The state of psychiatry in Europe: facing the challenges, developing consensus

All European countries are facing the challenge to address the very high prevalence of mental disorders with limited mental health resources, resulting in a treatment gap. Countries have drafted mental health strategies, replacing institutions with community based models of care with the aim to offer good and decent care. Psychiatry across Europe is very diverse, whether one considers models of care, resources, ways of working or training. Variation within countries, due to regionalization, can be as large as across frontiers. Valid comparisons of service delivery and their outcomes is essential for identification and dissemination of effective and efficient practice, but hampered by widely used but poorly defined terminology such as 'primary care' and 'community services', or assumptions about common ways of working. There is also still a lack of standardisation of outcome indicators. The combination of high morbidity and low supply in the presence of effective interventions is a strong argument in favour of investment, especially at times of growing need. It is necessary to support this argument with consistent evidence of improved outcome. It is essential that international groups now accept the challenge to reach consensus in order to advocate for more mental health resources.