Mental health policy and practice across Europe: an overview

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164 Mental health policy and practice Figure 7.1 EU comparative prescribing of main drug classes, 2002 (SU per 1000 population) Source : IMS Health Third Study. See Note 1. Table 7.15 Antidepressant prescribing 1996–2001 in the Nordic countries in DDD per 1000 inhabitants 1996 1997 1998 1999 2000 2001 Denmark 20.5 24.1 27.1 30.3 33.5 – Finland 23.5 25.4 27.4 31.8 35.5 39.4 Norway 30.9 31.5 31.8 36.1 41.4 – Sweden 34.8 32.0 37.5 41.7 48.8 – Table 7.16 Antipsychotic prescribing 1996–2001 in the Nordic countries in DDD per 1000 inhabitants 1996 1997 1998 1999 2000 2001 Denmark 8.1 8.3 8.3 8.3 8.9 – Finland 15.2 15.0 14.7 15.2 15.3 15.7 Norway 8.5 8.5 8.5 8.7 9.0 – Sweden 9.3 7.8 8.3 8.5 8.6 – although the direction of causality was disputed. Comparative data on the decline in psychiatric inpatient beds is available from the WHO’s ‘European Health for All’ database. These data give a picture of a common direction of
Psychopharmaceuticals in Europe 165 Table 7.17 Anxiolytic prescribing 1996–2001 in the Nordic countries in DDD per 1000 inhabitants 1996 1997 1998 1999 2000 2001 Denmark 25.7 24.2 23.4 22.6 22.0 – Finland 29.0 29.1 28.9 29.8 30.1 31.0 Norway 18.0 18.0 18.5 18.8 19.0 – Sweden 17.4 16.0 16.4 16.8 17.1 – Table 7.18 Hypnotic prescribing 1996–2001 in the Nordic countries in DDD per 1000 inhabitants 1996 1997 1998 1999 2000 2001 Denmark 38.9 35.1 33.2 32.0 31.1 – Finland 40.8 42.9 43.7 47.3 49.0 51.6 Norway 26.8 28.4 29.4 30.3 31.8 – Sweden 44.3 42.3 44.3 45.5 47.2 – change across all European countries, but show that the nature and pace of the changes, as well as the politics and organization, varies greatly from country to country (see Tables 7.19 and 7.20). According to these WHO data, in 2000, the number of inpatient beds per 100,000 of the population, within the EU-15, varied from 14.1 in Italy to 186.3 in Belgium, and the decline from 1986 to 2000 varied from 85.9 per cent in Italy to as low as 7.1 per cent in the Netherlands. There is reason to be sceptical about the accuracy of these figures, which are not always confirmed by other research, especially when non-hospital psychiatric residential facilities are included. This is particularly notable in the case of Italy where, as we shall see presently, the issue of bed numbers has a particular salience given the debate over the consequences of Law 180, passed in 1978, which was intended to initiate the phasing-out of mental hospitals. In 1978 there were 78,538 beds in public mental hospitals; the PROGRES study, funded by the Italian National Institute of Health, found that on 31 May 2000, 1370 non-hospital residential facilities provided a total of 17,138 beds, and recommended an additional 4500 acute beds in public wards, and 5500 in private facilities: a total of 27,138 beds or 47.6 per 100,000 – a figure that is still low by European standards but is over three times that given in the WHO database (De Girolamo et al. 2002). Indeed, overall, the inpatient bed figures given by WHO are not a good indicator of actual bed use. For example, in the United Kingdom, inpatient numbers in public hospitals for those with a mental illness (expressed as available hospital beds for the year from 1984) declined from a peak of over 150,000 in 1954 to under 40,000 in 1998, and the rate declined from almost 3.5 persons detained per 1000 population in 1954, to less than 0.8 per 1000 at the end of the century. But a different picture is given if one considers the number of occupied bed days
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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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The evidence base 111 facilitate gl
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Page 143 and 144: The evidence base 115 sources of ev
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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
Page 183 and 184: Table 7.6 Europe by drug type and c
Page 185 and 186: Table 7.8 Europe by drug type and c
Page 187 and 188: Table 7.10 Europe by drug type and
Page 189 and 190: Table 7.12 Europe by drug type and
Page 191: Table 7.14 Europe comparative presc
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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Page 237 and 238: Promotion and prevention 209 health
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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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