Mental health policy and practice across Europe: an overview

136 Mental health policy and practice
2003; Stiles et al. 2006), contributing to a growth in credibility and popularity of
psychotherapeutic intervention. In recent years, it has been possible to summarize
the results of several studies through meta-analyses, providing estimates of
efficacy by type of disorders and type of psychotherapy (Bateman and Fonagy
2000; Roth and Fonagy 2004; INSERM 2004).
The following conclusions can be drawn from these reviews:
• psychodynamic psychotherapies have proved to be effective, especially in
personality disorders;
• cognitive-behavioural therapies have shown their effectiveness in treating
depression, anxiety, schizophrenia, bipolar disorder, alcohol abuse disorders,
bulimia and personality disorders;
• family therapies have worked in anorexia, schizophrenia and bi-polar
disorder;
• psychoeducational interventions have been effective in bi-polar disorder and
schizophrenia.
In most cases psychotherapy was evaluated in conjunction with, or compared to
psychotropic drug treatment.
Psychotherapy and policy issues
Psychotherapies are effective in treating a variety of mental health problems,
but there are still many controversies concerning their most appropriate place
in the treatment of these conditions. One problem is the large number of
schools of psychotherapy, with their own traditions and training systems,
which do not always understand each other, and may even fight each other.
Similar misunderstandings exist between psychotherapists and professionals
favouring somatic treatments, especially drugs, although in most cases an
appropriate combination of psychotropic drugs and psychotherapy would be
the most effective treatment.
It is also clear that the development of different psychotherapeutic techniques
has greatly influenced public attitudes towards mental illness, as reflected in
the media, and the development of mental health service systems. The psychological
theories behind these techniques have helped us to gain a better understanding
of mental health problems, and to accept them as part of our normal
everyday life, like physical illnesses. Today, psychotherapy is an essential and
appropriate part of the range of treatments required for the comprehensive
treatment of mental disorders. The provision of psychotherapies should be an
integral part of the mental health plan or strategy of every country, region and
treatment unit.
The financing of psychotherapy is also an important issue. In many countries,
treatment is provided mainly by private psychotherapists, raising questions
about the range of indications and conditions that should be partially or totally
reimbursed to allow patients to cover their treatment costs. The type of provider
is also essential since non-medical providers are less costly and are often
more accessible than psychiatrists – provided the former have been trained
adequately. One policy recommendation is to set up national guidelines for the