Mental health policy and practice across Europe: an overview

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190 Mental health policy and practice the public mental health field is increasingly recognizing the need for a comprehensive approach to mental health. It is noted that, although treatment for mental disorders can be very effective, this is only once mental ill health has already emerged. A public health policy that only comprises cure and maintenance would have clear disadvantages. In addition to the consequences of only starting to take action when there has already been long-lasting suffering of individuals and families, evidence shows that there is a large proportion of under-treated cases (Kazdin 1993) and high rates of relapse after treatment (Muñoz 1998). A policy framework for promotion and prevention in mental health This chapter builds on existing evidence and recent reviews (WHO 2004b, 2004c; Jané-Llopis et al. 2005) and presents the policy response for action in mental health promotion and mental disorder prevention (Jané-Llopis and Anderson 2005). The next section outlines examples of policies and programmes for mental health promotion across the lifespan. The following section presents a policy response to reduce the risk of some mental health problems: depression, anxiety, conduct disorders, substance use disorders and associated suicide. While there is strong evidence for the reduction of risk factors and the increase of protective factors related to mental disorders, there is to date less evidence available for the actual prevention of mental disorders. Several reasons for this have been described elsewhere (WHO 2004c), but one of the frequent explanations is the need for large numbers of people that need to be involved in efficacy studies to ensure sufficient power to prove reductions in onset of mental disorders, especially when populations are not at increased risk. However, there are a few studies that have shown actual prevention of new cases of major depression, especially in children and adolescents (Clarke et al. 1995, 2001). Box 8.2 summarizes preventive and promotion approaches from which some interventions have proven to be efficacious. Examples of such efficacious interventions are described across the different sections in this chapter, outlining a policy framework that could guide decision-making and implementation. However, it is important to note that not all interventions can be or are effective, and that it is crucial to base implementation on the knowledge of available efficacious interventions. Mental health promotion policies across the lifespan The implementation of policies specially designed to promote mental health in the whole population and to tackle mental health problems can lead to substantial gains in mental health and improve the social and economic development of society (WHO 2004c). This section reviews the options for designing a mental health policy composed of effective strategies across the lifespan to improve mental health and to reduce the risks of mental disorders.
Promotion and prevention 191 Box 8.2 Some efficacious approaches for prevention and promotion in mental health Childhood/ adolescence Adulthood Older groups General school skillbuilding programmes, like life skills and problem-solving Parenting visits for depressed mothers Early screening interventions in primary care Mental health policy and programmes Changing school environment Holistic school interventions combining skillbuilding and changes in the environment Cognitive-behavioural programmes for children at risk of depression Stress management techniques Parenting group interventions for difficult children Mental health support and early treatment for those at risk Stress management techniques Cognitive-behavioural models for depression Prescriptions of antidepressants to prevent suicide Brief interventions for alcohol in primary health care Prescription of antidepressants to prevent suicide Public health and public policy Home visiting, healthy development Parenting interventions Pregnancy free of addictive substances Parenting interventions Workplace task and technical improvement interventions Workplace improvement role clarity and social relationships Combined interventions addressing the organization and employees Physical activity Patient education
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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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The evidence base 123 Lavis, J., Ro
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The evidence base 125 World Health
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The treatment of mental disorders 1
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Page 167 and 168: The treatment of mental disorders 1
Page 175 and 176: Psychopharmaceuticals in Europe 147
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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 245 and 246: Mental health disorders in primary
Page 247 and 248: Mental health problems in primary c
Page 263 and 264: chapter ten Reforms in community ca
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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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