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Joint Action on Mental Health and Well-Being PART II. MAINSTREAMING E-MENTAL HEALTH INTERVENTIONS IN EUROPE Joint Action on Mental Health and Well-being DEPRESSION, SUICIDE PREVENTION AND E-HEALTH Situation analysis and recommendations for action MENTAL HEALTH AND WELLBEING REPORT | 1 Co-funded by the European Union Joint Action on Mental Health and Well-being DEPRESSION, SUICIDE PREVENTION AND E-HEALTH Situation analysis and recommendations for action AUTHORS: György Purebl, Ionela Petrea, Laura Shields, Mónika Ditta Tóth, András Székely,Tamás Kurimay, David McDaid, Ella Arensman, Isabela Granic, Katherina Martin Abello EXPERT REVIEW: Danuta Wasserman, Vladimir Carli, Gergő Hadlaczky CONTRIBUTORS: Ulrich Hegerl (Germany), Elisabeth Kohls (Germany), Nicole Koburger (Germany), Toms Pulmanis (Latvia), Airi Värnik (Estonia), Peeter Värnik (Estonia), Merike Sisask (Estonia), Grace O’Regan (Ireland), Marianne Jespersen (Denmark), Dorthe Goldschmidt (Denmark), Gerle Mårten (Sweden), Sara Lundgren (Sweden), Hristo Hinkov (Bulgaria) Date of preparation 29 October 2015 Co-funded by the European Union Joint Action on Mental Health and Well-being DEPRESSION, SUICIDE PREVENTION AND E-HEALTH Situation analysis and recommendations for action Co-funded by the European Union ACKNOWLEDGEMENTS This report has been prepared by the teams from Hungary (Semmelweis University Budapest) and Netherlands (Trimbos Institute, Netherlands Institute of Mental Health and Addictions) co-leading the implementation of Workpackage 4 of the Joint Action on Mental Health and Well-being with input from lead experts in the fields of prevention of depression and suicide and e-mental health and from national experts in Member States participating in the Workplackage 4. INDEX 11 EXECUTIVE SUMMARY 14 INTRODUCTION 16 PART I. PREVENTION OF DEPRESSION AND SUICIDE IN EUROPE 1. The burden of depression and suicide in Europe – frequency, significance, economic and societal impacts 1.1. Frequency of depression and suicide in Europe 1.2. ­­Socio-demographic characteristics, high risk groups 1.3. The link between depression and highly prevalent chronic diseases 1.4. Treatment gaps in depression and suicide 1.5. The Economic and societal burden of depression and suicide in Europe 2. Social determinants, economic crise and depression: suicide and harmful alcohol consumption in focus 2.1. Mental health and economic crisis 2.2. Consumption and abuse of psychoactives during the economic crisis 2.3. Gender differences and the response to economic recession 2.4. Economic crisis and suicide 2.4. Policy responses to economic crisis in mental health 3. Investment in international actions to address depression and prevent suicide 3.1. Background and context 3.2. Selected EU level policy developments 3.3. EU level investments to tackle depression and risk of suicide across Europe 3.4. European research funding 3.5. Example: support for telephone helplines 4. Best practices against depression and suicide – a Comprehensive review of European activities 4.1. Search strategy 4.2. Training programs provided to health care professionals in Europe on depression and suicide 4.3. Restriction of access to lethal means 4.4. Restriction of alcohol consumption 4.5. Media reporting guidelines 4.6. Health care approaches to depression and suicide: prevention and treatment 1. Pharmacotherapy 4.7. Health care approaches to depression and suicide: prevention and treatment 2. Psychotherapy 4.8. prevention and therapy among Adolescents 4.9. prevention and therapy among the elderly 4.10. follow up care of suicide attempters 4.11. Low threshold crisis intervention helplines 4.12. Multi-level community-based programs 4.13. Some Examples of national Suicide prevention activities in European countries 4.14. The WHO world suicide report 5. Prevention of depression and suicide in Europe: review conclusions 6. Situation analysis on prevention of depression and suicide in WP4 participating Member States 6.1. Methodology 6.2. Mental health legislation, policy and planning for prevention of depression and suicide 6.3. Mental health financing in countries for prevention of depression and suicide 6.4. The situation at the programmatic level for prevention of depression and suicide 6.5. Involvement of service users and carers at the programmatic level in prevention of depression and suicide 6.6. National and international collaborations in the prevention of depression and suicide 6.7. Prevalence and service utilisation data for prevention of depression and suicide 6.8. Treatment availability for prevention of depression and suicide 7. Analysis of interventions on prevention of depression and suicide in WP4 participating Member States 7.1. Overview of submitted interventions for prevention of depression and suicide 7.2. Description of interventions 7.3. Collaboration and ownership of interventions 7.4. Evidence-based approaches within submitted interventions 7.5. Efficacy of submitted interventions 7.6. Problems and gaps identified 7.7. Prevention of depression and suicide in Europe: conclusions of situation analysis 8. Recommendations for action for prevention of depression and suicide 8.1. How to employ the recommendation? 8.2. Taking evidence-based actions against depression 8.3. Taking evidence-based actions against suicide 8.4. Summary of key recommendations for tackling depression and suicide 8.5. Recommended indicators of measuring success 8.6. Prominent EU Structures for possible partnership in implementation 9. Conclusions of part I on prevention of depression and suicide 145 PART II. MAINSTREAMING E-MENTAL HEALTH INTERVENTIONS IN EUROPE 1. Background and context 1.1. Rationale for implementing e-mental health interventions 1.2. Why is a joint framework for action needed at the EU level for mainstreaming e-mental health initiatives 2. E-mental health in Europe: state of the field 2.1. E-health policy context 2.2. Situational analysis of the mainstreaming of e-mental health in WP4 Member States 2.3. E-mental health interventions available in Europe 3. Challenges for e-mental health in Europe 3.1. Challenges for mainstreaming e-mental health 3.2. Challenges in design and development of interventions 4. Recommendations for action on e-mental health in Europe 4.1. Recommendations for action for mainstreaming e-mental health 4.2. Recommendations for action for improved design and dissemination 184 ANNEX 1: RESULTS OF SITUATIONAL ANALYSIS ON THE LEVEL OF PARTICIPATING COUNTRIES SUMMARY CHARTS 194 ANNEX 2: SWOT ANALYSIS 199 ANNEX 3: RECOMMENDED TOPICS OF PUBLIC EDUCATION PROGRAMS FOR DEPRESSION PREVENTION LIST OF FIGURES Figure 1. Prevalence of mental disorders in Europe Figure 2: Disability Adjusted Life Years (DALY) rate of different diseases in Europe Figure 3: Answers rate regarding mental health from the Eurobarometer project Figure 4: Proportion of people reporting diagnosed chronic depression in the past 12 months in 2008 Figure 5: Trends in suicide rates in selected European countries (2000-2011) Figure 6: Changes in suicide rates between 1995 and 2010 Figure 7: Antidepressant treatment in primary and specialised care Figure 8: Psychotherapy in primary and specialised care Figure 9: Target groups of the programs Figure 10: Length of hospitalisation due to depression or suicidal attempt Figure 11: Availability of treatment possibilities in depression and suicidal behaviour Figure 14: Treatment overview for depression and/or suicidal behaviour in Bulgaria Figure 15: Treatment overview for depression and/or suicidal behaviour in Denmark Figure 16: Treatment overview for depression and/or suicidal behaviour in Estonia Figure 17: Treatment overview for depression and/or suicidal behaviour in Germany Figure 18: Treatment overview for depression and/or suicidal behaviour in Hungary Figure 19: Treatment overview for depression and/or suicidal behaviour in Latvia Figure 20: Treatment overview for depression and/or suicidal behaviour in The Netherlands Figure 21: Treatment overview for depression and/or suicidal behaviour in Sweden LIST OF TABLES Table 1: Major depression is amongst the top 6 causes of years lived with disability in Europe in 2010 Table 2: Standardized suicide rate by residence in 2012 Table 3. Summary of the main results of situational analysis on country level Table 4: Availability of programs directed to specific target groups Table 5: Involvement of users and carers in program planning Table 6: Prevalence of depression and suicide among specific target groups Table 7: Outpatient facilities (per 100 000) across participating Member States Table 8: Number of outpatient visits (per 100 000) across participating Member States Table 9: Number of human resources per 100 000 across participating Member States Table 10: Detection rates of depression Table 11: Availability of evidence-based treatments across participating Member States Table 12: Main outcomes across submitted interventions Table 13: Who delivers the intervention? Table 14: Structure of interventions Table 15: List of partners collaborating in interventions Table 16: Outcomes assessed in interventions Table 17: Obstacles to implementation of interventions Table 18: Action areas in which Member States focused on in their e-health strategy (2006-2010) Table 19: Availability of e-mental health programs directed at particular target groups Table 20: Overview of themes in the e-health SWOT analysis Table 21: Aggregated table of answers for e-health SWOT analysis Table 22: SWOT table for the prevention of depression Table 23: SWOT table for the prevention of suicide Table 24: Overview of
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