Mental health policy and practice across Europe: an overview

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264 Mental health policy and practice Table 11.5 Continued Effectiveness 1 Breadth of research support 2 Cross-cultural testing 3 Cost efficiency 4 Target group 5 (TG) and comments Alcohol problems treatment Mutual help/selfhelp attendance Mandatory treatment of repeat drinking-drivers + +++ +++ 0 TG = HD; population reach is low because most countries have limited treatment facilities + + ++ +++ TG = HD; a feasible, costeffective complement or alternative to formal treatment in many countries + ++ + ++ TG = HD; punitive and coercive approaches tend to have time-limited effects, and sometimes distract attention from more effective interventions Altering the drinking context Training servers to not serve persons to intoxication Training bar staff and managers to prevent and better manage aggression Voluntary codes of bar practice Enforcement of onpremise regulations Safer bar environment/ containers Community mobilization + +++ ++ ++ TG = HR; external signs of intoxication often difficult to recognize + + + ++ TG = HR 0 + + +++ TG = HR; ineffective without enforcement ++ + ++ + TG = HR; compliance depends on perceived likelihood of enforcement ? + + ++ TG = HR; one controlled study questions whether tempered glassware is actually safer ++ ++ + + TG = GP; sustainability of changes has not been demonstrated Education and persuasion Alcohol education in schools 0 +++ ++ + TG = HR; may increase knowledge and change attitudes but has no effect on drinking
Addiction and alcohol 265 College student education Public service messages 0 + + + TG = HR; may increase knowledge and change attitudes but has no effect on drinking 0 +++ ++ ++ TG = GP; refers to messages to the drinker about limiting drinking; messages to strengthen policy support untested Warning labels + + 0 +++ TG = GP; effect on message awareness, none shown on behaviour Promotion of alternatives Alcohol-free activities ? + ? ? TG = GP; not enough research to draw conclusions about this strategy 0 ++ ++ ++ TG = GP; evidence mostly from youth alternative programmes 1 Evidence of effectiveness – This criterion refers the scientific evidence demonstrating whether a particular strategy is effective in reducing alcohol consumption, alcohol-related problems or their costs to society. To be considered in this compendium, at a minimum the strategy had to be carefully investigated in at least one well designed study which accounted for alternative and competing explanations. The following rating scale was used as a guide: 0 Evidence indicates a lack of effectiveness + Evidence for limited effectiveness ++ Evidence for moderate effectiveness +++ Evidence of a high degree of effectiveness ? No studies have been undertaken or there is insufficient evidence upon which to make a judgement 2 Breadth of research support. The highest rating was influenced by the availability of integrative reviews and meta-analyses. Breadth of research support was evaluated independent of the rating of effectiveness (i.e. it is possible for a strategy to be rated low in effectiveness but to also have a high rating on the breadth of research supporting this evaluation). The following scale was used: 0 No studies of effectiveness have been undertaken + Only one well designed study of effectiveness completed ++ From two to four studies of effectiveness have been completed +++ Five or more studies of effectiveness have been completed ? There is insufficient evidence on which to make a judgement 3 Tested across cultures. This criterion is concerned with the diversity of geography and culture in which each strategy has actually been applied and tested. It refers to the robustness of international or multinational testing of a strategy as well as the extent to which a strategy applies to multiple countries and cultures. The following scale was used: 0 The strategy has not been tested adequately + The strategy has been studied in only one country or appears to be unique to one country ++ The strategy has been studied in two to four countries or appears relevant to more than one country but perhaps is culturally bounded +++ The strategy has been studied in five or more countries or appears to be relevant to a large number of countries ? There is inadequate information on which to make a judgement 4 Cost efficiency. This criterion seeks to estimate the relative monetary cost to the state to implement, operate and sustain this strategy, regardless of effectiveness. For instance, increasing alcohol excise duties does not cost much to the state but may be costly to alcohol consumers. In this criterion, the lowest possible cost is the highest standard. Therefore, the higher the rating, the lower the relative cost to implement and sustain this strategy. The following scale was used: 0 Very high cost to implement and sustain Continue overleaf
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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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Promotion and prevention 203 income
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Promotion and prevention 205 implem
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Promotion and prevention 207 When d
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Promotion and prevention 209 health
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Promotion and prevention 211 Murphy
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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 279 and 280: Addiction and alcohol 251 (Brown et
Page 281 and 282: Addiction and alcohol 253 Figure 11
Page 283 and 284: Addiction and alcohol 255 Table 11.
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: Addiction and alcohol 263 Hours and
Page 301 and 302: Addiction and alcohol 273 Alcohol t
Page 303 and 304: Addiction and alcohol 275 developme
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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
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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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Page 337 and 338: A human rights perspective 309 Nor
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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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