Mental health policy and practice across Europe: an overview

Promotion and prevention 199
and unintentional injuries, suicide, family violence and the associated negative
mental health impacts of the consequences attributed to alcohol consumption.
In the European Union (EU), it is estimated that with the tax on alcohol set
to the current level plus a 25 per cent increase, 656,000 incidents a year of
disability and premature death would be averted at a total administrative cost of
159 million each year (Anderson and Baumberg 2006, adopted from Chisholm
et al. 2004). An increase in the cost of alcohol would lead to a reduction in the
harm from neuropsychiatric disorders, reduce alcohol-related costs and increase
government revenue per year from tax (Babor et al. 2003).
Increases in government revenue would also allow for the hypothecation or
earmarking of such revenue to be used for additional mental health promotion
policy measures. Advertising bans and restrictions on the availability of substances
are also effective (Anderson et al. 2006). Other policy measures include
media and comprehensive community interventions. Restrictions on smoking
in public places and private workplaces reduce both smoking prevalence and
average daily cigarette consumption among smokers (Fichtenberg and Glantz
2002). An econometric analysis found that workplace smoking bans reduced
smoking prevalence by 4–6 per cent and reduced average daily cigarette
consumption among smokers by 10 per cent (Evans et al. 1999). The introduction
of public smoking bans in one jurisdiction of California led to a 40 per cent
reduction in hospital admissions for myocardial infarction (Sargent et al. 2004).
School-based interventions, although popular, unfortunately have limited
effectiveness (Babor et al. 2003). In contrast, interventions based in primary
health care are effective in reducing tobacco and alcohol-related disorders,
being among the most cost-effective of all health care interventions (Anderson
et al. 2006).
Suicide prevention
The most important risk factors for suicide are psychiatric disorders (mostly
depression, alcohol dependence and schizophrenia), post or recent social
stressors (e.g. childhood adversities, sexual or physical abuse, unemployment,
social isolation, serious economic problems), suicide in the family or among
friends or peers, low access to psychological help and access to means for
committing suicide (Wasserman 2001).
Among youngsters, suicide education in school settings has produced mixed
results, and has mostly failed to demonstrate an impact on suicide behaviours
(Wasserman 2001). While some studies have shown changes in attitudes and
reported attempts (Hosman et al. 2006b), others have suggested that school
education may increase the number of students who consider suicide as a possible
solution to their problems (Shaffer et al. 1990). These mixed results have
led to the conclusion that school programmes should be developed according to
the science-base and should not be left to enthusiastic amateur initiatives
(Wasserman and Narboni 2001). One effective strategy for adolescent suicide
prevention implemented in the United States encompasses a multi-component,
school-based approach which includes a suicide prevention school policy,
teacher training and consultation, education for parents, stress management