Mental Health Services In Europe Research Articles

Community mental health services in Europe: the state of art

AbstractIn Europe there is significant variability of attitudes, procedure and strategies in clinical care between psychiatrists and settings across different regions and countries. However, there is a significant overrepresentation of data from mental health services from Western and Northern European countries, due a lack of data from Eastern and Central European countries as it has been suggested the Eastern and Central European regions are a “blind spot on the global mental health map”. In respect to community mental health services, Northern and Western countries introduced a large array of multidisciplinary community-based services for people with mental health problems and reorganized the mental health care services towards the community mental health care, replacing largely large hospitals and hospital-based care following recovery-oriented care models with introduction of numerous services which supported full recovery, including supported employment and housing. This process is only in the beginning in the majority of countries in the South and East of Europe. Here we present the data from these countries including the results of the RECOVER-E study (Large-scale implementation of community based mental health care for people with severe and enduring mental ill health in Europe), which incorporated the implementation of community mental health services in five South-eastern European countries.Disclosure of InterestNone Declared

The importance of clinicians' and parents' awareness of suicidal behaviour in adolescents reaching the upper age limit of their mental health services in Europe

BackgroundTo study clinicians' and parents' awareness of suicidal behaviour in adolescents reaching the upper age limit of their Child and Adolescent Mental Health Service (CAMHS) and its association with mental health indicators, transition recommendations and mental health service (MHS) use. Methods763 CAMHS users from eight European countries were assessed using multi-informant and standardised assessment tools at baseline and nine months follow-up. Separate ANCOVA's and pairwise comparisons were conducted to assess whether clinicians' and parents' awareness of young people's suicidal behaviour were associated with mental health indicators, clinician's recommendations to continue treatment and MHS use at nine months follow-up. Results53.5 % of clinicians and 56.9 % of parents were unaware of young people's self-reported suicidal behaviour at baseline. Compared to those whose clinicians/parents were aware, unawareness was associated with a 72–80 % lower proportion of being recommended to continue treatment. Self-reported mental health problems at baseline were comparable for young people whose clinicians and parents were aware and unaware of suicidal behaviour. Clinicians' and parents' unawareness were not associated with MHS use at follow-up. LimitationsAspects of suicidal behaviour, such as suicide ideation, -plans and -attempts, could not be distinguished. Few young people transitioned to Adult Mental Health Services (AMHS), therefore power to study factors associated with AMHS use was limited. ConclusionClinicians and parents are often unaware of suicidal behaviour, which decreases the likelihood of a recommendation to continue treatment, but does not seem to affect young people's MHS use or their mental health problems.

The impact of COVID-19 on psychiatric and mental health services in Europe: suffering experienced by professionals

BackgroundThe COVID-19 pandemic has not only impacted intensive care units, but all healthcare services generally. This PsyGipo2C project specifically investigates how psychiatry and mental health professionals have been affected by the reorganizations and constraints imposed, which have reshaped their often already difficult working conditions.MethodsOur research combined quantitative and qualitative methods, surveying and interviewing health professionals of all occupations working in psychiatric and mental health services. A questionnaire was completed by 1241 professionals from 10 European countries, and 13 group interviews were conducted across 5 countries. In addition to this, 31 individual interviews were conducted in Belgium and France.ResultsAmong the questionnaire respondents, 70.2% felt that their workload had increased, particularly due to their tasks being diversified and due to increased complexity in the provision of care. 48.9% felt that finding a work-life balance had become more difficult, and 59.5% felt their health had been affected by the crisis. The impact of the health crisis nevertheless varied across professions: our data provides insight into how the health measures have had a differential impact on professional tasks and roles across the various categories of occupations, obliging professionals to make various adaptations. The distress incurred has been linked not only to these new constraints in their work, but also to the combination of these with other pressures in their personal lives, which has consequently compromised their well-being and their ability to cope with multiple demands.DiscussionThe COVID-19 health crisis has had varying impacts depending on the profession and access to remote work, sometimes leading to conflicts within the teams. The suffering expressed by the professionals was tied to their values and patterns of investment in work. Our research also highlights how these professionals made little use of the psychological supports offered, probably due to a reluctance to acknowledge that their mental health was affected.

The impact of the early phase of the COVID-19 pandemic on mental-health services in Europe

Purpose The current COVID-19 pandemic confronts psychiatric patients and mental health services with unique and severe challenges. Methods In order to identify these trans-national challenges across Europe, an ad-hoc survey was conducted among 23 experts, each answering for one European or aligned country. Results A number of important themes and issues were raised for the impact of COVID-19 on mental health and mental health services, barriers to service provision and future consequences. A number of key issues were reported by colleagues across several jurisdictions, even though these were at different stages of their national epidemics. Conclusions Based on these findings, we articulate some important learnings from the early stages of the COVID-19 European pandemic, and highlight key considerations for all countries’ mental health services as the current pandemic develops and for future pandemics.

Variations in use and access of mental health services in Europe

Abstract Background Mental illnesses comprise a wide range of mental health (MH) conditions -prevalence 3,90%- among European (EU) countries with significant effects on quality of life, life expectancy and disability. They are also related to substantial direct and indirect costs, consequences of inpatient care - not always beneficial for those patients. The main goals of our study are: to report on geographic variations in utilization rates and quality of care for adults MH diseases among 30 EU countries and regions; to explain the determinants of such variations. Methods Different data from EUROSTAT regarding healthcare resources, activities and self-perceived health and wellbeing for the years 2013-2015 are combined in a unique database at level of EU countries and NUTS 2 regions to allow for comparisons in utilization rates, perceived conditions and service local supply for MH diseases in Europe. Results Preliminary findings show a decline in the global trend of hospitalization rates for mental diseases; however, significant variations were observed among and within countries (High-Low ratio=25 in 2015, at country level). Males were more hospitalized than females (p = 0.40). Women were more likely than men to report depressive symptoms and to access to MH consultations (p < 0.001). Significant and positive correlations were found between resources (hospital beds and psychiatrists per capita) and adjusted hospitalization rates for MH disorders and between self-reported MH consultations and psychiatrists per capita (p < 0.001). Conclusions Preliminary findings confirm the presence of wide variations in the care of mental diseases across and within EU countries. Significant correlations between utilization rates and local supply of resources might indicate that part of the variation might be explained by differences in the local organization and availability of resources rather than patients' needs. Key messages There is a wide variation in the care of mental diseases across and within EU countries which might be explained by differences in the local organization and resources instead patients’ needs. These results can help policy makers and professionals to identify unwarranted variations that need to be removed and to shift to value-based healthcare.

COVID-19 and mental health services in Europe

The area of mental health is directly affected by the pandemic and its consequences, for various reasons: 1-the pandemic triggered a global lockdown, with dramatic socioeconomic and therefore psychosocial implications; 2-mental health services, which treat by definition a fragile population from the psychological, biological and social points of view, have a complex organizational frame, and it was expected that this would be affected (or overwhelmed) by the pandemic; 3-mental health services should, at least in theory, be able to help guide public health policies when these involve a significant modification of individual behaviour. It was conducted a narrative review of the publications produced by European researchers in the period February-June 2020 and indexed in PubMed. A total of 34 papers were analyzed, which document the profound clinical, organizational and procedural changes introduced in mental health services following this exceptional and largely unforeseen planetary event.Among the main innovations recorded everywhere, the strong push towards the use of telemedicine techniques should be mentioned: however, these require an adequate critical evaluation, which highlights their possibilities, limits, advantages and disadvantages instead of simple triumphalist judgments. Furthermore, should be emphasized the scarcity of quantitative studies conducted in this period and the absence of studies aimed, for example, at exploring the consequences of prolonged and forced face-to-face contact between patients and family members with a high index of "expressed emotions".

Análisis del mundo asociativo «en primera persona» en salud mental en Cataluña

Las respuestas a las problemáticas relacionadas con el ámbito de la salud mental se han centrado en la creencia de que la diversidad era un hecho individual de cada persona, responsabilizando al individuo de su voluntad de cambio, olvidando las condicionantes sociales de este hecho. En contraposición, en Europa se han creado diferentes movimientos fomentados por personas usuarias y ex-usuarias de los servicios de la red de salud mental que reivindican una serie de derechos, de soluciones y de propuestas alternativas a las institucionales. El presente artículo se basa en la primera parte de la tesis doctoral, que se centra en el estudio del papel de Trabajo Social como facilitador de los procesos de empoderamiento de las personas diagnosticadas con un trastorno mental. La intención es la aproximación al mundo asociativo «en primera persona» y el papel que ha obtenido en el momento actual en Cataluña. Para ello se cuenta con la opinión de nueve personas vinculadas a las nueve asociaciones que forman la Federació Veus. La metodología escogida es de carácter cualitativo, siendo dos las herramientas para la recogida de datos: la observación y la entrevista en profundidad. El análisis de los datos extraídos permitió concluir que las redes relacionales y el trabajo comunitario ayudan en la mejora de la calidad de vida de las personas usuarias de las asociaciones «en primera persona», mediante la paliación de los estigmas y las desigualdades que se pueden generar en torno a un diagnóstico.

Position paper about the care of refugees : Astatement about the psychosocial health care of refugees

This paper is general statement about the psychosocial care of refugees, developed by the of the Austrian Society for Psychiatry, Psychotherapy and Psychosomatics as well as by the Austrian Society for Social Psychiatry. Reasons of recent wave of refugees and the usual mental disorders among refugees are described. The increasing number of refugees, asylum seekers and irregular migrants poses achallenge for mental health services in Europe. As aconsequence, several expert recommendations were given. As afirst step, basic needs of refugees such as regular housing facilities, sufficient nutrition and safety in everyday life should be met. Fast decisions about the applications for asylum and support of social integration through education and employment are essential for mental health. Provision of mental health care should be needs based as described by the intervention pyramid for mental health and psychosocial support as given by the Inter-Agency Standing Committee of the World Health Organization. In addition, culture-specific aspects must be considered in everyday clinical work and the training of health professionals.

Cultural Sensitive Care Provision in a Public Child and Adolescent Mental Health Centre: A Case Study from the Toulouse University Hospital Intercultural Consultation.

Child and adolescent mental health services in Europe are confronted with children with increasingly diverse socio-cultural backgrounds. Clinicians encounter cultural environments of hyperdiversity in terms of languages and countries of origin, growing diversity within groups, and accelerated change with regards to social and administrational situations (Hannah, in: DelVecchio Good et al. (eds) Shattering culture: American medicine responds to cultural diversity, Russel Sage Foundation, New York, 2011). Children and families who live in these complex constellations face multiple vulnerabilizing factors related to overlapping or intersecting social identities (Crenshaw in Univ Chic Leg Forum 140:139-167, 1989). Mobilizing existing resources in terms of social and family support, and encouraging creative strategies of interculturation in therapeutic work (Denoux, in: Blomart and Krewer (eds) Perspectives de l'interculturel, L'Harmattan, Paris, 1994) may be helpful in order to enhance resilience. Drawing from experiences in the context of French transcultural and intercultural psychiatry, and inspired by the Mc Gill Cultural Consultation in Child Psychiatry, we developed an innovative model, the Intercultural Consultation Service (ICS). This consultation proposes short term interventions to children and families with complex migration experiences. It has been implemented into a local public health care structure in Toulouse, the Medical and Psychological Centre la Grave. The innovation includes the creation of a specific setting for short term therapeutic interventions and team training via shared case discussions. Our objectives are (a) to improve outcomes of mental health care for the children through a better understanding of the child's family context (exploration of family dynamics and their relatedness to complex migration histories), (b) to enhance intercultural competencies in professionals via shared case discussions, and, (c) to improve the therapeutic relationship between children and professionals on the basis of the work with the family and the dialogue with the team. In our paper, we present the rationale and functioning of the ICS and illustrate our work with a case study. The presentation of the case uses the Mc Gill B-version of the Cultural Formulation, combined with a relational and process oriented reflection on the intercultural dynamics that unfold during the encounter with a family.

The current state of child and adolescent mental health services in Europe: A survey in 28 countries

IntroductionTransition to adulthood is the period of onset of most serious mental disorders. The current discontinuity of care between Child and Adolescent Mental Health (CAMHS) and Adult Mental Health (AMHS) Services is a major socioeconomic and societal challenge for the EU.Objectives/aimsIn the framework of the MILESTONE project this study aims to map current services and transitional policies across Europe, highlighting current gaps and the need for innovation in care provision.MethodsAn on-line mapping survey has been conducted across all 28 European countries through the administration of two ad-hoc instruments: the Standardized Assessment Tool for Mental Health Transition (SATMEHT) and the European CAMHS Mapping Questionnaire (ECM-Q). The survey systematically collected data about CAMHS organization and characteristics, with a specific focus on actual national transition policies and practice.ResultsResponse rate was 100%. Despite up to 49% of CAMHS service users need to continue with specialist AMHS care, written policies for managing the interface between these two services are available only in 4/28 countries and transition support services are reported as missing by half of the respondents. Lack of connection between CAMHS and AMHS is reported as the major (82%) difficulty experienced by young service users.ConclusionPreliminary results indicate a marked variability in characteristics of services and in data activity among the 28 European countries, with important missing information at national level about CAMHS and their functioning. All these conclusions warrant an improvement in data collection and service planning and delivery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Novel research on transition from child to adult mental health services in Europe: The MILESTONE project

IntroductionCurrent service configuration of distinct Child and Adolescent Mental Health (CAMHS) and Adult Mental Health Services (AMHS) is considered the weakest link where the care pathway should be most robust. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge for the EU.ObjectivesThe overall objective of the MILESTONE project is to improve transition from CAMHS to AMHS in diverse healthcare settings in Europe.AimsTo improve the understanding of current transition-related service characteristics, and processes, outcomes and experiences of transition from CAMHS to AMHS using a bespoke suite of measures; to explore the ethical challenges of providing appropriate care to young people as they move to adulthood; to test a model of managed transition in a cluster randomized controlled trial (cRCT) for improving health, social outcomes and transition to adult roles; and to develop training modules for clinicians and policy guidelines.MethodsData will be collected via systematic literature reviews; bespoke surveys to CAMHS professionals, experts and other stakeholders; focus groups with service providers and users and members of youth and mental health advocacy groups; and a longitudinal cohort study with a nested cRCT in eight EU countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS service users, their parents/carers, and clinicians, with assessments at baseline, 9, 18 and 27 months.ResultsFirst results are expected in 2016 with further major findings following in 2019.ConclusionsThe MILESTONE project will provide unprecedented information on the nature and magnitude of problems at the CAMHS-AMHS interface, and potential solutions to overcome these.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Book review: Mental health services in Europe: Provision and practice

Book review: Mental health services in Europe: Provision and practice

Where is the path to recovery when psychiatric hospitalization becomes too difficult?

Where is the path to recovery when psychiatric hospitalization becomes too difficult?

EPA guidance on the quality of mental health services

The main aim of this guidance of the European Psychiatric Association is to provide evidence-based recommendations on the quality of mental health services in Europe. The recommendations were derived from a systematic search of the best available evidence in the scientific literature, supplemented by information from documents retrieved upon reviewing the identified articles. While most recommendations could be based on empirical studies (although of varying quality), some had to be based on expert opinion alone, but were deemed necessary as well. Another limitation was that the wide variety of service models and service traditions for the mentally ill worldwide often made generalisations difficult. In spite of these limitations, we arrived at 30 recommendations covering structure, process and outcome quality both on a generic and a setting-specific level. Operationalisations for each recommendation with measures to be considered as denominators and numerators are given as well to suggest quality indicators for future benchmarking across European countries. Further pan-European research will need to show whether the implementation of this guidance will lead to improved quality of mental healthcare, and may help to develop useful country-specific cutoffs for the suggested quality indicators.

Chinese forensic psychiatry and its wider implications

The current configuration of forensic mental health services in Europe and Australia, whereby mentally ill offenders are directed on treatment orders to secure psychiatric hospitals away from the c...

Forensic psychiatric nursing: a description of the role of the psychiatric nurse in a high secure psychiatric facility in Ireland

The Central Mental Hospital is one of the oldest high secure mental health services in Europe dating back to 1845 but has been one of the last to introduce (forensic) psychiatric nurses. This paper describes the role of psychiatric nurses working in this high secure psychiatric facility in Ireland. The United Kingdom Central Council competency framework was considered to be a prudent starting point for beginning to understand this role in an Irish context. The study received a response rate of 74% and found that the Irish Forensic Mental Health Nurse experiences many of the same challenges as their international colleagues. A high proportion of nursing practice is focused on assessment, communication and creating a therapeutic environment based very much in keeping with the mainstream role in mental health nursing. Skills in specialist assessments and addressing offending behaviour were considered important but deficient at that time. The importance of recovery and human rights were considered paramount but challenged by the need for risk management and security.

Focus on Mental Health Care Reforms in Europe: Mental Health Services in Europe: An Overview

Focus on Mental Health Care Reforms in Europe: Mental Health Services in Europe: An Overview

Focus on Mental Health Care Reforms in Europe: Mental Health Services in Europe: An Overview

Psychiatric services in Europe are experiencing a period of change, driven by political commitment at national and intergovernmental levels in response to the public health challenges posed by mental health problems. However, diversity among European countries makes any generalization speculative. Resources such as funding, workforce, and infrastructure vary dramatically, and new investment is limited. Some European countries can take pride in sophisticated service systems, whereas others continue to rely almost exclusively on asylums. Reforms are hampered by a lack of comparable information and a lack of research, particularly in less developed countries. However, many exciting local initiatives are emerging, even in the poorest countries. The challenge will be to translate good local practice into national policies and practice, supported by adequate resources.

Current perspectives on assessment and therapy with survivors of torture: the use of a cognitive behavioural approach

Increasing numbers of refugees are presenting to mental health services in Europe and Scandinavia and pose significant clinical challenges for practitioners. The most clinically challenging to engage in a psychotherapeutic context are survivors of torture and politically organized violence. Much of the literature on therapeutic work with torture survivors has tended to focus on psychodynamic approaches. There have also been attempts to describe other approaches, such as the use of testimony, with some attempts to study and describe cognitive behavioural approaches in torture survivors. It has been demonstrated that cognitive behavioural therapy is effective for PTSD, as recommended by the NICE (2005) guidelines for the assessment and management of PTSD in primary and secondary care. This paper will review and critique the current literature on therapy with refugees and survivors of torture. Through case examples, the use of CBT will be illustrated as an effective treatment intervention for this group. It will be demonstrated that the model can have effective clinical outcomes and provide a practical, problem-orientated approach to working with survivors of torture and political violence. This paper will also describe the use of assessment and treatment approaches using CBT principles, demonstrating the flexibility and applicability of the model. It also demonstrates the utility of CBT in different cultural contexts, despite perceived cultural limitations. Implications for assessment and practice in a cross-cultural setting will be discussed.

The Barents project in psychiatry: a systematic comparative mental health services study between Northern Norway and Archangelsk County

There is virtually no readily accessible systematically recorded evidence on how the organization of mental health services in Europe's largest country, Russia, may differ from other national systems. This study systematically compares the mental health services in Archangelsk County and Northern Norway using instruments developed for trans-cultural use. The European Service Mapping Schedule (ESMS) and The International Classification of Mental Health Care (ICMHC) were used to describe: (i) resources, organisation and utilisation of the services; (ii) their decentralisation and differentiation; (iii) some interventions delivered by the mental health service units (n = 132) in both regions. The Norwegian services are more decentralised and differentiated, while the Russian services are largely hospital-based. The GPs are of considerable importance to the Norwegian services, functioning as gatekeepers-both centrally and peripherally. In contrast, the GP model is still poorly established in Archangelsk County. There are more units for long term stay in the Russian services than in Norway. General health care and taking over daily living activities are more organised in Archangelsk County, while psychopharmacological treatment and psychosocial interventions are more developed in Norway. The study has revealed several differences in resources, organisation and utilisation of the mental health services between the two compared areas. The very large variations indicate that underlying local patterns of service delivering must be further investigated and taken into account in the planning of the services development.