Mental health policy and practice across Europe: an overview

Psychopharmaceuticals in Europe 169
It might be thought that the best predictor of the usage of psychiatric drugs
would be the prevalence of mental disorder. Unfortunately, the data in the
European Health for All database on the incidence and prevalence of mental
disorders by European country is very patchy, and not available for most of the
newer member states and pre-accession countries of the EU – that is to say, for
those countries where we have the best data on the use of psychiatric drugs. The
information that is available, which is based on the existing national systems of
reporting from health facilities, does not support the belief that there is some
simple relationship of this type. For example, at the start of the 1990s, the
recorded prevalence of mental disorders in Austria and France was almost identical,
at around 0.95 per cent, yet prescribing rates in France for antidepressants
and antipsychotics were twice as high as those in Austria. The recorded prevalence
rates in the United Kingdom and Finland were also roughly equivalent, at
around 1.5 per cent, but while these two countries had roughly equivalent
levels of antidepressant prescribing, the rate of prescription of antipsychotics in
Finland was over four times higher than that in the United Kingdom. While the
data on prevalence is certainly not robust, it gives little support to the suggestion
that we can, in any simple way, look to differences in the prevalence of
diagnosed disorders to account for variations in prescribing rates.
The database contains information on another factor that might be anticipated
to be related to use of psychiatric drugs – the proportion of total health
expenditure spent on pharmaceuticals. One might have predicted that psychiatric
drug prescribing rates would be linked to the general propensity of the
health system and practitioners in any county to use drug-based treatments.
However, as shown in Table 7.22, there is no clear relationship between these
indices.
We have little option, then, but to conclude that rates of prescribing of psychiatric
drugs have more to do with divergences in the prescribing beliefs and
habits of physicians in different countries, no doubt linked also to the demands
and expectations of the actual and potential patient population, than with the
overall characteristics of health care systems, or the general propensity of such
systems to depend on inpatient treatment. Let us turn to a limited exploration
of data on individual countries within the EU.
The United Kingdom
Data on psychiatric drug prescribing in the early part of the period under consideration
is hard to obtain. Data from the United Kingdom presented by
Ghodse and Khan (1988) covering 1960–85 (see Figure 7.2) show a rising trend
in prescriptions of tranquillizers and antidepressants over this period, and a
decline in prescriptions for stimulants (which may arise from their reclassification
as appetite suppressants). 11 While, in the 1980s, there was a public debate
about the extent to which minor tranquillizers were being prescribed for everyday
unhappiness and stress, about the possible long-term consequences of such
drugs, and about problems of dependence, this debate did not extend to the use
of other psychiatric drugs in the growing community-psychiatric sector. Or
rather, it did so obliquely, in terms of the problems caused by patients in the