Mental health policy and practice across Europe: an overview

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14 Mental health policy and practice Thornicroft, G. and Tansella, M. (2004) Components of a modern mental health service: a pragmatic balance of community and hospital care: overview of systematic evidence, British Journal of Psychiatry, 185: 283–90. Thornicroft, G., Becker, T., Knapp, M., Knudsen, HC., Schene, AH., Tansella, M. and Váquez-Barquero, J.L. (2006) International Outcome Measures in Mental Health: Quality of Life, Needs, Service Satisfaction, Costs and Impact on Carers. London: Gaskell, Royal College of Psychiatrists. Ungerson, C. (2004) Whose empowerment and independence? A cross-national perspective on cash for care schemes, Ageing and Society, 24: 189–212. Varekamp, I. (2004) Ulysses directives in the Netherlands: opinions of psychiatrists and clients, Health Policy, 70(3): 291–301. World Bank (2002) World Development Report 2002: Building Institutions for Markets. Washington, DC: World Bank. World Health Organization (2001) The World Health Report 2001. Mental Health: New Understanding, New Hope. Geneva: World Health Organization. World Health Organization (2004) The World Health Report 2004. Changing History. Geneva: World Health Organization. World Health Organization (2005a) Mental Health Declaration for Europe: Facing the Challenges, Building Solutions. Copenhagen: World Health Organization. World Health Organization (2005b) Mental Health Action Plan for Europe: Facing the Challenges, Building Solutions. Copenhagen: World Health Organization. World Health Organization (2005c) Suicide prevention website, http://www.who.int/ mental_health/prevention/suicide/suicideprevent/en/index.html.
chapter two The historical development of mental health services in Europe Edward Shorter * This chapter traces the evolution of mental health care from the early nineteenth century to the present in the countries that came to form the European Union (EU) – and in the candidates for membership in 2004. What are the overall themes of change? What patterns emerge among the various states? Given that in Europe and America neuropsychiatric illness represents 43 per cent of the total burden of disability (Thornicroft and Maingay 2002), these are important questions. This huge undertaking reminds us that there are two ways of looking at systems of mental health care: the vertical and the horizontal. The vertical dimension refers to how well the system is integrated, in the sense of providing continuous care from the community to mental hospital and back to the community; or from the community to the psychiatry department of a general hospital and back. The horizontal dimension refers to how comprehensive the system is: whether, in addition to family doctors and psychiatrists, a health care team based in community centres includes psychologists, psychiatric nurses and social workers, and even nutritionists and occupational therapists. (One can conceive this horizontal dimension as a functional model of disability rather than an illness model. As Bob Grove (1994: 431) puts it, ‘The doctor or psychiatrist becomes only one expert among many others in the management of a disability.’) Both dimensions, vertical and horizontal, have their own patterns of change. Why begin in the early nineteenth century? One could, in fact, begin much earlier (Porter 1987). It goes without saying that patients with psychiatric illnesses have always existed, and that society has always devised some means of coping with them. Yet in Europe prior to the early nineteenth century, these
Page 1 and 2: European Observatory on Health Syst
Page 3 and 4: The European Observatory on Health
Page 5 and 6: Open University Press McGraw-Hill E
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Page 9 and 10: viii Contents five six The evidence
Page 11 and 12: List of tables 2.1 Beds in state ps
Page 13 and 14: List of figures 4.1 The production
Page 15 and 16: List of boxes 3.1 A personal testim
Page 17 and 18: List of contributors Francesco Amad
Page 19 and 20: xviii List of contributors Viviane
Page 21 and 22: Series editors’ introduction Euro
Page 23 and 24: Foreword Mental health may be the m
Page 25 and 26: Foreword by the Minister of Health
Page 27 and 28: Acknowledgements This volume is par
Page 29 and 30: chapter one Mental health policy an
Page 31 and 32: An overview 3 agencies (see Chapter
Page 33 and 34: An overview 5 Funding In broad term
Page 35 and 36: An overview 7 Social inclusion and
Page 37 and 38: An overview 9 actions such as inter
Page 39 and 40: An overview 11 of symptom alleviati
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Page 45 and 46: Historical development of mental he
Page 55 and 56: A lack of historical continuity His
Page 63 and 64: Tackling social exclusion 35 • in
Page 65 and 66: Tackling social exclusion 37 networ
Page 67 and 68: Tackling social exclusion 39 regula
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Page 73 and 74: Tackling social exclusion 45 addres
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Page 77 and 78: Tackling social exclusion 49 in thi
Page 79 and 80: Tackling social exclusion 51 not ho
Page 81 and 82: Tackling social exclusion 53 Box 3.
Page 83 and 84: Tackling social exclusion 55 Conclu
Page 85 and 86: Tackling social exclusion 57 Disabi
Page 87 and 88: Tackling social exclusion 59 Read,
Page 89 and 90: Financing and funding 61 problems h
Page 91 and 92: 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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Promotion and prevention 213 Vuori,
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chapter nine Common mental health p
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Mental health disorders in primary
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Mental health problems in primary c
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chapter ten Reforms in community ca
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Table 10.1 Mental health care in th
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Reforms in community care 239 syste
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Reforms in community care 241 integ
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Reforms in community care 243 In 19
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Reforms in community care 245 Secon
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Reforms in community care 247 must
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Reforms in community care 249 Goldb
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Addiction and alcohol 251 (Brown et
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Addiction and alcohol 253 Figure 11
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Addiction and alcohol 255 Table 11.
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Addiction and alcohol 257 Some stud
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Addiction and alcohol 259 availabil
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Addiction and alcohol 261 Table 11.
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Addiction and alcohol 263 Hours and
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Addiction and alcohol 265 College s
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Addiction and alcohol 273 Alcohol t
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Addiction and alcohol 275 developme
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Addiction and alcohol 277 Greenfiel
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Addiction and alcohol 279 World Hea
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Housing and employment 281 European
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Housing and employment 283 to a lif
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Housing and employment 285 relative
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Housing and employment 287 comprise
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Housing and employment 289 treatmen
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Housing and employment 291 rented h
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Housing and employment 293 occupati
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Housing and employment 295 market;
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Housing and employment 297 Table 12
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Housing and employment 299 Return t
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Effectiveness of pre-vocational and
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Housing and employment 303 where re
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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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