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mental health mondays :: the place to be?

at the beginning of the year, i wrote a post about global mental health statistics. it was a little pastiche of data pr0n, but all that i could really establish after putting all my statistical ducks in a row was that global mental health was probably even more complicated than you would think and that mental health was a huge problem almost everywhere. although i touched on issues of access to resources among the stats, i didn't focus on where treatments were the best and worst. but this week, i came across the results of a study released late last year that dealt with just that, albeit in one area only.

this study, conducted by the economist intelligence unit [an information branch of the group that's probably best known for publishing the economist magazine] and sponsored by a branch of janssen pharmaceutica, is quite a detailed look at europe, including all 28 e.c. members plus norway and switzerland. the methodology of the study is given on the page linked above, but the basic points of evaluation are the environment, access, opportunities [work being done towards the future] and governance. [you can download a very detailed version of the report in ms excel, with all the data arranged into convenient drill-down form, however you have to register with the site. i'll leave that decision to you, your computer and your internet connection.]

so what does europe have to tell us?

first of all let us congratulate the winner of the "best place to be crazy" sweepstakes

germany :: tops in soccer and psychiatry

but more generally...

wealth matters

there's no getting around it. the nations with the best outreach, the best access, the most support and the greatest chance for people with mental disorders to live happy, healthy lives reads a lot like a list of europe's largest economies, from top to bottom. germany, with the largest gdp in europe, ranks #1. bulgaria, with one of the smallest gdps in europe, comes dead last on the list, and a fairly distant last at that.

but it's not the only thing that matters

if only there were a word to describe switzerland's policies
estonia and slovenia, who rank just behind bulgaria in terms of gdp, punch wwwwaaaaaayyyyy above their weight when it comes to the quality of mental health care offered, finishing at 8th and 9th on the list overall. as you might expect, neither fares terribly well on indicators where financial investment is paramount [numbers of psychiatrists and psychiatric nurses, number of facilities and beds], but both have found ways to make their systems work in spite of this. estonia does extremely well in helping the mentally ill find stable employment and better than almost anyone in terms of the structure being laid down for the future. slovenia has a system that's built on accessibility, outpatient care and patient advocacy.

nor is money a guarantee of a better system. switzerland, one of the wealthiest countries in europe, fares terribly, coming an embarrassing 24th out of the 30 countries surveyed. switzerland finishes in the top ten in all the financial measurements and has the highest number of psychiatrists of any european country, but fails on every other front- faring particularly poorly in the areas that allow patients to live independently [areas where slovenia does particularly well].

in other words, the easiest way to maximize investment is to look at what can be done outside hospitals, by keeping patients at home and offering support rather than institutional care.

the best are aiming to stay the best

if you look at the list of who scores highest on the "opportunities" scale, it's more or less just a scrambled version of the existing top ten, with france more or less swapping places with the united kingdom. one would expect that those systems that are already the best would be the ones that had the least need of improvement, which does seem to be the case, but all of the countries that do well now seem to recognize that the work continues. that's an exceptionally important thing for other governments to note when developing their own policies.


rules are important

the countries that have the most legal protections in place- and the united kingdom far outpaces
all of these children are insane: who's going to recover?
everyone else in this regard- are the ones that score the best overall. while it's true that successive governments can overturn laws, such decisions tend to draw a lot of attention and, often, public outcry. giving the mentally ill the protection of the law basically forces governments to make plans that take those laws into consideration.

we need more information

one of the points addressed on the study's web site is that there is what they term a "data chasm". as much data as they've compiled, there are areas that are woefully lacking. in particular, there is a need to get patient feedback and to build that feedback into mental health care systems as a whole. only eight countries of the thirty have even indicated plans to do this [including patient empowerment superheroes slovenia] and none have made it mandatory.

i sincerely hope that this sort of research is expanded to look at other areas of the world, but i have a feeling that the results might be a little frightening. after all, social welfare programs are deeply entrenched in much of europe [even in areas where its adoption has been relatively recent, public healthcare is a priority for most governments]. that means that europe is likely better off than almost anywhere else in the world. the rest of us are just trying to catch up. 

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