Mental health policy and practice across Europe: an overview

Financing and funding 61
problems have multiple needs, often eliciting multiple responses from health
care and other bodies, adding necessary complexity to these frameworks. We set
them out in the following sections. We then pull out some key topics for more
focused attention, starting with financing arrangements and mental health
budgets, then looking at the efficient and equitable targeting of resources, and
finally discussing resource challenges for mental health in Europe and how to
overcome them.
Production of welfare
Descriptions of the resources available to a mental health system tend to focus
primarily on those used in providing treatment of identified symptoms or
needs. In fact, resources might be deployed in various ways:
• promotion of well-being and prevention of symptoms;
• screening for, and assessment of, needs;
• purchasing or providing treatment for identified needs;
• maintenance of, or rehabilitation back into, ‘mainstream’ activities and
lifestyles;
• coordination of treatment and rehabilitation services (brokerage);
• monitoring of service quality and service users’ outcomes;
• regulation of procedures, services, choices and opportunities; and
• research and development.
What then do we mean by resources? How are they linked to outcomes?
We can start with a simple framework which represents the links between
budgets, the resource inputs they purchase or fund, the services produced by
those inputs, and the health and quality of life outcomes that hopefully will
result for service users, their families and relevant others. These are among the
most pertinent links in any mental health system and the framework therefore
helps us identify many of the issues faced by decision-makers.
The framework is illustrated schematically in a highly simplified form in
Figure 4.1 and shows the connections between a number of entities:
• The resource inputs used in promoting good mental health or in assessing,
supporting, treating or monitoring people with mental health problems.
These are mainly staff, physical capital, medications and other consumables.
• The costs of these resource inputs expressed in monetary terms.
• The service volumes and qualities (perhaps weighted in some way for user
characteristics, including casemix) produced from combinations of the
resource inputs, which we can call the intermediate outputs.
• The final outcomes from prevention and care, principally outcomes for individual
service users and others gauged in terms of symptom alleviation,
improved functioning and quality of life, improved family well-being and
perhaps some wider social consequences.
• The non-resource inputs, which do not have a readily identified cost (since they
are not directly marketed) but which exert influences on user outcomes and
also mediate the influences of the resource inputs. Examples would be the