Mental health policy and practice across Europe: an overview

The WHO perspective 431
high when compared to other regions where the percentage ranges from
21 per cent (eastern Mediterranean region) to 10 per cent (the Americas). Only
the African region has a substantially higher percentage of countries without
basic psychotropic medicines (29 per cent).
Forty per cent of countries worldwide do not provide treatment for severe
mental disorders at primary care level. This figure ranges from 56 per cent of
countries in South-East Asia to 35 and 34 per cent in Europe and the Americas
respectively. In spite of policy shifts to deinstitutionalization, more than 65 per
cent of psychiatric beds in the world are still in mental hospitals. Seventy
per cent of countries in Europe have psychiatric beds in mental hospitals,
which is higher than both the Americas (47 per cent) and the western Pacific
(69 per cent).
These figures are more alarming due to the fact that the level of financial
resources being invested to improve mental health is disproportionately low
compared with the disability and burden of disease resulting from mental
disorders. Twenty-eight per cent of countries do not have a specified mental
health budget and of those countries reporting actual mental health expenditure,
36 per cent spend less than 1 per cent of their total health budget on mental
health (World Health Organization 2001a). Interestingly, in the European region
more than 54 per cent of countries spend more than 5 per cent of their health
budget on mental health.
Impact of broader policy issues on the mental health of
the population
The mental health of populations and societies is influenced by many macrosocial
and economic factors, including urbanization, poverty, education and
employment among many others. For example, the complex interaction of factors
associated with urbanization can increase the risk of developing mental
health problems. Urbanization can exacerbate poverty, increase the risk of
homelessness and of exposure to environmental adversities such as pollution. It
also disrupts established patterns of family life, leading to reduced social support
(Desjarlais et al. 1995). Poverty is one of the strongest factors affecting
mental health. In both market economies and developing countries it is both a
cause and effect of mental disorders (Patel 2001). Given the strong linkages
between macro-socio, economic factors and mental health, the latter needs to
be an important consideration in the implementation of millennium development
goals and poverty reduction strategies. Furthermore, government policies
impacting on macro-social factors need to be carefully considered for potential
negative and unintended effects on mental health before being implemented.
Mechanisms should be introduced in order to prevent mental disorders and to
monitor the mental health situation that arises in response to policies. Using
the case of poverty as an example, government policies aimed at reducing absolute
and relative levels of poverty are likely to have a significant positive impact
on mental disorders.