Mental health policy and practice across Europe: an overview

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162 Mental health policy and practice Table 7.13 Europe by drug type and country: psychostimulants (methylphenidate and dexamphetamine) Psychostimulants (SU per 1000 population) 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Austria 0 2 4 3 6 20 36 56 85 109 Belgium 107 125 153 193 265 333 455 582 699 885 Denmark** – – – – – – – – – – Finland** – – – – – – – – – – France 3 4 4 9 15 19 25 39 53 77 Germany 47 59 82 123 167 241 351 521 665 681 Greece* – – – 51 4 – – – – 8 Ireland – – – 138 12 – – – – 23 Italy** – – – – – – – – – – Luxembourg 32 38 41 86 138 225 372 726 999 1,191 Netherlands – – – – – – – 568 1,257 1,423 Portugal** – – – – – – – – – – Spain 250 187 71 77 86 106 128 170 211 262 Sweden** – – – – – – – – – – United Kingdom 114 124 166 247 337 419 507 602 646 667 * Data from retail panels only. ** No IMS data available. Source: IMS Health Third Study. See Note 1. there is good data on these countries, although it uses the WHO index of the DDD. These data are presented in Tables 7.15 to 7.18. 10 Using Finland (for which we also have IMS data) as a comparator, we can see that all the Nordic countries are at the higher end of European antidepressant usage. However, Finland remains remarkable, even among the Nordic countries, for its very high use of antipsychotics (see Table 7.16) together with the highest levels of the Nordic countries in the use of sedative and tranquillizing drugs, anxiolytics and hypnotics. Psychopharmaceuticals and the health care system These shifts have to be placed in the context of the general transformation of mental health practice in Europe over this period, notably the move away from inpatient care to ‘care in the community’. In the 1980s, most of those who wrote on changes in mental health policy linked the move from inpatient treatment to treatment in the community to the rising use of psychiatric drugs,
Table 7.14 Europe comparative prescribing of major drug classes by country (2002) (SU per 1000 population) All antidepressants SSRIs Anxiolytics Antipsychotics Psychostimulants Austria 18,639 8,774 12,411 8,165 109 Belgium 26,691 11,473 38,583 9,040 885 Denmark* – – – 17,661 – Finland 20,759 10,207 22,201 112,259 – France 26,893 11,024 39,960 9,868 77 Germany 17,438 2,351 7,719 10,310 681 Greece*** 11,656 5,717 21,682 8,466 8 Ireland*** 20,906 8,450 16,400 6,768 23 Italy 11,155 5,792 23,416 5,558 – Luxembourg*** 17,786 8,397 31,530 5,861 1,191 Netherlands** 16,754 8,339 16,643 4,275 1,423 Portugal*** 22,659 10,384 59,131 9,881 – Spain** 18,673 10,923 37,824 9,615 262 Sweden* – – – 10,710 – United Kingdom 25,623 10,169 6,960 3,838 667 * No IMS date available. ** No data available for Spain (hospital) until 1999 and from Netherlands (retail) until 2000. *** Data from retail panels only. Source: IMS Health Third Study. See Note 1.
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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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Tackling social exclusion 57 Disabi
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Tackling social exclusion 59 Read,
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Financing and funding 61 problems h
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Financing and funding 63 provides a
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Financing and funding 65 recognizin
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Financing and funding 67 care docto
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Financing and funding 69 Trends in
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Financing and funding 71 employment
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Financing and funding 73 kind, cove
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Financing and funding 75 emphasis o
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Financing and funding 77 provided i
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Financing and funding 79 for differ
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Financing and funding 81 budgets in
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Financing and funding 83 Europe or
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Financing and funding 85 the famili
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Financing and funding 87 of further
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Financing and funding 89 mental hea
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Financing and funding 91 community
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Financing and funding 93 Available
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Financing and funding 95 Basu, A. (
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Financing and funding 97 of interve
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Financing and funding 99 World Heal
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The evidence base 101 result of pub
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The evidence base 103 campaigns, it
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The evidence base 105 using health
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Table 5.1 A matrix of evidence Rese
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Identifying needs using epidemiolog
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Page 141 and 142: The evidence base 113 Learning from
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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
Page 183 and 184: Table 7.6 Europe by drug type and c
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Page 189: Table 7.12 Europe by drug type and
Page 195 and 196: Table 7.20 Decline in psychiatric i
Page 217 and 218: Promotion and prevention 189 Mental
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Page 221 and 222: Promotion and prevention 193 risk o
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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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