Profiling mental health systems in the European Union Member States and activities in prevention and promotion of mental health

Chiara Samele, Senior FellowFoundation Anniversary Celebration

Institute of Mental Health7 November 2012

Acknowledgments Funders: Executive Agency for Health and Consumers (EAHC, EC) – Jurgen Scheftlein and Roisin Rooney

Researchers: Stuart Frew and Norman UrquíaSteering group: Gerry Carton, Professors Nick Manning, Peter Bartlett, Justine Schneider, Eddie KaneProject Manager: Lesia Joubert

Country collaborators: a network of 25 Mental Health experts

EU Governmental Experts in Mental Health and Well-being: from Member States and other countries

Advisory group: Dr Teresa Di Fiandra (Ministry of Health, Italy) , Dr Matt Muijen (WHO Europe), Dr Bernd Puschner, (Ulm University, Germany), Professor Mirella Ruggeri (University of Verona) and Professor Norman Sartorius (former director WHO Division of Mental Health)Dr Lynne Friedli (Mental Health Promotion Specialist)

Context of the project

• Concerning levels of mental illness, unmet need for services, economic and social costs

• Prevention of mental illness and mental health promotion – an important focal point

• Growing evidence-based, rise of recovery- oriented and person-centred approaches

• Concerns about the impact of the economic crisis on mental health

EU mental health policy overview12-point action plan

– promotion of mental well-being

– tackle stigma & discrimination

– effective care in the community…

WHO European Region, the EU and the Council of Europe approved a ‘Mental Health Declaration’ and Action Plan for Europe (WHO, 2005)

Followed by the EC’s Green Paper ‘Improving the MH of the Population’ (2005) and the ‘European Pact for MH and Well-Being’ – 5 priority areas (2008)

Recent developmentsEU Council Conclusions in June 2011 reaffirmed its support for the Green Paper (2005) and the EU Pact (2008)

Council invited Member States and the Commission to set up a ‘Joint Action on MH and W-B’ under EU Public Health Programme 2008-2013

Forthcoming WHO European MH Strategy – to bring together promotion, prevention and treatment

Main objectives

• Describe mental health systems, how currently organised (prevention and promotion)

• Describe mental health status of the population• Describe the types of prevention of mental illness and

promotion of mental health programmes implemented – policies and future directions

• Set out proposals to strengthen prevention and promotion initiatives

• Identify potential economic and social benefits of actions and investments in prevention and promotion

Methods1. Searched for academic and grey literature since 2005

2. Using a structured template we collected information/ data on 29 countries

3. Surveyed MH prevention and promotion experts across participating countries4. Searched EU and

WHO databases for EU statistics

Data collected

1. Background information2. Legislation and policy3. Mental health services

(access, usage, variations…)

4. Financing of MH services5. Workforce6. Prevalence and incidence7. Protective and risk factors8. Monitoring systems –

available indicators

1. Prevention and promotion activities (schools, workplace and older people)

2. Delivery of prevention and promotion

3. Financial responsibility for prevention and promotion

4. Investments into mental health

5. Initiatives to strengthen mental health systems for prevention and promotion

Analyses

Produced a set of 29 country profiles (validated by Governmental experts):

• Performed an overall descriptive analysis of country profiles with the supplementary data (Excel and SPSS)

• An analysis of the qualitative responses received from mental health promotion and prevention experts (Nvivo)

Some initial findings on …

• Mental health systems

• Prevention and promotion activities

Legislation and policies and prevention and promotion priorities

Mental

Health Legislation MH policies or

strategies

Legislation include MH prevention and/or

promotion

Policies and strategies include MH promotion

Policies and strategies include prevention

Austria General yes yes yes yes Belgium yes yes no yes yes Bulgaria General yes yes no no Croatia yes yes no yes yes Cyprus yes yes no yes yes

Czech Rep General yes no nk nk Denmark yes yes nk yes yes Estonia yes General no General General Finland yes yes yes yes yes France yes yes yes yes yes

Germany yes yes no yes yes Greece yes yes yes yes yes

Hungary General yes yes yes yes Ireland yes yes no yes yes

Italy yes yes no yes nk Latvia General yes no yes yes

Lithuania yes yes no yes yes Luxembourg yes yes yes yes yes

Malta yes yes yes yes nk Netherlands yes yes no yes yes

Norway yes yes nk yes yes Poland yes yes yes yes yes

Portugal yes yes yes yes yes Romania yes yes yes yes yes Slovakia General yes yes General General Slovenia yes yes no yes yes

Spain yes yes no yes yes Sweden yes yes yes General yes

UK yes yes no yes yes

Yes 23 28 13 24 23 No 0 0 14 1 1

General 6 1 0 3 2 nk 0 0 1 1 3

Source: Country profiles

Types of psychiatric inpatient services

Country Institutional care

Psychiatric Hospitals

Psychiatric services in general hospitals Day centers/ hospitals

Austria yes yes yes

Belgium yes yes yes

Bulgaria yes yes yes yes

Croatia yes yes yes yes

Cyprus yes yes yes

Czech Rep yes yes yes yes

Denmark ? yes yes

Estonia ? yes yes yes

Finland yes yes yes

France yes yes yes

Germany yes yes yes

Greece yes yes yes yes

Hungary yes yes yes

Ireland yes yes yes

Italy yes yes

Latvia yes yes yes yes

Lithuania yes yes yes

Luxembourg yes yes yes

Malta yes yes yes

Netherlands yes yes yes

Norway ? ? yes

Poland yes yes yes

Portugal yes yes yes yes

Romania yes yes yes yes

Slovakia ? yes yes yes

Slovenia yes yes yes yes

Spain yes yes yes

Sweden ? yes yes

UK yes yes yes

Total no: 11 24 27 26

Source: WHO European Hospital Morbidity Database 2012

?

Types of community-based mental health services

Primary MH care

Outpatient services

Mental health centres

Home Visits Residential care / Sheltered home

Crisis intervention

Austria Yes Yes ? ? Yes Yes

Belgium Yes Yes Yes Yes Yes Yes

Bulgaria Yes Yes Yes No Yes No

Croatia Yes Yes Yes Yes Yes No

Cyprus Yes Yes Yes Yes ? Yes

Czech Rep Yes Yes No Yes ? No

Denmark Yes Yes Yes Yes Yes ?

Estonia Yes Yes Yes ? ? No

Finland Yes Yes Yes Yes Yes ?

France Yes Yes Yes Yes ? ?

Germany Yes Yes ? Yes Yes ?

Greece Yes Yes Yes Yes Yes ?

Hungary ? Yes Yes Yes Yes Some

Ireland Yes Yes Yes Yes Yes Yes

Italy Yes Yes Yes Yes Yes Yes

Latvia Some Yes No No Yes No

Lithuania Yes Yes Yes ? Yes No

Luxembourg Yes Yes Yes ? ? ?

Malta Yes Yes ? Yes Yes Yes

Netherlands Yes Yes ? ? Yes ?

Norway Yes Yes Yes ? ? ?

Poland Yes Yes Yes Yes Yes Yes

Portugal Yes Yes No No Yes No

Romania Some Yes Yes ? Yes Yes

Slovakia Yes Yes Yes Yes Yes Yes

Slovenia Yes Yes No No Yes No

Spain Yes Yes Yes Yes Yes ?

Sweden Yes Yes Yes ? ? ?

UK Yes Yes Yes Yes Yes Yes

Yes 26 29 21 17 22 10

Source: Country profiles and WHO Atlas 2011

Variations and gaps in services

Theme Country

Lack of a range and distribution of community based services

Bulgaria, Czech Republic, Croatia, Estonia, Malta, Latvia…

Decentralised systems of healthcare creating problems with coordination and integration of services

Austria, Denmark, Estonia, Finland, France, Germany, Italy, Netherlands, Spain

Source: Country profiles; WHO MH Atlas 2011 (figures for 2009-2012)

Combined prevention &

promotion programsPrevention programs

Promotion programs Total

Schools 16 128 44188

Workplace 15 61 2399

Older people 8 12 1434

General 15 70 26111

Total 54 253 107 414

Number of prevention and promotion programs by setting/target group

Responsibility for delivering prevention and promotion initiatives

It’s everyone’s business and cannot be seen as the sole responsibility of specialist mental health

agencies

Source: Eurostat 2012

Source: Eurostat 2012

EU focus – impact of economic crisis on mental health - suicide

Country with increases >10%

% increase in number of suicides (2007-2009)

Sweden 10.1%

Lithuania 11.0%

The Netherlands 12.7%

Latvia 13.9%

Ireland 15.1%

Norway 18.1%

Slovakia 19.0%

Greece 20.3%

Poland 22.6%

Malta 34.6%

Cyprus 63%

Responses by MS:-Action plans-Increase MH spending-Easier access to MH services-Improving guidelines and training-Campaigns and helplines

Source: Informal European Commission survey 2012

Joint Action on Mental Health and Well-being

Due to commence in 2013Lead by: Prof Jose-Miguel Caldas de Almeida, Nova University of Lisbon

Key objective: To formulate policy recommendations - based on previous EU work - and to build a sustainable commitment to implement these

Address issues relating to: Strengthening partnerships between health and other sectors for

promotion for employees and children and adolescents Promote the evidence-based action on depression and suicide Manage the transition from institutional to community mental health

care Promote social inclusion and tackle discrimination Promote the integration of mental health in all policies

The EuroPoPP-MH project will form a platform for the forthcoming Joint Action

Thank you

Email: informedthinking@gmail.com