Mental health policy and practice across Europe: an overview

Financing and funding 63
provides a conceptual structure for cost-effectiveness evaluations of different
policies or interventions and for discussions of equity (again, see below).
The success of a mental health system in improving the health and quality of
life of the population will depend on the mix, volume and deployment of
resource inputs and the services they deliver, which in turn are dependent on
the finances made available. And, of course, we know that different countries
choose different levels and mixes of resource inputs. To give an example, we can
see very different patterns of employment of professional staff across Europe.
According to the (2005a) WHO Atlas on mental health, northern European
countries generally employ more mental health staff than eastern or southern
European countries. Denmark, Finland, Iceland, Ireland, Luxembourg, the
Netherlands, Norway, Sweden and the United Kingdom, with San Marino being
the southern exception, have more than 100 mental health personnel (including
social workers) per 100,000 population. Within this group of countries,
Finland has the highest figure at 436 personnel per 100,000 of population. Of
the 52 countries in the European Region, Bulgaria, with 41.5 personnel per
100,000, is the median. This is just one illustration of variations in approach;
others will be considered later.
Multiple needs, multiple resources
It is quite common for someone with a mental health problem to have needs for
support across multiple life domains. For instance, someone who experiences
recurrent bouts of psychosis may need not only health care but assistance or
support in finding and/or retaining paid employment. If they are not working
they are likely to need some alternative source of income and may qualify for
financial support from government or a social insurance fund. They may have
relationship or family difficulties, in more extreme cases even leading to the
involvement of social care agencies. If the consequences of their illness are especially
debilitating, or if they have dislocated normal family relations, they may
need help in finding appropriate housing, or family members may themselves
need services or financial support. For some people with behavioural problems,
desperation or victimization might lead to higher than average contact with the
criminal justice system.
Some symptoms of mental illness have a tendency to generate multiple needs
because they are chronically disabling for the person concerned, distressing for
the family and widely misunderstood by the community. Regardless of circumstances,
where or from whom an individual gets their support, treatment might
almost be a lottery in some countries. Some people may be supported by health
services, some by social care services, some by their employers, some by religious
and charitable groups, some solely by family members, and some – unfortunately
– by no one at all: across the world, many needs still go unrecognized or ignored
(World Mental Health Survey Consortium 2004).
In well-developed and well-resourced health systems, the multiple needs of
individuals and populations are likely to be identified, assessed and addressed
by a range of agencies. Similarly, dedicated promotion and prevention strategies
may be in place in a number of settings such as schools or workplaces (see