Mental health policy and practice across Europe: an overview

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Table 7.24 Psychiatric drug prescribing (retail sales) 1990–2001 in Italy and France in standard dosage units per 1000 population 1990 1992 1994 1996 1998 2000 2001 Italy: tranquillizers 2,118 2,085 2,146 2,318 2,280 2,269 2,279 France: tranquillizers 4,998 4,821 4,584 4,301 4,150 4,089 4,192 Italy: antidepressants 640 633 644 691 711 852 1,036 France: antidepressants 1,952 1,998 2,059 2,052 2,236 2,411 2,653 Italy: sedatives + hypnotics 956 862 857 908 863 868 885 France: sedatives + hypnotics 2,870 2,924 3,136 3,211 3,524 3,369 3,482 Italy: antipsychotics 337 322 339 382 410 442 475 France: antipsychotics 1,204 1,147 1,114 1,080 1,026 1,018 1,018 Italy: psychostimulants 0 0 0 0 0 0 0 France: psychostimulants 0 0 0 1 2 4 5 Italy: psycholeptics/psychoanaleptics 113 106 104 98 90 78 74 Italy: total 4,164 4,007 4,089 4,397 4,354 4,508 4,749 France: total 11,025 10,891 10,894 10,645 10,938 10,891 11,350 Source: IMS Health Second Study. See Note 2.
Psychopharmaceuticals in Europe 175 1000 population, and 13-fold in Italy from 43 to 583 SUs per 1000 population. 14 A second striking feature is the low level of use of psychostimulants – none are prescribed in Italy, and the rate of prescribing in France, while increasing, remains low. Tranquillizer prescribing remains relatively stable across this period, but here, as in other categories, the rate of prescription in France is about twice that in Italy. France We have seen that, among EU countries, while France is about average in its use of antipsychotics, it has a very high rate of prescribing of antidepressants and tranquillizers. This may, in part, arise from the fact that France spends the third highest proportion of its overall health budget on pharmaceuticals at 21 per cent. However, Italy, despite its low usage of psychopharmaceuticals, spends an even greater proportion (22.3 per cent) on pharmaceuticals. There must, therefore, be particular national cultural, patient or practitioner characteristics involved. This certainly appears to be the view of French commentators. A report published in November 2003, described in the English newspaper, The Guardian, estimated that nearly one in four French people are on tranquillizers, antidepressants, antipsychotics or other mood-altering prescription drugs. According to The Guardian, the report revealed that an average of 40 per cent of men and women aged over 70 in France were routinely prescribed at least one of this class of dependence-creating drug, as well as some 4 per cent of all children under nine. Commentators linked this to the fact that the French are keen consumers of medication, and pointed to recent attempts by the health minister to remove some 900 medicines out of the total of 4300 prescribed in France, from the list of those that would be reimbursed by the health service. Edouard Zarifian, a professor of medical psychology, was reported as saying that the rate of use of these drugs arose from both doctors and patients – patients not being happy unless they walk out of a consultation with a prescription, and doctors because they are happy to write them. He is quoted as remarking that ‘French doctors have become merchants of false happiness. They are unable to resist the pressures of either the patients or the big drugs companies. They are the ones who really need educating’. 15 This comment exemplifies the most common way in which the rise of psychopharmaceuticals has been understood by critical psychiatrists and social scientists – as the influence of the pharmaceutical companies and their marketing strategies on the beliefs and prescribing habits of doctors, both psychiatric specialists and GPs. In December 2004, the French Minister of Health raised the possibility of a complete ban on prescriptions of antidepressants for under-18s, joining a growing number of those who have expressed concern about the use of such drugs for children.
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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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The evidence base 121 Finally, it i
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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 and 190: Table 7.12 Europe by drug type and
Page 191 and 192: Table 7.14 Europe comparative presc
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Page 201: Psychopharmaceuticals in Europe 173
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 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
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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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