Mental health policy and practice across Europe: an overview

Financing and funding 93
Available resources could be deployed more efficiently in every health system.
Although somewhat clichéd, much can be improved by ensuring that money
follows the patients or service users. Supportive actions might include proper
needs assessments, creating opportunities for patients to be involved in decisionmaking,
shifting responsibility for arranging and purchasing services to localities
while ensuring that national policies and treatment fidelity are followed,
and that good standards are achieved.
Improved coordination might be obtained by reducing budgetary conflicts
between ministries, seeking compensation between budgets for greater overall
efficiency and again encouraging patient decision-making. This would certainly
be aided through cross-ministry discussions and perhaps even the transfer of
funds into joint budgets and the introduction of case management or similar
case-finding, brokerage and micro coordinated efforts. These arrangements
have their own (transaction) costs, of course, and a careful spending balance
must be struck between resources that deliver mental health care and resources
that simply coordinate. However, such initiatives are only going to be remotely
possible in countries that already have some degree of coordination and strategic
policy steer. In fragmented multi-provider health care systems with little
centralized control the challenge is likely to be huge, although may be more
feasible in regions with devolved powers.
Another way of helping to ensure that funds are allocated to meet needs,
particularly within the community, is by encouraging ‘direct payments’ or
‘individual budgets’ (consumer-directed care). Individuals are given cash with
which to purchase some or all of their services. This not only empowers individuals,
but promotes independence and inclusion, and offers greater opportunities
for rehabilitation, education, leisure and employment. This system has
only been introduced in a few countries, for example in England, Scotland and
the Netherlands. While not fully evaluated, if experience is similar to that when
such payments have been used for people with physical or sensory disabilities it
may avoid some of the problems of funding and coordinating services across
different provider sectors.
Looking forward
The last decade has seen a significant increase in the attention given to mental
health by many supra-national bodies, including WHO, the European Commission
and many European governments, most notably with the recent commitment
by all European governments to providing a ‘fair and adequate’
level of resources for mental health (World Health Organization 2005b). There
is now substantial evidence that greater resource investment in many areas
of mental health is not only justified on the grounds of tackling inequalities,
the high degree of social exclusion and adverse consequences, but also that
it represents a more efficient use of health (and other) resources. Efficiency
gains can be both immediate and long-term. There remain gaps in knowledge,
however, and international initiatives aimed at improving awareness, and
looking at the transferability of the results of cost-effectiveness and related
studies, such as the work of the WHO CHOICE programme globally and