Mental health policy and practice across Europe: an overview

chapter
four
Financing and funding
mental health care services
Martin Knapp and David McDaid
The centrality of funds and resources
Although prevalence rates for the majority of psychiatric disorders vary little
across Europe, different health systems identify different levels of need, devote
different levels of funding to meet those needs and choose different ways to
deliver services. These variations in need, funding and response arise for many
reasons, including demographic pressures, socioeconomic contexts, macroeconomic
capabilities, societal attitudes, cultural and religious orientation, and
– of course – the political commitment and policy priorities that flow from
them. In turn, these factors tend to influence the routes and details of mental
health services financing and resourcing. Despite these inter-country economic
differences, there is a common core of resource challenges to be faced. The aim
of this chapter is to discuss those challenges.
Mental health interventions include actions and services for the promotion
of mental well-being, prevention of mental health problems, treatment of
symptoms and their sequelae, rehabilitation and support. Good quality services
that are also well coordinated and well targeted will have significant impacts
on the mental health and general well-being of individuals and populations.
Those services will be delivered by skilled staff with access to appropriate
information and support, evidence-based medications, psychological therapies
and psychosocial interventions in specialist and other settings. That is the
ideal: the key to a successful mental health system is obviously access to
good physical and human capital resources. The reality is usually rather different:
pervasive limitations on resources restrict access and constrain health
improvements.
The structure of this chapter is as follows. We first introduce a conceptual
framework that links resources and outcomes and helps to stylize the complex
interplay between funding and provision. Many people with mental health