Integrating mental health into primary health care across Europe

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1 Integrating mental health into primary health care across Europe Social Breakthroughs Symposium Friday, 26th june BMAG Porto Authors Tiago Vieira Pinto Registered Nurse Serpa Pinto Family Health Unit Family Health Units National Association European Forum for Primary Care Advisory Board Porto, Portugal Henk Parmentier General Practitioner Edridge Road Community Health Centre Virgin Care Ltd European Forum for Primary Care Advisory Board London, UK This presentation has the institutional support of:

2 Index 1 Introduction 2 Integration of mental health: what it is and what it is not 3 Why integrate mental health? 4 How to integrate mental health? 5 State of the art across Europe

3 Index 1 Introduction

4 1 Introduction

5 Index 2 Integration of mental health: what it is and what it is not

6 2 Integration of primary health care: what it is and what it is not Fig. The WHO service organization pyramid for an optimal mix of services Low FREQUENCY OF NEED Psychiatric services in general hospitals Long stay facilities and specialist psychiatric services Community mental health services Primary care services for mental health High COSTS Informal services Informal community care Self-care High Low QUANTITY OF SERVICES NEEDED

7 2 Integration of primary health care: what it is and what it is not Fig. An holistic mental health care vision

8 2 Integration of primary health care: what it is and what it is not Fig. The threedimensional matrix of primary care diagnosis Social problems C Mental health problems A General medical problems B

9 Index 3 Why integrate mental health?

10 3 Why integrate mental health? Fig. The WHO 7 good reasons for integrating mental health into primary care Prevalence of mental disorders Comorbidity of mental and physical health problems Treatment gap Mental health integration into primary health care Enhanced access Respect of human rights Affordability Cost effectiveness Good health outcomes

11 Index 4 How to integrate mental health?

12 4 How to integrate mental health? The WHO 10 principles for integrating mental health into primary care Policy and plans need to incorporate primary care for mental health. Advocacy is required to shift attitudes and behaviour. Advocacy is required to shift attitudes and behaviour. Adequate training of primary care workers is required. Adequate training of primary care workers is required. Primary care tasks must be limited and doable. Primary care tasks must be limited and doable. Specialist mental health professionals and facilities must be available to support primary care. Patients must have access to essential psychotropic medications in primary care. Integration is a process, not an event. Integration is a process, not an event. A mental health service coordinator is crucial. A mental health service coordinator is crucial. 9. Collaboration with other government non-health sectors, nongovernmental organizations, village and community health workers, and volunteers is required. 10. Financial and human resources are needed.

13 Index 5 State of the art across Europe

14 5 State of the art across Europe Fig. A system framework to evaluate the strength of primary care in Europe Dimensions of the PC structure Governance of PC system Economic conditions of PC system PC workforce development (PHAMEU study - European Primary Care Activity Monitor) Dimensions of the PC process Access to PC services Comprehensiveness of PC services Continuity of PC Coordination of PC Dimensions of the PC outcomes Quality of PC Efficiency of PC Equity in health

15 5 State of the art across Europe PC governance Fig. Matrix with the overall level of the PC structure dimensions DK ES NL PT SIUK FI EE IT LT NO RO BE DE FR SE TR AT BG CZ GR LV HIGH MEDIUM EE NO BG CZ GR DK LT PT AT FR LV SE TR IT ES NL RO SIUK BE DE FI CH IEMT HU CY ISLU PL SK LOW CY IE ISLU MT PL CH HU SK PC workforce development HIGH MEDIUM LOW LOW MEDIUM HIGH PC economic conditions LOW BG CY CZ GR ISLU PL AT LV SK MEDIUM EE NO FR HU LT SE TR DE BE IT RO HIGH IEMT CH DK PT ES FINL SIUK PC workforce development Key: AT Austria; BE Belgium; BG Bulgaria; CH Switzerland; CY Cyprus; CZ Czech Rep.; DE Germany; DK Denmark; EE Estonia; ES Spain; FI Finland; FR France; GR Greece; HU Hungary; IE Ireland; IS Iceland; IT Italy; LT Lithuania; LU Luxembourg; LV Latvia; MT Malta; NL Netherlands; NO Norway; PL Poland; PT Portugal; RO Romania; SE Sweden; SI Slovenia; SK Slovakia; TR Turkey; UK United Kingdom.

16 5 State of the art across Europe Fig. Total coordination of PC score by country (scale 1 (low) - 3 (high)) Total coordination of primary care score by country (scale 1 (low) 3 (high)) Sweden Netherlands Lithuania Denmark Greece Poland United Kingdom Slovenia Spain Malta Finland Italy Estonia Belgium Latvia Czech Republic Switzerland Luxembourg France Portugal Turkey Iceland Ireland Norway Romania Cyprus Hungary Bulgaria Slovakia Germany Austria

17 5 State of the art across Europe PC access Fig. Matrix with the overall level of the PC process dimensions DK ES LT NL PL SI UK SE CZ PT EE FI IT HU AT DE IS NO RO SK HIGH MEDIUM LT NL SI AT IT SE HU PL PT UK FI NO RO CZ DK ES DE EE IS SK GR MT BE CH FR LU LV BG CY IE TR LOW GR LU MT TR BG CH CY FR BE IE LV Coordination of care HIGH MEDIUM LOW LOW MEDIUM HIGH Continuity of care LOW AT TR BG CY HU NO RO DE IE IS SK MEDIUM IT LU CH FI FR PT BE CZ EE LV HIGH GR LT MT NL SE SI PL UK ES DK Coordination of care Key: AT Austria; BE Belgium; BG Bulgaria; CH Switzerland; CY Cyprus; CZ Czech Rep.; DE Germany; DK Denmark; EE Estonia; ES Spain; FI Finland; FR France; GR Greece; HU Hungary; IE Ireland; IS Iceland; IT Italy; LT Lithuania; LU Luxembourg; LV Latvia; MT Malta; NL Netherlands; NO Norway; PL Poland; PT Portugal; RO Romania; SE Sweden; SI Slovenia; SK Slovakia; TR Turkey; UK United Kingdom.

18 5 State of the art across Europe Total level of primary care orientation Fig. Variation of the overall strength of PC in Europe high medium low

19 5 State of the art across Europe Strong PC Less strong PC Mental health care defined within PC Estonia UK Netherlands France Ireland Sweden Emphasis in SC mental health care Belgium Spain Portugal Italy Poland Romania No info/poor info in mental health care - Germany Switzerland

20 5 State of the art across Europe Integration and coordination deserve major attention. The lack of multidisciplinary collaboration and teamwork is not only identified as a gap in health policy but also as a weakness in the process of service delivery. The problem is not new, but it is becoming more urgent in the light of growing complexity of care. Breaking down barriers between medical professions and between levels of care could start in medical education and be facilitated by specific incentives. Cooperation and coordination between primary and secondary care might benefit from the creation of multidisciplinary professional education programmes, teamwork and multidisciplinary practices. There is an urgent need for countries to take appropriate measures to

21 Thank you all for your attention. For further information please contact or

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