When reading this material, it is important to realise first of all that it is not a comparison of the performance and accessibility of mental health care systems across Europe. The Mental Health Integration Index does not describe how well or how poorly the public mental health system works, but has a different objective - to describe the degree of integration of people with mental disorders into their community. In developing the Index, the focus was on topics such as human rights, stigma, the possibility of living with a full family and employability - in other words, on describing the efforts of European countries to integrate people with mental disorders into society and employment. The Index was developed by The Economist Intelligence Unit (EIU) and covered 28 EU member states plus Norway and Switzerland. The development of the index was commissioned and sponsored by Janssen Pharmaceutica NV, (part of the Janssen Pharmaceutical Companies, Johnson & Johnson).

The Index-based country comparison was developed on the basis of 18 unique indicators that focused on the degree of commitment of governments and societies to the inclusion of people with mental disorders and seven 'secondary' indicators. These 18 primary indicators can be grouped into four categories:

- environment - describes the presence or absence of social policies and conditions that allow people with mental disorders to benefit from stable housing and family life; includes indicators such as the proportion of beds/places in community and hospital care, the availability of sheltered housing and benefits for people with mental disorders

- accessibility - refers to the policy or lack of policy on access to health and social care for people with mental disorders; this category includes, inter alia, accessibility to professional health care professionals, availability of reimbursable medicines, community and home-based care, and prevention programmes

- opportunities - this element of the indicator describes the presence or absence of policies relating to the employment of people with mental disorders: getting a job, keeping a job and working conditions free from discrimination

- regulation - describes policies aimed at counteracting the stigmatisation of people with mental disorders - social campaigns relating to awareness of mental illness and encouraging/involving people with social disorders in social decision-making

The list of indicators was developed by an expert panel:

• Prof Peter Huxley - Bangor University, Wales

• Kevin Jones - Secretary General of the European Federation of Associations of Families of People with Mental Illness (EUALPMI)

• Pedro Montellano - President, Global alliance of Mental Illness Advocacy Networks (GMAIAN)

• Slawomir Murawiec - co-organiser of the European Mental Health Systems Network Conference in cooperation with the European Health Management Association (EHMA)

• Stephanie Saenger - President of the Council of Occupational Therapist for the European Countries (COTEC)
  

According to the executive committee compiling the Index, Germany coming first in the published list comes as a surprise and was not at all expected to occupy the top position. However, a strong healthcare system and a generous welfare system have many features that prove useful for the effective social integration of people with mental disorders. More in line with popular opinion are countries just behind Germany - such as the UK and the Scandinavian countries - with a reputation in Europe for doing well in this field. Countries in the south and south-east of Europe achieved the lowest rankings, which is by no means solely due to a history burdened by being part of the communist bloc (Estonia is in 8th position), but more due to a long tradition of neglecting people with mental disorders.

The authors of the Index also refer in their discussion to many other aspects of the situation of people with mental disorders living in Europe, and note that "Europe as a whole is only in the early stages of a journey from institution-based to community-based care."

The entire Mental Health Integration Index study is available at:

http://www.janssen.ie/sites/stage-janssen-ie.emea.cl.datapipe.net/files/FINAL%20WHITE%20PAPER%20-%20PHIRPSY10140001_v1.0.pdf

Total assessment of 30 European countries in terms of the Mental Health Integration Index 2014 (map).

Source: The Economist Intelligence Unit

Overall assessment of 30 European countries in terms of the Mental Health Integration Index 2014.

Source: The Economist Intelligence Unit

The table below shows the following elements that make up the Mental Healt Integration Index:

• total score - Poland ranks 15
• environment - providing a stable home and family - Poland ranks 13
• accessibility - ease of access to health services - Poland ranks 21
• opportunities - improvement in work and education - Poland ranks 9
• regulation - reducing stigma - Poland ranks 10

Source: The Economist Intelligence Unit

Compiled by Sławomir Murawiec