Mental health policy and practice across Europe: an overview

170 Mental health policy and practice
Table 7.22 Relation of psychiatric drug prescribing and proportion of health budget
spent on pharmaceuticals
Countries ranked by
proportion of total
health expenditure
spent on
pharmaceuticals
Total pharmaceutical
expenditure as % of total
health expenditure both
sexes (2001 except where
specified)
Antidepressant
prescribing (SU per
1000 population)
(2001)
Antipsychotic
prescribing (SU per
1000 population)
(2001)
Portugal *22.8 20,983 9,600
Italy 22.3 10,589 5,697
France 21.0 25,954 10,071
Spain **17.8 16,902 9,367
Belgium ***16.3 25,178 8,868
United Kingdom ***15.8 24,167 4,045
Finland 15.7 19,471 18,273
Austria 15.1 17,460 7,759
Germany 14.3 17,523 9,951
Greece 14.0 9,751 7,563
Sweden 13.5 – –
Luxembourg ****12.1 16,817 5,748
Ireland 10.3 19,625 6,600
Netherlands 10.1 15,983 4,228
Denmark 8.9 – –
* 1998 ** 1990 *** 1997 **** 2000
Source: IMS data and European Health for All Database at http://www.euro.who.int/hfadb.
community being inadequately supervised, and discontinuing their medication
to the detriment of their own capacity to function and with undesirable
consequences for their family and the community. The debate was largely
between those who thought that ‘care in the community’ was inherently more
humane because it was less restrictive of freedom and who were concerned
about its partial and slow implementation, and those who suggested that the
problem lay in the ‘abandonment’ of the mentally ill under the dangerous illusion
that they could survive in the harsh world outside the hospital. It did not
dwell much on the possibility that there might be a simple substitution of psychopharmacological
restraints for physical ones. In this debate, whatever their
differences, most people took the view that progress lay in emphasizing the
similarity of mental illness and physical illness, which would remove or reduce
stigma and facilitate prompt treatment, and also in emphasizing the availability
of effective and appropriate pharmacological treatments for mental illness.
Objections to the rise of pharmacological psychiatry were left to a few maverick
psychiatrists, displaced and defensive psychoanalysts and psychodynamic therapists,
and the residual elements of the antipsychiatric movements of the 1960s.
And as the focus of political concern shifted in the 1980s to the management of
the risk apparently posed to ‘the general public’ by ‘community psychiatric
patients’, a key role, once again, was accorded to drugs; it was, apparently, lack
of compliance with drug regimes that was a major cause of the relapse of these