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Mental Health: Facing the Challenges, Building Solutions

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Mental Health: Facing the Challenges, Building Solutions Mental health: facing the challenges, buildingsolutions facingthechallenges, Mental health: The WHO Regional Offi ce for Europe The Member States in the WHO European Region The World Health Organization met at the WHO European Ministerial Conference (WHO) is a specialized agency of the United Nations created on Mental Health in Helsinki in January 2005 to in 1948 with the primary tackle one of the major threats to the well-being responsibility for international health matters and public of Europeans: the epidemic of psychosocial dis- health. The WHO Regional Offi ce for Europe is one of six regional tress and mental ill health. These countries took offi ces throughout the world, each with its own programme mental health from the shadow of stigma and geared to the particular health conditions of the countries it discrimination and brought it to the centre of the serves. public health policy arena. By adopting the Men- Member States tal Health Declaration and Action Plan for Europe, Albania they set the course for mental health policy for Andorra Armenia the next 5–10 years. Austria Mental health: Azerbaijan Belarus Belgium Member States now face the challenge of acting Bosnia and Herzegovina on the principles of the Declaration and accom- Bulgaria facing the challenges, Croatia plishing the goals in the Action Plan’s 12 areas of Cyprus Czech Republic work. This book contributes to the achievement Denmark Estonia of this task by describing the current situation in building solutions Finland France the Region, presenting the Declaration and Ac- Georgia Germany tion Plan, off ering brief discussions of the areas of Greece work (with examples of initiatives already under- Hungary Iceland way in each) and describing WHO’s plans to assist Ireland Israel Member States in improving mental health in the Italy Kazakhstan European Region. Kyrgyzstan Latvia Lithuania The commitments in the Declaration and the Ac- Luxembourg Malta tion Plan are based on information and evidence Monaco Netherlands from across the WHO European Region. Together, Norway Poland they form a solid and inspiring foundation on Portugal Republic of Moldova which governments, policy-makers, nongovern- Romania mental organizations and other stakeholders, Russian Federation San Marino along with WHO, can build solutions to improve Serbia and Montenegro Slovakia the quality of life of all citizens. Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan ISBN 92-890-1377-X World Health Organization Regional Offi ce for Europe Scherfi gsvej 8, DK-2100 Copenhagen Ø, Denmark Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-mail: [email protected] Web site: www.euro.who.int Mental health: facing the challenges, building solutions Report from the WHO European Ministerial Conference Mental health: facing the challenges, building solutions Report from the WHO European Ministerial Conference WHO Library Cataloguing in Publication Data Mental health : facing the challenges, building solutions : report from the WHO European Ministerial Conference 1.Mental health – congresses 2.Mental health services 3.Health policy 4.Health planning 5.Treaties 6.Europe ISBN 92-890-1377-X (NLM Classification : WM 105) ISBN 92-890-1377-X Address requests about publications of the WHO Regional Office to: • by e-mail [email protected] (for copies of publications) [email protected] (for permission to reproduce them) [email protected] (for permission to translate them) • by post Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark © World Health Organization 2005, updated reprint 2005 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not necessarily represent the decisions or the stated policy of the World Health Organization. Printed in Denmark Contents Abbreviations ..............................................................................................vi Acknowledgements .....................................................................................vii Foreword ......................................................................................................ix Foreword .......................................................................................................x 1. Mental health in Europe – The context .................................................. 1 2. Main issues and challenges ..................................................................... 5 3. Mental Health Declaration for Europe ................................................... 9 4. Mental Health Action Plan for Europe ................................................. 17 5. Mental health services in Europe: the treatment gap ............................31 6. Stigma and discrimination against the mentally ill in Europe .............. 41 7. Mental health promotion and mental disorder prevention ...................49 8. Mental health and working life............................................................ 59 9. Alcohol and mental health .................................................................. 67 10. Suicide prevention ...............................................................................75 11. Mental health of children and adolescents ........................................... 83 12. Access to good primary care in mental health ...................................... 93 13. Mental health care in community-based services ................................. 99 14. Human resources and training for mental health ...............................105 15. Mental health legislation ................................................................... 111 16. Empowerment and mental health advocacy .......................................117 17. The economics of mental health in Europe ....................................... 127 18. Mental health information and research ............................................ 135 19. The way forward ...............................................................................141 Annex 1. Conference participants ............................................................147 v Abbreviations Organizations and programmes EU European Union IMHPA Implementing Mental Health Promotion Action (network) NIS newly independent states of the former USSR NGOs nongovernmental organizations VVGG Flemish Mental Health Association WHO-AIMS WHO Assessment instrument for Mental Health Systems WHO-CHOICE CHOosing Interventions that are Cost Effective Technical terms ADHD attention-defi cit hyperactivity disorder ASD autism spectrum disorders DALYs disability-adjusted life years GPs general practitioners PHC primary health care PO personal ombudsman (Sweden) PTSD post-traumatic stress disorder SSRIs selective serotonin reuptake inhibitors YLD years lived with disability vi Acknowledgements The staff of the mental health programme at the WHO Regional Offi ce for Europe are grateful for the help of many experts in preparing this publication. In particular, we thank the following for their help with particular chapters: • Professor David J. Hunter, Health Policy and Management, Wolfson Research Institute, University of Durham, United Kingdom (Chapter 2); • Dr Shekhar Saxena and Dr Pratap Sharan, Mental Health: Evidence and Research, Department of Mental Health and Substance Abuse, WHO head- quarters (Chapter 5); • Dr Lars Jacobsson, Department of Psychiatry, University of Umeå, Sweden and Dr Héðinn Unnsteinsson, Technical Offi cer, Mental Health, WHO Regional Offi ce for Europe (Chapter 6); • Dr Eva Jané-Llopis, Prevention Research Centre, University of Nijmegen, Netherlands (Chapter 7); • Dr Ivan Ivanov, Environment and Health Coordination and Partnership, WHO Regional Offi ce for Europe (Chapter 8); • Mr Dag Rekve, Programme Manager Alcohol and Drugs and Dr Lars Møller, Manager, Health in Prison Project and European Drugs Information System, WHO Regional Offi ce for Europe (Chapter 9); • Dr Leen Meulenbergs, Ministry of Health, Belgium, Dr José Manoel Bertolote, Coordinator, Noncommunicable Diseases and Mental Health, Mental Health and Substance Abuse, Management of Mental and Brain Disorders, WHO headquarters and Ms Roxana Radulescu, Mental Health Europe (Chapter 10); • Dr Myron Belfer, Senior
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