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Module 6: A Health Care Initiative

 

The Issue: Mental Health – Who, Where, and How Much?

 

            Statistics of prevalence.

 

            Mental illness has a strong prevalence worldwide that is often overlooked and deprioritized by other disorders in the realm of health and well-being.  In the European Union (EU), within adults of the age bracket 18-65, 27% of these individuals have battled a mental illness just within the last year.  These mental illnesses take on a wide array of forms including substance abuse, psychoses, depression, anxiety, and eating disorders.  This statistics varies slightly among genders with a prevalence of 33.2% in males and 21.7% in females (“Mental Health: Data and Statistics,” 2015).  Furthermore, mental illness is not only prevalent among adults but children as well.  Children and adolescents are affected by mental illness at a rate of 10-20% worldwide.  Moreover, if children do not receive timely treatment and early intervention, their development and ability to succeed later in life can steeply diminish (“Mental Health and Well-Being,” 2015). 

 

            Not only is mental illness astoundingly prevalent across age brackets, it is also a major player in causing disability and even death.  In a measurement of “disability-adjusted life years” (DALYs), mental illness holds the title as the third leading cause in the EU.  In fact, three different mental illnesses rank within the top fifteen disorders responsible for DALYs.  Even more astonishing, is that mental illnesses is the primary contributor to chronic conditions in the EU, accounting for 36.1% of all chronic conditions (“Mental Health: Data and Statistics,” 2015).    

     

            When considering mental illness, suicide rates and prevalence must be examined in conjunction because of the close connection between the two.  There is a connection or attribution to mental illness in 90% of all suicides.  Suicide accounts for 17.6% of deaths in ages 15-29 and the global suicide rate is estimated to be 11.4 per every 100,000 persons in the population.  Suicide can possibly be linked to income and economic indicators.  In low-income countries, the suicide rate for males is 4.1 times higher than that for females, whereas the suicide rate for males in high-income countries is 3.5 times higher than that for females.  Nevertheless, suicide and mental illness holds a heavy existence in considering the EU.  Out of the top 20 countries with the highest suicide rates worldwide, the EU contains six of those twenty (“Mental Health: Data and Statistics,” 2015). 

 

            Prevalence of services and workforce.

 

            Most countries admit that typically general practitioners (GPs) hold the position of providing mental health referrals, giving diagnoses, and treating most all mental health disorders.  Psych inpatient beds can be found across the EU at an average of 72 per every 100,000 inhabitants, while inpatient admission rates exceed that by a rate of 568 per every 100,000 (“Mental Health: Data and Statistics,” 2015).  Yet these numbers rank as the worldwide leader in comparison to other continental regions (see Figure 1 for international comparison) (“Innovation in Deinstitutionalization: a WHO Expert Survey,” 2014, p. 18).  Furthermore, nurses working in the psychiatric and mental health setting in the EU average about 21.7 per every 100,000 while psychiatrists average 9 per every 100,000 (“Mental Health: Data and Statistics,” 2015).  This last figure leaves it unsurprising that 50-70% of depressed patients remain undiagnosed, not receiving adequate treatment or support despite the high concern for comorbidities and suicide associated with depression (“Mental Health and Well-Being,” 2015). 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(“Innovation in Deinstitutionalization: a WHO Expert Survey,” 2014, p. 18)

 

A European Mental Health Care Initiative

 

            The European pact for mental health and well-being 2008.

 

            The European Pact began in 2008 as a collaborative EU effort to combat mental illness and improve the health care system in respect to this specific sector.  The multi-national pact addressed five different areas to promote improvements within the realm of mental health.  These included prevention of depression and suicide, mental health in youth and education, mental health in workplace settings, mental health of older people, and combating stigma and social exclusion.  Many countries across the EU united at a conference in 2008 to establish these five priorities and commit to feeding time, energy, and resources into expanding these venues because without mental health there cannot be holistic health (“European Pact for Mental Health and Well-Being,” 2008).

 

            Prevention of depression and suicide qualified as one of the top five priorities because of its prevalence and impact.  Depression is a leader among risk factors for suicide.  In regards to the impact, within the EU, someone commits suicide every nine minutes and the prevalence of suicide attempts is as much as ten times higher than this figure (“European Pact for Mental Health and Well-Being,” 2008, p. 3).  Mental health among youth and education ranked as a priority because half of all mental disorders onset within the adolescent years.  Workplace settings ranked among the priorities because mental health in this setting is absolutely essential for both productivity and continued innovation.  The workplace setting, additionally, finds itself subject to continuous pressures and a shifting environment.  The workplace also plays a major role in an individual’s social inclusion, which can drive or negate the onset of a mental illness (p. 4).  Furthermore, the pact recognized mental health among the population of older adults as a priority because of their increased exposure to risk factors including loss of social support systems, possible physical or neurological degeneration, and increased rates of suicide (p. 5).  Finally, the pact’s concluding priority revolved around fighting social stigma and exclusion in order to promote integration and socialization of those with mental illness (p. 6).  The following bullets outlines the pact’s five basic categories of goals, means to achieving these goals, and how to practically address these priorities.  

 

Prevention of Depression and Suicide

  • Training for social work professionals on mental health.

  • Limit access to common means for suicide.

  • Increase mental health awareness among the general public and within health professions.

  • Address and reduce incidence of suicide risk factors including alcohol and drug abuse, depression, stressors, and social exclusion.

  • Provide support for those recently attempting suicide or loved one of those who have committed suicide (“European Pact for Mental Health and Well-Being,” 2008, p. 4).

 

Mental Health in Youth and Education

  • Use the education system as grounds for early intervention programs.

  • Provide parenting skills programs to parents of children in the education system. 

  • Increase training on mental health for those working in the education system.

  • Incorporate emotional awareness learning into school curriculums and into extracurricular activities.

  • Provide students with programs that promote the prevention of abuse, bullying, social exclusion, and violence.

  • Encourage students to partake in furthering their education, learning about their own culture, participate in sports and possibly employment (p. 4). 

 

Mental Health in the Workplace Setting

  • Improve the culture of leadership and organization among the workforce.

  • Promote balance between work and family life and the cooperation of the two.

  • Engage in risk assessment and provide prevention programs for the following: stress, abuse, violence, alcohol abuse, harassment, and drug abuse.  Also provide early intervention for the occurrence of any of these risk factors.

  • Promote the return to work of those with mental illness by offering opportunities for recruitment, retention, and rehabilitation (p. 5). 

 

Mental Health of Older People

  • Encourage people in this population to engage in the community, low-weight bearing exercise, and continued education.

  • Assist in planning flexible retirements that allow for continued full- or part-time work.

  • Encourage mental health within long-term care communities.

  • Promote mental health among the caregiver community (p. 5).

 

Combating Stigma and Social Exclusion

  • Increase the prevalence of anti-stigma campaigns. 

  • Integrate those with mental disorders into the community through the workplace environment, training, and education.

  • Invite participation by those with mental disorders into mental health care policy and decision-making (p. 6).

 

Joint action on mental health and well-being.

 

            In building on the purpose and mission of the European Pact, a conglomerate of governmental and non-profit organizations came together in the subsequent years to become the hands and feet of this mission.  This multi-national joint committee seeks to address the fact that there exists an abundance of knowledge and research on effective mental health care and prevention but there is inadequate implementation.  With 30% of those with severe mental disorders not having adequate access to mental health care across Europe, the European Pact addressed the need for intervention and political policy change.  Between the years 2009-2011, several conferences were held to team-build among the nations and share experiences.  Later, this led to the formation of Joint Action in 2013 whose primary goal is to build a framework for implementation of policy.  Joint Action upholds five similar areas of interest as compared with the European Pact including the workplace, education system, depression and suicide through e-health, community-based interventions and social inclusion, and incorporating mental health into all health care policies (“Mental Health and Well-Being,” 2015).   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(“Mental Health and Well-Being,” 2015)

 

            One tangible measure of progress by the Joint Action is evident in a WHO Expert Survey from 2014.  This survey, titled Innovation in deinstitutionalization, emphasized one necessary means to progressing mental health care and methods to implementing this goal.  The conclusion that this survey operated on was as follows: “Long-stay psychiatric institutions tend to be inefficient and too frequently inhumane, yet continue to consume the majority of mental health budgets in low- and middle-income countries while managing relatively few people” (“Innovation in Deinstitutionalization: a WHO Expert Survey,” 2014, p. 14).  Long-term mental hospitals are inefficient in that they do not provide individualized care, cost more per capita as compared with community-based care, focus on interventions for severe disorders, and geographic locations are mainly concentrated in urban areas versus being equally distributed among the population (p. 16).  Therefore, one of the actions prompted by the European Pact and Joint Action has been a push for deinstitutionalization.  Implementation of this policy operates on the basis of five principles:

 

  • Emphasis on community-based programs.

  • Health professionals united behind change.

  • Evidence of strong political support.

  • Proper timing in acting upon advantageous situations that propel change.

  • Increasing financial resources (p. 14). 

 

The WHO Expert Survey referenced here found the following means as the most highly rated modes for deinstitutionalizing:  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(“Innovation in Deinstitutionalization: a WHO Expert Survey,” 2014, p. 13)

 

            Wagner-Jauregg clinic as evidence of mental health care evolution in Austria.

 

            The Wagner-Jauregg clinic is a regional hospital located in Linz, Austria.  It is one example within the EU of an institution that provides holistic care to those suffering from mental illness without restrictions to who has access to this care.  Within this institution, there are numerous mental health departments that specifically cater to different populations.  This hospital contains a department of psychiatry, child and adolescent psychiatry, a center for addiction medicine, geriatric neuropsychiatry, and a department of forensic psychiatry.  Within these departments are evidence of the five areas of interest belonging to the European Pact and Joint Action.  These departments utilize a variety of holistic interventions including psychopharmacology, socio-therapy, occupational therapy, musical therapy, physiotherapy, logotherapy, reintegration services, and sports therapy.  Furthermore, in regards to children and adolescents, this institution collaborates with the education system to provide schooling and aim for early intervention.  This institution also shows evidence of community-based care by addressing the mental health needs of criminals and felons before entering them into the penal system (“Medical Services,” 2015).  This is only one example of alternative and evolving solutions coming onto the forefront in Europe to address the national and international mental health state as an integral aspect of health and well-being. 

 

The Expected and Potential Impact

 

            The combined efforts of the campaigns discussed above have the potential to rapidly evolve the mental health care setting.  The objective of the European Pact was to foremost establish a platform on which to exchange research and evidence, discourse on the evidence-based best practices, and exchange results of action (“European Pact for Mental Health and Well-Being,” 2008, p. 7).  The proposed effects of Joint Action are outlined in the following expected outcomes of the campaign: wider knowledge base supporting the subject, development of an inventory of evidence-based best practices, stronger bonds among the network of EU nations, increased recommendations for action, increased policy development capabilities for future changes, clear framework to guide efforts in the EU and Member States (MS), and cooperation for policy implementation.  However, the main effort and expected outcome from these combined efforts is for a transition from a mental hospital-based care model to a community-based care model, even for those with severe mental illness (“Mental Health and Well-Being,” 2015). 

 

Source of Initiatives

 

            The above campaigns represent truly mixed-modal collaborations between government and the private sector.  The European Pact was founded by partnerships among various MS Ministers of Health under the direction of the WHO Mental Health Declaration for Europe of 2005.  These partnerships also sought support from relevant stakeholders including those with mental illness and the research community (“European Pact for Mental Health and Well-Being,” 2008, p. 6). 

 

            Joint Action is being funded by the European Agency for Health and Consumers along with 51 partners within 28 MS all under the coordination of Nova Medical School of Lisbon, Portugal (“Mental Health and Well-Being,” 2015). 

 

            The Wagner-Jauregg Clinic is a public hospital funded by a mixture of providers.  See module 3 for more information on health care system funding in Austria. 

 

Personal Global Health, Relief, or Mission Efforts and Interests

 

            Relief work is a personal interest and potential passion of mine.  I do not have any experience working in a global mission under the specific realm of mental health.  However, in October of 2010, after being very involved in a local student chapter of Operation Smile from 2008-2010, I traveled to Asuncion, Paraguay with the organization as a student volunteer and part of a medical mission team.  Operation Smile seeks to provide free surgeries to children of low-income families that are affected by cleft lip or cleft palate deformities.  As a student volunteer, I was able to interact with children and their families during screening days and pre-op as well as provide education on nutrition, dental hygiene, burn care and prevention, and preventative health care.  This two-week experience astonished me by how far these families were willing to travel and the measures they had to take to seek adequate health care.  I also remember being surprised by the wider impact that these deformities possibly had on these children and their families.  Through the positive work of Operation Smile and other health relief efforts, some of the stigma associated with facial deformities has faded in some countries.  However, in some low-income countries, even to this day, cleft lips or other facial deformities are regarded by many communities as a curse upon that family and there is a negative social stigma strongly associated with these medical conditions.  Learning about the effects that a facial deformity could have on a child, even beyond any physiological effects, was astounding to me and engrained in me a more holistic definition and viewpoint of health and well-being. 

 

Therefore, mental health is one area of health care that truly draws up compassion within me.  My personal experience with mental health care

in the United States has no where near lived up to the same standards of health care in dealing with physical ailments that I have experienced myself or alongside other.  Yet, my personal perspective and belief is that mental health is just as important a contributor to overall well-being and being considered “healthy” as is being free from disease or a physical ailment.  Moreover, I believe that if someone is truly experiencing a state of mental instability alongside a physical ailment, the mental illness will stand as a barrier to recovery despite the quality of physical care if the mental well-being is never addressed. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Photographs property of Rachel Tucker)

 

 

 

 

 

References

 

The Joint Action (2015).  Mental health and well-being.  Retrieved from http://www.mentalhealthandwellbeing.eu

 

Together for Mental Health and Well-Being (13 June 2008).  European pact for mental health and well-being.  Retrieved from

http://ec.europa.eu/health/ph_determinants/life_style/mental/docs/pact_en.pdf

 

Wagner-Jauregg (2015).  Medical services.  Retrieved from http://www.wagner-jauregg.at/en/medical-services.html

 

World Health Organization and the Gulbenkian Global Mental Health Platform (2014).  Innovation in deinstitutionalization: a WHO expert survey.  Geneva:

World Health Organization.

 

World Health Organization: Regional Office for Europe (2015).  Mental health: Data and statistics.  Retrieved from http://www.euro.who.int/en/health-

topics/noncommunicable-diseases/mental-health/data-and-statistics

 

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