Depression in Europe
Building resilience through raised awareness, improved access, integrated care, and parity of esteem
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The burden of depression is growing, exacerbated by the stress of covid-19. In many European countries, the prevalence of depression during the pandemic doubled or even tripled from the year before. Reflected in these numbers is an alarming rise in the number of young people who are experiencing symptoms of depression.
Europe’s health systems are struggling. With health budgets stretched in many countries, policymakers face the challenge of having to cope with increasing demands from both mental ill health and chronic physical conditions. There is a concern that mental health budgets may be seen as easier to cut than those for physical health.
This cannot be allowed to happen. Healthcare systems need to remain sufficiently resourced so that they can adapt to changing circumstances. They need to be able to identify groups that are vulnerable to depression, which increasingly includes young people, as well as the elderly and socially marginalised groups. The continuing rise in both incidence and burden of depression in Europe suggests that a step change is needed. Business as usual is not delivering adequate levels of care for many people.
Tap on the map to read more about each country
Methods
After describing the burden of depression, we focus on four thematic areas, using the language of resilience to tie them together. Healthcare systems need to be able to absorb the rising demand for services, adapt to the changing needs of people with depression and transform in response to failures and the lessons they teach. The four themes, which together will help build resiliency, are:
Awareness
Awareness, including patient empowerment and improved community recognition of depression as a serious condition
Building blocks
Recognition
Attitudes
Knowledge
Case studies
First European Art Festival for Mental Health in Greece
This is Me prevention programme in Slovenia
Suicide Prevention Action Networks (SUPRANET Community) in the Netherlands
Treatment
Access to treatment and innovation
Access to treatment and innovation, including both non-pharmacological and pharmacological measures
Building blocks
Technology-based interventions
Community-based interventions
Talk-based interventions
Interventions for underserved groups
Case studies
Using technology to improve mental health in France, Germany, the Netherlands, and the UK
Peer support workers (médiateur de santé pair) in France
Self-help for less severe mental illness in the UK
Care
Integrated approach to care
Integrated approach to care, including prevention measures and co-ordinated support system for patients’ physical health, mental health and wider social needs
Building blocks
Collaborative care
Patient-centred care
Family engagement
Case studies
Identifying co-morbidities to support integrated care pathways in the United Kingdom
Using primary care as a gatekeeper in the Netherlands
Integrated, person-centred primary health care produces results in Slovenia
Parity
Parity of esteem with physical health
Parity of esteem with physical health, and the need for support across the entire patient journey, including prevention, early detection, education, and support at the workplace and in the community
Building blocks
Access and utilisation
Resource allocation
Quality Assurance
Education
Treatment Goals and Outcomes
Case studies
Policymakers enshrining a road to parity in the UK
First Aid for Mental Health in the Netherlands
Main findings
Through a literature review and series of interviews, a mixed picture emerges. First, care remains fragmented. In many European countries, there is little communication between primary and secondary healthcare provision, or between psychiatric healthcare providers and physicians providing care for long-term physical conditions. This lack of coordination makes it more difficult to both identify depression at an earlier stage and determine which patients need to be referred to specialist services. Related to this deficiency is the finding that treatment of depression fails to take a holistic approach. Even in countries where there has been a renewed focus on mental health, there is rarely holistic treatment of patients living with depression. Although families are often actively involved in care and face their own burdens as a result, they are not always integrated into treatment. In addition, specialists and policymakers are only just beginning to understand the impact of the wider environment and society on mental health in the wake of the pandemic.
For those with depression, access to talking therapy and innovative treatment is uneven. Although people living with depression often have access to pharmaceutical interventions—albeit most such medications date from the 1980s and 1990s—there are often long waits for “talking” therapy, if it is even available. Shortages of trained specialists and a lack of co-ordinated workforce planning mean this problem is unlikely to be easily solved. In cases where traditional anti-depressants or psychotherapy fail to have an effect, there appear to be few alternative or innovative treatments options available. Thirty percent of patients who have not responded to two or more antidepressant regimens will attempt suicide.
0%
of patients who have not responded to two antidepressant regimens will attempt suicide
Parity of esteem is a term increasingly heard, but mental health remains undervalued compared with physical health. Mental health has long been a lower healthcare priority, especially in comparison with chronic conditions, even though depression is often a comorbidity of long-term conditions, and vice versa. Failure to understand the interaction between mental and physical health, and to give mental healthcare equal resources, makes it difficult to reduce the burden on healthcare services.
Underlying all efforts to improve the prevention and management of depression, stigma remains a problem in many environments. Despite attempts in many countries to improve awareness and understanding of mental health issues, stigma remains a problem in many European societies. In some cases, the persistence may result from a tendency to focus awareness campaigns on the general public, rather than concentrating on schools, universities or the workplace, where discrimination has a particularly negative impact.
For those with depression, access to talking therapy and innovative treatment is uneven. Although people living with depression often have access to pharmaceutical interventions—albeit most such medications date from the 1980s and 1990s—there are often long waits for “talking” therapy, if it is even available. Shortages of trained specialists and a lack of co-ordinated workforce planning mean this problem is unlikely to be easily solved. In cases where traditional anti-depressants or psychotherapy fail to have an effect, there appear to be few alternative or innovative treatments options available. Thirty percent of patients who have not responded to two or more antidepressant regimens will attempt suicide.
0%
of patients who have not responded to two antidepressant regimens will attempt suicide
Parity of esteem is a term increasingly heard, but mental health remains undervalued compared with physical health. Mental health has long been a lower healthcare priority, especially in comparison with chronic conditions, even though depression is often a comorbidity of long-term conditions, and vice versa. Failure to understand the interaction between mental and physical health, and to give mental healthcare equal resources, makes it difficult to reduce the burden on healthcare services.
Underlying all efforts to improve the prevention and management of depression, stigma remains a problem in many environments. Despite attempts in many countries to improve awareness and understanding of mental health issues, stigma remains a problem in many European societies. In some cases, the persistence may result from a tendency to focus awareness campaigns on the general public, rather than concentrating on schools, universities or the workplace, where discrimination has a particularly negative impact.
Key takeaways
Each of the thematic chapters concludes with suggestions on how resilience can be built within care systems and their wider context. We conclude with five overarching principles around which policymakers can build effective and resilient services.
Adaptability
Healthcare systems need to remain adaptable as rates of depression are rising in most European countries, particularly among the young.While there are many examples of good practice—particularly in attempts to integrate care settings and pathways—they are rarely scaled-up to larger populations.
Awareness and stigma
Awareness needs to be targeted to remove stigma.Depression remains one of healthcare’s last, and most difficult to change, objects of stigma, even as the condition itself becomes more prevalent.
Integrated systems
Healthcare systems should be integrated on all levels, leading to care delivery that is both more efficient and resilient.Primary care needs to be re-established as the home of integrated, co-ordinated, patient-centred care, with well-established referral pathways into specialist care. But apart from a few pilot programmes, delivery of care remains stubbornly fragmented.
Increased support
More support is needed to get people treatment, whether through digital health, talking therapies or other therapeutic or diagnostic innovations.Staffing shortages remain a barrier to access, as is the lack of data infrastructure for tracking treatment and evaluation. Payment systems for digital health and other new innovations remain in their infancy, and pharmacological innovations are few. Industry, regulators, health technology assessment (HTA) organisations and payers need to work together to improve access to therapeutic or diagnostic innovations.
Inclusive treatment
Family and carers should be included in treatment plans.Family life can be one of the stressors that causes depression in some individuals—but with the right focus and interventions, family can also be the greatest support.
Adaptability
Healthcare systems need to remain adaptable as rates of depression are rising in most European countries, particularly among the young.While there are many examples of good practice—particularly in attempts to integrate care settings and pathways—they are rarely scaled-up to larger populations.
Awareness and stigma
Awareness needs to be targeted to remove stigma.Depression remains one of healthcare’s last, and most difficult to change, objects of stigma, even as the condition itself becomes more prevalent.
Integrated systems
Healthcare systems should be integrated on all levels, leading to care delivery that is both more efficient and resilient.Primary care needs to be re-established as the home of integrated, co-ordinated, patient-centred care, with well-established referral pathways into specialist care. But apart from a few pilot programmes, delivery of care remains stubbornly fragmented.
Increased support
More support is needed to get people treatment, whether through digital health, talking therapies or other therapeutic or diagnostic innovations.Staffing shortages remain a barrier to access, as is the lack of data infrastructure for tracking treatment and evaluation. Payment systems for digital health and other new innovations remain in their infancy, and pharmacological innovations are few. Industry, regulators, health technology assessment (HTA) organisations and payers need to work together to improve access to therapeutic or diagnostic innovations.
Inclusive treatment
Family and carers should be included in treatment plans.Family life can be one of the stressors that causes depression in some individuals—but with the right focus and interventions, family can also be the greatest support.
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“Depression in Europe: building resilience through raised awareness, improved access, integrated care and parity of esteem” is an Economist Impact report, sponsored by Janssen. The report looks beyond the data on depression in Europe and describes what good care could look like over the next decade.