may be ignorant
of the high prevalence of illness. They may be unsympathetic towards people
whose ‘ill health’ they attribute to weakness or hypochondria. Improving mental
health awareness or literacy may lead to a greater willingness to support mental
health initiatives and develop national mental health policies and action plans
(Jorm 2000). This is an ambitious aim, of course, for while there are examples of
policies and practices that are successful in reducing stigma (Sartorius 2002),
many attitudes about mental illness have deep cultural and religious roots.
National anti-stigma programmes have nevertheless been introduced and are
being evaluated in several European countries, such as in Scotland.
Increasing the resources available for mental health care would not remove all
of the barriers, but it would represent an important start. Some governments
certainly need to consider giving greater priority to meeting mental health
needs. The contribution of mental health problems to overall disease or disability
burden, combined with the availability of effective and cost-effective
interventions to prevent, treat and/or rehabilitate individuals, would appear to
justify a significant increase in funding for mental health in many countries.
This makes sense from both social justice and efficiency perspectives.
Another argument for increased investment is to support implementation of a
mental health reform process. As is abundantly clear from other chapters in this
book, there have been dramatic changes to many systems of mental health care
over recent decades, with most western and some other European countries
moving from an era dominated by the old asylums to one that is much more
proactively focused on community-based support arrangements. Such shifts
require additional resources, at least in the short term. There is obviously a need
to invest in new physical capital and human capital resources in the community
prior to the closure of a hospital, to ensure the smooth and effective movement
from one system to another. Secondly, community and hospital systems will
need to run in parallel for some time, resulting in double running costs. Consequently,
mental health reformers will almost certainly need to invest in
order to save. Many countries will definitely need injections of additional
resources in order to promote quality of life. Reforms that are introduced in a
cost-neutral way – or, worse that are intent on saving money – could result in
many people being denied care, or offered substandard support. This case needs
to be forcefully made.
Evidence on cost-effectiveness can support the case for investment in mental
health across many sectors of society; benefits from greater investment could
include reduced reliance on social welfare payments, increased productivity,
reduced contact with the criminal justice system and improved family and