Expanding affordable access to mental health care: WHO/Europe outlines lessons from 4 countries

Mental health care needs are rising across the WHO European Region, adding to pressure on health systems already facing long waiting times, gaps in coverage and shortages of health workers. To support countries in improving affordable access to mental health care, WHO/Europe has published 4 new briefs, highlighting the role of health financing reforms in addressing existing barriers to access.

Based on the experience of Czechia, Estonia, Finland and Ireland, each brief focuses on reforms in one country but offers lessons for other countries wanting to make mental health care more accessible, particularly for people with low incomes and for children and adolescents.

"Across the Region, countries are finding new ways to remove barriers and make access to mental health care more affordable for people - from expanding community-based and primary care mental health services to adopting targeted programmes to reach those who need them the most," said Dr Natasha Azzopardi-Muscat, Director of the Division of Health Systems at WHO/Europe.

"The 4 countries show that with the right mix of financing and service delivery reforms, workforce and infrastructure investments, as well as political commitment, it is possible to reduce waiting times, strengthen early intervention and protect people from financial hardship when seeking mental health care."

The briefs - and more detailed comparative data on financial protection - are featured on UHC Watch, an online platform tracking progress on affordable access to health care in Europe and central Asia.

Shared lessons

Despite differences in context, the briefs highlight policy lessons for countries across the Region.

• A clear vision for the service delivery model, combined with stable funding and upfront investment in infrastructure and capacity planning, are crucial to pilot and expand mental health care reforms and ensure timely access to services.
• Strong governance is essential to ensure adequate financing and delivery of mental health care and maintain long-term reform momentum.
• Strengthening primary care and community-based mental health care can reduce waiting times, enhance early intervention and improve continuity of care.
• Reducing long waiting times and regional variation in access requires stable funding, targeted investment to address staff shortages and investment in infrastructure and capacity planning.
• Protecting people from user charges (co-payments) for mental health care, helps to reduce out-of-pocket payments, financial hardship and unmet need, particularly for people with low incomes - for example, by introducing automatic exemptions from co-payments for people with low incomes and an automatic income-based cap on all co-payments.
• Aligning provider payment mechanisms and incentives with reform objectives and strengthening clinical leadership helps to ensure continuity in expanding access to mental health care.
• Improving cross-sectoral collaboration through better alignment of financing objectives and coordination between health and social care is needed to strengthen preventative interventions and sustain reform progress.
• Digital tools can improve access to mental health care but must be used carefully to address safety, quality and equity concerns.
• Monitoring service use, quality of care and funding flows and evaluating reform effectiveness can help to identify gaps, strengthen accountability and provide evidence in support of further expansion.

Leveraging European Union funds to improve access to community-based mental health care

Czechia has used European Union (EU) funds to develop community mental health centres. These centres have expanded access to more person-centred mental health care, improved functioning and quality of life for people with severe mental health conditions and reduced hospitalizations. Although the Czech case focuses on the use of EU funds, the lessons apply to any external or domestic targeted funding used to scale up new models of health service delivery.

Increasing the role of primary health care in addressing mental health conditions

Estonia has experienced a gradual evolution in mental health service delivery and financing at the primary care level. This achievement has involved the use of multiple policy instruments including changes to primary health care financing to foster a multidisciplinary approach and stimulate the delivery of mental health services; the development of policy frameworks and clinical guidelines; the use of e-consultations between family doctors and psychiatrists; and greater use of remote mental health consultations and psychotherapy in primary health care.

Improving access to mental health care for children and adolescents

Finland's health system has struggled to meet a growing need for mental health care, particularly in young people. To address this, Finland has recently introduced a series of reforms aiming to expand early intervention and service delivery for children and adolescents with mild to moderate mental health conditions in primary health care. Key measures have focused on introducing waiting time guarantees, increasing mental health service delivery in primary health care and adopting a national mental health strategy.

Improving access to mental health care for people with low incomes

Ireland has recently introduced reforms to improve access to mental health care for people with low incomes. The Counselling in Primary Care programme - a national programme providing community-based counselling for people with mild to moderate mental health conditions who have low incomes and are eligible for publicly financed access to primary health care (people with a medical card) - has contributed to better mental health in people with low incomes and has been highly effective in reducing the risk of self-harm and suicide.

About WHO/Europe's work on financial protection

WHO/Europe monitors affordable access to health care through the WHO Barcelona Office for Health Systems Financing, using regional indicators that are sensitive to equity. Financial protection is central to universal health coverage and is a key dimension of health system performance assessment. It is an indicator of the Sustainable Development Goals, part of the European Pillar of Social Rights and at the heart of the second European Programme of Work, WHO/Europe's strategic framework.

Explore country-level and comparative data and analysis on UHC Watch.

These briefs and UHC Watch have benefited from financial assistance from the EU through the EU4Health programme.