Moving beyond the mental health care system: An exploration of the interfaces between health and non-health sectors

Background: Many interventions both to promote good mental health and to tackle the consequences of poor mental health may be funded and/or delivered outside the health care sector. Aims: To describe the interfaces between health and other sectors, particularly social care, in 17 European countries, and to look at potential ways in which challenges to the efficient and fair delivery of services across sectors may be overcome. Methods: A structured questionnaire was completed by partners in the Mental Health Economics European Network (MHEEN) to review the extent to which mental health related services are funded and delivered outside the health care sector, with a particular emphasis on social care services. This was augmented by a review of the literature. Results: The boundaries between health and other sectors differ across and within countries. The provision and funding of services may be highly fragmented and poorly coordinated, with little incentive for funding to follow individuals along the care pathway. Out-of-pocket payments for non-health sector services can be substantial and much responsibility may fall to families. Conclusions: Differing rules of entitlement, as well as fragmentation and poor coordination between health and non-health services can act as barriers to a truly holistic approach to mental health across Europe. Useful insights on how to overcome some of these barriers may be drawn from experiences of joint working and innovative financing arrangements in respect of older people and those with physical disabilities. However as yet there have been comparatively few attempts to smooth the sector interfaces that confront those with mental health needs