EUROPEAN COMMISSION Mental health promotion and mental disorder prevention across European Member States: a collection of country stories (Second edition) Mental health promotion and mental disorder prevention across European Member States: a collection of country stories European Commission Neither the European Commission nor any person acting on its behalf is responsible for any use that might be made of the following information. The information contained in this publication does not necessarily reflect the opinion or the position of the European Commission. European Network on Mental Health Promotion and Mental Disorder Prevention Implementing Mental Health Promotion Action Partners of countries involved: Ludwig EESTI - ROOTSI VAIMSE TERVISE JA Boltzmann SUITSIDOLOOGIA INSTITUUT (ERSI) Institute for the ESTONIAN - SWEDISH MENTAL HEALTH Sociology of AND SUICIDOLOGY INSTITUTE (ERSI) Health and Medicine HELLENIC REPUBLIC 2 nd REGIONAL HEALTH AUTHORITY OF ATTICA ATHENS GENERAL HOSPITAL “GEORGIOS GENNIMATAS” MENTAL HEALTH CENTRE MINISTRY OF HEALTH, CARE OF THE ELDERLY & COMMUNITY CARE MALTA With the support of: MHEEN Mental Health Economics European Network More information on the country stories is available at: http://www.imhpa.net A great deal of additional information on the European Union is available on the Internet. It can be accessed through the Europa server (http://europa.eu.int). This document should be quoted: Jané-Llopis, E. & Anderson, P. (Eds). (2006). Mental health promotion and mental disorder prevention across European Member States: a collection of country stories. Luxembourg: European Communities. ISBN-10: 92-79-01160-X © European Communities, 2006 Reproduction is authorised, except for commercial purposes, provided the source is acknowledged. Inside layout design by Scriptura, Nijmegen, The Netherlands Printed by the services of the European Commission Preface 1 Preface Positive mental health is an integral part of the health and well-being of the citizens of Europe. In the European Union, mental ill health is one of the leading causes of disease burden. Research suggests that one in four Europeans suffer from a mental health problem at least once during their life, and some 58,000 citizens die from suicide every year, more than the annual deaths from road traffic accidents, homicide, or HIV/AIDS. The European Commission with its mandate for public health has a long tradition in supporting mental health. It contributed to the WHO European Ministerial Conference on Mental Health, held in Helsinki in January 2005. Through its Declaration and Action Plan1, this conference created strong political commitment for mental health and established a framework for comprehensive action. The launch of the European Commission’s Green Paper on Mental Health2 and the following consultation process (October 2005 – May 2006) support the implementation of this framework. The aim of the Green paper is to stimulate a debate with the European institutions, Governments, health professionals, stakeholders in other sectors, civil society, and the research community about the relevance of mental health for the EU, the need for a strategy at EU level, and its possible priorities. With the Green paper and activities under the EU Public Health Programme 2003-20083, the European Commission seeks to give support to EU Member States in developing mental health. In order to develop infrastructures that will promote mental health and prevent mental ill health, it is important to have a starting point that accounts what is available, and provides information on existing programmes and policies at the country level. The Directorate-General for Health and Consumer Protection of the European Commission therefore encouraged the initiative of the IMHPA Network for Mental Health Promotion and Mental Disorder Prevention to assess the situation and to collect available information on prevention and promotion in mental health. This report presents a first overview, a snapshot of mental health promotion and mental disorder prevention across Europe describing the available policies and underlying challenges and areas for future development. It constitutes a valuable contribution to building a base line of the situation of mental health promotion and mental disorder prevention across EU Member States, and facilitates the identification of possible areas for future action. As it stands it can already be a first step contributing to the consultation process at the community level and supporting Member States with a first, although not exhaustive, overview of prevention and promotion in mental health across Europe. I thank all those involved in the preparation of this report for their significant efforts and the leadership of the IMHPA Network in this work. Robert Madelin Director General for Health and Consumer Protection 1 Mental Health Declaration for Europe and a Mental Health Action Plan for Europe, http://www.euro.who.int/mentalhealth2005 2 European Commission Green Paper. Improving the Mental Health of the population. Towards a strategy on mental health for the European Union. http://europa.eu.int/comm/health/ph_determinants/life_style/mental/green_paper/consultation_en.htm 3 Decision No 1786/2002/EC of the European Parliament and of the Council of 23 September 2002 adopting a programme of Community action in the field of public health (2003-2008). Official Journal L 271, 09.10.2002 Table of contents 3 Table of contents Preface 1 An introductory word 5 A snapshot across Europe 7 A Collection of Country Stories Austria 21 Belgium 29 Bulgaria 35 Croatia 39 Cyprus 45 Czech Republic 51 Denmark 55 Estonia 59 Finland 63 France 67 Germany 71 Greece 77 Hungary 83 Ireland 87 Italy 93 Latvia 99 Lithuania 103 Luxembourg 109 Malta 113 Norway 119 Poland 123 Portugal 129 Romania 135 Slovakia 141 Slovenia 145 Spain, Catalonia 151 Sweden 157 The Netherlands 163 Turkey 171 United Kingdom, England 177 United Kingdom, Scotland 183 Acknowledgements 191 Annex I Partners of the European Network for Mental Health 193 Promotion and Mental Disorder Prevention, IMHPA An introductory word 5 An introductory word This report presents a snapshot of the situation of mental health promotion and mental disorder prevention across 30 European countries, Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain (Catalonia), Sweden, the Netherlands, Turkey and the United Kingdom (England and Scotland). The country stories presented in this report have been prepared by the members of the European IMHPA Network for Mental Health Promotion and Mental Disorder Prevention (see annex I), who are key experts on mental health in their respective countries. For the preparation of this report, the European Network members have involved stakeholders in their countries to collect information about available policies, programmes, workforce and infrastructures for mental health promotion and mental disorder prevention. The European Commission has supported this initiative on the understanding that the country stories are not official and exhaustive reports, but rather a snapshot of current activities. This document is therefore not an official account, but rather a first attempt to collect some baseline information on ongoing initiatives in countries and regions. The selection of information included and the described programmes and policies should not be interpreted as the only available sources of action nor should they be considered evidence based or recommended action, since the report was not intended to be a completely exhaustive or evaluative exercise, but rather the first stage in a process that hopefully will be updated and extended. We welcome any further information that can help in this process. The country stories presented in this report, by the authors in their own words, highlight the richness of approaches and topics which can be addressed, and that are being implemented as mental health promotion and mental disorder prevention across Europe. These accounts from different cultural, economic and political backgrounds provide a framework for learning from each other and for stimulating cross-fertilization. Maybe a more remarkable outcome of this initiative, rather than the country stories themselves, is the process of raising awareness, dialogue, and co-operation that has been created through the development of country groups and the 240 or more people that came together to discuss the situation of prevention and promotion in their countries and who provided the information for the stories; we are indebted to them all. Dr. Eva Jané-Llopis Project leader of the European Network for Mental Health Promotion and Mental Disorder Prevention, IMHPA on behalf of IMHPA Mental Health Promotion and Mental Disorder Prevention: a snapshot across Europe 7 Mental Health Promotion and Mental Disorder Prevention: a snapshot across Europe Prepared by Dr. Eva Jané-Llopis, Sjoerd van Alst and Dr. Peter Anderson 1 Introduction European mental health Positive mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”1. Positive mental health enhances social cohesion and social capital and improves peace and stability in the living environment,