Mental health systems in European countries are undergoing reform. In Central and Eastern European countries, this means a shift from institutionally centred care to community based mental health services. This requires changes to ways of working and competencies, both in hospital settings and in the community, stradling specialist mental health services and primary care.

A concern expressed by policy makers annd managers is the absence of information about quality of care and cost and outcomes of interventions, both of old and new services. Management information systems are rudimentary, relying on basic process data related to reimbursements, and practice guidelines are often not availlable or monitored. This hinders changes of practice, since there are no indicators that show areas of poor care, or improvements in outcome or satisfaction following change. Incentives often are perverse, reinforcing the status quo in the absence of information that would encourage change.

The European Mental Health Action Plan is endorsed by all European Member States, and proposes actions to address these challenges. This requires a partnership between policy makers and professionals to agree practice guidelines and outcome indicators that are meaningful and feasible. EPA and WHO are considering steps to take this forward.