the next 5–10 years. facing the challenges, - WHO/Europe

1 mental health : facing the challenges, building solutions The WHO Regional O ce for Europe The Member States in the WHO European Region The World health Organization met at the WHO European Ministerial Conference (WHO) is a specialized agency of the United Nations created on mental health in Helsinki in January 2005 to in 1948 with the primary tackle one of the major threats to the well-being responsibility for international health matters and public of Europeans: the epidemic of psychosocial dis- health . The WHO Regional O ce for Europe is one of six regional tress and mental ill health .

2 These countries took o ces throughout the world, each with its own programme mental health from the shadow of stigma and geared to the particular health conditions of the countries it discrimination and brought it to the centre of the serves. public health policy arena. By adopting the Men- Member States tal health Declaration and Action Plan for Europe, Albania Andorra Armenia Austria Azerbaijan they set the course for mental health policy for the next 5 10 years. mental health : Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Member States now face the challenge of acting on the principles of the Declaration and accom- plishing the goals in the Action Plan's 12 areas of facing the challenges, Cyprus Czech Republic Denmark Estonia Finland work.

3 This book contributes to the achievement of this task by describing the current situation in the Region, presenting the Declaration and Ac- building solutions France Georgia Germany tion Plan, o ering brief discussions of the areas of Greece work (with examples of initiatives already under- Hungary Iceland way in each) and describing WHO's plans to assist Ireland Israel Member States in improving mental health in the Italy Kazakhstan European Region. Kyrgyzstan Latvia Lithuania Luxembourg The commitments in the Declaration and the Ac- Malta tion Plan are based on information and evidence Monaco Netherlands from across the WHO European Region.

4 Together, Norway Poland they form a solid and inspiring foundation on Portugal Republic of Moldova which governments, policy-makers, nongovern- Romania Russian Federation mental organizations and other stakeholders, San Marino along with WHO, can build solutions to improve Serbia and Montenegro Slovakia the quality of life of all citizens. Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan ISBN 92-890-1377-X. World health Organization Regional Office for Europe Scherfigsvej 8, DK-2100 Copenhagen , Denmark Tel.

5 : +45 39 17 17 17. Fax: +45 39 17 18 18. E-mail: Web site: mental health : facing the challenges, building solutions Report from the WHO European Ministerial Conference mental health : facing the challenges, building solutions Report from the WHO European Ministerial Conference WHO Library Cataloguing in Publication Data mental health : facing the challenges, building solutions : report from the WHO European Ministerial Conference health congresses health services policy planning ISBN 92-890-1377-X (NLM Classification : WM 105). ISBN 92-890-1377-X.

6 Address requests about publications of the WHO Regional Office to: by e-mail (for copies of publications). (for permission to reproduce them). (for permission to translate them). by post Publications WHO Regional Office for Europe Scherfigsvej 8. DK-2100 Copenhagen , Denmark World health Organization 2005, updated reprint 2005. All rights reserved. The Regional Office for Europe of the World health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

7 Where the designation country or area appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

8 The World health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not necessarily represent the decisions or the stated policy of the World health Organization. Printed in Denmark Contents Abbreviations ..vi Foreword ..ix Foreword ..x 1. mental health in Europe The context .. 1. 2. Main issues and challenges .. 5. 3. mental health Declaration for Europe .. 9. 4. mental health Action Plan for Europe.

9 17. 5. mental health services in Europe: the treatment 31. 6. Stigma and discrimination against the mentally ill in Europe .. 41. 7. mental health promotion and mental disorder 49. 8. mental health and working 59. 9. Alcohol and mental health .. 67. 10. Suicide 75. 11. mental health of children and adolescents .. 83. 12. Access to good primary care in mental health .. 93. 13. mental health care in community-based services .. 99. 14. Human resources and training for mental health .. 105. 15. mental health legislation .. 111. 16. Empowerment and mental health 117.

10 17. The economics of mental health in Europe .. 127. 18. mental health information and research .. 135. 19. The way forward .. 141. Annex 1. Conference 147. v Abbreviations Organizations and programmes EU European Union IMHPA Implementing mental health Promotion Action (network). NIS newly independent states of the former USSR. NGOs nongovernmental organizations VVGG Flemish mental health Association WHO-AIMS WHO Assessment instrument for mental health Systems WHO-CHOICE CHOosing Interventions that are Cost Effective Technical terms ADHD attention-deficit hyperactivity disorder ASD autism spectrum disorders DALYs disability-adjusted life years GPs general practitioners PHC primary health care PO personal ombudsman (Sweden).