Mental health policy and practice across Europe: an overview

Reforms in community care 243
In 1991, ENUSP (www.enusp.org), the European Network of (ex-) users and
survivors of psychiatry was founded. Selecting a name for the organization
among all the descriptions commonly used by different groups 1 was an important
issue. Finally, the term (ex-) users and survivors of psychiatry was chosen
(Hölling 2001). Every two years ENUSP delegates from 40 different countries
meet in congress. The movement supports the concept of user/survivorcontrolled
services, advocating that for every psychiatric bed there should be
one bed in an anti- or non-psychiatric ‘runaway house’. The prototype of this
kind of facility is, in fact, Runaway House in Berlin, a crisis centre operated by
the clients themselves. The house has been in existence since the mid-1990s and
has accommodated more than 300 people.
Comprehensiveness of health and social care
Besides improving patients’ competencies and increasing the resources available
in the care settings offered to service users, rehabilitation has to secure patients’
rights to self-determination and help them to resume meaningful social roles.
Having a job is central in the process of recovery. A movement stemming from
the worker cooperatives (known as ‘the social enterprise’) has been successful in
Italy in offering (ex-) users jobs and opportunities to become actively involved
in companies as associates (Warner 1994).
Psychiatric consumer groups are also effective in meeting users’ practical
needs with regard to work, accommodation and social life while promoting
members’ emancipation and empowerment. There are examples of joint programmes
where users collaborate with mental health services and/or non-profit
organizations to run such programmes. In Verona, a programme has now been
in operation for almost ten years, with encouraging results. It is attended by
about 400 users per year, offering 150 vocational rehabilitation interventions,
350 interventions for job placements and support at work, housing for 60 users
and about 40 regular activities per week (Burti et al. 2005).
The economic impact of shifting care from institutions to
the community
A consequence of shifting care from institutions to the community is the rising
indirect costs sustained by caregivers – mainly families, voluntary or self-help
organizations – and society as a whole. Very few countries have available data
on the percentage of their total health budget spent on mental health (see Table
10.1). Despite the international diversity of health care systems, most developed
nations spend approximately 10 per cent of their total health care expenditures
on the treatment of mental disorders (Souetre 1994). Among EU countries, it
seems that the amount of money allocated to mental health is generally close to
that of other developed countries; it ranges from 13.4 per cent in Luxembourg
to 2 per cent in Slovakia.
From an economic point of view, the planning of mental health services’
reform should consider several points: i) human rights; ii) the public impact of