Mental health policy and practice across Europe: an overview

More documents

Recommendations

Info

230 Mental health policy and practice resources to be provided overall, or for resources to be removed from other forms of mental health care. Depression has its greatest impact on productive societal costs (see Chapter 1), and it is this area where the economic benefits of effective interventions might be most readily realized. Unfortunately, economic evaluations of models of care, such as collaborative care, have tended to focus on short-term health care costs alone. The longer-term and wider economic impact from a societal perspective have not been adequately studied. However, the economic benefits, in terms of relapse prevention and reduced health care utilization might become apparent over the longer term. There is now emerging evidence from longerterm cost-effectiveness studies that collaborative care may have a longer-term cost offset effect and might be a more technically efficient method of delivering care (Wells et al. 2004). Economic evaluations have also included cost per quality adjusted life year (QALY) assessments and the incremental health gains have been shown to be achieved at a cost that is the same as, or less than, other interventions (such as breast screening), which are funded. Interestingly, the work of Schoenbaum et al. (2001) and longer-term follow-up (Wells et al. 2004) have shown that costs per QALY estimates of cognitive-behavioural interventions delivered in primary care are similar to those achieved through medication management programmes. The caveat to this research is that such cost utility analyses have been conducted within US managed care settings and it is difficult to know to what extent these costs and health care gains can be directly extrapolated to the lower funded and more socialized health care systems in Europe. However, primary care organizational programmes remain a strong candidate in improving health at a population level and the overall funding of these programmes will be a question of allocative efficiency and health gain within finite resources. Future policy and research In addition to the extensive research presented in this chapter, a more solid evidential base is likely to emerge in coming years to help guide decision-makers and to help make a case for a more equitable provision of primary care focused health care, where mental health competes more readily with other conditions and specialties. These priorities were reflected in the Declaration of the WHO European Ministerial Conference on Mental Health in Helsinki (WHO 2005) where 12 key aims were outlined. Primary care was seen as being central to the successful transformation of mental health services and care, where the declaration highlights the need to: ‘build up the capacity and ability of general practitioners and primary care services, networking with specialized medical and non-medical care, to offer effective access, identification and treatments to people with mental health problems’ (p. 3). The Declaration had a final explicit aim to: ‘initiate research and support evaluation and dissemination of [these] actions’. An evaluation programme is therefore needed to more fully explore the application and implementation of primary care programmes at a micro and macro level throughout each of the health care systems represented in the EU.
Mental health problems in primary care 231 References Andersen, S. and Harthorn, B. (1989) The recognition, diagnosis and treatment of mental disorders by primary care physicians, Medical Care, 27(9): 869–86. Araya, R., Rojas, G., Fritsch, R., Gaete, J., Rojas, M., Simon, S. and Peters, T.J. (2003) Treating depression in primary care in low income women in Santiago, Chile: a randomised controlled trial, Lancet, 361: 995–1010. Barrett, B., Byford, S. and Knapp, M. (2005) Evidence of cost-effective treatments for depression: a systematic review, Journal of Affective Disorders, 84(1): 1–13. Black, N. (1996) Why we need observational studies to evaluate the effectiveness of health care, British Medical Journal, 312: 1215–18. Boerma, W., de Jong, F. and Mulder, P. (1993) Health Care and General Practice Across Europe. Utrecht: NIVEL, Netherlands Institute of Primary Health Care. Boerma, W. and Verhaak, P. (1999) The general practitioner as the first contacted health professional by patients with psychosocial problems: a European study, Psychological Medicine, 29(3): 689–96. Bolton, P., Bass, J., Neugebauer, R., Verdeli, H., Clougherty, K.F., Wickramartne, P., Speelman, L., Ndogoni, L. and Weissman, M. (2003) Group interpersonal psychotherapy for depression in rural Uganda, Journal of the American Medical Association, 289(23): 3117–24. Bower, P. (2002) Primary care mental health workers: models of working and evidence of effectiveness, British Journal of General Practice, 52(484): 926–33. Bower, P. and Gask, L. (2002) The changing nature of consultation-liaison in primary care: bridging the gap between research and practice, General Hospital Psychiatry, 24(2): 63–70. Bower, P. and Gilbody, S. (2005) Managing common mental health disorders in primary care: conceptual models and evidence base, British Medical Journal, 330, 839–42. Bower, P. and Sibbald, B. (2000a) Systematic review of the effect of on-site mental health professionals on the clinical behaviour of general practitioners, British Medical Journal, 320: 614–17. Bower, P. and Sibbald, B. (2000b) Do consultation-liaison services change the behaviour of primary care providers? A review, General Hospital Psychiatry, 22(2): 84–96. Bower, P. and Sibbald, B. (2002) On site mental health workers in primary care: effects on professional practice (Cochrane Review), The Cochrane Library, Issue 2. Oxford: Update Software. Bower, P., Richards, D. and Lovell, K. (2001) The clinical and cost-effectiveness of self-help treatments for anxiety and depressive disorders in primary care: a systematic review. British Journal of General Practice, 51(471): 838–45. Bower, P., Byford, S., Barber. J, Beecham, J., Simpson, S., Friedli, K., Corney, R., King, M. and Harvey, I. (2003a) Meta-analysis of data on costs from trials of counselling in primary care: using individual patient data to overcome sample size limitations in economic analyses, British Medical Journal, 326: 1247. Bower, P., Rowland, N. and Hardy, R. (2003b) The clinical effectiveness of counselling in primary care: a systematic review and meta-analysis, Psychological Medicine, 33(2): 203–15. Byford, S. and Bower, P. (2002) Cost-effectiveness of cognitive-behaviour therapy for depression: current evidence and future research priorities, Expert Review of Pharmacoeconomics and Outcomes Research, 2: 457–66. Corney, R. (1996) Links between mental health professionals and general practices in England and Wales: the impact of GP fundholding, British Journal of General Practice, 46(405): 221–4. Corney, R. and Briscoe, M. (1977) Social workers and their clients: a comparison between
Page 1 and 2:
European Observatory on Health Syst
Page 3 and 4:
The European Observatory on Health
Page 5 and 6:
Open University Press McGraw-Hill E
Page 7 and 8:
European Observatory on Health Syst
Page 9 and 10:
viii Contents five six The evidence
Page 11 and 12:
List of tables 2.1 Beds in state ps
Page 13 and 14:
List of figures 4.1 The production
Page 15 and 16:
List of boxes 3.1 A personal testim
Page 17 and 18:
List of contributors Francesco Amad
Page 19 and 20:
xviii List of contributors Viviane
Page 21 and 22:
Series editors’ introduction Euro
Page 23 and 24:
Foreword Mental health may be the m
Page 25 and 26:
Foreword by the Minister of Health
Page 27 and 28:
Acknowledgements This volume is par
Page 29 and 30:
chapter one Mental health policy an
Page 31 and 32:
An overview 3 agencies (see Chapter
Page 33 and 34:
An overview 5 Funding In broad term
Page 35 and 36:
An overview 7 Social inclusion and
Page 37 and 38:
An overview 9 actions such as inter
Page 39 and 40:
An overview 11 of symptom alleviati
Page 41 and 42:
An overview 13 Kessler, R.C., Demle
Page 43 and 44:
chapter two The historical developm
Page 45 and 46:
Historical development of mental he
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
A lack of historical continuity His
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Tackling social exclusion 35 • in
Page 65 and 66:
Tackling social exclusion 37 networ
Page 67 and 68:
Tackling social exclusion 39 regula
Page 69 and 70:
Tackling social exclusion 41 where
Page 71 and 72:
Tackling social exclusion 43 and Sw
Page 73 and 74:
Tackling social exclusion 45 addres
Page 75 and 76:
Tackling social exclusion 47 than o
Page 77 and 78:
Tackling social exclusion 49 in thi
Page 79 and 80:
Tackling social exclusion 51 not ho
Page 81 and 82:
Tackling social exclusion 53 Box 3.
Page 83 and 84:
Tackling social exclusion 55 Conclu
Page 85 and 86:
Tackling social exclusion 57 Disabi
Page 87 and 88:
Tackling social exclusion 59 Read,
Page 89 and 90:
Financing and funding 61 problems h
Page 91 and 92:
Financing and funding 63 provides a
Page 93 and 94:
Financing and funding 65 recognizin
Page 95 and 96:
Financing and funding 67 care docto
Page 97 and 98:
Financing and funding 69 Trends in
Page 99 and 100:
Financing and funding 71 employment
Page 101 and 102:
Financing and funding 73 kind, cove
Page 103 and 104:
Financing and funding 75 emphasis o
Page 105 and 106:
Financing and funding 77 provided i
Page 107 and 108:
Financing and funding 79 for differ
Page 109 and 110:
Financing and funding 81 budgets in
Page 111 and 112:
Financing and funding 83 Europe or
Page 113 and 114:
Financing and funding 85 the famili
Page 115 and 116:
Financing and funding 87 of further
Page 117 and 118:
Financing and funding 89 mental hea
Page 119 and 120:
Financing and funding 91 community
Page 121 and 122:
Financing and funding 93 Available
Page 123 and 124:
Financing and funding 95 Basu, A. (
Page 125 and 126:
Financing and funding 97 of interve
Page 127 and 128:
Financing and funding 99 World Heal
Page 129 and 130:
The evidence base 101 result of pub
Page 131 and 132:
The evidence base 103 campaigns, it
Page 133 and 134:
The evidence base 105 using health
Page 135 and 136:
Table 5.1 A matrix of evidence Rese
Page 137 and 138:
Identifying needs using epidemiolog
Page 139 and 140:
The evidence base 111 facilitate gl
Page 141 and 142:
The evidence base 113 Learning from
Page 143 and 144:
The evidence base 115 sources of ev
Page 145 and 146:
The evidence base 117 Europe, and i
Page 147 and 148:
The evidence base 119 to Policy pro
Page 149 and 150:
The evidence base 121 Finally, it i
Page 151 and 152:
The evidence base 123 Lavis, J., Ro
Page 153 and 154:
The evidence base 125 World Health
Page 155 and 156:
The treatment of mental disorders 1
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Psychopharmaceuticals in Europe 147
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Table 7.6 Europe by drug type and c
Page 185 and 186:
Table 7.8 Europe by drug type and c
Page 187 and 188:
Table 7.10 Europe by drug type and
Page 189 and 190:
Table 7.12 Europe by drug type and
Page 191 and 192:
Table 7.14 Europe comparative presc
Page 193 and 194:
Page 195 and 196:
Table 7.20 Decline in psychiatric i
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208: Psychopharmaceuticals in Europe 179
Page 217 and 218: Promotion and prevention 189 Mental
Page 219 and 220: Promotion and prevention 191 Box 8.
Page 221 and 222: Promotion and prevention 193 risk o
Page 223 and 224: Promotion and prevention 195 and th
Page 225 and 226: Promotion and prevention 197 (Üstu
Page 227 and 228: Promotion and prevention 199 and un
Page 229 and 230: Promotion and prevention 201 The li
Page 231 and 232: Promotion and prevention 203 income
Page 233 and 234: Promotion and prevention 205 implem
Page 235 and 236: Promotion and prevention 207 When d
Page 237 and 238: Promotion and prevention 209 health
Page 239 and 240: Promotion and prevention 211 Murphy
Page 241 and 242: Promotion and prevention 213 Vuori,
Page 243 and 244: chapter nine Common mental health p
Page 245 and 246: Mental health disorders in primary
Page 247 and 248: Mental health problems in primary c
Page 257: Mental health problems in primary c
Page 263 and 264: chapter ten Reforms in community ca
Page 265 and 266: Table 10.1 Mental health care in th
Page 267 and 268: Reforms in community care 239 syste
Page 269 and 270: Reforms in community care 241 integ
Page 271 and 272: Reforms in community care 243 In 19
Page 273 and 274: Reforms in community care 245 Secon
Page 275 and 276: Reforms in community care 247 must
Page 277 and 278: Reforms in community care 249 Goldb
Page 279 and 280: Addiction and alcohol 251 (Brown et
Page 281 and 282: Addiction and alcohol 253 Figure 11
Page 283 and 284: Addiction and alcohol 255 Table 11.
Page 285 and 286: Addiction and alcohol 257 Some stud
Page 287 and 288: Addiction and alcohol 259 availabil
Page 289 and 290: Addiction and alcohol 261 Table 11.
Page 291 and 292: Addiction and alcohol 263 Hours and
Page 293 and 294: Addiction and alcohol 265 College s
Page 301 and 302: Addiction and alcohol 273 Alcohol t
Page 303 and 304: Addiction and alcohol 275 developme
Page 305 and 306: Addiction and alcohol 277 Greenfiel
Page 307 and 308: Addiction and alcohol 279 World Hea
Page 309 and 310:
Housing and employment 281 European
Page 311 and 312:
Housing and employment 283 to a lif
Page 313 and 314:
Housing and employment 285 relative
Page 315 and 316:
Housing and employment 287 comprise
Page 317 and 318:
Housing and employment 289 treatmen
Page 319 and 320:
Housing and employment 291 rented h
Page 321 and 322:
Housing and employment 293 occupati
Page 323 and 324:
Housing and employment 295 market;
Page 325 and 326:
Housing and employment 297 Table 12
Page 327 and 328:
Housing and employment 299 Return t
Page 329 and 330:
Effectiveness of pre-vocational and
Page 331 and 332:
Housing and employment 303 where re
Page 333 and 334:
Housing and employment 305 mental h
Page 335 and 336:
Housing and employment 307 S.M. (20
Page 337 and 338:
A human rights perspective 309 Nor
Page 339 and 340:
Monitoring compliance with the inte
Page 341 and 342:
A human rights perspective 313 Ment
Page 343 and 344:
A human rights perspective 315 Equa
Page 345 and 346:
A human rights perspective 317 Last
Page 347 and 348:
A human rights perspective 319 Comb
Page 349 and 350:
A human rights perspective 321 segr
Page 351 and 352:
A human rights perspective 323 The
Page 353 and 354:
A human rights perspective 325 •
Page 355 and 356:
A human rights perspective 327 ensu
Page 357 and 358:
A human rights perspective 329 •
Page 359 and 360:
A human rights perspective 331 Arti
Page 361 and 362:
A human rights perspective 333 Refe
Page 363 and 364:
A human rights perspective 335 Will
Page 365 and 366:
The user and survivor movement 337
Page 367 and 368:
Page 369 and 370:
Page 371 and 372:
Page 373 and 374:
Page 375 and 376:
Page 377 and 378:
Page 379 and 380:
Page 381 and 382:
Page 383 and 384:
Page 385 and 386:
Care of asylum seekers and refugees
Page 387 and 388:
Page 389 and 390:
Page 391 and 392:
Page 393 and 394:
Page 395 and 396:
Page 397 and 398:
generic local team or psychiatric h
Page 399 and 400:
Page 401 and 402:
Page 403 and 404:
Carers and families 375 In this cha
Page 405 and 406:
Carers and families 377 impact they
Page 407 and 408:
Carers and families 379 2002). In a
Page 409 and 410:
Carers and families 381 conducted i
Page 411 and 412:
Carers and families 383 Interventio
Page 413 and 414:
Carers and families 385 Child careg
Page 415 and 416:
Carers and families 387 subject to
Page 417 and 418:
Carers and families 389 Conclusion
Page 419 and 420:
Carers and families 391 Cohen, C.A.
Page 421 and 422:
Carers and families 393 in long-ter
Page 423 and 424:
Carers and families 395 care in rel
Page 425 and 426:
chapter seventeen Mental health pol
Page 427 and 428:
Policy in former eastern bloc count
Page 429 and 430:
Page 431 and 432:
Page 433 and 434:
Page 435 and 436:
Page 437 and 438:
Page 439 and 440:
Page 441 and 442:
Page 443 and 444:
Page 445 and 446:
Page 447 and 448:
Page 449 and 450:
Table 17.1 General information and
Page 451 and 452:
Page 453 and 454:
Page 455 and 456:
Box 18.1 Recommendations in The Wor
Page 457 and 458:
The WHO perspective 429 isolation,
Page 459 and 460:
The WHO perspective 431 high when c
Page 461 and 462:
The WHO perspective 433 Key issues
Page 463 and 464:
The WHO perspective 435 Box 18.2 Qu
Page 465 and 466:
The WHO perspective 437 services is
Page 467 and 468:
The WHO perspective 439 Desjarlais,
Page 469 and 470:
Index abuse of psychiatry, eastern
Page 471 and 472:
Index 443 community care ECHR, 321
Page 473 and 474:
Index 445 European countries commun
Page 475 and 476:
Index 447 initiatives, discriminati
Page 477 and 478:
Index 449 applying principles, 317-
Page 479 and 480:
Index 451 policy, 228-9 practice, 2
Page 481 and 482:
Related books from Open University
Page 483:
PURCHASING TO IMPROVE HEALTH SYSTEM
show all

Mental health policy and practice across Europe: an overview

Create successful ePaper yourself

Delete template?

Save as template?