Mental health policy and practice across Europe: an overview

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