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Education And Debate

Caring for mentally ill people

BMJ 1994; 309 doi: (Published 05 November 1994) Cite this as: BMJ 1994;309:1218
  1. J V Os,
  2. J Neeleman
  1. Department of Psychological Medicine, Institute of Psychiatry, London SE5 8AF
  2. Maudsley and Bethlem Royal Hospital, London SE5 8AF
  1. Correspondence to: Dr van Os.
  • Accepted 9 August 1994

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.

Box 1 - Harmonisation of psychiatric practice in Europe: initiatives and effects

1950 European Convention of Human Rights: rights for psychiatric patients; scrutiny of national mental health legislations

1953 European Convention on Social and Medical Assistance: right of treatment of foreign nationals (including psychiatric detention)

1957 Treaty of Rome (amended as Single European Act, 1961): right of settlement of professionals, necessitating harmonisation of specialist training

1961 United Nations convention: theoretical uniformity in legislation on illicit drugs

1993 Free internal market and public health chapter (129) in Maastricht Treaty: may lead to changes in the epidemiology of problems related to substance misuse

Box 2 - Mental illness programmes in Europe

WHO/EURO: strategies for reducing suicidal behaviour: multicentre study on parasuicide and collaboration in developing preventive programmes on suicide

WHO/EURO: the development of …

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