Introduction

Mental health warrants a dedicated chapter within this book as it accounts for 14% of the global burden of disease. An estimated 450 million people worldwide are affected by mental health problems at any given time and one in five people will experience a psychiatric disorder (excluding dementia) within any given year (Horton 2007; WHO Regional Office for Europe 2003). Moreover, as we will indicate, assessment of the performance of mental health services presents challenges that may be unique within health care.

Within Europe, mental health problems account for approximately 20% of the total disability burden of ill health but often appear to be a lower policy priority than many other areas of health. This is despite the fact that nearly all countries readily admit that poor mental health has major impacts, not only on health but also on many other sectors of the economy (Taipale 2001).

The costs of poor mental health are conservatively estimated to account for 3%-4% of GDP in the European Union (EU) alone, yet none of these countries actually spends much more than 1% of GDP on mental health (Knapp et al. 2007). Differences in the boundaries between health and social care make cross-country comparisons difficult but health system funding for mental health in the EU ranges from almost 14% in England to much less than 4% in other countries including Bulgaria, the Czech Republic, Poland and Portugal.