Psychiatry and geriatric psychiatry in Romania

Mental health systems in countries: where are we now?

More than 85% of the world's population lives in 153 low-income and middle-income countries (LAMICs). Although country-level information on mental health systems has recently become available, it still has substantial gaps and inconsistencies. Most of these countries allocate very scarce financial resources and have grossly inadequate manpower and infrastructure for mental health. Many LAMICs also lack mental health policy and legislation to direct their mental health programmes and services, which is of particular concern in Africa and South East Asia. Different components of mental health systems seem to vary greatly, even in the same-income categories, with some countries having developed their mental health system despite their low-income levels. These examples need careful scrutiny to derive useful lessons. Furthermore, mental health resources in countries seem to be related as much to measures of general health as to economic and developmental indicators, arguing for improved prioritisation for mental health even in low-resource settings. Increased emphasis on mental health, improved resources, and enhanced monitoring of the situation in countries is called for to advance global mental health.

The emerging mental health strategy of the European Union: a multi-level work-in-progress

Policy-making in the European Union (EU) is a complex process that can appear impenetrable and opaque. This paper examines the ongoing process of mental health policy-making in the EU. In 2005, the Health and Consumer Protectorate Director-General of the European Commission published a Green Paper and launched a consultation process aimed at mental health service-users, advocates, providers, business, social services and governments. While there were varying levels of participation between member states, a range of trans-national, national and infra-national actors made contributions. Based on these consultations, a 'Consultative Platform' was created and made 10 recommendations centered on the principles of partnership; establishing policy competencies; integrating mental health into national policies; involving stakeholders; and protecting human rights. This ongoing process illustrates many features of EU policy-making: (a) the European Commission generates an initiative; (b) policy focuses on EU standardization, with member states remaining central actors in service-delivery; (c) policy focuses on social inclusion; (d) the European Commission coordinates diverse networks of actors; and (e) there is 'multi-level' involvement, with direct interaction between trans-national, national and infra-national actors. An enhanced focus on epidemiological data and 'evidence-based policy' would increase rigor and focus further attention on this relatively neglected policy area.