Definitions
Mental health promotion aims to protect, support and sustain emotional and social well-being and create individual, social and environmental conditions that enable optimal psychological and psychophysiological development and improve the coping capacity of individuals. Mental health promotion refers to positive mental health rather than mental ill health.
a stigma is a distinguishing mark establishing a demarcation between the stigmatized person and others attributing negative characteristics to this person.
the stigma attached to mental illness often leads to social exclusion and discrimination and creates an additional burden for the affected individual.
Mental disorder prevention focuses on reducing risk factors and enhancing protective factors associated with mental ill health with the aim of reducing the risk, incidence, prevalence and recurrence of mental disorders.
and radio broadcasts and single awareness- raising events.
Of the 36 countries indicating that programmes have been implemented, only 7 said that the activities have been evaluated and the results of evaluation are available. The evaluations show an overall positive effect in terms of raising awareness and sensitivity for mental health–related topics.
Five countries said that no programmes and/
or activities have been implemented during the past five years.
In most of the countries, nongovernmental organizations or government agencies have promoted programmes and activities (Table 4.2). International agencies have been particularly active in countries in south- eastern Europe and CIS countries.
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the United Kingdom (England and Wales) as well as partnerships within Open the Doors, the global anti-stigma programme of the World Psychiatric Association in Germany, Greece, Italy, Poland and Slovakia. There are also local initiatives such as anti-stigma seminars for health professionals about the human rights situation in mental health services and the needs of service users in Latvia.
Few countries reported about evaluation of activities. Where evaluation has taken place, an overall reduction of stigma as a result from the activities has been reported. Zero Stigma in Austria placed 30 000 free cards at public Tackling stigma and discrimination
Programmes and/or activities to tackle stigma and discrimination against people with mental health problems have been implemented in 83% of the countries (Fig. 4.1).
Almost all EU countries, 71% of the countries in south-eastern Europe and 40% of the CIS countries participating in the survey indicated programmes and/or activities (Table 4.3).
Similar to mental health promotion, there is a wide range of anti-stigma activities. There are campaigns carried out by organizations of carers such as Zero Stigma in several European countries, national campaigns such as Shift in
Table 4.2. Extent to which agencies, institutions or services have promoted public education and awareness campaigns on mental health and mental disorders during the past five years in groups of countries
Promoters of campaigns
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South- eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
government agenciesa
Yes 22 81 13 87 9 75 3 100 6 86 3 60 34 81
no 5 19 2 13 3 25 0 0 1 14 2 40 8 19
nongovernmental organizations
Yes 24 89 13 87 11 92 3 100 6 86 4 80 37 88
no 2 7 1 7 1 8 0 0 0 0 1 20 3 7
no information available
1 4 1 7 0 0 0 0 1 14 0 0 2 5
Professional associations
Yes 15 56 9 60 6 50 3 100 5 71 4 80 27 64
no 6 22 1 7 5 42 0 0 1 14 1 20 8 19
no information available
6 22 5 33 1 8 0 0 1 14 0 0 7 17
Private trusts and foundations
Yes 13 48 7 47 6 50 1 33 3 43 1 20 18 43
no 6 22 2 13 4 33 1 33 2 29 3 60 12 29
no information available
8 30 6 40 2 17 1 33 2 29 1 20 12 29
international agencies
Yes 11 41 7 47 4 33 0 0 6 86 4 80 21 50
no 8 30 3 20 5 42 0 0 0 0 1 20 9 21
no information available
8 30 5 33 3 25 3 100 1 14 0 0 12 29
a Such as the ministry of health or department of mental health services.
Table 4.1. Implementation of programmes and/or activities to raise public awareness about mental health and mental disorders during the past five years in groups of countries
Implementation
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Yes 24 89 13 87 11 92 3 100 6 86 3 60 36 86
no 2 7 1 7 1 8 0 0 1 14 2 40 5 12
information not available
1 4 1 7 0 0 0 0 0 0 0 0 1 2
23
them has declined. Open the Doors Düsseldorf in Germany has reduced social distance in the general public by implementing the global anti- stigma programme of the World Psychiatric Association at various levels and in different target groups over years. See Me in the United Kingdom (Scotland) has been thoroughly evaluated (see http://www.seemescotland.org.
uk for its methods and results).
Nongovernmental organizations and government agencies have initiated most of the anti-stigma activities (Table 4.4).
places in Vienna, carried out by the Austrian carer organization HPE (Hilfe für Angehörige und Freunde psychisch Erkrankter) with the support of the European Federation of Associations of Families of People with Mental Illness. This activity led to an increased number of visits at the web site, numerous e-mail enquiries and increased distribution of information booklets. The Bavarian Anti- stigma Action (BASTA) in Germany evaluated workshops with police officers. Attitudes towards people with mental disorders have improved and the social distance towards
Table 4.3. Implementation of programmes and/or activities to tackle stigma and discrimination against people with mental disorders during the past five years in groups of countries
Implementation
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Yes 25 93 13 87 12 100 3 100 5 71 2 40 35 83
no 0 0 0 0 0 0 0 0 2 29 3 60 5 12
information not available
2 7 2 13 0 0 0 0 0 0 0 0 2 5
Table 4.4. Extent to which agencies, institutions or services have run activities to tackle stigma and discrimination against people with mental disorders during the past five years in groups of countries
Implementers of activities
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South- eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
government agenciesa
Yes 16 59 8 53 8 67 3 100 5 71 3 60 27 64
no 6 22 4 27 2 17 0 0 2 29 2 40 10 24
no information available
5 19 3 20 2 17 0 0 0 0 0 0 5 12
nongovernmental organizations
Yes 24 89 12 80 12 100 3 100 4 57 3 60 34 81
no 1 4 1 7 0 0 0 0 2 29 2 40 5 12
no information available
2 7 2 13 0 0 0 0 1 14 0 0 3 7
Professional associations
Yes 9 33 6 40 3 25 2 67 2 29 2 40 15 36
no 10 37 4 27 6 50 0 0 3 43 3 60 16 38
no information available
8 30 5 33 3 25 1 33 2 29 0 0 11 26
Private trusts and foundations
Yes 12 44 9 60 3 25 2 67 2 29 1 20 17 40
no 5 19 1 7 4 33 0 0 3 43 3 60 11 26
no information available
10 37 5 33 5 42 1 33 2 29 1 20 14 33
international agencies
Yes 6 22 4 27 2 17 0 0 3 43 4 80 13 31
no 8 30 3 20 5 42 0 0 2 29 1 20 11 26
no information available
13 48 8 53 5 42 3 100 2 29 0 0 18 43
a Such as the ministry of health or department of mental health services.
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Yes:
Albania, Austria, Belgium, Bosnia and Herzegovina (Federation of Bosnia and Herzegovina and Republika Srpska), Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Israel, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Romania, Russian Federation, Serbia, Slovakia, Slovenia, Spain (Castilla y León, Catalonia, Extremadura and Galicia), Sweden, Switzerland, the former Yugoslav Republic of Macedonia, United Kingdom (England and Wales and Scotland)
No:
Azerbaijan, Montenegro, Moldova, Spain (Murcia), Turkey, Uzbekistan
Information not available:
Ireland, Portugal
Fig. 4.1. Programmes and/or activities to tackle stigma and discrimination in countries
Mental health promotion programmes and activities
Almost forty per cent of the countries indicate that programmes to improve parenting have been implemented during the past five years in all or in the majority of community settings.
Most of the activities mentioned to improve parenting have been implemented over a longer period, are still ongoing and, in some cases, are integrated in national policy and government action plans (Table 4.5).
In Austria, several nongovernmental organizations have carried out the parenting skills training programme Elternbildung with support from the Federal Ministry of Health, Family and Youth. It has been implemented in all nine provinces to promote nonviolent education and to prevent problems in familial relationships.
Centres for social services for children and families have been established in 10 large cities in Bulgaria since 2006 in the framework of the EU-funded project Reform for Improving the Well-being of Children. The centres provide consultations for families at risk and future foster parents and adoptive parents.
In Germany, a national Prevention Prize (€50 000) under the motto “Enhancing the Competency of Parents during Pregnancy and Early Childhood” was awarded in 2006.
Programmes to promote the mental health of children and adolescents are available in more than half the schools in more than 40% of the countries. The activities range from workshops on conflict resolution and social and emotional learning to overarching programmes that address several topics specific to target groups.
Six countries responded that they have no promotion activities in schools (Table 4.6).
Table 4.5. Implementation of programmes and/or activities to improve parenting during the past five years in groups of countries
Programmes and/or activities implemented in community or home-based settings
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Yes all or most (81–100%)
8 30 5 33 3 25 1 33 1 14 1 20 11 26
Majority (51–80%)
3 11 1 7 2 17 1 33 1 14 0 0 5 12
some (21–50%)
3 11 3 20 0 0 1 33 1 14 2 40 7 17
a few (1–20%)
6 22 2 13 4 33 0 0 1 14 1 20 8 19
no (0%) 0 0 0 0 0 0 0 0 3 43 1 20 4 10
information not available
7 26 4 27 3 25 0 0 0 0 0 0 7 17
25
The results for promoting the mental health of older people were similar to those in the workplace. Only 4 of 42 countries have activities reaching all or almost all older people:
Denmark, Luxembourg, Spain (Catalonia) and the United Kingdom (Scotland). More than half the countries have no or few programmes available. The implemented activities focus on physical activity, self-help and memory training (Table 4.8).
In all three areas, raising public awareness, tackling stigma and discrimination and mental health promotion, countries indicated that conducting public campaigns, working with the mass media, holding high-level expert meetings and involving governments as the main activities initiated and developed since 2005.
Austria implemented Eigenständig werden (Promoting Independence), a programme that combines personality development, health promotion, promoting life skills and preventing addiction and violence in primary schools among children 6–10 years old in about 600 schools by 2006. The Austrian Health Promotion Foundation co-funded this.
In contrast to the findings about the relatively high availability of school programmes, few countries indicate programmes and/or activities to promote mental health at the workplace. Only Belgium, the Netherlands, Norway and Slovenia report that activities are available in all or most workplaces. Twenty-six of the 42 countries report no promotion activities or only in 1–20% of workplaces. The available activities focus on managing stress and preventing burnout and bullying. Almost no activities have been evaluated according to the responses from countries (Table 4.7).
Table 4.6. Implementation of programmes and/or activities in schools to promote the mental health of children and adolescents during the past five years in groups of countries
Programmes and/or activities implemented in schools
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Yes all or most (81–100%)
2 7 0 0 2 17 0 0 1 14 1 20 4 10
Majority (51–80%)
8 30 5 33 3 25 2 67 2 29 1 20 13 31
some (21–50%)
2 7 1 7 1 8 1 33 2 29 0 0 5 12
a few (1–20%)
11 41 6 40 5 42 0 0 1 14 1 20 13 31
no (0%) 3 11 2 13 1 8 0 0 1 14 2 40 6 14
information not available
1 4 1 7 0 0 0 0 0 0 0 0 1 2
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Fourteen countries have policies to prevent depression directed towards the whole population and 17 have programmes (Table 4.12).
More of the EU countries have implemented depression prevention programmes than policies.
Programmes and activities to prevent depression show greater diversity of interventions and target groups than health promotion or anti-stigma programmes do.
Austria, Germany and Spain (Catalonia) are partners in the European Alliance against Depression. Bosnia and Herzegovina (Federation of Bosnia and Herzegovina), Czech Republic and Israel reported specific mass- media campaigns and other close collaboration with the mass media. Latvia implemented a Preventing mental disorders
Policies and programmes implemented during the past five years
Eleven of the 42 countries have introduced policies to prevent suicide during the past five years by reducing access to lethal means.
Programmes have been implemented in 11 countries (Table 4.9).
Policies to improve the recognition and treatment of population groups at risk in primary health care have been introduced in 15 countries and programmes in 19.
Similar results have been found for policies and programmes to prevent suicide by recognizing and treating population groups at risk in specialized care: policies have been implemented in 13 countries and programmes in 18 (Tables 4.10 and 4.11).
Table 4.7. Implementation of programmes and/or activities to promote mental health at the workplace during the past five years in groups of countries
Programmes and/or activities implemented in the workplace
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Yes all or most (81–100%)
1 4 1 7 0 0 1 33 0 0 0 0 2 5
Majority (51–80%)
2 7 1 7 1 8 0 0 0 0 0 0 2 5
some (21–50%)
5 19 4 27 1 8 0 0 2 29 0 0 1 17
a few (1–20%)
12 44 6 40 6 50 1 33 1 14 3 60 17 40
no (0%) 4 15 2 13 2 17 0 0 3 43 2 40 9 21
information not available
3 11 1 7 2 17 1 33 1 14 0 0 5 12
Table 4.8. Implementation of programmes and/or activities to promote the mental health of older people during the past five years in groups of countries
Programmes and/or activities reaching older people
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Yes all or almost all (81–100%)
4 15 4 27 0 0 0 0 0 0 0 0 4 10
some (21–50%)
5 19 4 27 1 8 0 0 1 14 1 20 7 17
a few (1–20%)
11 41 5 33 6 50 2 67 3 43 1 20 17 40
none (0%) 3 11 0 0 3 25 0 0 2 29 2 40 7 17
information not available
4 15 2 13 2 17 1 33 1 14 1 20 7 17
27
In Germany, a Competency Network for Depression and Suicidality has been established, a national network aimed at optimizing research and care related to depressive disorders funded by the Federal Ministry for Education and Research.
crisis phone line. In Belgium and especially in the Flemish region, a public campaign for the primary prevention of depression: Fit in je hoofd, goed in je vel (Fit in your head, good in your skin) has been run, offering a web site with exercises for mental fitness for preventing depression.
Table 4.9. Implementation of policies or programmes to prevent suicide by reducing access to lethal means during the past five years in groups of countries
Policies and programmes implemented
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Policies
Yes 5 19 3 20 2 17 2 67 3 43 1 20 11 26
no 19 70 11 73 8 67 1 33 4 57 4 80 28 67
information not available
3 11 1 7 2 17 0 0 0 0 0 0 3 7
Programmes
Yes 8 30 7 47 1 8 2 67 1 14 0 0 11 26
no 16 59 7 47 9 75 1 33 6 86 4 80 27 64
information not available
3 11 1 7 2 17 0 0 0 0 1 20 4 10
Table 4.10. Implementation of policies and programmes to prevent suicide by recognition and treatment of population groups at risk in primary health care during the past five years in groups of countries
Policies and programmes implemented
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Policies
Yes 8 30 7 47 1 8 3 100 3 43 1 20 15 36
no 18 67 8 53 10 83 0 0 4 57 4 80 26 62
information not available
1 4 0 0 1 8 0 0 0 0 0 0 1 2
Programmes
Yes 12 44 8 53 4 33 1 33 4 57 2 40 19 45
no 14 52 7 47 7 58 1 33 3 43 3 60 21 50
information not available
1 4 0 0 1 8 1 33 0 0 0 0 2 5
Table 4.11. Implementation of policies and programmes to prevent suicide by recognition and treatment of population groups at risk in specialized care during the past five years in groups of countries
Policies and programmes implemented
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Policies
Yes 7 26 6 40 1 8 1 33 4 57 1 20 13 31
no 19 70 9 60 10 83 1 33 3 43 4 80 27 64
information not available
1 4 0 0 1 8 1 33 0 0 0 0 2 5
Programmes
Yes 13 48 8 53 5 42 1 33 2 29 2 40 18 43
no 13 48 7 47 6 50 2 67 5 71 3 60 23 55
information not available
1 4 0 0 1 8 0 0 0 0 0 0 1 2
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have post-traumatic stress syndrome, day care centres and hostels for refugees with mental illness have been established in Greece and the former Yugoslav Republic of Macedonia reports a project to support Roma refugees from Kosovo (Table 4.17). Serbia had several programmes:
preventing mental disorders among
•
refugees (supported by the Office of the United Nations High Commissioner for Refugees (UNHCR) from 1993 to 2000);
preventing mental disorders among
•
ex-detainees (2000) supported by the Norwegian Committee for Human Rights;
the Centre for Rehabilitation of Torture
•
Victims, which was started by the nongovernmental organization IAN (International Aid Network) and supported by the European Commission (2000–
2004);
Of the 42 countries, 7 have introduced policies and 11 countries programmes targeting the children of mentally ill parents or other children at risk. Policies addressing women at risk (such as preventing postpartum depression) have been implemented in 6 countries and programmes in 14 countries.
For employees at risk, only four countries have introduced policies and eight countries programmes. Five countries have implemented policies to improve bereavement and support for widows and widowers and eight countries programmes (Tables 4.13–4.16).
Two thirds of the countries have implemented policies or programmes to prevent mental disorders among population groups that are at risk or vulnerable. Many of the activities target refugees. Denmark has specialized centres for treating traumatized refugees who
Table 4.12. Implementation of policies and programmes to prevent depression directed towards the whole population during the past five years in groups of countries
Policies and programmes implemented
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Policies
Yes 10 37 9 60 1 8 1 33 1 14 2 40 14 33
no 14 52 4 27 10 83 2 67 6 86 3 60 25 60
information not available
3 11 2 13 1 8 0 0 0 0 0 0 3 7
Programmes
Yes 13 48 9 60 4 33 2 67 1 14 1 20 17 40
no 12 44 5 33 7 58 1 33 6 86 4 80 23 55
information not available
2 7 1 7 1 8 0 0 0 0 0 0 2 5
Table 4.13. Implementation of policies and programmes to prevent depression among children of mentally ill parents (or other children at risk) during the past five years in groups of countries
Policies and programmes implemented
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Policies
Yes 5 19 5 33 0 0 1 33 1 14 0 0 7 17
no 19 70 8 53 11 92 2 67 6 86 5 100 32 76
information not available
3 11 2 13 1 8 0 0 0 0 0 0 3 7
Programmes
Yes 8 30 7 47 1 8 2 67 1 14 0 0 11 26
no 17 63 7 47 10 83 1 33 6 86 5 100 29 69
information not available
2 7 1 7 1 8 0 0 0 0 0 0 2 5
29
Table 4.14. Implementation of policies and programmes to prevent depression among women at risk (such as preventing postpartum depression) during the past five years in groups of countries
Policies and programmes implemented
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Policies
Yes 4 15 4 27 0 0 1 33 1 14 0 0 6 14
no 20 74 9 60 11 92 2 67 6 86 5 100 33 79
information not available
3 11 2 13 1 8 0 0 0 0 0 0 3 7
Programmes
Yes 10 37 8 53 2 17 1 33 1 14 2 40 14 33
no 15 56 6 40 9 75 2 67 6 86 3 60 26 62
information not available
2 7 1 7 1 8 0 0 0 0 0 0 2 5
Table 4.15. Implementation of policies and programmes to prevent depression among employees at risk during the past five years in groups of countries
Policies and programmes implemented
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Policies
Yes 3 11 3 20 0 0 0 0 1 14 0 0 4 10
no 21 78 10 67 11 92 3 100 6 86 5 100 35 83
information not available
3 11 2 13 1 8 0 0 0 0 0 0 3 7
Programmes
Yes 5 19 4 27 1 8 1 33 1 14 1 20 8 19
no 19 70 9 60 10 83 2 67 6 86 4 80 31 74
information not available
3 11 2 13 1 8 0 0 0 0 0 0 3 7
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Table 4.16. Implementation of policies and programmes to prevent depression related to bereavement and to support widows and widowers during the past five years in groups of countries
Policies and programmes implemented
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Policies
Yes 3 11 3 20 0 0 1 33 1 14 0 0 5 12
no 21 78 10 67 11 92 2 67 6 86 5 100 34 81
information not available
3 11 2 13 1 8 0 0 0 0 0 0 3 7
Programmes
Yes 5 19 5 33 0 0 1 33 1 14 1 20 8 19
no 19 70 8 53 11 92 2 67 6 86 4 80 31 74
information not available
3 11 2 13 1 8 0 0 0 0 0 0 3 7
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Table 4.17. Development of policies and programmes to prevent mental disorders specifically in at-risk or vulnerable population groups during the past five years in groups of countries
Policies and programmes developed
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Yes 19 70 13 87 6 50 2 67 4 57 3 60 28 67
no 5 19 0 0 5 42 1 33 3 43 2 40 11 26
information not available
3 11 2 13 1 8 0 0 0 0 0 0 3 7
Table 4.18. Procedures in place in the school setting to identify and refer children at risk for mental disorders to mental health support in groups of countries
Availability of staff in schools
EU EU15
New EU countries since 2004
Israel, Norway and Switzerland
South-eastern
Europe CIS Total
No. % No. % No. % No. % No. % No. % No. %
Mental health specialists
Yes 14 52 8 53 6 50 2 67 5 71 1 20 22 52
no 10 37 5 33 5 42 0 0 0 0 4 80 14 33
information not available
3 11 2 13 1 8 1 33 2 29 0 0 6 14
teachers trained in identification and referral
Yes 9 33 6 40 3 25 0 0 3 43 1 20 13 31
no 9 33 4 27 5 42 1 33 4 57 4 80 18 43
information not available
9 33 5 33 4 33 2 67 0 0 0 0 11 26
programmes for preventing mental
•
disorders among older people, children and adolescents (supported by the United Nations Children’s Fund (UNICEF));
preventing child abuse (supported by
•
Intercare the Netherlands); and preventing mental disorders among
•
internally displaced people.
Mental health specialists are available in schools in more than half the countries, and teachers are trained in identifying mental health problems in one third of the countries.
The mental health specialists are mainly school psychologists and social workers. In several countries, schools can refer children with learning problems to educational counsellors (Table 4.18).
In Ireland, all primary and post-primary schools have access to psychological assessments either directly through the National Education Psychological Service
or through the Scheme for Commissioning Psychological Assessments. These agents provide a range of services to support the personal, social and educational development of children in primary and secondary schools by applying psychological theory and practice in education with particular regard for those with special education needs.
Main activities initiated and developed since 2005
The main activities initiated and developed for preventing suicide and depression since 2005 have been implementing public campaigns, working with the mass media, training health professionals, especially general practitioners (GPs), and collaborating with governments.
Three countries (Belgium, Germany and the United Kingdom (England and Wales)) have integrated activities to prevent mental disorders into government action plans since 2005.