Mental health policy and practice across Europe: an overview

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108 Mental health policy and practice A blueprint for improving the construction of evidence-informed policy We have looked at EBM and its link with policy-making, setting out some of the informational needs of policy-makers. In this section we set out some of the key elements of a blueprint to help facilitate and improve both the construction and implementation of evidence-informed policy (see Box 5.1). Box 5.1 Elements of a blueprint for improving the construction of evidence-informed policy 1 Enhance understanding of the kinds of information which are helpful for policy development. 2 Ensure that situation appraisals are undertaken to obtain contextual information that will assist policy being tailored to the local situation. Develop frameworks and methods of synthesis. 3 Enhance accessibility to information. 4 Plan future research and development to support evidence-based mental health policy. 5 Invest in the development of knowledge transfer mechanisms between policy-makers and other stakeholders. Enhance understanding of how different types of information can be used in policy development A key first step in the development of policy for mental health is to understand how different types of information can be used in policy development. Policy ultimately is dependent first on identifying the needs of the population, then understanding what current structures and services are available, and finally determining how to augment or change the current service mix. Epidemiological research and information obtained from routine data collection and local surveys can help inform both our understanding of population needs and the current structure and utilization of services. For policies and their implementation strategies to be credible, they need to be highly tailored to the local situation for which they are intended. Rapid situation assessment and appraisal can be used to enhance our understanding of the local context. Once needs have been identified and local services and structures mapped, policy needs to consider the evidence base on interventions and strategies to improve mental health. It is at this stage that information from both qualitative and quantitative studies of specific interventions should be collected. If previous national or local policies and strategies have been evaluated, this information can also be used to inform the policy debate.
Identifying needs using epidemiological research The evidence base 109 One powerful way of identifying mental health needs is through the use of epidemiological research (Jenkins 2001). Methods, namely epidemiological interviewing techniques (Wing et al. 1990; Lewis et al. 1992; Jenkins and Meltzer 2003) can be used to appraise mental health, mental disorders and the accompanying disability in individuals and populations. There are also methods to assess the service needs of sick populations (e.g. Marshall et al. 1995; Phelan et al. 1995; Avon Measure Working Group 1996). Although epidemiology is crucial for policy-makers (Jenkins 2001), few countries perform national epidemiological studies on the general household population because of the perception that such studies are relatively expensive and time-consuming. This need not be the case; the current world mental health survey has been working with 14 countries worldwide to run national surveys (World Mental Health Survey Consortium 2004). Relatively small-scale, but nonetheless useful, community-based and primary care studies on mental disorders have already been undertaken in many low-income countries (Institute of Medicine 2001). Identifying needs and mapping service availability Data from household and service-user surveys (at various levels in the service), routine data on patients, service inputs and processes can also play a vital role. Again, there are limitations in existing health information systems which often focus largely on routine data collection of hospital admissions, consultations and discharges. They may gather little information on specialist outpatient clinics, less still on consultations in primary care or the community, and nothing at all on population rates of illness. They sometimes include mortality data, but they hardly ever include health or social outcomes – although efforts to introduce routine mental health outcome measurements have grown (Jenkins 1990; Wing et al. 1998). There have been developments, for instance in England, with the introduction of the mental health minimum data set, which aimed to bring together data covering many aspects of individual patients’ personal characteristics, problems and care (Glover and Sinclair-Smith 2000). Timing and access to this information is also important. In some countries these data are often collected and published much too late to be useful in health planning and decision-making (Smith 1989). They may not be sufficiently synthesized with qualitative information so as to be easily interpreted by decision-makers. Moreover, information and evidence may not always be accessible outside the narrow confines of the specific governmental department in which it was produced (e.g. the prison service). Obtaining different perspectives on what constitutes evidence of effectiveness While discussion occurs over what type of evidence should be used to inform policy-making and practice, much less is said about who decides what evidence should be used or which sources of evidence should be given priority. Evidence generated by service users traditionally has had little impact in the development
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European Observatory on Health Syst
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The European Observatory on Health
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Open University Press McGraw-Hill E
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European Observatory on Health Syst
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viii Contents five six The evidence
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List of tables 2.1 Beds in state ps
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List of figures 4.1 The production
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List of boxes 3.1 A personal testim
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List of contributors Francesco Amad
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xviii List of contributors Viviane
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Series editors’ introduction Euro
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Foreword Mental health may be the m
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Foreword by the Minister of Health
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Acknowledgements This volume is par
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chapter one Mental health policy an
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An overview 3 agencies (see Chapter
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An overview 5 Funding In broad term
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An overview 7 Social inclusion and
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An overview 9 actions such as inter
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An overview 11 of symptom alleviati
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An overview 13 Kessler, R.C., Demle
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chapter two The historical developm
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Historical development of mental he
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A lack of historical continuity His
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Tackling social exclusion 35 • in
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Tackling social exclusion 37 networ
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Tackling social exclusion 39 regula
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Tackling social exclusion 41 where
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Tackling social exclusion 43 and Sw
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Tackling social exclusion 45 addres
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Tackling social exclusion 47 than o
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Tackling social exclusion 49 in thi
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Tackling social exclusion 51 not ho
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Tackling social exclusion 53 Box 3.
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Tackling social exclusion 55 Conclu
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Page 89 and 90: Financing and funding 61 problems h
Page 91 and 92: Financing and funding 63 provides a
Page 93 and 94: Financing and funding 65 recognizin
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Page 99 and 100: Financing and funding 71 employment
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Page 107 and 108: Financing and funding 79 for differ
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Page 117 and 118: Financing and funding 89 mental hea
Page 119 and 120: Financing and funding 91 community
Page 121 and 122: Financing and funding 93 Available
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Page 125 and 126: Financing and funding 97 of interve
Page 127 and 128: Financing and funding 99 World Heal
Page 129 and 130: The evidence base 101 result of pub
Page 131 and 132: The evidence base 103 campaigns, it
Page 133 and 134: The evidence base 105 using health
Page 135: Table 5.1 A matrix of evidence Rese
Page 139 and 140: The evidence base 111 facilitate gl
Page 141 and 142: The evidence base 113 Learning from
Page 143 and 144: The evidence base 115 sources of ev
Page 145 and 146: The evidence base 117 Europe, and i
Page 147 and 148: The evidence base 119 to Policy pro
Page 149 and 150: The evidence base 121 Finally, it i
Page 151 and 152: The evidence base 123 Lavis, J., Ro
Page 153 and 154: The evidence base 125 World Health
Page 155 and 156: The treatment of mental disorders 1
Page 175 and 176: Psychopharmaceuticals in Europe 147
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Table 7.10 Europe by drug type and
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Table 7.12 Europe by drug type and
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Table 7.14 Europe comparative presc
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Psychopharmaceuticals in Europe 165
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Table 7.20 Decline in psychiatric i
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Promotion and prevention 189 Mental
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Promotion and prevention 191 Box 8.
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Promotion and prevention 193 risk o
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Promotion and prevention 195 and th
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Promotion and prevention 197 (Üstu
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Promotion and prevention 199 and un
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Promotion and prevention 201 The li
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Promotion and prevention 203 income
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Promotion and prevention 205 implem
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Promotion and prevention 207 When d
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Promotion and prevention 209 health
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Promotion and prevention 211 Murphy
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Promotion and prevention 213 Vuori,
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chapter nine Common mental health p
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Mental health disorders in primary
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Mental health problems in primary c
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chapter ten Reforms in community ca
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Table 10.1 Mental health care in th
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Reforms in community care 239 syste
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Reforms in community care 241 integ
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Reforms in community care 243 In 19
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Reforms in community care 245 Secon
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Reforms in community care 247 must
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Reforms in community care 249 Goldb
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Addiction and alcohol 251 (Brown et
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Addiction and alcohol 253 Figure 11
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Addiction and alcohol 255 Table 11.
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Addiction and alcohol 257 Some stud
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Addiction and alcohol 259 availabil
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Addiction and alcohol 261 Table 11.
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Addiction and alcohol 263 Hours and
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Addiction and alcohol 265 College s
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Addiction and alcohol 273 Alcohol t
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Addiction and alcohol 275 developme
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Addiction and alcohol 277 Greenfiel
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Addiction and alcohol 279 World Hea
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Housing and employment 281 European
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Housing and employment 283 to a lif
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Housing and employment 285 relative
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Housing and employment 287 comprise
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Housing and employment 289 treatmen
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Housing and employment 291 rented h
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Housing and employment 293 occupati
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Housing and employment 295 market;
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Housing and employment 297 Table 12
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Housing and employment 299 Return t
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Effectiveness of pre-vocational and
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Housing and employment 303 where re
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Housing and employment 305 mental h
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Housing and employment 307 S.M. (20
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A human rights perspective 309 Nor
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Monitoring compliance with the inte
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A human rights perspective 313 Ment
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A human rights perspective 315 Equa
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A human rights perspective 317 Last
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A human rights perspective 319 Comb
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A human rights perspective 321 segr
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A human rights perspective 323 The
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A human rights perspective 325 •
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A human rights perspective 327 ensu
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A human rights perspective 329 •
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A human rights perspective 331 Arti
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A human rights perspective 333 Refe
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A human rights perspective 335 Will
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The user and survivor movement 337
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Care of asylum seekers and refugees
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generic local team or psychiatric h
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Carers and families 375 In this cha
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Carers and families 377 impact they
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Carers and families 379 2002). In a
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Carers and families 381 conducted i
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Carers and families 383 Interventio
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Carers and families 385 Child careg
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Carers and families 387 subject to
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Carers and families 389 Conclusion
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Carers and families 391 Cohen, C.A.
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Carers and families 393 in long-ter
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Carers and families 395 care in rel
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chapter seventeen Mental health pol
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Policy in former eastern bloc count
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Table 17.1 General information and
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Box 18.1 Recommendations in The Wor
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The WHO perspective 429 isolation,
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The WHO perspective 431 high when c
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The WHO perspective 433 Key issues
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The WHO perspective 435 Box 18.2 Qu
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The WHO perspective 437 services is
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The WHO perspective 439 Desjarlais,
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Index abuse of psychiatry, eastern
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Index 443 community care ECHR, 321
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Index 445 European countries commun
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Index 447 initiatives, discriminati
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Index 449 applying principles, 317-
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Index 451 policy, 228-9 practice, 2
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