Mental disorders are one of the greatest public health challenges in terms of prevalence, burden of disease and disability as they cause major burden to economies, calling for demanding policy action. Economic costs for Mental Health amount to €600 billion across 27 EU countries, equivalent to 4.1% of GDP according to a WHO 2019 data.
Information and data from which information is derived could be really useful and of crucial importance in mental healthcare. Monitoring the system, evaluating quality of care, supporting research, respecting human rights, as well as financing and implementing mental health policies are the main instances of why they can be so important and how could be used. Furthermore, information is an essential step to improve the accountability and transparency of a Health System (HS) (i.e., a system, intended as the organization of people, institutions and resources, providing and delivering healthcare assistance to target populations, at local or national level), and it must be shared among stakeholders (government, the community, etc.). Indeed, information is needed by all stakeholders, at all levels, to monitor the quality of care and its respect for human rights.
Finally, information is needed to verify system infrastructure and the responsible and transparent utilization of resources. There is a consensus that rational planning aimed at achieving a well-functioning system is hard to obtain in the absence of sound monitoring and evaluation. Monitoring refers to tracking key elements of program or service performance (inputs, activities, results) on a regular basis, while evaluation refers to the systematic appraisal of the value, effectiveness and impact of programs or services implemented. Monitoring is usually an ongoing assessment, which does not take into consideration longer term impact, while evaluation is a systematic application of scientific methods to assess the change in targeted results which can be attributed to the implementation of specific programs or projects, investigating their effectiveness or analyzing inputs and outputs to determine their contribution to outcomes.
Given the need of sound monitoring and evaluation programs for the mental healthcare, the quality of care of mental health disorders will continue to trail behind that of other diseases until appropriate data are collected and appropriate indicators are used to measure quality. This issue could be addressed implementing structured and standardized Information systems to collect information and managing the mental healthcare.
The role of information should be made better known in order to shift the attitudes of mental health staff from resistance to a seemingly hitherto alien one of genuine interest in the data analysed. Indeed, collecting good quality information is not only a matter of epidemiological expertise or training but a continuous effort that renders better mental health services. With this in mind, clinical executives, mental health managers, patient and family representatives, as well as politicians should be educated to operate with facts and not just intuition.
Joint Action on Implementation of Best Practices in the area of Mental Health (JA ImpleMENTAL) is a major programme co-funded by the European Union engaging in piloting and mainstreaming Mental Health policies. The programme involves 39 participating organizations from competent authorities in 21 EU/EEA countries. The programme is focusing on the adaptation and transfer of two best practices in mental health taken from Belgium ‘community based services as an alternative to hospitalization’ and Austria on suicide prevention in order to improve citizens’ mental health, especially amid the COVID-19 pandemic. The aim is to extend the benefits of these best practices by transferring and implementing them as a pilot in the participating countries.
Indeed, one of the main tasks of JA ImpleMENTAL is the “Adaptation, development and (pilot) application of a dashboard of mental health indicators” (Task 5.4). The ultimate aim of this task is to make mental health visible through timely, relevant and comparable data; the goal is to design and implement a shared dashboard measuring a minimum set of indicators which will enable the monitoring and evaluation of mental healthcare pathways provided by the National Health Services of the participating Countries. As outlined by the “WHO European Framework For Action On Mental Health 2021–2025”, it is fundamental to develop a mental health data platform that can serve to routinely collect data based on indicators jointly discussed and endorsed. This will lead to a better understanding of the mental health status of a population and of the performance of mental health systems, including social functioning, financial protection and service responsiveness.
Understanding the availability of the data gathered and recorded in the various national Mental Health Information Systems (MHIS in the following) is one of the key and essential objectives for accomplishing this goal, and to further set up a proposal of indicators to implement on a mental health data platform.
Project Partners, mainly from WP2, WP3, WP5 and WP6, with representatives of users and their families, as well as major stakeholders were gathering online on 12 June 2023 for the first WP5 Consensus workshop for Mental Health indicators, organized by, the University of Milano-Bicocca (UNIMIB) in cooperation with the Politecnico di Milano (POLIMI).
Propaedeutic for the achievement of Task 5.4, this event was the first chance to start a discussion on (i) the availability of the data gathered and recorded in the various national Mental Health Information Systems (MHIS), (ii) a proposal draft of mental health indicators and (iii) the future steps for a further implementation of a dashboard in the 2nd and 3rd year of the project.
Key note addresses were given by Prof. Giovanni Corrao, Full Professor of Medical Statistics at UNIMIB, Dr. Antonio Lora, former Head of the Department of Mental health and Substance Abuse of ASST Lecco and consultant for Welfare Directorate of Lombardy Region, Dr. Matteo Monzio Compagnoni, post-doc researcher in Biostatistics at UNIMIB, Prof. Francesca Ieva, Associate Professor of Statistics at Politecnico di Milano. Dr. Nathalie Belorgey, Scientific Project Officer at Federal Centre for Health Education (BZgA), and Dr. Teresa di Fiandra, consultant for Welfare Directorate of Lombardy Region, greeted participants and expressed the significance of the event. Opening addresses were closed by Antonio Lora and Nathalie Belorgey.
As Italy works as a co-leader with the German leadership in WP5 on the status of health information systems in MSs and regions, along with the German co-leader, the Italian participants gave an overview on the potential of information in Mental health and the activities so far executed (e.g., the implementation of a questionnaire to gather data on the Mental Health Information Systems (MHIS), presentation of the preliminary results of the MHIS questionnaire, the identification of a list of indicators to monitor and evaluate the quality of mental healthcare, the presentation of what a dashboard is and how it could be used for).
Region Lombardy and the two universities are actively involved in the work package 5, specialized on MHIS and the evaluation and monitoring of mental healthcare; and they will give their contribution in the adaptation, development and (pilot) application of a dashboard of mental health indicators.
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