Mental health - summary of key points
There is no health without mental health
The European Commission and the WHO have recognised that mental ill-health is one of the most urgent public health issues facing us.1 2
One person in four - a clear priority for Europe
Mental ill-health accounts for nearly one-quarter of the total burden of ill health in Europe, and is second only to cardiovascular diseases in its toll on morbidity.3 4
Mental health affects 27% of adult Europeans in any given year,5 corresponding to around 133 million people in the EU-276.
The European Region has one of the highest rates of suicide in the world, with 163,000 suicides per year.7
Rapid societal change in many European countries has been accompanied by a growth in mental ill-health.8
Yet policy makers do not afford the issue the attention it deserves;1 in 10 EU countries do not have any mental health legislation, three fifths do not have a national suicide prevention initiative, and the WHO estimates that 10 out of 25 EU Member states have no comprehensive national policy on mental health.9
Severe mental illness poses special challenges
Although severe mental illness is less prevalent than depression, it reduces life expectancy drastically. Estimates range from 8-25 years lower life expectancy compared to the general population.10 11
Stigma and discrimination around mental health are prevalent in all facets of community life, however they are strongest for severe mental illnesses, such as schizophrenia and bipolar disorder.
There is poor understanding of severe mental illness by professionals and policymakers,12 13 and even by carers and patients themselves.
Enforced hospitalisations pose important human rights issues.14
Severe mental illness and physical disease go hand in hand
Mental and physical health are inextricably linked.15
People with schizophrenia show considerably worse health than the general population.16 This includes a higher risk of mortality, diabetes, cardiovascular disease, respiratory disease, and infectious diseases,17 not to mention suicide.18 The greatest cause of death in people with schizophrenia is cardiovascular disease, with at 2.3 times the risk in the general population. 19
De-institutionalisation with inadequate community care has been linked to worsened physical health for people with severe mental illness.20
The economic costs of mental ill-health are staggering
The cost of mental ill-health accounts for 3-4% of GDP.21
Total annual costs to the EU have been estimated at between ?300 billion22 and ?1 trillion.23
Much of the burden of mental ill-health is due to lost productivity24 and the burden on carers. Indirect costs attached to mental disorders outweigh direct treatment costs by 2 to 6 times.25
Effective treatments exist to help people with severe mental illness
Psychological and psychosocial interventions can hasten and sustain recovery from common mental disorders such as depression and anxiety, as well as severe mental illnesses such as schizophrenia and bipolar disorder. 26
Modern treatments involving regular medication alongside family involvement, education and support can reduce relapses of people with schizophrenia from 50% to less than 10%.27 28
Given the enormous externalities and costs of mental ill-health across society, investment in treatments can be highly cost-effective.29
Carers play a central role in effective treatments
Involvement of families in treatment has been shown to enhance the quality of life of persons with severe mental illness 30 31 and reduce the risk of relapse32 - even by as much as by 50%.33
Social exclusion is endemic to severe mental illness
Stigma around mental health is rife across all European society.34 35 Unnecessary institutionalisation and fundamental abuses of human rights still occur in many European countries.36
Where de-institutionalisation has taken place, investment in community services has rarely followed.37
Some 25% of EU countries still do not provide any community care for mental disorders,38 yet these services are a vital part of social inclusion and effective treatments for people with severe mental illness.39
Prevalence of psychosis is high amongst the long-term homeless,40 with one study estimating prevalence rates of 50%.41
Access to care remains inadequate
Mental health is grossly under-funded in many European Countries.42
Only one quarter of all cases of mental disorders seek consultation from professional health care services, suggesting a considerable degree of unmet need across Europe43
Access to the most effective medicines, psychosocial interventions and community services is lacking across most European countries.44
Policy can make a real difference
Countries that have adopted national mental health policies and plans have shown a demonstrable impact on mental health outcomes.45 46 47 48 49 Yet 10 out of 27 EU Member states are yet to implement a comprehensive national policy on mental health50
References:
Brown S, (1997). Excess mortality of schizophrenia. A meta-analysis. The British Journal of Psychiatry 171: 502-508 (1997)
Caldwell CP, Gottesman II, (1990). Schizophrenics kill themselves too: a review of risk factors for suicide. Schizophr Bull 1990; 16(4): 571-589
Cohen H, Natella G (1995) Trabajar en salud mental, la desmanicomilizaci?n en Rio Negro [Working on mental health, the deinstitutionalization in Rio Negro].
Buenos Aires: Lugar Editorial. In Spanish.
Commonwealth Department of Health and Family Services, Australia (1997) Evaluation of the National Mental Health Strategy. Canberra: Commonwealth Department of Health and Family Services, Mental Health Branch. www.health.gov.au.
Corrigan, P.W., & Phelan, S.M. (2004). Social support and recovery in people with serious mental illness. Community Mental Health Journal, 40, 513-524.
Dembling B P, Chen D T, Vachon L, (1999). Death in a Population Treated
for Serious Mental Illness. Psychiatric Services, 50:8.
De Jong JTV (1996) A comprehensive public mental health programme in Guinea-Bissau: a useful model for African, Asian and Latin-American countries. Psychological Medicine 1996, 26:97-108.
Dixon L, Adams C, Lucksted A (2000). Update on family psycho-education for schizophrenia. Schizophrenia Bulletin, 26: 5-20.
European Commission (2005). Green Paper: Improving the mental health of the population. Towards a strategy on mental health for the European Union. Luxembourg.
EUFAMI (2004). 'Zerostigma' briefing paper. www.eufami.org.
Gabriel P, Liimatainen MR (2000). Mental health in the workplace. Geneva, International Labour Organization.
Geddes J, Newton R, Young G, Bailey S, Freeman C, Priest R (1994). Comparison of prevalence of schizophrenia among residents of hostels for homeless people in 1966 and 1992. BMJ 1994;308:816-819 (26March)
Jan?-Llopis E, and Anderson P (2005) Mental health promotion and mental disorder prevention: a policy for Europe. Nijmegen: Radboud University. www.imhpa.net/actionplan
Kemp DR (1994). An overview of mental health policy from an international perspective. In: Kemp DR (ed). International handbook on mental health policy. London: Greenwood Press.
Lauber C, Anthony M, Vladeta A et al. (2004). What about psychaitrists' attitudes to mentally ill people? Eur Psychiatry, Volume 19, Issue 7, November 2004, Pages 423-427.
Mangan, S. P. (1994). 'Continuing care': An emerging issue in European mental health policy, International Journal of Social Psychiatry 1994; 40 (4): 235-245.
McDaid (2005). Policy Brief I, Mental Health Key issues in the development of policy and practice across Europe. European Observatory on Health Systems and Policies, World Health Organization
McDaid D, Thornicroft G, (2005). Policy Brief Mental Health II, Balancing Institutional and Community Care. European Observatory on Health Systems and Policies, World Health Organization.
McDaid, Knapp & Curran (2005). Policy Brief Mental Health III Funding Mental Health in Europe, European Observatory on Health Systems and Policies, World Health Organization.
Osby U, Correia N, Brandt L, Ekbom A, Sparen P (2000). Time trends in schizophrenia mortality in Stockholm county, Sweden: cohort study. BMJ 2000: 321: 483-4.
Ostman M, Hansson L, & Andersson K, (2000). Family burden, participation in care and mentalhealth - an 11-year comparison of the situation of relatives to compulsorily and voluntarily admitted patients, International Journal of Social Psychiatry 46 (3): 191-200.
Parks J, Svendsen D, Singer P, Foti M E, Mauer B, (2006). Morbidity and Mortality in People with Serious Mental Illness. National Association of State Mental Health Program, National Association of State Mental Health Program Directors, Medical Directors Council, Alexandria Virginia.
Pharaoh FM, Marij J, Streiner D (2000). Family intervention for schizophrenia. Cochrane Collaboration database of systematic reviews, 1: 1-36.
Scott J. Homelessness and mental illness. Br J Psychiatry 1993;162:313-24.
Thornicroft G, Tansella M (1999). The mental health matrix. A manual to improve services. London: Cambridge University Press.
Wittchen H, Jacobi B. (2005). Size and burden of mental disorders in Europe - a critical review and appraisal of 27 Studies. European Neuropsychopharmacology 2005; 15: 357-376
Wittchen H, Jonsson B, Olesen J. (2005). Towards a better understanding of the size and burden and cost of brain disorders in Europe. European Neuropsychopharmacology 2005; 15: 355? 356
WHO (2001). Mental Health Global Action Programme: http://www.who.int/mental_health/actionprogramme/en/index.html
WHO (2001b). World Health Report. Mental Health: New Understanding, New Hope. Geneva, World Health Organization.
WHO (2001c). Mental Health in Europe, Stop Exclusion, Dare to Care. Geneva,
WHO (2002). Suicide Prevention in Europe, The WHO European monitoring survey on national suicide prevention programmes and strategies, EUROWHO, Copenhagen.
WHO (2003).The mental health context. Geneva, World Health Organization, (Mental Health Policy and Service Guidance Package).
WHO (2005) - World Health Atlas. Geneva, World Health Organization.
WHO (2005). The Social Determinants of Health - The Solid Facts. Second Edition. Edited by Richard Wilkinson and Michael Marmot. Copenhagen.
WHO (2005b). Mental Health Atlas. Geneva.
Endnotes:
1 - European Commission, (2004).
2 - WHO (2001)
3 - Jan?-Llopis E & Anderson P, (2005).
4 - McDaid D, (2005).
5 - Wittchen H, & Jacobi B, (2005).
6 - Data pertaining to EU-27 are not as yet available.
7 - WHO (2002).
8 - McDaid D, (2005).
9 - WHO (2005)
10 - Dembling B P, Chen D T, Vachon L, (1999).
11 - Parks J, et al (2006).
12 - McDaid D, (2005).
13 - Lauber C, Anthony M, Vladeta A et al. (2004).
14 - McDaid D, (2005).
15 - WHO (2005).
16 - Brown S, (1997).
17 - Parks J, et al (2006)
18 - Caudwell C P, Grottesman II (1990).
19 - Parks J, et al (2006).
20 - Osby et al (2000).
21 - Gabriel and Liimatanien (2000).
22 - Wittchen H, Jonsson B, Olesen J, (2005).
23 - EUFAMI (2002).
24 - Wittchens H & Jacobi B, (2005).
25 - WHO (2003).
26 - WHO (2003).
27 - Pharaoh FM, Marij J, Streiner D (2000).
28 - Dixon L, Adams C, Lucksted A, (2000).
29 - McDaid D, Knapp M, Curran C (2005).
30 - Mangan SP, (1994)
31 - Pharaoh FM, Marij J, Streiner D, (2000)
32 - Ostman M, Hansson L, & Andersson K, (2000).
33 - WHO (2001)
34 - EUFAMI (2004)
35 - WHO (2001c).
36 - McDaid D, (2005)
37 - Mc Daid D, Thornicroft G, (2005)
38 - WHO (2005b)
39 - Corrigan P W, & Phelan S M, (2004).
40 - Geddes J, et al (1994).
41 - Scott J, (2003).
42 - McDaid D, (2005).
43 - Wittchens H & Jacobi B, (2005).
44 - McDaid D, (2005).
45 - Kemp, (1994).
46 - Cohen & Natella, (1995).
47 - De Jong, (1996).
48 - Commonwealth Department of Health and Family Services, Australia, (1997).
49 - Thornicroft G & Tansella M, (1999).
50 - WHO (2005b).