Mental health policy and practice across Europe: an overview

436 Mental health policy and practice
which attempts to comprehensively address the full range of psychosocial needs
of people with mental disorders. A number of policy recommendations for
service organization have been highlighted in the World Health Report 2001,
and elaborated upon in the WHO Mental Health Policy and Service Guidance
Package. They include:
• shifting care away from large psychiatric hospitals;
• developing community mental health services; and
• integrating mental health care into general health services.
Essentially, ethical and scientific considerations have given impetus to the
movement to transfer mental health care from mental hospitals to primary
health care, general hospitals and a range of community services in the expectation
of enhancing accessibility and acceptability of services, achieving better
‘mental’ and ‘physical’ health outcomes and also achieving a better rationalization
of resources.
While it is not appropriate to be prescriptive at a global level about the microlevel
details of service organization in individual countries, as this will depend
on a number of important social, economic and political variables, a number of
general recommendations can be made. These are summarized in Figure 18.1
which shows the degree to which different categories of services should be provided
and their relative cost. A large part of mental health care can be selfmanaged
and/or managed by informal community mental health services
and low-cost resources can be made available in the community to this effect.
Where additional expertise and support is needed a more formalized network of
Figure 18.1
WHO-recommended optimal mix of services
Source : Adapted from World Health Organization (2003c)