Public-health psychiatry in today's Europe: scope and limitations

Public-health psychiatry is concerned, on the one hand, to ensure access to mental health services for all persons in need and, on the other hand, to advance knowledge of the social and environmental risk factors of mental disorders, and to establish a basis for preventive action. It is unclear how far current European Community (EC) policies will serve to achieve these objectives. This study aimed to review the mental health reform policies adopted in European countries since 1970, and to identify the main factors impeding progress in practice and research.

The relevant publications and statistical documentation for EC countries over the period in question were analysed.

Despite a broad consensus on principles and aims, the implementation of mental health reforms in EC countries has been slow. Progress is subject to constraints imposed by service infrastructures, reductions in state responsibility, changing public attitudes, and growth of relative poverty. Much inferential evidence has accumulated on the importance of social risk factors such as unemployment and socio-economic deprivation, but most studies have had to rely on analysis of ecological correlations, based on administrative data, and there is an urgent need for more direct research making use of case- control and cohort study designs.

EC harmonization will lead to improved mental health care only if the basic principles of public-health psychiatry are adopted and put into practice.