Mental health policy and practice across Europe: an overview

Promotion and prevention 195
and their subsequent effects (Murphy 1996), rather than the reduction or elimination
of the stress factors themselves. Similarly, organizational downsizing,
involuntary job loss and long-term unemployment produce both stress and
adverse health and mental health problems including depression, substance
abuse and marital conflict (Price et al. 2002). Many of these problems associated
with unemployment increase health and human service costs to society (Vinokur
et al. 1991).
A number of intervention programmes have been developed and evaluated to
help unemployed workers to re-enter the labour market. Such programmes
combine basic instruction on job search skills, with enhancing motivation,
skills in coping with setbacks and social support among job seekers (Price et al.
1992). For example, the Winning New Jobs programme (see Box 8.3) has been
tested and replicated in large-scale randomized trials both in the United States
and Finland, showing positive effects on rates of re-employment, the quality
and pay of jobs obtained, increases in job search self-efficacy and mastery, and
reductions in depression and distress (Price et al. 1992; Price and Vinokur 1995;
Vuori et al. 2002; Vuori and Silvonen 2005).
Retirement and older age
Over the next 30 years, the proportion of people aged over 80, as a share of those
aged over 65, will increase in Europe as a whole from 22 to 30 per cent (WHO
2002a). This rapid increase in the ageing population implies a shift in the demographic
structures of society, bringing associated problems such as an increased
risk of some mental illness (e.g. dementia), age-related chronic diseases and
decreases in the quality of life (Levkoff et al. 1995). In addition to loss of health
and functional and cognitive abilities, elder populations are more likely to
experience individual losses both within their social network (e.g. bereavement,
diminished social contacts) as well as within their personal positioning in
life (e.g. facing retirement, loss of income), placing them at risk of suffering
mental health problems (Reynolds et al. 2001).
The mental health of older populations has been successfully improved
through interventions to increase physical activity (Deuster 1996; Mather et al.
2002), for example through practising tai chi (Chen et al. 2001; Li et al. 2001).
A Cochrane review of patient education programmes that included an instruction
component for people with arthritis identified 24 randomized controlled
trials indicating short-term improvements in disability and the psychological
status of patients, including depression (Riemsma et al. 2002). Early screening,
interventions in primary care (Burns et al. 2000; Shapiro and Taylor 2002) have
also proven to be successful in improving the mental health of older people who
are at risk. The risk of dementia is likely to be reduced by preventing craniocerebral
traumas, and lowering raised blood pressure and cholesterol levels
(Cooper 2002), although there is still a need for more research in this area.