Mental health reforms in Eastern Europe

OBJECTIVE: To describe the background in general culture, public and professional discourse against which mental health care reform initiatives in Eastern Europe need to be seen. METHOD: An account of some key aspects of sociopolitical and cultural transition in Eastern European countries is given, and core results of a research project on attitudes and needs assessment in psychiatry in six Eastern European countries are reported. RESULTS: In post-totalitarian cultures mental health reforms impinge on imagination in ways which are not easy to predict. Some of the reasons for this are traced to the psychiatric practices under the system of total control, e.g. dispensary care, political abuse, reification of classificatory terms. Data on a study of attitudes suggest that institutions had replaced community life in those parts of Europe. CONCLUSION: It is predicted that with time trust in the capacity of community to contain mental illness will be regained.     

Mental health promotion policies in Europe

There is little evidence that systematic mental health promotion (MHP) policies exist in the countries of the European Union (EU). In order to explore this, a sample of public health stakeholders in ten European regions was selected. Each region was asked to complete a postal questionnaire about structural indicators of those environmental factors that might have an impact on mental health; stakeholders were also provided with information on MHP concepts and strategies. Subsequently the regions were visited, and stakeholders were interviewed on their MHP policies using an open-ended questionnaire. It was found that there were no existing procedures or plans that could support the hope that systematic MHP policies would be developed in the next years in the EU. Only three of the ten regions had started to develop such policies. An 8-item questionnaire on the framework and process of MHP policy development was developed and used in the present study. This questionnaire may be a useful instrument in future studies on structural indicators of mental health.     

Focus on mental health care reforms in Europe. Mental health services in Europe: an overview

Psychiatric services in Europe are experiencing a period of change, driven by political commitment at national and intergovernmental levels in response to the public health challenges posed by mental health problems. However, diversity among European countries makes any generalization speculative. Resources such as funding, workforce, and infrastructure vary dramatically, and new investment is limited. Some European countries can take pride in sophisticated service systems, whereas others continue to rely almost exclusively on asylums. Reforms are hampered by a lack of comparable information and a lack of research, particularly in less developed countries. However, many exciting local initiatives are emerging, even in the poorest countries. The challenge will be to translate good local practice into national policies and practice, supported by adequate resources.     

Mental health in Europe: problems, advances and challenges

OBJECTIVE: To describe mental health care needs and challenges across the WHO European region of 51 nations. METHOD: Based on morbidity and mortality data from HFA Statistical Database and Health2l, the policy framework of WHO Europe, major trends in mental health care needs, psychiatric reform and mental health promotion are discussed. RESULTS: There is a mortality crisis related to mental ill health in Eastern European populations of transition. Destigmatization is required to improve early intervention and humanization of services, and national mental health audits are needed to create the basis for national mental health planning, implementation and monitoring. There are both problems and advances in service restructuring, and comprehensive mental health promotion programmes, preventive and monitoring strategies are required. CONCLUSION: Partnerships between national and international organizations, especially WHO and the European Union, have to be strengthened to make progress on the way to integrated community mental health services.     

Strengthening CAMHS and reducing child and adolescent mental health inequalities in Europe

European Child & Adolescent Psychiatry -     

Education and Mental Health in Europe

Poor mental health is a major burden of disease in Europe. The cost to society is substantial and is estimated to increase as the population ages. A high level of education is associated with better health and greater longevity both in developed and developing countries, but little research has been done on mental health and depression. An instrumental variable framework is used in conjuction with data collected through the third edition of the European Social Survey to estimate the impact of school attainment on depression in 23 countries across Europe. The results indicate a significant relationship between higher education level and better mental health. The magnitude of this relationship is small but not negligible. Increasing the overall education among new generations is not likely to substantially prevent the occurrence of mental disorders in a country but can mitigate it. The results of the analysis suggest that other factors, such as employment and living with a partner, might help reduce the risk of depression.     

Mental health

OBJECTIVE: Only in the last 30 years has psychiatry begun to develop empirical approaches to conceptualizing and assessing positive mental health. Six models of mental health are reviewed here. METHOD: The author points out pitfalls in research on mental health, e.g., equating average with healthy, failing to distinguish trait from state, overlooking cultural norms, and conversely, blindly accepting the culture's values. He describes the six models and provides history and research needs for each. RESULTS: The first model, being "above normal," is epitomized by DSM-IV's axis V, the Global Assessment of Functioning Scale. High scores represent "superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities." The goal of the second model, positive psychology, is intervention to maximize positive qualities, such as self-efficacy. Maturity and Erikson's four developmental tasks (identity, intimacy, generativity, integrity) are the basis of the third model. The author adds two other tasks: career consolidation and "keeper of the meaning." The fourth model is emotional or social intelligence, the ability to read other people's emotions. Surprisingly, subjective well-being, the fifth model, is as much a characteristic of temperament as of a benign environment. The last model, resilience, is epitomized by DSM-IV's Defense Function Scale, which categorizes coping mechanisms in terms of adaptational value. CONCLUSIONS: As with the blind men and the elephant, each model describes only some aspects of mental health. Further research may reveal the contribution of each.     

Social inequalities in mental health: results from the EU contribution to the World Mental Health Surveys Initiative

Purpose

The objective of the present study was to provide updated data from nine European countries about the impact of social inequalities in the prevalence of common mental disorders.

Methods

Cross-sectional household survey of a representative sample of the adult general population of Belgium, Bulgaria, Germany, Italy, The Netherlands, Northern Ireland, Portugal, Romania and Spain. In total, 34,395 individuals were included. Social inequalities in 12-month mood, anxiety and alcohol-related disorders were evaluated.

Results

In Europe, income seems not to be related to the prevalence of mental disorders. Unemployment and disablement are associated with mental disorders. Lower educational level augments the risk for mood disorders. Living in small (rural) areas decreases the risk for mood disorders and living in urban settings increases it. Northern Ireland, Portugal and Belgium are the countries with the highest risks for mental disorders.

Conclusions

Despite some contradictions with previous literature, in Europe there are social inequalities in the prevalence of mental disorders. However, income showed not to be associated with inequalities in mental health. Being younger, unemployed or disabled, with no education or incomplete primary studies, living in urban settings, and in Northern Ireland, Portugal or Belgium were associated to an augmented prevalence of mental disorders. Policy makers could focus on mental health promotion and mental disorders prevention programmes for risk groups such as unemployed/disabled individuals. Support to vulnerable groups (unemployed or those with less education) and mental health literacy can improve European citizens’ mental health.     

Mental health in Egypt

The concepts and management of mental health in Egypt are presented from the Pharaonic era through the Islamic Renaissance until today. Papyri from the Pharaonic period show that Soma and Psyche were not differentiated and mental disorders were described as symptoms of the heart and uterus. Although theories of causation were of a mystical nature, mental disorders were treated on a somatic basis. In the Islamic era, mental patients were neither maltreated nor tortured as a consequence of the belief that they may be possessed by a good Moslem genie. In the 14th century mental disorders was one of the four departments in Cairo's Kalawoon Hospital, a precursor of the place of psychiatry in general hospitals that was accepted in Europe six centuries later. The mental health services in Egypt today are described, and transcultural studies carried out in Egypt of the prevalence and phenomenology of anxiety, schizophrenia, depression, suicide, conversion and obsessive compulsive disorders are reviewed. The psychiatric services for children are in their infancy. Since 1983 the common and semi-accepted use of hashish has been joined by abuse by heroin and other substances.     

Educational inequalities in mental disorders in the Czech Republic: data from CZEch Mental health Study (CZEMS)

Purpose

We aimed to study the association of educational attainment with occurrence of mental disorders in the Czech Republic.

Methods

Data were derived from the CZEch Mental health Study (CZEMS), a cross-sectional study of community-dwelling individuals. Mental disorders were assessed with Mini International Neuropsychiatric Interview (M.I.N.I.), and information on completed education was acquired as a part of a paper and pencil interview. Logistic regression was used to estimate odds ratio (OR) with 95% confidence intervals (CI) for the association of educational attainment with all mental disorders as well as with specific groups (affective, anxiety, alcohol use and substance use disorders), stepwise adjusting for socio-demographic, social and health-related characteristics.

Results

We studied 3175 individuals (average age 50 years, range 18–96 years; 54% women). Compared to individuals with higher education, those educated below high school graduation had higher odds of mental disorders (OR 2.07; 95% CI 1.58–1.71), even after adjustment for all covariates (OR 1.64; 95% CI 1.21–2.23). Education showed the strongest association with alcohol use disorders, even when covariates were adjusted for, but was not related to anxiety disorders. The association of education with affective as well as substance use disorders was explained by covariates.

Conclusions

Interventions aimed at reducing the burden of mental disorders should target individuals with low education. Strategies to improve population mental health need to go hand in hand with policies to enhance education as well as reduce alcohol consumption in the Czech Republic.