cannot cover every issue affecting mental health policy or practice

Of course, we cannot cover every issue affecting mental health policy or practice across a collection of more than 50 countries which demonstrate diversity along so many dimensions. We have, for example, given less attention to mental health problems in childhood, adolescence and older age (and the policy responses to them) than we have to what are sometimes called ‘working-age adults’ (although the term in itself makes a number of assumptions worthy of debate). We have given more attention to the organization and configuration of services than to the details of the precise treatments they deliver – writing a psychiatry, psychology or nursing textbook was not our aim.

There is little in this book on the aetiology of illness, or on the rapidly developing field of enquiry that seeks to unravel the interplay of genes and environment. Doubtless, there are other omissions that will disappoint some readers, but what the book aims to do is to identify, analyse and discuss many of the core and most pressing policy challenges confronting Europe’s mental health system ‘architects’ today. In the remainder of this chapter we introduce those challenges. Policy responses Given the many and damaging consequences of poor mental health, one might have expected that promoting good mental well-being and intervening to tackle the consequences of illness would be major priorities for policy-makers. But both the development of national policies and the level of funding for mental health services or initiatives have been disappointing across almost the length and breadth of Europe.

Consequently, mental health promotion continues to receive little attention in most countries, and treatment strategies are somewhat unevenly and inconsistently implemented . Moreover, some therapeutic initiatives seem to overlook the broad functional and societal ramifications of a diverse group of disorders that includes chronic psychological malaise, destabilizing and disabling phobias and episodes of acute psychosis. Institution-focused services continue to dominate much of the European mental health landscape and community-based support systems are patchy in4Mental health policy and practice availability and quality.