Foreword
Acknowledgements
Executive summary
A benchmark for understanding mental health system performance
The state of mental health systems: Significant gaps in performance remain
Some countries are leading the way with policies to tackle the social and economic costs of mental ill-health
1 Key findings and recommendations
A framework for benchmarking mental health system performance
High-performing mental health systems have high quality and accessible services, are person-centred, innovative, and multi-sectoral
Measuring mental health performance
No OECD mental health system delivers excellent performance across the board
Principle 1. Person-centred approach: a policy priority that is not sufficiently implemented in routine care
Person-centred mental health is a policy priority in many OECD countries, but proving harder to deliver in practice
Moving from consultation to co-production is key for increasing person-centredness of mental health policy and services
Principle 2. Accessible and high-quality care: service availability has been scaled-up, but still doesn’t meet demand
Unmet need for mental health care is an enduring concern across countries, despite efforts to scale up services
Quality and outcomes of care remains a major challenge – both to measure, and to improve
Scaling-up available to mental health services is critical for increasing access
Principle 3. Integrated and multi-sectoral approach: in practice integration remains the exception, and not the norm
The COVID-19 crisis calls for a re-doubling of efforts to integrate mental health, work, and education policy
Some impressive efforts to improve mental health knowledge of key front-line actors but inconsistent implementation
Integration of mental health, skills, and work policy is uneven, and tools to make integrated care more systematic could be more widely used
Principle 4. Promoting mental well-being and preventing mental ill-health: the COVID-19 crisis has highlighted the importance of good mental well-being, and gaps in support
Mental health policies should focus on promoting positive mental health
Countries are focusing on promoting good mental health in early life
Steps to promote mental resilience in the face of the COVID-19 pandemic should be maintained
Principle 5. Strong mental health leadership and governance: mental health has risen to the forefront of governments’ agendas, and investment improvements is now needed
Mental health is now a priority area for many governments, and has been prioritised in COVID-19 responses
Overall mental health spending is increasing, but not significantly
Decisive action to reduce stigma around mental illness is critical, but is infrequently measured
Some population groups are significantly more vulnerable to mental illness and mental health services must be tailored to support their unique needs
Principle 6. A future-focused and innovative approach: COVID-19 has accelerated mental health innovation, but workforce shortages are a limiting factors in improving mental health system performance
Data availability makes workforce planning and international comparisons very challenging
Use of digital tools increase access to services
The way that mental health services are delivered is changing, accelerated by the COVID-19 outbreak
The future of mental health performance measurement
At present, OECD countries are not able to comprehensively measure mental health performance across the domains that they identify as priorities
More measures of quality and outcomes are warranted, even as important gaps in ‘input’ measures remain
Patient-reported measures should be at the centre of policy making and service-monitoring
References
2 People-centred mental health policies and services
Introduction
Individual-centred mental health care puts the individual at the centre
People-centred care is a way forward to improve health care systems
OECD countries are taking important steps towards a people-centred health system
People-centred care is essential to build high-performing mental health systems
How effectively are OECD countries delivering individual-centred mental health care?
Do individuals have ownership of their own care?
Elevating the service users’ voice in mental health care
Individual care plans are common in OECD countries, but not systematically used to their full potential
Countries are reshaping involuntary care and putting in place frameworks to protect patient rights, including under involuntary admission
Is mental health care respectful and inclusive of the individual, carer and family?
Patient-reported measures show some signs of gaps between the widely held policy principle of person-centred mental health care, and the experience of mental health service users
The significant economic role of carers and family members in mental health care must be recognised
Are care and treatment tailored to individual needs and preferences?
Offering service users choice is key to tailoring care to individual needs and preferences, but choice is not possible in most mental health service settings
Deinstitutionalisation expands the range of choice for people in need of mental health care
Can OECD countries deliver individual-centred mental health services which are culturally, age and gender appropriate?
Mental health services should be adapted to meet the needs of key population groups
Many countries have strategies in place to support the mental health of key population groups
Does the mental health system empower the individual to realise his or her own potential and contribute to society?
Strengthening people-centred mental health care provision
Moving from consultation to co-production is key for increasing person-centredness of mental health policy and services
Peer-delivered services are of value for creating appropriate people-centred care
More widespread use of patient-reported measures will be critical for driving more people-centred systems
References
3 Accessible, high-quality mental health services
Introduction
Building high-performing mental health services
What are accessible and high-quality mental health services?
How accessible and high-quality are mental health services in OECD countries?
Are services accessible and provided in a timely manner?
Historically, rates of unmet need for mental health care have been high
Coverage of mental health services varies across countries
Average waiting times for mental health services decreased in countries tracking them
Are services developed close to the community?
Inpatient psychiatric beds are declining in almost all OECD countries
The use of inpatient mental health services varies across countries
Community-care capacity for mental health varies more than 30-fold between OECD countries
Is continuity of care assured?
Community-based mental health care demands good care co-ordination
Emergency care visits and repeat admissions to inpatient care point to gaps in care co-ordination between inpatient and community care
Services after discharge – suicide following discharge inpatient admissions
Do services deliver improvement of individual’s condition?
Are services safe?
Inpatient suicides point to shortcoming in OECD countries
Coercion in contemporary mental health care
Do mental health services account for and respect the needs of vulnerable groups?
Improving the accessibility and quality of mental health services
Strengthening community services by developing early intervention approaches and accessible services such as talking therapies
Early intervention techniques can effectively target adolescents or young adults
Integrated continuous community care to improve mental health for people with severe mental health conditions
Creating safe inpatient settings while reducing coercive measures
When coercive measures are inevitable, care facilities should strive for using the least intrusive measures possible
References
4 An integrated and multi-sectoral approach to mental health
Introduction
Why do mental health systems need to be integrated and multi-sectoral?
Cross-sectoral mental health policies can support good mental health
The economic costs of mental ill-health are distributed across multiple sectors
The COVID-19 crisis calls for a re-doubling of efforts to integrate mental health, work, and education policy
Are OECD mental health systems integrated and multi-sectoral?
Do OECD countries take a ‘mental health in all policies’ approach?
International mental health strategies recognise the importance of sectors beyond the health system for mental health policy
OECD countries have made cross-sectoral mental health policy a priority in strategies, but implementation in practice is inconsistent
Integration of mental health, skills, and work policy is uneven
Do mental health systems ensure physical health needs are met?
People with severe mental health conditions have a lower life expectancy than the general population
A small number of OECD countries have specific initiatives relating to physical health care support or liaison for mental health service users
Managing the risks of COVID-19 to people with severe mental health conditions
Are social protection systems tailored to promote recovery, return to education, or to work for people with mental health conditions?
People living with mental ill-health have consistently worse education and employment outcomes
A few countries have dedicated efforts to support young people with mental health during critical moments in their education or transition to work
Good examples of initiatives to integrate services to promote return to the labour market can be found across OECD countries, but are far from systematic
Can front line actors recognise and respond to mental distress, to connect individuals to appropriate services?
Front line actors can help people find access to mental health care system and improve the stigmatisation around mental health problems in a community
Some impressive efforts to improve mental health knowledge of key front-line actors exist, but implementation is inconsistent
If front line actors are better able to identify mental distress, this needs to be backed up by good referral pathways
Improving performance: Policies to promote multi-sectoral integration
Strengthening integration between the ‘mental health’ and ‘physical health’ sectors through multidisciplinary teams, and cross-sectoral training
A mix of targeted employment support programmes could be backed by a more proactive employment- or education-focus in mental health outcome tracking
More mental health training should be provided to a bigger range of front line actors
References
5 Preventing mental illness and promoting mental well-being
Introduction
Why do mental health systems need to prevent mental illness, and promote mental well-being?
Mental health exists on a spectrum – and includes both positive mental health and poor mental health
Preventing mental ill-health and promoting mental well-being has taken on a new importance – and new complexity – in light of the COVID-19 crisis
Up until 2020, adult mental health status was largely stable but children and young people were showing signs of increased mental distress
During 2020, population mental health status worsened across OECD countries
Investing in promotion and prevention in mental health makes good economic sense
Are OECD mental health systems effectively preventing mental illness and promotion mental well-being?
Are countries reducing the rate of suicide?
Suicide rates are falling in OECD countries but still cause significant numbers of deaths every year
Every year a small but concerning number of children and young people die by suicide
Are countries ensuring mental health literacy?
Good mental health literacy can reduce stigma, support self-management of mental distress, and encourage help-seeking
Efforts to improve mental health literacy are in place in many countries
During the COVID-19 crisis countries have increased public communication about mental health and staying mentally well
Are schools mental health-friendly environments that build resilience?
Promoting good mental health in early life is critical
Schools are a very good place to do mental health promotion and prevention
Do OECD workplaces foster good mental health?
Workplaces can be good, or bad, for mental health
Some countries have been focusing on reducing mental health risks in workplaces
Workplace programmes can build mental health literacy, reduce stigma, build mental resilience, and direct people towards appropriate support
Can front line actors recognise and respond to mental distress, to connect individuals to appropriate services?
Do OECD countries make it easy for individuals to seek help?
Strengthening prevention and promotion in mental health
An comprehensive approach to suicide prevention and harm reduction can reduce can reduce deaths by suicide
Building good mental health for children and young people represents good value-for-money
Mental health policies should focus on promoting positive mental health
Steps to promote mental resilience in the face of the COVID-19 pandemic should be maintained
Promoting strategies for mental health self-care – exercise, mindfulness, social connection
References
6 Strong leadership and good governance
Introduction
Why are good governance and strong leadership important for mental health system performance?
Making mental health a high-level priority is critical to changing attitudes and awareness
How effective are OECD countries at delivering strong leadership and good governance for mental health?
Are OECD countries making mental health a high-level national priority?
OECD governments have been leading the discourse on improving mental health
On average, the share of mental health spending remains low
Are countries ensuring mental health literacy, and reducing stigma around mental illness?
Stigma is a major barrier to help-seeking, and an additional burden for persons living with a mental health condition
Reducing mental health stigma is a priority in OECD countries
The impact of anti-stigma campaigns is inconsistently, but where stigma has been measured over time attitudes towards mental health have improved
Are countries investing in delivering a high-performing mental health system?
Spending on mental health has increased, but the total share of health spending going towards mental health has stayed stable or even fallen
Mental health has been prioritised in COVID-19 responses
Prioritising efficient and effective distribution of resources
Promoting equity geographically, between population groups, and between mental disorders
Strengthening mental health leadership and governance to improve performance
Policy attention needs to be backed with smart and significant investment in mental health services
Investing in programmes to reduce mental health stigma and improve mental health literacy can transform population attitudes
References
7 Building future-focused and innovative mental health systems
Introduction
Why do mental health systems need to be future-focused and innovative?
How future-focused and innovative are OECD mental health systems?
Are OECD countries investing in mental health research?
In recent decades mental health research has had low levels of attention and investment
Governments are leading the push for more mental health research
Are OECD countries promoting innovative solutions to mental health challenges?
The COVID-19 outbreak has rapidly accelerated the use of digital tools in the mental health space
Countries are at different stages in taking advantage of the growing number of mental health apps and digital tools
Interest in the use of artificial intelligence in the mental health field is growing
Are care and services delivered in the most effective and efficient way, based on best available evidence?
It is extremely difficult to assess how ‘efficient’ and ‘evidence-based’ mental health systems are
Do countries have strong mental health information systems?
With a few exceptions, countries are unable to comprehensively measure the dimensions of mental health performance that they defined as most important
Do countries have mental health workforce capacity for future generations?
There is significant variation in mental health workforce capacity, between and within countries
Workforce projections show that action is needed to increase the numbers of mental health professionals
Improving performance: future-focused and innovative policies and practices
Prioritising mental health workforce growth, new workforce categories and models
Digital apps and tools offer the possibility of massively increasing access to mental health support, but need to be integrated into the mental health system
Evidence shows that a significant number of mental health treatments are efficient and effective, and should be prioritised in mental health systems
Further data development is needed to make international mental health benchmarking more effective
More measures of quality and outcomes are warranted, even as important gaps in ‘input’ measures remain
Patient-reported measures should be at the centre of policy making and service-monitoring
References
更多信息……