Mental health policy and practice across Europe: an overview

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254 Mental health policy and practice Figure 11.3 SDR chronic liver disease and cirrhosis in the original EU-15, the new EU-10 and the EU-25, 1970–2001 (excluding Hungary) Source: World Health Organization (2004c) Hungary, which has more than four times the average cirrhosis death rate of the EU, possibly due to aliphatic alcohol congeners arising from home-made spirits (Szucs et al. 2005); this might also suggests a higher rate of unrecorded alcohol consumption in the new member states, compared with the 15. Alcohol and the burden of harm in individuals and societies Alcohol and individuals The relationship between alcohol consumption and individual harm is summarized in Table 11.1. For many conditions there is an increasing risk with increasing levels of alcohol consumption, with no evidence of a threshold effect. The slopes of the risks vary by gender and the geographical areas in which studies are performed. The absolute risk of death from alcohol-related cancers (mouth, oesophagus, pharynx, larynx and liver) increases from 13 per 100,000 at no alcohol consumption to 37 per 100,000 at four or more drinks (40+g) per day (Thun et al. 1997). The cumulative incidence of breast cancer by age 80 years increases from 8.8 per 100 women in non-drinkers to 13.3 per 100 women consuming an average of 60g each day (Collaborative Group on Hormonal Factors in Breast Cancer 2002). The absolute risk of death from liver cirrhosis
Addiction and alcohol 255 Table 11.1 Relative risks for stated conditions based on alcohol consumption Women Men Conditions arising during the perinatal period Alcohol consumption, g/day 0–19.99 20–39.99 40+ 0–39.99 40–59.99 60+ Low birth weight (RR refers to drinking of mother) 1.00 1.40 1.40 1.00 1.40 1.40 Malignant neoplasms Mouth and oropharynx cancers 1.45 1.85 5.39 1.45 1.85 5.39 Oesophageal cancer 1.8 2.38 4.36 1.8 2.38 4.36 Liver cancer 1.45 3.03 3.60 1.45 3.03 3.60 Breast cancer 1.14 1.41 1.59 N/A N/A N/A under 45 years of age 1.15 1.41 1.46 N/A N/A N/A 45 years and over 1.14 1.38 1.62 N/A N/A N/A Other neoplasms 1.10 1.30 1.70 1.10 1.30 1.70 Diabetes mellitus 0.92 0.87 1.13 1.00 0.57 0.73 Neuropsychiatric conditions Unipolar major depression Attributable fraction = 6% Epilepsy 1.34 7.22 7.52 1.23 7.52 6.83 Alcohol use disorders Attributable fraction = 6% Cardiovascular (CVD) diseases Hypertensive disease 1.40 2.00 2.00 1.40 2.00 4.10 Coronary heart disease 0.82 0.83 1.12 0.82 0.83 1.00 Cerebrovascular disease Ischaemic stroke 0.52 0.64 1.06 0.94 1.33 1.65 Haemorrhagic stroke 0.59 0.65 7.98 1.27 2.19 2.38 Digestive diseases Cirrhosis of the liver 1.30 9.50 13.00 1.30 9.05 13.00 Source: Rehm et al. (2003)
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European Observatory on Health Syst
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The European Observatory on Health
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Open University Press McGraw-Hill E
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European Observatory on Health Syst
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viii Contents five six The evidence
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List of tables 2.1 Beds in state ps
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List of figures 4.1 The production
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List of boxes 3.1 A personal testim
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List of contributors Francesco Amad
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xviii List of contributors Viviane
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Series editors’ introduction Euro
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Foreword Mental health may be the m
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Foreword by the Minister of Health
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Acknowledgements This volume is par
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chapter one Mental health policy an
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An overview 3 agencies (see Chapter
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An overview 5 Funding In broad term
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An overview 7 Social inclusion and
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An overview 9 actions such as inter
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An overview 11 of symptom alleviati
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An overview 13 Kessler, R.C., Demle
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chapter two The historical developm
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Historical development of mental he
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A lack of historical continuity His
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Tackling social exclusion 35 • in
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Tackling social exclusion 37 networ
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Tackling social exclusion 39 regula
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Tackling social exclusion 41 where
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Tackling social exclusion 43 and Sw
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Tackling social exclusion 45 addres
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Tackling social exclusion 47 than o
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Tackling social exclusion 49 in thi
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Tackling social exclusion 51 not ho
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Tackling social exclusion 53 Box 3.
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Tackling social exclusion 55 Conclu
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Tackling social exclusion 57 Disabi
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Tackling social exclusion 59 Read,
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Financing and funding 61 problems h
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Financing and funding 63 provides a
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Financing and funding 65 recognizin
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Financing and funding 67 care docto
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Financing and funding 69 Trends in
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Financing and funding 71 employment
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Financing and funding 73 kind, cove
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Financing and funding 75 emphasis o
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Financing and funding 77 provided i
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Financing and funding 79 for differ
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Financing and funding 81 budgets in
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Financing and funding 83 Europe or
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Financing and funding 85 the famili
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Financing and funding 87 of further
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Financing and funding 89 mental hea
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Financing and funding 91 community
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Financing and funding 93 Available
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Financing and funding 95 Basu, A. (
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Financing and funding 97 of interve
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Financing and funding 99 World Heal
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The evidence base 101 result of pub
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The evidence base 103 campaigns, it
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The evidence base 105 using health
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Table 5.1 A matrix of evidence Rese
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Identifying needs using epidemiolog
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The evidence base 111 facilitate gl
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The evidence base 113 Learning from
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The evidence base 115 sources of ev
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The evidence base 117 Europe, and i
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The evidence base 119 to Policy pro
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The evidence base 121 Finally, it i
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The evidence base 123 Lavis, J., Ro
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The evidence base 125 World Health
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The treatment of mental disorders 1
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Psychopharmaceuticals in Europe 147
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Table 7.6 Europe by drug type and c
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Table 7.8 Europe by drug type and c
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Table 7.10 Europe by drug type and
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Table 7.12 Europe by drug type and
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Table 7.14 Europe comparative presc
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Table 7.20 Decline in psychiatric i
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Promotion and prevention 189 Mental
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Promotion and prevention 191 Box 8.
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Promotion and prevention 193 risk o
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Promotion and prevention 195 and th
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Promotion and prevention 197 (Üstu
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Promotion and prevention 199 and un
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Promotion and prevention 201 The li
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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
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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
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Page 277 and 278: Reforms in community care 249 Goldb
Page 279 and 280: Addiction and alcohol 251 (Brown et
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Page 285 and 286: Addiction and alcohol 257 Some stud
Page 287 and 288: Addiction and alcohol 259 availabil
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Page 291 and 292: Addiction and alcohol 263 Hours and
Page 293 and 294: Addiction and alcohol 265 College s
Page 295 and 296: Addiction and alcohol 267 Figure 11
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
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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
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Housing and employment 305 mental h
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Housing and employment 307 S.M. (20
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A human rights perspective 309 Nor
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Monitoring compliance with the inte
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A human rights perspective 313 Ment
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A human rights perspective 315 Equa
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A human rights perspective 317 Last
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A human rights perspective 319 Comb
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A human rights perspective 321 segr
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A human rights perspective 323 The
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A human rights perspective 325 •
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A human rights perspective 327 ensu
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A human rights perspective 329 •
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A human rights perspective 331 Arti
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A human rights perspective 333 Refe
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A human rights perspective 335 Will
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The user and survivor movement 337
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Care of asylum seekers and refugees
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generic local team or psychiatric h
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Carers and families 375 In this cha
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Carers and families 377 impact they
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Carers and families 379 2002). In a
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Carers and families 381 conducted i
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Carers and families 383 Interventio
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Carers and families 385 Child careg
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Carers and families 387 subject to
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Carers and families 389 Conclusion
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Carers and families 391 Cohen, C.A.
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Carers and families 393 in long-ter
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Carers and families 395 care in rel
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chapter seventeen Mental health pol
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Policy in former eastern bloc count
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Table 17.1 General information and
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Box 18.1 Recommendations in The Wor
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The WHO perspective 429 isolation,
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The WHO perspective 431 high when c
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The WHO perspective 433 Key issues
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The WHO perspective 435 Box 18.2 Qu
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The WHO perspective 437 services is
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The WHO perspective 439 Desjarlais,
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Index abuse of psychiatry, eastern
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Index 443 community care ECHR, 321
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Index 445 European countries commun
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Index 447 initiatives, discriminati
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Index 449 applying principles, 317-
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Index 451 policy, 228-9 practice, 2
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