Mental health policy and practice across Europe: an overview

Reforms in community care 239
system (Burti 2001). The most recent legislation, known as the ‘Target Project
1998–2000’ provides for the establishment of local ‘Departments for Mental
Health’ at health-district level (about 100,000 population). The main points
covered by the project are: mental health promotion during a person’s whole
life; early detection of mental health problems; prevention of relapses and their
psychological and social consequences; attention to the life of patients’ families;
and prevention of suicide and self-harm behaviour.
The Dutch government has developed a policy (the National Mental Health
Plan) to create a mental health care sector with the following characteristics:
demand-driven care that is tailored to the care needs of the individual client and
his or her specific social or cultural characteristics, generated through consultation
with the client, easily accessible and consisting of both medical and psychiatric
treatment and social assistance; effectively organized provision of care
in accordance with a clear profile from ‘light and general care to heavy and
specialized care’; disorders that can be treated in the short term and by general
means are dealt with in the locally-organized, first echelon of mental health care
by general practitioners (GPs), health care psychologists and social workers;
disorders that are beyond the capacities of the first echelon are referred to the
regionally-organized specialist mental health care centres, which are preferably
located in or near the general hospital. These regional centres offer a complete
range of facilities (prevention, diagnosis, crisis care, outpatient and short-term
inpatient treatment, resocialization and sheltered accommodation); superspecialist
help is provided at the supraregional or national level in university
hospitals and in a number of designated mental health care institutions.
In the United Kingdom, despite relatively low expenditure, substantial progress
has been made in deinstitutionalization and the development of comprehensive
community-based services. The closure of large asylums has largely
been achieved (Johnson et al. 2001).
Recently, an international multi-centre study (EPSILON study) compared
provision of services in five European regions (Becker et al. 2002). Using the
European Service Mapping Schedule (ESMS), differences in mental health services
across the five centres were identified. The study found that there was
some heterogeneity in outpatient and community services across the sites with
a focus on community mental health teams in London (United Kingdom) and
Verona (Italy) and in outpatient care in Santander (Spain). Amsterdam (the
Netherlands) took an intermediate position. However, in spite of substantial
inter-site differences in service provision all the centres shared some elements of
community mental health care.
WHO recommendations on mental health policies
Principles of deinstitutionalization and the public
health approach
The WHO has embraced, developed and disseminated the principle of deinstitutionalization
and the public health approach since the 1970s when a longterm
programme of the WHO Regional Office for Europe was approved. The