Mental health policy and practice across Europe: an overview

242 Mental health policy and practice
‘provide care in the community’ implies moving people out of prison, downsizing
mental hospitals and improving care within them in countries with low
levels of resources. In countries with greater resources the same recommendation
implies completing the closure of remaining custodial mental hospitals
and assuring 100 per cent coverage of community care.
However, reports from European areas indicate that psychiatric hospitals still
provide inpatient care, including acute hospitalization, in most countries
(Becker and Vázquez-Barquero 2001) and the range of acute inpatient beds per
100,000 population varies between 17 in Italy (where the process of closing all
mental hospitals has been accomplished) and 165 in France. Thus, it is clear that
the process of psychiatric reform in Europe is still far from complying with the
WHO recommendations. In addition – as Becker and Vázquez-Barquero observe
– Europe is not equivalent to the EU; in eastern Europe physical and mental
health conditions have worsened considerably in the last decade. The decrease
in life expectancy by ten years in some eastern European countries dramatically
epitomizes the severity of the problem.
Involvement of carers and users in planning, evaluation and
managing services
While evidence demonstrates the benefits of involving families to improve
patient outcomes in a number of mental health conditions (WHO 2001b;
Chamberlin 2005; Thornicroft and Tansella 2005), and the WHO stresses the
need for partnership with patients and families, carers’ and users’ organizations
continue to complain about their far from satisfactory levels of involvement
and lack of recognition by the psychiatric establishment. This is unfortunate
and unjust as between 40 and 80 per cent of the chronically mentally ill now
live with their families and, consequently, relatives carry the greatest part of the
burden of care. Relatives are partners and their role should be fully acknowledged.
Family organizations have been in existence for decades, but only more
recently have they been successful in influencing health authorities in policymaking
decisions and been consulted over the functioning of mental health
services. A European network of family organizations, the European Federation
of Associations of Families of Mentally Ill People (EUFAMI) was founded in 1992
and has been actively coordinating efforts ever since. The needs most often
emphasized by families include: livelihood/subsistence; crisis management;
case management/community social interventions; work services for the mentally
ill; rehabilitation services; inpatient care; and innovative pharmacological
treatments (Brand 2001a, 2001b).
Users of mental health services have been recognized as partners only recently
because of the long-lasting prejudice that they were unable to have an accountable
say, let alone be considered responsible for their own destiny, and as such
were not consulted by professionals and administrators. Nonetheless, since the
1990s, in some European countries users have had an influence on their personal
treatment plans, have councils in mental hospitals and their representatives
participate in psychiatric services advisory boards at local and regional
levels (Schene and Faber 2001).