Standard comparison of local mental health care systems in eight European countries

Ilaria Montagni ,Raluca Sfectu ,José A. Salinas-Pérez ,Carlos R. García‐Alonso ,Luis Salvador‐Carulla ,Jordi Cid ,Christa Straßmayr ,A‐La Park ,Juan Luis González-Caballero ,Karine Chevreul ,Mencía R. Gutiérrez-Colosía ,L. Rabbi,Francesco Amaddeo ,Birgitte Kalseth ,Taina Ala-Nikkola ,Jorid Kalseth ,Gaia Cetrano ,Gisela Hagmair ,Federico Tedeschi ,Damiano Salazzari

doi:10.1017/s2045796017000415

Abstract

There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (≥18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sør-Trøndelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.

Highlights

Mental disorders are among the most common and disabling health conditions worldwide and should, be considered as a top global health priority
There is an important gap between such burden and the availability of resources to manage and reduce it (Patel et al 2013). To satisfactorily bridge this gap, more information is needed about existing infrastructures for adults across Europe at national and local levels. This information is important with regard to budget allocation and control of expenditure, as well as for efficiency analysis and policy planning (WHO, 2013)
We describe direct provision of care in three main coding branches of DESDE-LTC: Outpatient or ambulatory care (O), Day care (D) and Residential care (R)

Summary

Introduction

Mental disorders are among the most common and disabling health conditions worldwide and should, be considered as a top global health priority. Every year over a third of the total EU population. This information is important with regard to budget allocation and control of expenditure, as well as for efficiency analysis and policy planning (WHO, 2013)

Results

Discussion

Conclusion