Mental health policy and practice across Europe: an overview

228 Mental health policy and practice
Developing information technology
Many primary care systems operate in an ‘information free’ environment and it
is difficult to know what treatments are offered to whom, and if the quality of
care is improving. The WHO recommends that primary care information systems
be developed or enhanced to take on board the needs of mental health
care. Such systems provide the potential for better integration of care and can
form a component of case identification and monitoring of treatment and follow-up
visits – all key components of collaborative care models. Examples
include case registers of those with depression in order to monitor relapse prevention
and to flag up the presence of depression as a presenting problem
within the primary care consultation. Other innovations include: (computerized)
decision aids on the optimum management of depression; specific computerized
algorithms to ensure evidence-based prescribing and referral, and that
follow-up is offered at the appropriate time; and links to pharmacy refill records
in order to check when patients do not order their medication on time.
Raising the profile of mental health and reducing stigma
Mental health suffers from a low profile within the general medical profession
and within the wider population. Strategies aimed at improving awareness and
reducing stigma at each of these levels are needed. As mentioned above, the
evidence to support interventions that target awareness and stigma is scarce –
largely because this field is not well researched. The Nuremberg Depression Alliance
provides an example of a coherent and multi-faceted strategy that is being
evaluated alongside its implementation. Financial levers might also be needed
to raise the profile and quality of care for mental health problems. A new
employment contract for United Kingdom primary care physicians provides
financial incentives for the improved recognition and management of depression
and might form a model for other health care systems. Many of the performance
targets that are set in order to provide better quality care for depression
are those that are outlined in this chapter – including case management and
structured follow-up. However, concerns have been raised that enhanced care
for depression is just one of a number of performance indicators that are sought
in primary care, and that others (such as immunization and physical screening
programmes) are technically easier to comply with. Therefore, depression may
be not seen as a priority in comparison with other performance targets.
Research into policy and practice – making it happen
A cohesive series of priorities have emerged recently from the WHO (2005),
which provide an agenda for action for improving mental health and reflect the
primary care focus outlined in this chapter. Decision-makers are likely to look
for concrete examples of the implementation of policy initiatives that are
underpinned by research evidence and a theoretical framework. Fortunately,
examples do exist.