Capítulo 1 –Promoting mental health in Europe: Why and how? [p. 19-40]
Mental illness affects tens of millions of Europeans every year
Mental health problems affect about 84 million people across EU countries
Although there are significant gaps in information about the prevalence of mental health problems across EU countries, all available evidence suggests that mental health problems affect tens of millions of Europeans every year. The data currently available from population-based surveys are often limited to a few specific mental health disorders, or specific age groups. However, the Institute for Health Metrics and Evaluation (IHME) provides estimates of the prevalence of a wide range of mental health disorders across all age groups based on a wide variety of data sources and a set of assumptions.
According to the latest IHME estimates, more than one in six people across EU countries (17.3%) had a mental health problem in 2016 (Figure 1.1) – that is, nearly 84 million people.
The most common mental disorder across EU countries is anxiety disorder, with an estimated 25 million people (or 5.4% of the population) living with anxiety disorders, followed by depressive disorders, which affect over 21 million people (or 4.5% of the population). An estimated 11 million people across EU countries (2.4%) have drug and alcohol use disorders. Severe mental illnesses such as bipolar disorders affect almost 5 million people (1.0% of the population), while schizophrenic disorders affect another estimated 1.5 million people (0.3%).
By country, the estimated prevalence of mental health disorders is highest in Finland, the Netherlands, France and Ireland (with rates of 18.5% or more of the population with at least one disorder), and lowest in Romania, Bulgaria and Poland (with rates of less than 15% of the population).
Portugal é o quinto país da União Europeia com maior prevalência de problemas de saúde mental.
Some of these cross-country differences may be due to the fact that people living in countries with greater awareness and less stigma associated with mental illness, as well as easier access to mental health services, may be diagnosed more easily or may be more likely to self-report mental ill-health. In many countries, there is still strong stigma associated with various mental health problems, and in some countries this stigma sits alongside a still-widespread belief that it is better to simply avoid talking about mental illness (Munizza et al., 2013).
Several mental illnesses are more common amongst women, including anxiety disorders, depressive disorders and bipolar disorders. Some of these gender gaps may be due to a greater propensity of women to report these problems. However, one exception is drug and alcohol use disorders, which are more than two times more likely to occur in men than women on average across EU countries (IHME, 2018).
Mortality related to mental health problems and suicides is substantial
Over 84 000 people died of mental health problems and suicides across EU countries in 2015, and this is an under-estimation as many people with mental health problems also die prematurely because of higher rates of physical health problems and chronic diseases that are not properly treated. “Excess mortality” for mental disorders – the gap between the mortality rate of the general population and the mortality rate for people with a mental disorder – is huge. For example, excess mortality amongst women who have been diagnosed with schizophrenia is above 6 in Finland, Norway and Sweden (OECD, 2018). Persons with severe mental illness die 10-20 years earlier than the general population (Liu et al., 2017; OECD, 2014; Coldefy and Gandré, 2018).
Of the 84 000 deaths directly related to mental health problems and suicides, most of these deaths were among men, mainly because of higher suicide rates among men (Figure 1.4). Some 43 000 men in EU countries died from suicide in 2015, compared with 13 000 women. However, the gender gap in suicide attempts is much smaller or even reversed in some countries, because women often use less fatal methods.
The costs of mental health problems exceed 4% of GDP
The total costs of mental health problems on EU economies are huge, highlighting the need for greater efforts to prevent mental ill-health and to provide timely and effective treatments when it occurs. Besides the costs on health care systems, mental health problems also result in substantial costs in terms of social security benefits as well as
negative labour market impacts in terms of reduced employment and productivity.
In 2015, the overall costs related to mental ill-health are estimated to have exceeded 4% of GDP across the 28 EU countries.
This equates to more than EUR 600 billion. This total breaks down approximately into the equivalent of 1.3% of GDP (or EUR 190 billion) in direct spending on health systems, 1.2% of GDP (or EUR 170 billion) on social security programmes, and a further 1.6% of GDP (or EUR 240 billion) in indirect costs related to labour market impacts (lower employment and lower productivity).
Despite these costs being considerable, they are still a significant under-estimate, as several additional costs have not been taken into account. These include, in particular, social spending related to mental health problems, such as higher social assistance benefits and higher work-injury benefits, and the higher cost of treating a physical illness if the patient also has a mental illness.
In addition, some of the indirect impacts of mental health problems on labour market participation such as reduced employment rates or working hours for informal caregivers taking care of people with mental health problems or the impact on co-workers, have not been taken into account.
Conclusions [p. 40] [bold nosso]
Many European countries are taking action to prevent mental illness and to promote mental well-being. More than one hundred interventions to promote good mental health and protect populations from the negative impacts of mental illness were found across the EU, targeting all age groups.
Measures are being adopted to promote well-being in schools and nurseries, with new parents, or in workplaces. Reducing stigma and increasing understanding of mental well-being are policy priorities. Furthermore, with improved population-level awareness and understanding of mental health, the stigma around seeking mental health care and talking about mental illness falls. Overcoming stigma and improving diagnosis rates can be expected, in turn, to contribute to more robust data on the true prevalence of mental ill-health.
As this chapter shows, mental ill-health is not distributed evenly across the population, and there are important age, gender and socio-economic differences in the burden of disease. Some groups are also less likely to be the target of promotion or prevention interventions. Supporting vulnerable groups, such as older people or unemployed people, is important to build more inclusive and active societies, but at present far fewer policies reach these groups. The dialectic relationship between distance from social structures and deteriorated mental well-being should also not be underestimated. Just as mental ill-health reduces the likelihood of being in employment, unemployment increases the risk of having poor mental health. Programmes that foster good mental health – reducing loneliness, encouraging social participation, building support structures – and interventions that can identify and respond to signs of mental distress, should be priorities for European countries.
The growing evidence base along with the significant burden of mental illness make clear that there is a societal case for introducing many such promotion and prevention programmes, but there is also a clear economic case for further investment in this area. Actions to prevent mental illness and promote good mental health can bring lifelong benefits to children and their families, workplace interventions can reduce absenteeism and presenteeism, and suicide prevention strategies can prevent tragic losses of life and potential.
The costs of mental illness are extremely high, the potential gains from strengthening mental well-being are significant, and the opportunities for promotion and prevention are far from exhausted. This chapter lays the grounds for a clear case: much more can and must still be done to promote mental well-being and prevent mental ill-health.