Mental health policy and practice across Europe: an overview

Mental health problems in primary care 227
High resource countries
This scenario relates mostly to industrialized countries in the EU with a
relatively high level of resources for mental health. Mental health policies, programmes
and legislation are implemented reasonably effectively. The proportion
of the total health budget allocated to mental health is above 5 per cent or
more, and most primary care providers are trained in mental health care. Efforts
are made to identify and treat major mental disorders in primary care, though
effectiveness and coverage may be inadequate. Specialized care facilities are more
comprehensive, but most may still be located in psychiatric hospitals. Psychotropic
drugs are readily available and community-based services generally
available.
Even within these countries, as has been seen, there remains substantial
opportunity to improve the quality of mental health care within primary care
settings and the key strategies should lie in the integration of primary and
secondary care services, and in the efficient management of resources by providing
specialist input within primary care settings and changing the organization
and delivery of care. Collaborative care remains the most effective and efficient
strategy in this scenario.
Key issues for the future development of primary care
mental health services
A number of issues relating to the future development of primary care mental
health services follow on from the evidence already presented. These can be
linked to a series of recommendations made by the WHO in deciding future
priorities.
Developing the workforce
Many health care systems, including those from medium and high resource
countries, are seeking to increase and change the emphasis of the primary care
workforce. For example, in the United Kingdom, 1000 graduate mental health
workers are to be recruited and trained (Bower 2002). Much needs to be decided
about their core function, the level of skills that they will require and how best to
organize their training. Evidence-based interventions from within the models of
collaborative care, such as case management for depression, are likely to be both
effective and efficient (Von Korff and Goldberg 2001). These are interventions
that can be readily adopted by non-mental health nurses working in primary
care, staff with a counselling or social care background and graduate psychologists,
who can be offered a postgraduate training programme of up to one year.
Simple training programmes have been shown to produce autonomous practitioners
capable of dealing with the range of problems that occur in primary care.
A substantial issue for the future is likely to be the retention and further training
of these professional groups in order that they remain within primary care,
rather than seeking more specialist challenges in secondary care settings.