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Purpose One in four individuals can expect to experience a mental health problem during their lifetimes. This has a significant impact on the health system and wider economy. Annual costs of depression in the EU were more than €136.3 billion in 2007. These costs are likely to increase, with depression predicted to become the leading cause of morbidity in high income countries by 2030. Policy makers thus want increasing information on the costs and benefits of investing in mental health promotion. Methods A rapid review of literature was undertaken to identify estimates of costs/effects of selected integrative approaches: mindfulness, meditation, Tai Chi, Qi-Gong and yoga. Decision-analytic modelling techniques were used to synthesise data on the costs/effectiveness of these integrative medicine approaches for the prevention and treatment of stress, anxiety and depressive disorders, as well as any benefits of improved mental wellbeing. Cost effectiveness data and net returns on investment over short (1 year); mid (5 year); and long (10 year) timeframes for improved mental health were estimated. This data were then compared with that calculated by the authors in a previous study undertaken for the Department of Health in England on a range of conventional interventions and other actions to promote mental health and wellbeing. Results If integrative medicine can achieve modest improvements in depressive symptoms, economic modelling indicates positive returns on investment greater than 2:1 in the long run. This is comparable to some psychological therapies now rolled out. Much benefit is realised outside the healthcare sector, and is due to greater participation in work and other everyday activities. Conclusion There is an economic case for greater consideration of the potential of mindfulness, meditation, Tai Chi, Qi-Gong and yoga as alternative or adjunct options both for the prevention and early intervention to treat mild and moderate stress, depression and anxiety disorders.

The evidence-based policy approach – the view that social policy ought to be based upon supporting evidence that the policy works (and why it works) – is currently in vogue. In this article we reflect upon one aspect of the evidence-based approach: the use of quantitative evidence in health care decision-making. In particular, we discuss both the potential usefulness of quantitative evidence in this context, and the barriers to the appropriate use of such evidence at the decision-making level.

Part of the six-volume Wellbeing: A Complete Reference Guide, this is a comprehensive look at the economics of wellbeing with coverage of history, research, policy, and practice. Examines the challenges inherent in studying and measuring wellbeing from an economic perspectiveDiscusses strategies and interventions to improve wellbeing across the lifespan and in different settingsAddresses the potential economic benefits for governments and policymakers of actively investing in initiatives to improve wellbeing, from the workplace to the home to the natural environmentEmphasizes the need to s

The organisation of inpatient care provision has undergone significant reform in many southern European countries. Overall across Europe, public management is moving towards the introduction of more flexibility and autonomy . In this setting, the promotion of the further decentralisation of health care provision stands out as a key salient policy option in all countries that have hitherto had a traditionally centralised structure. Yet, the success of the underlying incentives that decentralised structures create relies on the institutional design at the organisational level, especially in respect of achieving efficiency and promoting policy innovation without harming the essential principle of equal access for equal need that grounds National Health Systems (NHS). This paper explores some of the specific organisational developments of decentralisation structures drawing from the Spanish experience, and particularly those in the Catalonia. This experience provides some evidence of the extent to which organisation decentralisation structures that expand levels of autonomy and flexibility lead to organisational innovation while promoting activity and efficiency. In addition to this pure managerial decentralisation process, Spain is of particular interest as a result of the specific regional NHS decentralisation that started in the early 1980 s and was completed in 2002 when all seventeen autonomous communities that make up the country had responsibility for health care services. Already there is some evidence to suggest that this process of decentralisation has been accompanied by a degree of policy innovation and informal regional cooperation. Indeed, the Spanish experience is relevant because both institutional changes took place, namely managerial decentralisation leading to higher flexibility and autonomy- alongside an increasing political decentralisation at the regional level. The coincidence of both processes could potentially explain why some organisation and policy innovation resulting from policy experimentation at the regional level might be an additional feature to take into account when examining the benefits of decentralisation.

Maps the state of policy, service provision and funding for mental health care across Europe, taking into account the differing historical contexts that have shaped both the development and delivery of services. This book examines the legal rights of people with mental health problems

The organization of inpatient care provision has undergone significant reform in many southern European countries although the success of the underlying incentives relies on the institutional design with respect to achieving efficiency and promoting policy innovation without harming the essential principle of 'equal access for equal need' that grounds National Health Systems (NHS). This article explores some of the specific organizational developments of decentralizations structures drawing from the Catalonian experiences. We find that the coincidence of both managerial and political decentralization is associated with the mergence of organization and policy innovation resulting from policy experimentation at the regional level might be an additional feature to take into account when examining the benefits of decentralization.

Abstract In the clinical sciences, systematic reviews have proved useful in the aggregation of diverse sources of evidence. They identify, characterize and summate evidence, but these methodologies have not always proved suitable for the social sciences. We discuss some of the practical problems faced by researchers undertaking reviews of complex and cross‐disciplinary topics, using the example of mental health and social exclusion. The barriers to carrying out social science and cross‐disciplinary reviews are reported and some proposals for overcoming these barriers are made, not all of them tried and tested, and some of them controversial. Using a mapping approach, a wide‐ranging search of both clinical and social science databases was undertaken and a large volume of references was identified and characterized. Population sampling techniques were used to manage these references. The challenges encountered include: inconsistent definitions of social phenomena, differing use of key concepts across research fields and practical problems relating to database compatibility and computer processing power. The challenges and opportunities for social scientists or multidisciplinary research teams carrying out reviews are discussed. Literature mapping and systematic reviews are useful tools but methods need to be tailored to optimize their usefulness in the social sciences.

AbstractWe explore the implementation and development of individual placement and support (IPS) in Norway. IPS is an evidence‐based practice for supporting people experiencing mental illness to obtain and maintain competitive employment. Implementation of IPS into routine practice has been challenged by different paradigms in vocational rehabilitation, health and welfare policies. Data were mainly collected through individual and joint interviews of IPS experts and key stakeholders involved in the implementation of IPS. Data were analysed using thematic analysis. Three themes were derived from the analysis, representing different phases in the implementation process: (1) seeking a way to meet unmet need in work and mental health practice, (2) gathering knowledge and national evidence, and (3) embedding IPS into routine practice. The study demonstrates how health and welfare policy gradually developed IPS from vocational rehabilitation to a mainstreamed welfare employment scheme. This development may secure the future of IPS in Norway. However, the implications for practice in the longer term are unknown. Our study provides insight into how implementation of an evidence‐based practice both influences and is influenced by national policymaking.

Background: From 2008 on, a severe economic crisis (EC) has characterized the European Union (E.U.). However, changes in substance use behavioral patterns as a result of the economic crisis in Europe, have been poorly reflected upon, and underlying mechanisms remain to be identified; Methods: In this review we explore and systematize the available data on the effect of the 2008 economic crisis on patterns of substance use and related disorders, within the E.U. countries; Results: The results show that effects of the recession need to be differentiated. A number of studies point to reductions in population's overall substance use. In contrast, an increase in harmful use and negative effects is found within specific subgroups within the society. Risk factors include job-loss and long-term unemployment, and pre-existing vulnerabilities. Finally, our findings point to differences between types of substances in their response on economic crisis periods; Conclusions: the effects of the 2008 economic crisis on substance use patterns within countries of the European Union are two-sided. Next to a reduction in a population's overall substance use, a number of vulnerable subgroups experience serious negative effects. These groups are in need of specific attention and support, given that there is a real risk that they will continue to suffer negative health effects long after the economic downfall has formally been ended.

AbstractA high proportion of people with severe mental illness (SMI) want to work, consider it essential for recovery, yet employment rates are low. Many employees in public employment services (PES) work according to traditional attitudes that people with SMI are unable to work and if they do, risk harm from work‐related stress. These attitudes conflict with principles in evidence based vocational models like individual placement and support (IPS) and probably contributes to the low‐employment rate. The aim of this study was to investigate attitudes towards the evidence‐based principles of IPS among PES employees with and without exposure to IPS. A case vignette describing a person with SMI and statements referring to this vignette was developed and administered to PES employees at two timepoints, 4 years apart. Respondents indicated their attitudes on a six‐point Likert scale to statements in accordance to the principles of IPS. Independent two‐tailed sample t‐tests were used to analyse differences between respondents in municipalities with IPS exposure, compared to municipalities without. Multiple linear regressions with attitudes as a dependent variable was used to test whether attitudes changed over time dependent on exposure to IPS. Attitudes were generally aligned with IPS principles compared to current PES practice. The municipality with IPS exposure had more favourable attitudes (p < 0.01). Changes in attitudes were minimal over time and did not differ between regions (p < 0.287). Attitudes of employees in PES are aligned with the principles of IPS and to a greater extent if exposed to IPS.

AbstractIndividual Placement and Support (IPS) is an evidence-based supported employment program that helps people with severe mental illness to achieve steady, meaningful employment in competitive mainstream jobs. The purpose of this study is to investigate the impact of Covid-19 restrictions on IPS service delivery in Northern Norway between March and October 2020. In Norway, IPS is in the early stages of full-scale implementation and is therefore potentially sensitive to external stressors such as the Covid-19 pandemic. In October 2020 we conducted a retrospective, cross-sectional survey with IPS employment specialists in Northern Norway (n = 25). The purpose was to collect information about how Covid-19 restrictions between March and October 2020 impacted their ability to deliver IPS services. As a result of Covid-19 restrictions, more than half the employment specialists were reassigned to other roles or non-IPS related work tasks. They also reported less collaborative engagement with clinical teams and employers. 69 (20.4%) of IPS users supported by employment specialists gained employment after the Covid-19 restrictions were introduced and 82.8% of unemployed IPS users continued to seek competitive employment despite Covid-19 restrictions. Covid-19 restrictions appear to have created obstacles for IPS service delivery in Northern Norway and have negatively impacted the employment specialists' collaborative engagement with clinical teams. However, IPS employment specialists have shown strong capabilities in overcoming these challenges and services users have remained motivated to seek employment during the pandemic.