Caring for mentally ill people

Despite legislation to harmonise mental health practice throughout Europe and convergence in systems of training there remains an extraordinary diversity in psychiatric practice in Europe. Approaches to tackling substance misuse vary among nations; statistics on psychiatric morbidity are affected by different approaches to diagnosis and treatment of psychiatric disorders; attitudes towards mental illness show definite international differences. Everywhere, though, mental health care for patients with psychotic illnesses is a “cinderella service,” and there is a general move towards care falling increasingly on the family and the community.

Legislation is fostering harmonisation of mental health practice throughout Europe (box 1). Countries like Britain are forcing their system of training into the Procrustean beds of “Euro-training” and “Eurocertification,” and the past decades have seen an explosion of European psychiatric associations and European mental illness programmes (box 2). It is becoming increasingly clear, however, that there is an extraordinary diversity in psychiatric practice in Europe. We will discuss some of these contrasts in the light of the heterogeneity of the European sociocultural environment, differences in attitudes toward mentally ill people, and the miscellany of training programmes for mental health workers in Europe.