Mental health policy and practice across Europe: an overview

Historical development of mental health services 21
1 Mental-hospital dominated: the hospital looks after its own aftercare and may
not involve the community. Graylingwell and Littlemore Hospitals in
England corresponded to this model, as did most of the asylums in Italy
until 1978.
2 Partnership between mental hospital and community health authority: York,
England, represents a model of this arrangement (Furman 1965: 24–8).
3 The psychiatric division in a general hospital looks after a catchment area:
examples are the Glostrup State Hospital in Denmark, a large psychiatric service
adjacent to an 850-bed general hospital, and the psychiatry divisions
of the general hospitals in Hungary (Furman 1965: 124–9; Tringer 1999).
4 Community care controlled by a public health authority: the Netherlands in
the 1960s comes to mind at once as an example, with the large public health
departments of Amsterdam and Rotterdam integrating the mental health care
of the local populations covered by national health insurance (Furman 1965:
104–16). Stationary care remained mainly voluntary and religious, financed
by the Poor Laws of the municipalities. At this point integration with mental
hospitals, which were mostly in towns, had not been achieved.
5 Transitional systems, from large mental hospitals to community care centered
in general hospitals: In the 1960s and 1970s Sweden conformed to this model,
with the funding going to the large asylums and the start of sectorization
(WHO 1978: 7).
In this second period, an attachment to spa therapy and to physical therapy
for ‘nervous’ and mental disorders remained strong among the continental
members of the EU as well as among those candidate states which had strong
spa traditions. A 1985 guide to spa treatment in Romania, for example, listed
either central nervous system (CNS) or ‘asthenic neurosis’ indications for the
great majority of facilities that it mentioned (Teleki et al. 1985: 292–4). For the
Sliac spa, situated in today’s Slovakia, the prime indications were, ‘Diseases of
the nervous system and the spinal cord, neuralgia, neuritis, tabes dorsalis, neurasthenia,
mental exhaustion, disorders of the visceral nervous system. Nervous
symptoms in diseases of a gouty origin’ (Simon 1954). Sliac, and many similar
spas in the Czech Republic and Slovakia, still refer to a folk tradition of mental
health spa therapy that goes back to the early nineteenth century.
In sum, this second period saw increasing horizontal and vertical integration
of mental health care, accomplished under the militant banners of the
welfare state and all-embracing social insurance programmes. The timid initiatives
of the first period had now become state policy almost everywhere in
the EU.
Period III: 1970s to the present
This period is characterized by the vertical extension of mental health care, as
the smooth passage from the mental hospital to the community becomes the
norm; and by the horizontal extension of care, as mental health teams based in
non-hospital settings take the baton from isolated community psychiatrists and
family doctors. Mental health care starts to become demedicalized, in the sense