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POLICIES AND PRACTICES FOR MENTAL
HEALTH IN EUROPE
Meeting the challenges
WHO, 2008, 212 pages
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http://www.euro.who.int/document/E91732.pdf?language=Russian
Страны Европейского региона ВОЗ привержены целям реформирования
своих программ по охране психического здоровья, суть которого сводится
к переходу от практики, ориентированной на оказание стационарной
помощи, к практике, ориентированной на конкретных больных и на оказание
услуг по месту жительства. В данном докладе ВОЗ, составленном при
финансовой поддержке Европейской комиссии, приводится обзор политики
и практики охраны психического здоровья в 42 государствах - членах
Европейского региона. В последние несколько лет очень большому числу
стран удалось добиться значительного прогресса, а некоторые из них
стали мировыми лидерами в таких областях, как укрепление психического
здоровья, профилактика психических расстройств, реформирование психиатрических
служб, защита прав пациентов.
С другой стороны, в докладе указано как на ряд недостатков,
таких, например, как отсутствие консенсуса по определениям и дефицит
сопоставимых данных по психическому здоровью, так и на необходимость
в развитии и финансировании межсекторального сотрудничества. В нем
также указывается на нехватку информации о работе, которая должна
быть еще проведена, и он может послужить основой для сравнения прогресса
в выполнении ключевых положений и важнейших задач Декларации по
охране психического здоровья в Европе.
Данные, использованные в докладе, были получены от министерств
здравоохранения 42 европейских государств - членов ВОЗ. Доклад содержит
свыше 150 рисунков и таблиц, которые не только показывают значительные
различия, существующие в Европейском регионе, но и позволяют сравнить
страны по таким показателям, как численность психиатров, уровень
финансирования, оказание психиатрической помощи по месту жительства,
подготовка кадров, назначение антидепрессантов, а также уровень
представительства пациентов и лиц, осуществляющих за ними уход,
в службах психического здоровья.
Contents
Tables and figures
Foreword
Acknowledgements
1. Introduction
2. Methods
Content of the baseline assessment questionnaire
Development of the questionnaire
Languages
Data collection
Timeline
The data collection process
Data submission
Data sources and data cross-checking
Participating countries
Data analysis
Recording of the data
Methods of analysis
3. Policy and legislation on mental health
Mental health policy
Main developments since 2005
Mental health legislation
Discussion
4. Promoting mental health and preventing mental
disorders
Promoting mental health and tackling stigma and discrimination
Raising public awareness
Tackling stigma and discrimination
Mental health promotion programmes and activities
Preventing mental disorders
Policies and programmes implemented during the past five years
Main activities initiated and developed since 2005
Centrality of mental health
Discussion
5. Mental health in primary care
Roles of general practitioners and family doctors in mental health
care
Identification and referral to specialist services
Diagnosis
Treatment
Limitations on the role of general practitioners and family doctors
in treating people with mental disorders
Right to prescribe medication
Right to perform certain tasks
Pressure on mental health care in primary care
Availability of national guidelines on assessment and treatment
for GPs dealing with people with mental health problems
Refresher training courses in the rational use of psychotropic
drugs and in psychosocial intervention
Main activities initiated and developed since 2005 related to
mental health services in primary health care
Training
Structural changes
Discussion
6. Mental health services
Inpatient services
Availability of specialized mental health facilities
Beds in inpatient facilities
Median number of days in the facility
Admissions to inpatient units
Outpatient services
Availability of specialized mental health facilities
Visits to mental health outpatient facilities
Community-based specialist mental health treatment and care
Community-based crisis care - daytime only
Community-based crisis care - 24 hours
Home treatment
Assertive outreach
Community-based early intervention
Community-based rehabilitation services
Residential health facilities
Availability of specialized mental health facilities
Beds in residential facilities
Forensic units
Mental health services for children and adolescents
Inpatient facilities
Outpatient facilities
Social institutions
Main activities initiated and developed since 2005 related to
the mental health of children and adolescents
Mental health services for older people
Inpatient facilities
Outpatient facilities
Social institutions
Access to interventions
Access to psychosocial interventions
Use of prescribed antidepressants
Sex distribution
Sex distribution of visits and admissions
Sex distribution of beds and places
Access to and appropriateness of mental health services for linguistic
and ethnic minorities and other vulnerable groups
Access to mental health services for linguistic minorities
Use of mental health services by ethnic and minority groups
Discussion
7. Workforce for mental health care
National policies and programmes on the workforce for mental
health care
Availability of specialist mental health workers
Number of psychiatrists per 100 000 population
Number of nurses working in mental health care per 100 000 population
Other personnel groups
Psychiatrists emigrating and immigrating across the European Region
Main activities initiated and developed since 2005 related to
the availability of specialist mental health workers
Competencies of specialist mental health workers
Undergraduate training hours on mental health
Specialist training for psychiatrists and psychologists
Continuing education
Main activities initiated and developed since 2005 related to
education and training and the development of competencies
Discussion
8. Funding of mental health services
Mental health budget or expenditure as a proportion of the total
health budget or expenditure
Allocation of the national mental health budget or expenditure
(or aggregated regional or local budgets)
Free access (at least 80% covered) to psychotropic medication
and psychotherapy
Medication
Psychotherapy
Allocation of the local or regional budget for mental health based
on a formula taking into account the relative needs of the population
Main activities initiated or developed since 2005 related to funding
of mental health services
Discussion
9. Social inclusion and welfare
Social welfare benefits or pensions because of disability due
to mental health problems
Mental illness as a cause of sick leave
Policies and programmes to improve social inclusion
Legal protection from discrimination: housing, dismissal and lower
wages
Subsidized housing for people with severe mental disorders
Supported employment for people who are disabled due to mental
disorders
Formal collaborative programmes between mental health departments
and agencies and other parts of the health sector and other sectors
Partnerships within the health sector
Partnerships between the health sector and other sectors
Main activities initiated and developed since 2005 related to
social inclusion and partnership
Social inclusion of people with mental health problems
Partnership for intersectoral working
Discussion
10. Opportunities for the empowerment and representation
of service users and carers
Representation of service users on committees and groups responsible
for mental health services
Representation of service users on committees and groups responsible
for anti-stigma, mental disorder prevention and mental health
promotion activities
Representation of families or carers on committees and groups
responsible for mental health services
Representation of families or carers on committees and groups
responsible for anti-stigma, mental disorder prevention and mental
health promotion activities
Government support for organizations of service users and carers
Main activities initiated and developed since 2005 related to
empowering mental health service users and carers
Establishment of organizations of service users
Representation on boards and committees
Support for organizations of service users
Discussion
11. Human rights and mental health
Mechanisms in place to monitor and review the human rights protection
of users of mental health services
External inspection of human rights protection of the users of
mental health services in different types of facilities
Representation of service users and carers on review bodies
Availability of protocols for involuntary admission, restraint
and violence management
Registration of involuntary admission, restraint and seclusion
Right to access to legal representation free of charge for people
committed involuntarily
Main activities initiated and developed since 2005 related to
protecting the human rights of people with mental health problems
Discussion
12. Information and research on mental health
Information on mental health
Data collection systems in mental health facilities
Reports covering mental health data
Research on mental health
Funding of mental health research
Organizations responsible for producing and disseminating evidence-based
treatment guidelines for mental health
Discussion
13. Conclusion
WHO action
Annexes
Annex 1. Contributors from countries
Annex 2. Mental Health Declaration for Europe
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