Mental health policy and practice across Europe: an overview

202 Mental health policy and practice
Expand access to education
Educational levels produce a gradient in mental ill health similar to that
produced by income (WHO 2004b). Lack of education limits the ability of individuals
to access economic entitlements. Better education increases cognitiveemotional
and intellectual competencies and job prospects, and reduces social
inequity and the risk of mental disorders, including depression (Kuh and
Ben-Shlomo 1997). Children who are raised in limited learning environments
or enter school with depressed symptoms are less likely to benefit from primary
school, and this poor start can lead to slower achievement and a higher rate of
school failure later in life (Hertzman and Wiens 1996).
Access to preschool education can help break the link with deprivation and
poor mental health. For example, as described in Box 8.5, a randomized controlled
trial of preschool active learning with children from impoverished backgrounds,
combined with home visits, has been proven to lead to improved
cognitive development, educational achievement and less conduct and criminal
problems through to early adulthood – also proving to be highly cost-effective
over time (Schweinhart and Weikart 1998).
Box 8.5
Long-term effects of preschool education for at-risk children
One of the most convincing controlled studies of the long-term benefits of
preschool intervention for children living in poverty is the High/Scope
Perry Preschool Project (Schweinhart and Weikart 1998; Schweinhart
2000). Targeting at risk 3- to 4-year-old African-American children from
impoverished backgrounds, the programme combines half a day preschool
intervention using a developmentally appropriate curriculum with
weekly home visits. In the short term children in the intervention groups
showed improved cognitive development, lower levels of learning disability,
improved academic achievement, better social adjustment and
increased high-school completion. When followed up through to age 27,
young adults showed increased social competence, a 40 per cent reduction
in lifetime arrests, a 40 per cent increase in literacy and employment rates,
less welfare dependence and improved social responsibility (Schweinhart
and Weikart 1998). The costs of US$1000 per child were returned by the
benefit produced by the programme, which was estimated to be over
US$7000–8000 per child (Barnett 1993), due to decreased schooling costs,
increased taxes paid on higher earnings, reduced welfare costs, decreased
justice system costs and decreased crime victim costs (Schweinhart and
Weikart 1998).
Implement health-conducive labour policies
Labour policy can also influence mental health. Both the quantity and quality
of work have strong influences on mental health-related factors, including