Mental health policy and practice across Europe: an overview

The evidence base 105
using health visitors to screen for depression in postnatal mothers, our entire
policy for primary mental health care should therefore focus on this activity.
Such a piecemeal and unstrategic approach is not desirable. Policy, by definition,
has to take a broad systemic overview. It has to ensure that connections
are made, akin to putting all the elements of a jigsaw puzzle into place, so that
the system will work as an integrated and coherent whole, and the policy can be
implemented.
What types of information and evidence do
policy-makers need?
Policy-makers need to have both qualitative and quantitative information on
mental health policy options in a form which is accessible, organized, accurate,
triangulated, usable and owned by key stakeholders (Jick 1979; Smith 1989;
Kelle 2001). They require information on systemic as well as programmatic
issues (Hafner and Heiden 1991) and must analyse the political, economic and
institutional contexts carefully if they are to assess the need and potential for
reform (Cassells 1995).
Such assessments must cover multiple sectors, not only health but also social
welfare, housing, employment, education and criminal justice to name but a
few. They must also look at the role, and take account of the views, of different
stakeholders including service users, families, professionals within and outside
the health system, employers, non-governmental organizations (NGOs) and the
general public. The links between these different sectors and stakeholders must
be identified; analysis needs to look not just at the potential content of policy,
but also at the practicalities of implementation.
In developing mental health policy, experience in the development of generic
models for the design and reform of health systems (e.g. Hurst 1991; Roemer
1991; Frenk 1994; Cassells 1995; Murray and Frenk 2000), can be drawn on. It is
only recently that there has been interest in looking at mental health-specific
systems and the ways in which mental health systems interact with both
general health systems as well as broader social policy spheres within countries
(Jenkins et al. 2002; Goering et al. 2003; Gulbinat et al. 2004; World Health
Organization 2004).
Integrating knowledge
Information on the broad picture of system development, available infrastructure,
human capacity, demographic profile and epidemiological trends
within a country are required. Such broad information can help to inform
decisions, such as how much money should be spent overall and how it should
be divided up between promotion, prevention, treatment and rehabilitation
services. It can also help to decide the balance that should be sought between
public and private health care, generalist and specialist health, mental health
and social care. Finally, it can help determine the importance of public policy
on mental health. ‘Narrow’ information on the effectiveness of interventions