REFERENCE DOCUMENTS

Development of the International Classification of Mental Health Care (ICMHC)

OBJECTIVE: Evaluations of the process of providing mental health care have been hampered because a tool to systematically describe the interventions actually provided by the services was lacking. In this paper the development of such a tool (the International Classification of Mental Health Care; ICMHC) is described. METHOD: Subsequent versions of the ICMHC were developed, using comments from experts in 24 WHO field centres and results from a number of field trials. In the final version 10 Modalities of Care can be used to describe Modules of Care, using the Level of Specialization scale. The inter-rater reliability of this version was evaluated by the Italian research team, using data from 43 services. RESULTS: Reliability ranged from excellent for nine modalities to reasonably good for the remaining modality. CONCLUSION: In the context of evaluation studies, the ICMHC can be used to describe systematically mental health care interventions. (Source: PubMed)

Complete reference: de Jong, A (2000). Development of the International Classification of Mental Health Care (ICMHC). Acta Psychiatr Scand Suppl 405:8-13

International Classification for Health Accounts (ICHA)

National Health Accounts usually take the form of two-dimensional tables cross-classifying expenditure by health care providers/programmes and by sources of funding. Country-specific mixtures of institutional and functional criteria are currently used to classify health care providers. The resulting items (such as "general hospital", "maternity clinic and "family doctor") have different contexts across countries, and mean that the overall categories of health spending differ between countries and change over time. Over two decades of experience with international comparisons and health policy analysis at national level suggest that the separation of the institutional and functional aspects of health care services into two separate dimensions of reporting is essential to health accounting for international comparisons. This separation is also an indispensable tool for improving comparisons over time within National Health Accounts. This principle, only recently introduced in health accounting, has long been observed and applied in other data collection exercises for functionally defined fields of specific interest for public policy such as education, research and development, and social protection in general. Consequently, the SHA is organised around a tri-axial system for the recording of health expenditure, using the newly proposed International Classification for Health Accounts (ICHA ), which defines: health care by function (ICHA-HC), health care service provider industries (ICHA-HP) and sources of funding for health care (ICHA-HF). These proposed classifications provide basic links with non-monetary data such as employment and other resource statistics. Existing national and international classifications served as the starting point for the proposed classifications

Complete reference: OECD (2000). International Classification for Health Accounts (ICHA). Paris, OECD.

External link: International Classification for Health Accounts - online

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International Classification of Functioning, Disability and Health (ICF)

The International Classification of Functioning, Disability and Health, known more commonly as ICF, is a classification of health and health-related domains. These domains are classified from body, individual and societal perspectives by means of two lists: a list of body functions and structure, and a list of domains of activity and participation. Since an individual’s functioning and disability occurs in a context, the ICF also includes a list of environmental factors. The ICF puts the notions of ‘health’ and ‘disability’ in a new light. It acknowledges that every human being can experience a decrement in health and thereby experience some degree of disability. Disability is not something that only happens to a minority of humanity. The ICF thus ‘mainstreams’ the experience of disability and recognises it as a universal human experience. By shifting the focus from cause to impact it places all health conditions on an equal footing allowing them to be compared using a common metric – the ruler of health and disability. Furthermore ICF takes into account the social aspects of disability and does not see disability only as a 'medical' or 'biological' dysfunction. By including Contextual Factors, in which environmental factors are listed ICF allows to records the impact of the environment on the person's functioning. Chapter 5 (Services, systems and policies) is about: 1. Services that provide benefits, structured programmes and operations, in various sectors of society, designed to meet the needs of individuals. (Included in services are the people who provide them.) Services may be public, private or voluntary, and may be established at a local, community, regional, state, provincial, national or international level by individuals, associations, organizations, agencies or governments. The goods provided by these services may be general or adapted and specially designed. 2. Systems that are administrative control and organizational mechanisms, and are established by governments at the local, regional, national, and international levels, or by other recognized authorities. These systems are designed to organize, control and monitor services that provide benefits, structured programmes and operations in various sectors of society. 3. Policies constituted by rules, regulations, conventions and standards established by governments at the local, regional, national, and international levels, or by other recognized authorities. Policies govern and regulate the systems that organize, control and monitor services, structured programmes and operations in various sectors of society. (Source: World Health Organization website. Programs and projects. Classifications. International Classification of Functioning, Disability and Health (ICF).)

External link: WHO - International Classification of Functioning, Disability and Health (ICF)

International Classification of Health Interventions (ICHI)

The purpose of this classification is to provide Member States, health care service providers and organizers, and researchers with a common tool for reporting and analysing the distribution and evolution of health interventions for statistical purposes. It is structured with various degrees of specificity for use at the different levels of the health systems, and uses a common accepted terminology in order to permit comparison of data between countries and services. An initial ICHI version is being adapted to meet present day conformance criteria with recognized standards. In particular, the multiple application areas of such a classification calls for a multiaxial capture of the underlying knowledge. Furthermore rapid change in science and technology implies frequent updates. Adequate technical solutions must therefore be developed. The Family Development Committee of the Network of WHO Collaborating Centers for the Family of international Classifications is actively developing plans and canvassing support to that end. (Source: World Health Organization website. Programmes and projects. Classifications. International Classification of Health Interventions (ICHI).)

External link: WHO - International Classification of Health Interventions (ICHI)

International Statistical Classification of Diseases and Related Health Problems (ICD)

ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as from 1994. The classification is the latest in a series which has its origins in the 1850s. The first edition, known as the International List of Causes of Death, was adopted by the International Statistical Institute in 1893. WHO took over the responsibility for the ICD at its creation in 1948 when the Sixth Revision, which included causes of morbidity for the first time, was published. The World Health Assembly adopted in 1967 the WHO Nomenclature Regulations that stipulate use of ICD in its most current revision for mortality and morbidity statistics by all Member States. The ICD is the international standard diagnostic classification for all general epidemiological, many health management purposes and clinical use. These include the analysis of the general health situation of population groups and monitoring of the incidence and prevalence of diseases and other health problems in relation to other variables such as the characteristics and circumstances of the individuals affected, reimbursement, resource allocation, quality and guidelines. It is used to classify diseases and other health problems recorded on many types of health and vital records including death certificates and health records. In addition to enabling the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes, these records also provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States. (Source: http://www.who.int/classifications/icd/en/)

Complete reference: World Health Organization. International Statistical Classification of Diseases and Related Health Problems. Tenth edition ICD-10. WHO Library Cataloguing-in-Publication Data. Geneva, 2004.

External link: WHO - International Classification of Diseases (ICD)

A conceptual framework for mental health services: the matrix model

Background. The reform of mental health services needs to be guided by an overall conceptual framework. Such a framework is important to avoid many risks, including extrapolating from a specific service site to other services, without taking into account local and regional variables. Methods. A conceptual framework, the 'matrix model', is proposed. This model has been developed using the most relevant information that is necessary for describing and interpreting mental health services data as well as patient-based information. Results. The 'matrix model' has two dimensions: the geographical, which refers to three levels (country, local and patient) and the temporal, which refers to three phases (inputs, processes and outcomes). Using these two dimensions a nine-cell matrix is constructed to bring into focus critical issues for mental health services. The relevance of each level and each phase is briefly presented. Conclusions. The matrix is intended to assist clinicians, planners and researchers to deal with clinical phenomena, organizational issues, and research questions that share a degree of complexity that render inadequate analyses and the interventions made only at one level. The matrix model applies particularly to mental health systems of care that are provided with a public health framework, and is less useful for contexts that consist of clinicians offering only one-to-one treatments, within fragmented programmes of care.

Complete reference: Tansella M, Thornicroft G. A conceptual framework for mental health services: the matrix model. Psychol Med 1998; 28: 503-508.

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Comparative study of mental health services availability and use in Chile and Spain

There is an enormous interest about improving international comparisons to provide relevant information for policy and planning in mental health. Most of the available information is provided at the macro-level (countries or regions). However, information gathered at the meso-level may diverge from data aggregated at higher territorial levels. This study describes the comparison on availability and use of mental health services between Chile and Spain.

Complete reference: Romero C, Salinas JA, Saldivia S, Grandón P, Poole M, Salvador-Carulla L, García Gutiérrez JC. Comparative study of mental health services availability and use in Chile and Spain. International Journal of Integrated Care 2009: 9.

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Development and usefulness of an instrument for the standard description and comparison of services for disabilities based on a mental healthcare assessment model (DESDE)

Objective: Mental health research has made significant progress in international comparison and instrument development. This study reports the adaptation of the European Service Mapping Schedule (ESMS) to the assessment of services for persons with disabilities. Method: Qualitative groups were used to develop the Description and Evaluation of Services for Disabilities in Europe (DESDE). The psychometric analysis of DESDE covered: feasibility, inter-rater reliability, descriptive validity and internal validity. A demonstration study was also carried out. Results: Compared to the original ESMS, a new main branch and several sub-branches were added. We identified 826 services for persons with disabilities, which provided 1284 main types of care. The feasibility and reliability was good for the majority of codes. Only 6% of services were not properly classified. The Boolean factor analysis supported the internal validity of DESDE. Conclusion: DESDE is a useful and reliable instrument for the assessment of services for persons with disabilities.

Complete reference: Salvador-Carulla L, Poole M, González-Caballero JL, Romero C, Salinas JA, Lagares-Franco CM for RIRAG/PSICOST Group and DESDE Expert Panel. Development and usefulness of an instrument for the standard description and comparison of services for disabilities based on a mental healthcare assessment model (DESDE). Acta Psychiatr Scand 2006; 111(Suppl. 432): 19-28

External link: Access to article at Wiley

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Descripción estandarizada de los servicios de discapacidad para ancianos en España. IMSERSO

Descripción y clasificación estandarizada de los servicios destinados a personas mayores en situación de dependencia llevada a cabo con el objetivo de mejorar su gestión y planificación. Para ello se realizó un estudio de consenso realizado por un grupo de expertos mediante la técnica de Paneles Delphi modificada, efectuando una adaptación conceptual de contenido y de aceptabilidad del instrumento para la población diana. El instrumento elaborado fue el Diagrama Estandarizado de Servicios para Mayores en situación de Dependencia (DES-MD), cuestionario que se sirve de un sistema de diagramas que permiten la categorización de los servicios y el nivel de utilización de los mismos por parte de los usuarios del área seleccionada. Dicho instrumento es una adaptación de la Escala para la Descripción Estandarizada de Servicios para Personas con Discapacidad en España (DESDE). La unidad de análisis ha sido el servicio sociosanitario para personas de 60 años o más, en situación de dependencia. Se define servicio sociosanitario como "las unidades más pequeñas, con estructura administrativa propia, dentro del sistema local de atención sociosanitaria". Los resultados obtenidos en este estudio son de gran utilidad ya que permiten obtener un instrumento válido para la evaluación de servicios para personas mayores en situación de dependencia.

Complete reference: Salvador-Carulla L (2009). Descripción estandarizada de los servicios de discapacidad para ancianos en España. IMSERSO. (Spanish)

Classification, assessment and comparison of European LTC services. Development of an integrated system

Article published in the special Eurohealth issue on ageing and long-term care

Complete reference: Luis Salvador-Carulla, Cristina Romero, Germain Weber, Hristo Dimitrov, Lilijana Sprah, Britt Venner and David McDaid for the eDESDE-LTC Group (2011). Classification, assessment and comparison of European LTC services. Development of an integrated system. Eurohealth 17(2–3): 27-29.

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DESDE-LTC: EVALUATION AND CLASSIFICATION OF SERVICES FOR LONG TERM CARE IN EUROPE

This book arises from the project eDESDE-LTC which received funding from the European Union in the framework of the Health Programme

Complete reference: Salvador-Carulla L., Dimitrov H., Weber G., McDaid D., Venner B., Sprah L., Romero C., Ruiz M., Tibaldi G., Johnson S., for DESDE-LTC Group (eds.) (2011) DESDE-LTC: EVALUATION AND CLASSIFICATION OF SERVICES FOR LONG TERM CARE IN EUROPE. Spain: Psicost and Catalunya Caixa.

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A. Executive Summary

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B. Introduction and development of the system

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C. Nominal groups

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D. Classification and coding system

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E. Instrument - Mapping tree

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F. Usability of the eDESDE-LTC instrument: Feasibility, consistency, reliability and validity

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G. Training package

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H. Website technical report

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I. Pilot study: Comparison of availability of services for Long Term Care in Madrid (Spain) and Sofia (Bulgaria)

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J. Quality assessment and evaluation package

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K. References

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Assessment instruments: standardization of the European Service Mapping Schedule ESMS in Spain

The objective of the study was to adapt the European Service Mapping Schedule (ESMS) for use in Spain and assess its quality.

Complete reference: Salvador L, Romero C, Martínez A, Haro JM, Bustillo G, Ferreira A, Gaite L, Johnson S for the PSICOST Group. Assessment instruments: standardization of the European Service Mapping Schedule ESMS in Spain. Acta Psychiatrica Scandinavica, (suppl) 405 (102), 24-32, 2000.

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Patterns of mental health service utilisation in Italy and Spain: an investigation using the European Service Mapping Schedule

BACKGROUND: Methods for comparing local mental health service systems are needed to allow identification of different patterns of service provision and of inequities within and between countries. AIM : The aim of this study was to describe and compare mental health service systems in 13 catchment areas in Spain and Italy. Within each country, a range of area characteristics was represented. METHOD: The European Service Mapping Schedule (ESMS) and European Socio-Demographic Schedule (ESDS) were used to describe: (i) socio-demographic and geographical area characteristics; (ii) services provided; and (iii) service utilisation in each area. RESULTS: Great differences emerged in patterns of service provision and use between and within countries. In contrast to Northern Europe, high unemployment rates were not associated with high service utilisation rates, but areas with large numbers of single-person households tended to have high service use. Most service utilisation rates were substantially below those reported from Northern European studies. Spanish centres tended to have low rates of hospital service utilisation despite limited development of community-based services. Trieste, where there has been a strong emphasis on developing innovative community services, showed a distinctive pattern with low hospital bed use and high rates of day service use and of contacts in the community. CONCLUSION: This methodology yielded useful data, which raise significant questions regarding equity and the implementation of mental health policy. The very large variations indicate that underlying local patterns of service provision must be investigated and taken into account in the interpretation of research evaluations of interventions

Complete reference: Salvador-Carulla, L., Tibaldi, G., Johnson, S., Scala, E., Romero, C., & Munizza, C. Patterns of mental health service utilisation in Italy and Spain: an investigation using the European Service Mapping Schedule. Social Psychiatry and Psychiatric Epidemiology, 40(2):149-59, 2005

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The European Service Mapping Schedule (ESMS): development of an instrument for the description and classification of mental health services

Instrument for the description and classification of mental health services and for measurement of service use. Purposes to be served by the instrument include: (i) identification of gaps in the spectrum of services in a catchment area; (ii) obtaining background information which may be important to understanding why apparently similar interventions lead to different outcomes in different areas; (iii) investigating how introduction of a particular type of service influences use of other local services; and (iv) understanding the relationship between sociodemographic factors and service use. Method: The instrument was developed through meetings of an international expert panel and pilot stages in several European countries. Results: Use of the European Mapping Service Mapping Schedule (ESMS) appears feasible in several countries and allowed description and classification of the full range of services identified within each of the study catchment areas. Conclusion: The ESMS promises to fill a gap in the technology available for mental health services research. Further practical experiences of its use for a variety of purposes in a variety of settings are now needed to indicate how far the ESMS does successfully generate data which are useful to researchers and planners. (Source: Abstract Johnson et al, 2000)

Complete reference: Johnson S, Kuhlmann R and the EPCAT Group. The European Service Mapping Schedule (ESMS): development of an instrument for the description and classification of mental health services. Acta Psychiat Scand 2000; 102 (Suppl. 405): 14-23

The mental health system in Brazil: Policies and future challenges

BACKGROUND: The aim of this paper is to assess the mental health system in Brazil in relation to the human resources and the services available to the population. METHODS: The World Health Organization Assessment Instrument for Mental Health Systems (WHO AIMS) was recently applied in Brazil. This paper will analyse data on the following sections of the WHO-AIMS: a) mental health services; and b) human resources. In addition, two more national datasets will be used to complete the information provided by the WHO questionnaire: a) the Executive Bureau of the Department of Health (Datasus); and b) the National Register of Health Institutions (CNS).

Complete reference: Mateus MD, Maril JJ, Delgado PGG, Almeida-Filho N, Barrett T, Gerolin J, Goihman S, Razzouki D, Rodriguez J, Weber R, Andreoli SB and Saxena S. (2008) The mental health system in Brazil: Policies and future challenges. International Journal of Mental Health Systems 2008, 2:12 doi:10.1186/1752-4458-2-12.

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Utilização dos Centros de Atenção Psicossocial (CAPS) na cidade de Santos, São Paulo, Brasil

To report on the clientele treated at community mental health services (CAPS) in the city of Santos, São Paulo, Brazil, a census was conducted of the patients examined at the services from June 1, 2001, to June 30, 2001. The patient’s initial contact with the service was registered, and data were recorded on a standardized form, using the medical case history as a source of information. Among the 1,673 patients, average age was 46 years, 59.0% were female, 58.0% lived with their families, and mean duration of treatment was three years. Some 38.0% were schizophrenic, schizotypical, or in acute delusional states, 31.0% presented mood disorders, and 17.0% were neurotic. Treatment modalities included out-patient psychiatric (81.0%), individual (23.0%), group (13.0%), and psychosocial rehabilitation (4.3%). In Santos, CAPS treat all categories of mental disorders (and frequently those considered the most severe cases) expected at this type of service. The treatment model is that of an out-patient psychiatric clinic.

Complete reference: Baxter Andreoli S, de Souza B Ronchetti S, Pimenta de Miranda AL, Rodrigues Monteiro Bezerra C, Pestana de Barros Magalhães CC, Martin D and Ferreiro Pinto RM. (2004) Utilização dos Centros de Atenção Psicossocial (CAPS) na cidade de Santos, São Paulo, Brasil. Cad Saúde Pública, Rio de Janeiro, 20(3):836-844.

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Coding long-term care services—eDESDE-LTC

Complete reference: Salvador-Carulla L, Poole M, Bendeck M, Romero C, Salinas JA (2009). Coding long-term care services—eDESDE-LTC. International Journal of Integrated Care Vol.9 (Conference Supplement).

External link: Bridging Knowledge in Long Term Care - IJIC Conference Supplement

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Development of an integrated system for classification, assessment and comparison of services for long-term care in Europe (eDESDE-LTC)

European Psychiatric Services: Inputs Linked to Outcome Domains and Needs. Provision of services for people with schizophrenia in five European regions

Background: An increasing diversity of public, voluntary sector and private providers offer services for the mentally ill in the ongoing process of psychiatric reform. Good service description is one important prerequisite for mental health service research. Aims: 1) To describe service provision for the mentally ill in five European centres using the European Service Mapping Schedule (ESMS); and 2) to discuss the use of the instrument in describing service provision. Methods: All services providing care for people with severe mental illness in five European catchment areas (in Amsterdam, the Netherlands; Copenhagen, Denmark; London, UK; Santander, Spain; Verona, Italy) were identified through various sources. The identified services were classified, and service provision was quantified in accordance with the ESMS manual. Descriptive information was obtained. Results: We identified from 10 to 45 different services for catchment areas of between 50,000 (Copenhagen) and 560,000 (Santander) population run by three to 16 providers. They varied in aims, staffing and functioning. Hospital and non-hospital residential services, community-based services, and social support agencies were available in all sites. There was substantial variation across centres in the range, number and activities of services. Collecting comparable data sets on all service types, particularly for day and structured activity services and outpatient and community services required substantial effort. Conclusion: Operationalised description of mental health services across Europe is possible but requires further refinement.

Complete reference: Becker T, Hulsmann S, Knudsen HC, Martiny K, Amaddeo F, Herran A, Knapp M,Schene AH, Tansella M, Thornicroft G, Vazquez-Barquero JL; EPSILON Study Group. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs. Provision of services for people with schizophrenia in five European regions. Soc Psychiatry Psychiatr Epidemiol. 2002; 37(10):465-74

Refinement Project - Summary

Summary of the REFINEMENT project. Presents the aim, objectives and expected results of the project funded under EU European Union Seventh Framework Programme (FP7/2007-2013). Three of the toolkits being developed are briefly described.

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The OECD Health Project: Long Term Care for Older People

The study set out differences in long-term care expenditures and services and evaluated recent policy developments in 19 OECD countries.

Complete reference: OECD. The OECD Health Project: Long Term Care for Older People. Paris: OECD Publishing; 2005.

External link: Additional project information

European Union High level group on health services and medical care- Report

The 2003 report of the patient mobility reflection process represented a political milestone by recognising the potential value of European cooperation in helping Member States to achieve their health objectives. The Commission set out its response to the report of the reflection process in Communication COM (2004) 301 of 20 April 2004. The primary mechanism for taking forward the work set out in the Communication was to establish a High Level Group on health services and medical care. This High Level Group started work in July 2004.

Complete reference: European Union High level group on health services and medical care- Report. Brussels, 2004

External link: EU - High Level Group on Health Care

Feasibility Study – Comparable Statistics in the Area of Care of Dependent Adults in the European Union

Complete reference: Commission of the European Communities: Feasibility Study –Comparable Statistics in the Area of Care of Dependent Adults in the European Union. Papers and Studies. Luxembourg: Office for Official Publications of the European Communities, 2003.

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Glossary of Terms: Disability, Aging and Long Term Care

General information about words and terms associated with aging, disability or long-term care. The glossary was compiled by the Assistant Secretary for Planning and Evaluation of the US Department of Health & Human Services.

Complete reference: Office of Disability, Aging, and Long-Term Care Policy. Glossary of Terms. United States. Department of Health and Human Services. 12 November 2003 [cited 2009, January the 18th]

External link: Glossary of Terms Online

Indicators predicting use of mental health services in Piedmont, Italy

Background: Since the 1978 Italian reform, an integrated network of community mental health services has been introduced. With few exceptions, research on determinants of mental health service use at the district level has focused on inpatient activities and social deprivation indicators. The European Psychiatric Care Assessment Team (EPCAT) standardized methodology allows for an evidence-based comparison of mental health systems between geographical areas. Aims: To compare service provision and utilization between local catchment areas; to explore quantitative relationships between residential and community service use and socio-demographic indicators at the ecological level.

Complete reference: Tibaldi G, Munizza C, Pasian S, Johnson S, Salvador-Carulla L, Zucchi S, Cesano S, Testa C, Scala E, Pinciaroli L. Indicators predicting use of mental health services in Piedmont, Italy. J Ment Health Policy Econ. 2005;8(2):95-106.

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International experiments in integrated care for the elderly: a synthesis of the evidence

BACKGROUND: The OECD countries have recently promoted policies of deinstitutionalisation and community-based care for the elderly. These policies respond to common cost pressures associated with population aging, and the challenge of providing improved care for the elderly. They aim to substitute less costly services for institutional ones, to improve patient satisfaction and decrease expenses. However, views concerning their success are mixed. We took a comparative cross-national approach to examine the evidence, to identify common features of an effective system of integrated care, and to examine the potential of such models to positively affect care of the elderly, and public finances. METHODS: We conducted a systematic review of recent demonstration projects testing innovative models of care for the elderly in OECD countries. Projects included aimed to create comprehensive integration of acute and long-term care services, and were evaluated using a comparison group. RESULTS: For each project, we report available results on rates of hospitalisation, long term care institutionalisation, utilisation and costs, impact on process of care, and health outcomes. In addition, the following common features of an effective integrated system of care were identified: a single entry point system; case management, geriatric assessment and a multidisciplinary team; and use of financial incentives to promote downward substitution. CONCLUSIONS: Community-based care can impact favourably on rates of institutionalisation and costs. Comprehensive approaches to program restructuring are necessary, as cost-effectiveness depends on characteristics of the system of care. Expansion of successful programmes to achieve widespread use remains a critical challenge.

Complete reference: Johri M, Beland F, Bergman H. International experiments in integrated care for the elderly: a synthesis of the evidence. Int J Geriatr Psychiatry. 2003;18(3):222-35.

Measurement of consumer outcome in mental health: A report to the National Mental Health Information Strategy Committee

Complete reference: Andrews G, Peters L, Tesson, M. Measurement of consumer outcome in mental health: A report to the National Mental Health Information Strategy Committee. Sydney: Clinical Research Unit for Anxiety Disorders, 1994.

External link: Measuring Consumer Health Outcomes in Public Mental Health Services in Victoria, Australia

Metodología aplicada a la evaluación de procedimientos diagnósticos y terapéuticos

Complete reference: Lacalle JR, Pastor L, Reyes A, Pérez MJ, Alvarez R. Metodología aplicada a la evaluación de procedimientos diagnósticos y terapéuticos. En: Berra A, Marín I, Alvarez R eds. Consenso en Medicina. Metodología de expertos. Granada: Escuela Andaluza de Salud Pública; 1996. p. 53-55.

Prospective health impact assessment: pitfalls, problems, and possible ways forward

"The general objective of such assessments is to improve knowledge about the potential impact of a policy or programme, inform decision-­makers and affected people, and facilitate adjustment of the proposed policy in order to mitigate the negative and maximize the positive impacts.” European Centre for Health Policy

Complete reference: Parry J, Stevens A. Prospective health impact assessment: pitfalls, problems, and possible ways forward. BMJ. 2001; 323(7322):1177-82.

Mental health services in pilot study areas: Report of on a European study

Complete reference: WHO Regional Office for Europe: Mental health services in pilot study areas: Report of on a European study. Copenhagen: WHO Regional Office for Europe, 1987.

Mental Health: Evidence and Research Department of Mental Health and Substance Abuse

Project Atlas of the Department of Mental Health and Substance Abuse is designed to collect, compile and disseminate data on mental health and neurology resources in the world. Resources include policies, programmes, financing, services, professionals, treatment and medicines, information systems and related organizations. These resources are necessary to provide services and care for people with mental, behavioural and neurological diseases/disorders. The primary objective of the project is to raise public and professional awareness of the inadequacies of existing resources and services and the large inequities in their distribution at national and global level. The information is also useful in planning for enhancement of resources.

Complete reference: World Health Organization. World Mental Health Atlas: 2005. Mental Health: Evidence and Research Department of Mental Health and Substance Abuse. Geneva, WHO, 2005.

External link: Mental Health Atlas 2005 - online

The Ljubljana Charter on Reforming Health Care

The purpose of this Charter is to articulate a set of principles which are an integral part of current health care systems or which could improve health care in all the Member States of the World Health Organization in the European Region. These principles emerge from the experience of countries implementing health care reforms and from the European health for all targets, especially those related to health care systems.

Complete reference: World Health Organization (1996). The Ljubljana Charter on Reforming Health Care. Copenhagen: WHO Regional Office for Europe.

External link: The Ljubljana Charter on Reforming Health Care - online