Mental health policy and practice across Europe: an overview

128 Mental health policy and practice
The treatment of mental health problems
The treatment of mental illness can be categorized in a similar way to
determinants:
• biological treatments: the most important are psychotropic drugs but other
treatments can be mentioned, such as electro-convulsive therapy (ECT) and
bright light treatment;
• psychological treatments or psychotherapies;
• psychosocial interventions like case management, daily life activities, family
interventions, network therapy and counselling.
Although there were some treatment developments in the first half of
the twentieth century, there have been enormous developments in the past
50 years (see also Chapter 2). These developments have had an enormous
impact on people with mental health problems and their families, as well as
on mental health professionals, the care system and the general public. Below,
we describe the most important developments in the different treatment
categories during the last few decades, and their impacts (both positive and
negative).
According to epidemiological surveys in many countries, mental disorders are
quite common among the general population (Goldberg and Huxley 1980,
1992; Bland et al. 1994; Kessler et al. 1994; Meltzer et al. 1995; Almeida-Filho
et al. 1997; Bijl et al. 1998; Andrews et al. 2001; Jacobi et al. 2004; Kessler et al.
2005; Pirkola et al. 2005). Summarizing these studies, one can conclude that,
generally, the prevalence of all mental disorders during the previous month
varies between 10 and 15 per cent of the general population, the 6–12-month
prevalence rate is 15 to 25 per cent, and the lifetime prevalence rate has reached
up to 50 per cent. Studies conducted with children have also shown high prevalence
rates: from 10 to 20 per cent among school-aged children (e.g. Fombonne
1994; Puura et al. 1998). Depression and anxiety disorders are the most prevalent
mental health problems, followed by substance use disorders among
adults. Among children the most common are attention deficit and conduct
disorders.
However, the occurrence of mental illness does not always mean the need
for treatment, which must be assessed separately (Lehtinen 1985; Bebbington
1990). Assessing the need for treatment is not necessarily an easy task. This is
especially true when it comes to the mode of treatment to be offered, despite the
publication of several treatment guidelines in the last 20 years (e.g. American
Psychiatric Association 2002; National Collaborating Centre for Mental Health
2005). There still exist different schools in psychiatry, for example, with
regard to whether psychotherapy or drug treatment should be the treatment of
choice. Assessing the need for treatment is therefore easier than deciding what
kind of treatment is needed. In epidemiological surveys one also encounters
situations where the people in question are either not aware of their mental
health problem – and thus are not ready to seek any help – or are aware of
somatic symptoms for which no physical cause can be found, and seek help for
these rather than the accompanying mental condition. Should such people be
counted among those who need treatment?