Mental health policy and practice across Europe: an overview

236 Mental health policy and practice
settings, where the two are seen as mutually exclusive. This false dichotomy
should be replaced by a new agenda, in which balanced care includes both
modern community-based and modern hospital-based care (Thornicroft and
Tansella 2004).
Without investment in community-based structures during a period of transition
from institutional to community-based care, the burden of care may be
shifted from the formal sector to informal care provided by families. Moreover,
it should be noted that in some cases the motivation for hospital closures may
be to reduce financial costs rather than to change care delivery settings.
Changes in policies in European countries
The philosophy of psychiatric reforms in European countries has implicitly or
explicitly been based upon some key principles of community psychiatry and
incorporated actions along the following axes: i) the deinstitutionalization process
and closure of old mental hospitals; ii) the development of alternative
community services and programmes; iii) integration with other health services;
and iv) integration with social and community services (Becker and
Vázquez-Barquero 2001). Wide differences are present within the member states
of the European Union (EU), with different levels of implementation of the
principles of community psychiatry.
Table 10.1 summarizes some indicators derived from the Atlas of the World
Health Organization’s (WHO) World Health Report 2001 (WHO 2001a) on the
25 EU member states. The total number of psychiatric beds available in each
country ranges from 1.7 per 10,000 population in Italy to 25 per 10,000 in
Belgium (see Figure 10.1). The mean number of beds in the world is 4.4 per
10,000 population. Thirteen countries have more than 10 beds per 10,000
population: Belgium, the Czech Republic, Denmark, Estonia, France, Ireland,
Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Finland and Slovenia.
Only five countries (Austria, Cyprus, Spain, Italy and the United Kingdom) have
less than 6 beds per 10,000 population. Excluding Italy and Finland, all the
other countries still have psychiatric beds in mental hospitals.
Moreover, although the majority of EU countries have a national mental
health programme (absent in Austria, Spain, Slovakia, Slovenia and Sweden),
regional and local variations are present in most countries (Becker and Vázquez-
Barquero 2001).
Many countries, which have already chosen to switch to a community-based
mental health system (e.g. the United Kingdom) or have incorporated substantial
community services in a hospital-based system (e.g. the Netherlands,
Portugal, some Länder in Germany), have a high number of psychiatric beds.
The WHO Atlas 2001 (WHO 2001a) provides an overview of the development of
mental health services worldwide and a description of the shift from hospitalbased
to community-based mental health care is available for some EU countries.
In each of the EU-25 member states community facilities are available to
psychiatric patients at different levels.
In Austria, there are some mental health plans at the level of the provinces.
Since 1997, there has been a national hospital plan, which places a certain