Mental health policy and practice across Europe: an overview

Promotion and prevention 203
income, social networks and self-esteem. Conversely, unemployment puts mental
health at risk, both because of its psychological consequences and the financial
problems it brings, increasing both depression and anxiety (Price and
Kompier 2006). The risk is higher in regions where unemployment is widespread
(Bethune 1997). Because very unsatisfactory or insecure jobs can be as
harmful as unemployment, merely having a job will not always protect mental
health: job quality is also important. Within employment, there is a clear
association between grade of employment and mental ill health, including
sickness absence rates (Burchell 1994).
Government management of the economy that reduces the highs and lows of
the business cycle can improve job security and reduce unemployment. For
those out of work, higher unemployment benefits are likely to have a protective
effect on mental health. A variety of workplace policies are available to be
applied during times of economic difficulty to reduce the risk of job loss and
unemployment, including job sharing, job security policies, cutbacks on pay
and reduced hours, among others (Bartley and Plewis 2002). To equip people for
the work available, high standards of education and good retraining schemes
are important.
Improve housing and promote healthy urban planning
The home is the physical environment in which people spend most of their
time and it should be conducive to positive mental health (Shaw et al. 1999).
Poor housing conditions are related to impaired mental health and pose a risk of
developing mental health problems (Thomson and Petticrew 2005). Interventions
to improve housing conditions also improve mental health and have a
positive impact on broader social factors such as increased safety, crime reduction
and social and community participation (Raudenbush and Earls 1997).
Interventions to improve housing include those generated by health needs, by
relocation or community regeneration, and those aiming to improve energy efficiency
such as heating (Thomson et al. 2001). A systematic review of the health
effects of housing improvement has shown health and mental health outcomes
such as improvements in self-reported physical and mental health, broader
social impacts in social outcomes such as perceptions of safety, crime reduction
and increased social and community participation (Thomson et al. 2001).
Similarly, cities can also have direct implications for mental health. Urban
shape, zoning strategies, reduced noise levels and public amenities can reduce
stress, social dislocation and violence (WHO 1999). Socially underprivileged
and disintegrated neighbourhoods contribute to people’s sense of stress and
frustration and inhibit the development of supportive networks. Within urban
environments, transport policies that promote cycling, walking and the use of
public transport provide physical activity, reduce fatal accidents, increase social
contact and stimulate social interaction on the streets (McCarthy 1999; WHO
1999). Recreation areas, safe streets, and access to public transport and basic
amenities and services are essential resources for a healthy and safe community
and strong social networks, and should be maintained and improved (Social
Exclusion Unit 2003).