Mental health policy and practice across Europe: an overview

218 Mental health policy and practice
Figure 9.1
Pathways to care for common mental health problems
Source: Bower and Gilbody (2005)
structure of services (Gater et al. 1991), it provides an adequate general model
for the bulk of psychiatric morbidity in any primary care-led service.
This model highlights the fact that effective mental health provision depends
on accurate recognition and management of disorders in primary care, but
significant problems have been identified. Stigma within society and poor
knowledge about the nature of psychiatric disorders often prevents people from
consulting a doctor about psychiatric problems in the first instance (Goldberg
and Huxley 1980). For those that do consult, a wealth of evidence has indicated
that levels of recognition of disorders are low (Andersen and Harthorn 1989;
Ormel et al. 1990; Paykel and Priest 1992; Tiemens et al. 1996), and furthermore
there is wide variation in recognition rates between primary care clinicians
(Marks et al. 1979). Patients who are recognized often do not receive quality of
care in line with current guidelines, either in relation to pharmacological treatments
or the provision of evidence-based psychological therapies (Schulberg
and McClelland 1987; Katon et al. 1992; Katon et al. 1997; Schulberg et al. 1998).
Finally, provision of specialist services (such as psychological therapists working
on-site in practices) often varies widely (Sibbald et al. 1993; Corney 1996).
Policy goals in primary mental health care
As noted above, mental health policies are characterized by two main elements:
a statement of goals (and priorities among goals) and a statement of ways of