Mental health policy and practice across Europe: an overview

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Table 7.23 Psychiatric drug prescribing in England 1980–2000 (millions of prescription items dispensed) Drug class 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 Hypnotics and anxiolytics Drugs used in psychoses & related disorders 24,459 24,373 22,035 21,870 19,642 17,471 16,850 15,970 15,882 16,244 16,464 2,438 2,350 2,342 2,508 2,771 3,039 3,793 4,273 4,826 5,396 5,874 Antidepressant drugs 7,369 7,312 6,886 7,029 7,348 8,027 9,914 11,816 14,962 18,424 22,022 Central nervous 213 135 80 75 62 64 76 97 154 224 269 system stimulants Total* 34,480 34,171 31,343 31,481 29,824 28,601 30,633 32,156 35,822 40,284 44,629 * May not precisely match figures quoted because of rounding. Source: Government Statistical Service. See Note 1.
Psychopharmaceuticals in Europe 173 these ADHD-related drugs rose from GBP£72,970 in 1980 to a staggering GBP£29,358,340 in the year 2000. However, although the cost of all these classes of psychiatric drugs had risen tenfold, from around GBP£50 million per annum in 1980 to around GBP£530 million in 2000, this was broadly consistent with the rising cost of the drug bill generally, and expenditure on psychiatric drugs remains at about 8 per cent of NHS drug expenditure. Italy It is interesting to compare these data with the case of Italy, where the move to community psychiatry was spearheaded by the work of a group of politically committed young psychiatrists who gathered around Franco Basaglia from the early 1960s up to his early death in 1980 (Scheper-Hughes et al. 1987). Under the banner of ‘democratic psychiatry’, they tried to combat what they thought of as the scientific criminalization of otherness and deviance, which was manifested in the segregation of the mentally ill in the closed asylum. In Italy, this was invariably a result of a legal commitment process. Their campaign culminated in Law 180, enacted in 1978, which put severe legal constraints on any new compulsory admissions to asylums, and provided for their gradual phasing-out by the resocialization of their inmates, and the provision of a network of outpatient services, general hospital provision and community mental health centres. According to Michael Donnelly, mental hospital beds in Italy increased consistently in the post-war period until the mid-1960s to a peak of over 98,000 beds, or 173 beds per 100,000 of the adult population (Donnelly 1992). From that point on they began to decline by about 1390 beds per year, and the decline accelerated from 1973 to 1978 to a loss of over 3000 beds per year, and accelerated even further from 1978 to 1983, to a loss of over 4000 beds per year. The actual number of hospital residents (as opposed to available beds) reached its peak in 1993 at almost 92,000 patients, a figure which had declined to about 38,000 by 1981. There was much debate in the succeeding period as to whether these reforms had been fully implemented, with their proponents arguing that they had been blocked and betrayed, while their opponents argued that they had simply led to a transfer of institutional care to the private sector for those who could afford it, and to abandonment on the streets of those who could not. 13 Much less debated was the extent to which this new ‘open’ psychiatric system might be dependent on the prescription of psychiatric drugs to maintain patients ‘in the community’. Data on prescribing for the early period is hard to obtain. However, from 1990 to 2000, the data do not support the view that the decline in hospital beds in Italy is linked to a higher than average level of prescription of psychiatric drugs: despite a higher level of psychiatric hospital bed provision in France (even taking the higher Italian figures from the PROGRES study), the figures in all classes in France run at about twice the rate of that in Italy (see Table 7.24). In both countries, the increase in prescribing of antidepressants over this period is entirely produced by the SSRIs: these have risen sixfold in France over this period from 207 to 1323 SUs per
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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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The evidence base 113 Learning from
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The evidence base 115 sources of ev
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The evidence base 117 Europe, and i
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The evidence base 119 to Policy pro
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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
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 and 192: Table 7.14 Europe comparative presc
Page 195 and 196: Table 7.20 Decline in psychiatric i
Page 199: Psychopharmaceuticals in Europe 171
Page 217 and 218: Promotion and prevention 189 Mental
Page 219 and 220: Promotion and prevention 191 Box 8.
Page 221 and 222: Promotion and prevention 193 risk o
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Page 227 and 228: Promotion and prevention 199 and un
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Page 233 and 234: Promotion and prevention 205 implem
Page 235 and 236: Promotion and prevention 207 When d
Page 237 and 238: Promotion and prevention 209 health
Page 239 and 240: Promotion and prevention 211 Murphy
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Page 243 and 244: chapter nine Common mental health p
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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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Related books from Open University
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PURCHASING TO IMPROVE HEALTH SYSTEM
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