Health care recourses for treating Depression in the EU: current status Dr. André F. Joubert The Lundbeck International Neuroscience Foundation On behalf of the Expert Platform on Depression European Commission conference: Prevention of Suicide and Depression Budapest, 11 December 2009 Overview The Expert Platform on Depression The Lundbeck International Neuroscience Foundation (LINF) and its role in the Expert Platform Survey: State of mental health services for depression in EU Member States Origin Methodology Preliminary key findings
The Expert Platform on Depression Why an EU Expert Platform on Depression? The Platform aims to support policy developments at an EU level: European Pact on Mental Health and Well-Being published on 13 June 2008 European Parliament report on Mental Health (19 Febr 09) calling for a multi-stakeholder approach and establishment of an EU platform to implement the European Pact most effectively Need for multi-stakeholder contributions and perspectives on how to best address depression in Europe Depression Expert Platform: A neutral multistakeholder coalition of healthcare - professionals (psychiatrists, psychologists, GPs) - organisations (patients, carers, health economists and the workplace)
Composition of the Expert Platform on Depression Co-Chairs Dolores Gauci President GAMIAN-Europe Members Norman Sartorius Professor of Psychiatry University of Geneva Observers Jürgen Scheftlein DG SANCO European Commission Mary G. Baker Vice-President, EBC London, UK Vincenzo Costigliola President, European Depression Association Wolfgang Gaebel Prof of Psychiatry, University of Dusseldorf, Germany Guy Goodwin Prof of Psychiatry, Oxford. Cyril Höschl Board Member, EBC Prague, Czech Republic Kevin Jones Secretary General EUFAMI André Joubert LINF Copenhagen, Denmark Martin Knapp Prof of Social Policy, London School of Economics, UK Karl Kuhn Chairperson, European Network for Workplace Health Promotion Sarmite Lucava Member, European Fed of Psychologists Assoc David Nutt Prof Psychopharmacology, Imperial College, London. Zoltan Rihmer Professor of Psychiatry, Semmelweis University, Budapest Erzsebet Podmaniczky Member, Standing Com of European Drs Marianne Kant-Schaps Member, European Fed. of Psychologists Assoc Charles Pull Chair, Dept Neurosciences, Centre Hospitalier de Luxembourg Frieda Brepoels Member of the European Parliament Project Advisor Iman Barilero Divisional Director H. Lundbeck A/S Objectives of the Expert Platform on Depression Support the implementation of the EU Pact on Mental Health and Well-being by: 1. Increasing awareness and change perceptions and thinking within society and healthcare professionals around depression 2. Discussing the prevention of depression and contributing to the five themes as defined by the European Commission: In youth and education The prevention depression and suicide In the elderly population In workplace settings The need to fight stigma and social exclusion
Objectives of the Expert Platform on Depression 3. Developing policy recommendations for stakeholder actions to address depression in Europe in the following themes: How to generally raise awareness about depression and its many consequences in all populations, including the elderly and young people, and how to change the perception of society How to improve prevention and early diagnosis of depression How to support research into new management options of depression How to empower persons affected by depression How to create adequate structures in place in order to ensure the optimal care and social support for persons affected by depression The Lundbeck International Neuroscience Foundation (LINF) and its role in the Expert Platform
Lundbeck International Neuroscience Foundation Established in 1997, the LINF is registered in Denmark as an international non-profit Foundation Vision: Through education to contribute to improving the quality of life of patients, and their relatives, who are affected by CNS disorders Skodsborg, Denmark Goals: Education To improve awareness, recognition and management of CNS disorders through educational activities and Internet communities Quality of Care To encourage best-practice by discussing options for optimal prevention, management and care of CNS disorders Partnership To facilitate networking and strengthen collaboration with care providers, patients and CNS organisations LINF supports the Expert Platform with an unrestricted grant Lundbeck International Neuroscience Foundation LINF board Dr Anders Gersel Pedersen - Lundbeck (Chairman) CINP - Prof Brian Leonard (Deputy Chairman) EPA - Dr Marianne Kastrup WPA - Prof Juan Lopez-Ibor EFNS - Prof Jes Oelsen ECNP - Prof Julien Mendlewicz LINF faculty of 82 members from 39 countries: Psychiatrists Neurologists Psychologists Patient orgs Epidemiologists Psychopharm s
LINF Faculty 82 highly respected opinion leaders from 39 countries Their role is to: advise on educational seminars and scientific data addressed at the seminars write and review existing and new scientific material provide guidelines and develop input for reaching consensus moderate at the Institute interactive seminars and symposia participate in Meet the Expert sessions at the seminars support local implementation on their own countries review and contribute with scientific content on the websites Survey: State of mental health services for depression in EU Member States
Origins of the survey The European Comission issued a request to the Expert Platform on Depression for a survey to provide an overview of mental health services for depression in the EU member states Methodology Development of survey questions in collaboration with DG SANCO Questions divided into 6 categories: Health systems Infrastructure Other structure available Self-help facilities Information Quality of care Distribution to 27 depression experts in EU Member States 23 member country s responses received thus far Results collected and analysed by the Expert Platform on Depression Timing: Survey conducted within a short timeframe, but preliminary results already offer some interesting findings
Preliminary key findings Access and Reimbursement of Medicines Reimbursement Psychotropic medication is partially reimbursed Outpatient visits are fully reimbursed in the majority of Member States Psychotherapy is only fully reimbursed in 5 Member States Access to medicine GPs may prescribe benzodiazepines in all Member States GPs may prescribe all antidepressants in most Member States
Patients Access to Treatment and Information Access to healthcare professionals On average, 10 psychiatrists per 100,000 inhabitants are working in outpatient care Information to patients Structures to inform patients about disease management and diagnosis are still limited Psychoeducation in outpatient care has been introduced on an occasional basis in 12 states Is psychoeducation in outpatient care settings available? Is telephone case management available? Experimental Occasional Regularly Not available Telephone case management and crisis hotlines are often not available, or in only some regions Experimental In some regions Country wide Not available Quality of Care Collaborative, integrated and stepped care are most often only available in some regions Integrated care is never available country-wide, but almost always in some regions Stepped care is not available in 4 Member States, and country-wide only in 2 In what way is stepped care available? In some regions Country wide Not available Collaborative care is available country-wide in 4 Member States
Best Practices According to the survey, the following countries provide for the best mental health services in Europe: Best Practices According to the survey, the following countries provide for the best mental health services in Europe: 5. Denmark
Best Practices According to the survey, the following countries provide for the best mental health services in Europe: 5. Denmark 4. Belgium Best Practices According to the survey, the following countries provide for the best mental health services in Europe: 5. Denmark 4. Belgium 3. Slovakia
Best Practices According to the survey, the following countries provide for the best mental health services in Europe: 5. Denmark 4. Belgium 3. Slovakia 2. Slovenia Best Practices According to the survey, the following countries provide for the best mental health services in Europe: 5. Denmark 4. Belgium 3. Slovakia 2. Slovenia 1. Sweden
Best Practices According to the survey, the following countries provide for the best mental health services in Europe: 5. Denmark 4. Belgium 3. Slovakia 2. Slovenia 1. Sweden Best Practices According to the survey, the following countries provide for the best mental health services in Europe: Sweden Slovenia Slovakia Belgium Denmark
Preliminary Conclusions Preliminary Conclusions In general, great disparities exist between EU Member States in terms of healthcare recourses in order to treat depression: Health systems: in general the reimbursement of medicines is well covered, but with regard to access to psychotherapy great differences exist across Member States Big differences in the healthcare infrastructure exist: The coverage of psychotherapists working in outpatient care varies the most, from 0,01 (Latvia) to 100 (Luxembourg, Romania) per 100,000 The coverage of psychiatrists working in outpatient care varies between 0.34 (Latvia) to 30 (Luxembourg, Romania) per 100,000 The coverage of GPs across the EU varies between 30 (Greece) to 62.5 (Ireland) and 178 (Belgium) per 100,000
Preliminary Conclusions There is a need for EU Member States to support and invest in the following: Infrastructure on depression in other areas (telephone case management, internet based psychotherapy) Access to self-help groups across all regions Information provision via the internet Improving quality of care across all regions (collaborative, integrated and stepped care) Next steps
Survey Summary The results will be further examined and compiled in a summary report. Health care recourses for treating Depression in the EU: current status Thank you! Dr. André F. Joubert European Commission conference: Prevention of Suicide and Depression Budapest, 11 December 2009
This paper was produced for a meeting organized by Health & Consumers DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumers DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.