European Mental Health Research Articles

Meeting the challenge of funding and allocating resources to mental health across Europe: developing the Mental Health Economics European Network

There is growing demand for economic analysis to support strategic decision-making for mental health but the availability of economic evidence, in particular on system performance remains limited. The Mental Health Economics European Network (MHEEN) was set up in 2002 with the broad objective of developing a base for mental health economics information and subsequent work in 17 countries. Data on financing, expenditure and costs, provision of services, workforce, employment and capacity for economic evaluation were collected through bespoke questionnaires developed iteratively by the Network. This was augmented by a literature review and analysis of international databases. Findings on financing alone suggest that in many European countries mental health appears to be neglected while mechanisms for resource allocation are rarely linked to objective measure of population mental health needs. Numerous economic barriers and potential solutions were identified. Economic incentives may be one way of promoting change, although there is no 'one size fits all solution. There are significant benefits and synergies to be gained from the continuing development of networks such as MHEEN. In particular the analysis can be used to inform developments in Central and Eastern Europe. For instance there is much that can be learnt on both how the balance of care between institutional and non-institutional care has changed and on the role played by economic incentives in ensuring that resources were used to develop alternative community-based systems.

Suicide rates, life satisfaction and happiness as markers for population mental health

To examine the association of variables from survey data on well-being with suicide rates and other markers of population mental health in Europe. Ecological study correlating (Spearman's rank correlation) life satisfaction and happiness (European Values Survey 1999/2000) in 32 countries with suicide rates (WHO Mortality Database), rates of hospital discharge for mental and behavioural disorders and prevalence of mental disorders based on registered mental patients (WHO Regional Office for Europe) and Mental Health Index (MHI)-5 survey data (European Opinion Research Group). An inverse association exists between suicide rates and life satisfaction (r=-0.44; 95% CI: -0.68, -0.11) and happiness (r=-0.42; 95% CI: -0.67, -0.08). Similar though weaker associations were seen with hospital discharge data and MHI-5 data but not with the prevalence of mental disorders. The association between suicide rates and life satisfaction was weaker amongst 15-44 year olds (r=-0.31; 95% CI: -0.59, 0.04) than amongst 45-64 year olds (r=-0.47; 95% CI: -0.70, -0.14). It was strongest in the 65+ age group (r=-0.54; 95% CI: -0.75, -0.23). A similar pattern was observed for the association with happiness. In a subgroup analysis, the association between suicide and life satisfaction in Eastern Europe was similar to that in the whole dataset (r=-0.35) but a positive association was seen in Western Europe (r=0.47). Life satisfaction and happiness were modestly associated with other indicators of population mental health. Since all such markers have their limitations, surveys of well-being may be useful indicators of population mental health.

The Psychotherapist and the Sign Language Interpreter

Specialized psychotherapy for deaf people in the Dutch and Western European mental health systems is still a rather young specialism. A key policy principle in Dutch mental health care for the deaf is that they should receive treatment in the language most accessible to them, which is usually Dutch Sign Language (Nederlandse Gebarentaal or NGT). Although psychotherapists for the deaf are trained to use sign language, situations will always arise in which a sign language interpreter is needed. Most psychotherapists have the opinion that working with a sign language interpreter in therapy sessions can be a valuable alternative option but also see it as a second-best solution because of its impact on the therapeutic process. This paper describes our years of collaborationship as a therapist and a sign language interpreter. If this collaborationship is optimal, it can generate a certain "therapeutic power" in the therapy sessions. Achieving this depends largely on the interplay between the therapist and the interpreter, which in our case is the result of literature research and our experiences during the last 17 years. We analyze this special collaborative relationship, which has several dimensions and recurrent themes like, the role conception of the interpreter, situational interpreting, organizing the interpretation setting, or managing therapeutic phenomena during therapy sessions.

A time for reflection

Amsterdam, with its web of water-ways, was a fitting location for the tenth RCN European mental health nursing conference. For much has ebbed and flowed in the world of mental health nursing and mental health care during the last decade.

Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1)

BackgroundThis paper is a part of the work of the group that carried out the report "The state of the mental health in Europe" (European Commission, DG Health and Consumer Protection, 2004) and deals with the mental health issues related to the migration in Europe.MethodsThe paper tries to describe the social, demographical and political context of the emigration in Europe and tries to indicate the needs and (mental) health problems of immigrants. A review of the literature concerning mental health risk in immigrant is also carried out. The work also faces the problem of the health policy toward immigrants and the access to health care services in Europe.ResultsMigration during the 1990s has been high and characterised by new migrations. Some countries in Europe, that have been traditionally exporters of migrants have shifted to become importers. Migration has been a key force in the demographic changes of the European population. The policy of closed borders do not stop migration, but rather seems to set up a new underclass of so-called "illegals" who are suppressed and highly exploited. In 2000 there were also 392.200 asylum applications.The reviewed literature among mental health risk in some immigrant groups in Europe concerns: 1) highest rate of schizophrenia; suicide; alcohol and drug abuse; access of psychiatric facilities; risk of anxiety and depression; mental health of EU immigrants once they returned to their country; early EU immigrants in today disadvantaged countries; refugees and mental healthDue to the different condition of migration concerning variables as: motivation to migrations (e.g. settler, refugees, gastarbeiters); distance for the host culture; ability to develop mediating structures; legal residential status it is impossible to consider "migrants" as a homogeneous group concerning the risk for mental illness. In this sense, psychosocial studies should be undertaken to identify those factors which may under given conditions, imply an increased risk of psychiatric disorders and influence seeking for psychiatric care.Comments and RemarksDespite in the migrants some vulnerable groups were identified with respect to health problems, in many European countries there are migrants who fall outside the existing health and social services, something which is particularly true for asylum seekers and undocumented immigrants. In order to address these deficiencies, it is necessary to provide with an adequate financing and a continuity of the grants for research into the multicultural health demand. Finally, there is to highlight the importance of adopting an integrated approach to mental health care that moves away from psychiatric care only.

Prevalence of psychiatric disorder in Europe: the potential and reality of meta-analysis

Within the European Mental Health Status Project, over 200 psychiatric surveys concerning members of the European Union (plus Norway) were examined for their potential for meta-analysis with regard to prevalence of psychiatric disorders and basic demographic and social variables. The diversity of samples, methods, analysis and presentation was such that only data derived from GHQ-12 and CIDI studies could be used, and those relating to sex differentials only. The statistical program "Stata" was used to compute odds ratios (with confidence intervals) for individual studies, and to produce fixed and random effects estimates of the pooled odds ratio for all studies together, and a measure of heterogeneity. Forrest Plots were also produced. Analysis of GHQ-12 data with a cut-off point of 4, indicating a current or recent "probable mental health problem", showed, as expected, that women had higher prevalence rates than men. However, there was a relatively high heterogeneity score, suggesting that these studies may not be measuring the same thing. Analysis of CIDI results showed homogeneity for major depressive disorder within the last 12 months, with the risk for men about half of that for women. In terms of advancing epidemiological knowledge, the results are trivial, at most confirming what is already well known. However, the study shows the potential for pooled analysis, with much greater power in epidemiological investigation if consistency could be achieved in research. Various ways in which this might be done are discussed. It also shows the value of personal knowledge and personal networks in fields which are not well handled by electronic literature databases.

Psychische Gesundheit der älteren Bevölkerung in Europa

Mental Health in Europe's Elderly Populations

Editorial

I NEVER thought I’d mention Catherine Zeta-Jones and Michael Douglas in an MHP editorial. Normally, I wouldn’t have shown more than a passing interest in last month’s High Court bid by the celebrity couple to wrest damages from Hello! magazine. However, I was drawn to media coverage of their action because it was based on a dispute over whether photographs should be published without the subjects’ permission. By coincidence, the same issue had been raised just a couple of days earlier in a very different setting - the RCN’s eighth European mental health nursing conference in London (see pages, 6-7).

Beware paying lip service to service users

Dear Editor,I attended the recent RCN European Mental Health Nursing Conference, ‘Rewind – Refocus on global mental health nursing’. This rightly evoked reflection on past and present practices. This has led me to reconsider the current drive for increased service user participation in service delivery. Having attended Pat Mayer’s presentation on ‘Action research in action: A collaborative project between mental health service users and mental health providers in Cape Town’, I was struck by the power of such an approach to challenge routine clinical practice.

8th European Mental Health Nursing Conference `Rewind ‐ refocus on global mental health nursing' 7‐8 February 2003, Art and Tech Hotel, London

8th European Mental Health Nursing Conference `Rewind ‐ refocus on global mental health nursing' 7‐8 February 2003, Art and Tech Hotel, London

The use of patient-level outcomes to inform treatment.

The assessment of outcome for any purpose is not undertaken routinely in European mental health services. This paper discusses the merits of using outcome data to inform the planning of mental health care for individual patients, and provides practical advice to support the implementation of this new approach to working. The use of outcomes in North America and Europe is briefly reviewed. A conceptual basis is proposed for routine outcome assessment--the ongoing measurement and use of outcome data to inform decisions about whether to continue, change or curtail treatment. A cognitive psychology model is developed which indicates that the routine use of outcomes will improve mental health care. Perceived problems with routine outcome assessment are discussed, and principles for implementation are identified. Outcomes are used mainly for generating local-level (rather than patient-level) data in North America, and rarely used in Europe. The use of outcome data routinely may facilitate reflective clinical practice, a model of decision-making which leads to a higher quality of clinical care than automated problem-solving. One issue relates to the use of standardised assessments designed for research purposes in clinical settings, and this is being addressed through the development of a new generation of outcome measures which are explicitly designed for clinical use. However, most clinicians remain unconvinced of the benefits of routine outcome assessment, and relevant research is currently underway across Europe which will address this concern. Scientific principles to maximise quality and pragmatic principles to maximise the chances of successful implementation are identified. The routine use of outcomes will become increasingly prominent in European mental health services. This provides clinicians with an opportunity to improve the quality of clinical care offered to patients.

The gift of 'the gap' that appears unwanted.

As a member of the audience at the 7th European Mental Health Conference, it was good to hear Beverly Malone talk of the 'gift' of mental health nursing to the profession.

Mental health in Europe: problems, advances and challenges.

To describe mental health care needs and challenges across the WHO European region of 51 nations. Based on morbidity and mortality data from HFA Statistical Database and Health2l, the policy framework of WHO Europe, major trends in mental health care needs, psychiatric reform and mental health promotion are discussed. There is a mortality crisis related to mental ill health in Eastern European populations of transition. Destigmatization is required to improve early intervention and humanization of services, and national mental health audits are needed to create the basis for national mental health planning, implementation and monitoring. There are both problems and advances in service restructuring, and comprehensive mental health promotion programmes, preventive and monitoring strategies are required. Partnerships between national and international organizations, especially WHO and the European Union, have to be strengthened to make progress on the way to integrated community mental health services.

7th European Mental Health Nursing Conference

7th European Mental Health Nursing Conference

Mental health in Europe – the World Health Organization's perspective: diversities, possibilities, shortcomings and challenges

Mental health in Europe – the World Health Organization's perspective: diversities, possibilities, shortcomings and challenges

Public Health Approach on Mental Health in Europe

Public Health Approach on Mental Health in Europe

Introduction: Assessing mental health in Europe

Introduction: Assessing mental health in Europe

Introduction: Assessing mental health in Europe

Introduction: Assessing mental health in Europe

Treatment should reflect shorter inpatient stays

THERE IS no evidence that shortening inpatient stays for mentally ill patients harms their care, the RCN's annual European mental health nursing conference was told last week.

Valuing mental health nursing.

Date:19-21 February 1999 PLACE: Jersey, Channel Islands Date for receipt of abstracts: 31 July 1998 This is the fourth European Mental Health Nursing Conference. The theme this year is the relationship that exists between nurses and the users of services in all aspects of care provision, including management and education. Presenters from all fields and levels of experience are welcome, particularly those wishing to speak on effective leadership, employment practice and workforce planning.