Country Reports Implementation of Mental Health Promotion and Prevention Policies and Strategies in the EU member states and appplicant countries (EMIP) Volume II Austria 3 Gerlinde Rohrauer1 EMIP Project - National Coordinator Fonds Gesundes Österreich (Austrian Health Promotion Foundation) Mariahilferstraße 176 1150 Vienna E-Mail Mail: [email protected] Report on the Expert workshop on “Mental Health – Health Promotion and Prevention Strategies in Austria” as part of the project “Implementation of Mental Health Promotion and Prevention Policies and Strategies in EU Member States and Applicant Countries (EMIP)” Vienna, 17. February 2006 1 Thanks to Christian Scharinger and Christina Dietscher for inputs and comments on this report 4 Table of Contents 1. Introduction ....................................................................................................... 6 2. Facts and figures about mental health............................................................ 6 2.1 Epidemiological data...............................................................................................6 2.2 Workforce for mental health...................................................................................7 3. Organisations, policies and legislation in the field of MHP/MDP.................. 8 3.1 Organisations in the field of MHP/MDP .................................................................8 3.2 MHP/MDP policies and programmes ...................................................................10 3.3 Legislation related to health promotion and prevention ...................................10 4. Expert workshop on mental health in Austria .............................................. 11 4.1 Preparation.............................................................................................................11 4.2 Implementation ......................................................................................................11 4.3 Working group results ..........................................................................................14 A Early childhood, family, parenting...................................................................................... 14 B School and out-of-school setting ....................................................................................... 15 C Workplace setting .............................................................................................................. 16 D Healthy ageing................................................................................................................... 17 E Addiction prevention ..........................................................................................................18 F Mental disorder prevention and reduction of discrimination and stigma............................ 19 G Research, education and further training in the field of MHP in Austria ........................... 20 5. Summary and outlook..................................................................................... 22 6. List of participants .......................................................................................... 24 7. References ....................................................................................................... 27 5 1. Introduction This report is intended to provide an overview of the field of Mental Health Promotion (MHP) and Mental Disorders Prevention (MDP) in Austria, and documents the results of the expert workshop “Mental Health – Health Promotion and Prevention Strategies in Austria“. This national workshop was held in Vienna on 7 November 2005 within the framework of the project “EMIP - Implementation of Mental Health Promotion and Prevention Policies and Strategies in EU Member States and Applicant Countries“ by the Austrian Health Promotion Foundation (FGÖ) and in collaboration with the Ludwig Boltzmann Institute for the Sociology of Health and Medicine/WHO Collaborating Centre for Health Promotion in Hospitals and Health Care (Prof. Pelikan, Christina Dietscher). 2. Facts and figures about mental health Below is a short overview of facts and figures which, owing to a lack of data on dimensions of positive mental health, is based primarily on mental disorders statistics. For a comprehensive treatment please consult the reports cited (especially the reports issued by the Federal Ministry for Health and Women and Statistics Austria). In addition, the professional workforce involved in the field of MHP and MDP is listed below. Epidemiological data Only sparse information is available on the epidemiology of mental disorders in Austria. According to a representative health survey (General Health Questionnaire – GHQ-12) conducted in 1991, which gathered information on psychological complaints, among other things, 16.3 % of the Austrian population experienced anxiety or symptoms of depression within a four-week period, with the percentage of women affected (17.5 %) somewhat higher than that of men (15.1 %).1 In a survey assessing people’s experience of mental health that was conducted in the European countries in 2003 (Eurobarometer 58.2), 21.2 % of the Austrian women and 17 % of men reported experiencing mental health problems. 64.3 % of the Austrian men and 62.1 of women reported psychological wellbeing, measured by the energy and vitality scale (EVI)”.2 WHO’s Health Behaviour in School-Aged Children study reports the incidence of psychological and/or psychosomatic complaints among young people at the ages of 11, 13 and 15. According to the study’s results, between one-fourth and one-third of Austrian schoolchildren regularly suffer from headaches, irritability, nervousness and insomnia. Nearly half (45%) of schoolchildren experience tiredness and/or exhaustion.3 6 Austria’s suicide rate has traditionally been high, although it has dropped significantly since 1986, when it had reached a level of more than 28 per 100,000 inhabitants. Since 1997 it has remained below 20 per 100,000, for the first time since 1945.1 In 2004 the rate was 17 per 100,000 inhabitants.4 Statistics on the utilization of hospital beds offer an indication of the prevalence of mental disorders. In 2002 ten percent of all 2.3 million episodes of in-patient episodes in Austria result in a psychiatric diagnosis (episodes with and without psychiatric diagnosis as main diagnosis). The absolute number of discharges with a psychiatric diagnosis rose considerably between 1996 (155,922) and 2002 (233,853) (+50%), while the percentage of such discharges relative to all hospital discharges increased from 7.8% to 10.1%. For 4.6% of all discharges a psychiatric diagnosis was reported as the main diagnosis (approximately one in twenty discharges). This percentage remained nearly unchanged between 1997 and 2002, with levels of 4.6% and 4.8%.5 After musculoskeletal diseases, psychiatric disorders are the most common causes of illness-related retirement in Austria. Some 19 % of all early retirements among women and men are the result of psychiatric disorders.1 Between 1990 and 1999, psychiatric disorders as a cause of sickness leave days increased by 50% (from 307 to 460 sickness leave days per 1,000 workers), while most other illness categories declined slightly as a cause of sickness leave days.1 Apart from statistics of in-patient episodes or work disability records, no regular, systematic data are available for mental disorders. In the past few years a sizeable increase in expenditure for psychotropic drugs in Austria has been observed. In 2003 these drugs accounted for costs of 187 million Euro in Austria (data from social insurance institutions), since 1995 the cost have increased by just under a factor of three. Doctors in private practice prescribed psychotropic drugs some 7 million times in 2003, primarily antidepressants (53%) and tranquilisers (22%), followed by neuroleptics at 15%. Over the last 10 years tranquiliser prescriptions have declined, while prescriptions for antidepressants have increased dramatically. Expenditures for health insurance funded psychotherapy have also risen substantially, amounting to some 38 million Euro in 2003, while spending on psychotropic drugs by the statutory health insurance companies amounts to five times that figure.5 Workforce for mental health A variety of different professions are involved in activities related to mental health promotion/mental disorder, which does not mean, though, that there is any common self- understanding of the involved professional groups as a “mental health promotion/prevention workforce”. The most important occupational groups are the following (based on a summary by Dietscher & Pelikan6, for a comprehensive summary see also Katschnig1): 7 • Psychologists: Since 1991, there is the state certified profession of “clinical” and “health” psychologists. There were 3,902 clinical and health psychologists registered in Austria in 20021. • Psychotherapists: The psychotherapy act (1991) regulates training of psychotherapists and the possibility for reimbursement of psychotherapeutic care by health insurance in some cases. In 2002, there were 5,632 trained psychotherapists (a ratio of 7 per 10,000 population)1. • Psychiatrists: In 2002, Austria had 893 certified psychiatrists (which is one per 9,000 inhabitants)1. • Psychiatric nurses (a specific nursing diploma which is available since 1997). Further important professions include occupational health experts and centres, occupational psychologists, social workers, teachers, health scientists and public health