Mental health policy and practice across Europe: an overview

198 Mental health policy and practice
Other interventions that have led to reductions in depressive symptoms
in adults and older populations (Jané-Llopis et al. 2003) include cognitive
behavioural models (Allart-van Dam et al. 2003), home-based interventions
with families at risk (Aronen and Kurkela 1996), stress management policies
in the workplace (Heaney et al. 1995a, 1995b), detection and management
interventions in primary health care (Gilbody 2004), and the support of community
networks and physical activities in older age (Jané-Llopis et al. 2006).
Conduct disorders, bullying, aggression and violence
Conduct disorders and developmental learning disorders are associated with
educational failure, accidents, injuries, physical illness, unemployment and
poor work performance, criminal activity, adult problems in intimate relationships,
substance use disorders, anxiety disorders and depression (Yoshikawa
1994). The social and economic costs of conduct disorders, and of aggressive
and violent behaviour, are enormous, including the costs of treatment, the
criminal justice system, social services, academic failure, and the emotional and
economic costs for individuals and families (Eddy 2006).
Effective programmes to improve the behaviour of children at risk of behavioural
problems and later aggression are those that combine strategies of
classroom behaviour management, social skills enhancement and parent
involvement (Reid and Eddy 1997). Such programmes can cut disruptive behaviour
and aggression, including bullying, theft, and vandalism by half (Olweus
1991). Similarly, programmes targeting children of parents with substance use
disorders can reduce problem behaviour (Eddy 2006).
Addictive substances
Addictive substances (tobacco, alcohol and illicit drugs) can cause intoxication
and injuries, a very wide range of harm and dependence (see Chapter 11).
Together they cause over a fifth (tobacco 12 per cent, alcohol 8 per cent and
illicit drugs 2 per cent) of the total burden of ill health and premature death in
Europe (WHO 2002b). Such substances cause harm not only to users but also to
those surrounding users and are a major cause of socioeconomic inequities in
health. They cause an enormous economic burden to society and economic
productivity. Some 10 to 15 per cent of the total health care budget arises from
treating the harm done by substance use (WHO 2001). Substance use disorders
are a classified mental disorder as well as being co-morbid with a wide range of
mental and behavioural disorders including depression and suicide (WHO 1992).
Successful and cost-effective options to reduce substance use disorders are
environmental measures that influence the price, availability and marketing
of substances (Anderson 1999; WHO 2004a). Taxation is the most effective
policy option, with increases in the price of tobacco and alcohol reducing
both use and harm (Anderson et al. 2006). For alcohol, direct health and social
outcomes of taxation policies include the reduction of the incidence and prevalence
of alcohol-related liver disease, traffic accidents and other intentional