title: Monitoring mental healthcare on a system level: Country profiles and status from EU countries.
abstract: OBJECTIVE
  Routinely collected data can be used to monitor the performance and improve the quality of mental healthcare systems. Data-based and system-level Quality Monitoring Programmes in Mental Health Care (QMP-MHC) are increasingly being implemented in EU countries. They are believed to be indispensable for the sustainable improvement of the quality of mental healthcare. However, there is a paucity of comparative research on national strategies in quality monitoring. This study explores the status of system-level Quality Monitoring Programmes in Mental Health Care (QMP-MHC) in EU countries. It aims to provide a descriptive overview, which is intended to be the first step for comparative research in this field.
  
  
  METHODS
  Case studies of system-level QMP-MHCs were gathered from eight EU countries. Experts from each country were asked to describe their approach using a template. These experts were all members of a Europe-wide network of researchers and members of public institutions involved in quality assessment and performance monitoring of mental healthcare.
  
  
  RESULTS
  Country profiles were gathered from England, Denmark, France, Germany, Italy, the Netherlands, Portugal, and Sweden. All these countries have - or are in the process of implementing - system-level QMP-MHCs. Implementation seems to be facilitated when a national performance monitoring programme for general healthcare is already in place, although in the Netherlands, a QMP-MHC was established without being attached to a general monitoring programme. All the monitoring programmes described use various quality and performance indicators; some systems enhance this methodology with the addition of qualitative assessment methods such as peer reviews linked to accreditation processes.
  
  
  CONCLUSIONS
  Research is needed to better understand the historical, political and technical backgrounds of the different national cases and to explore the effectiveness of different improvement mechanisms on the actual quality of healthcare. Policy makers and those designing performance measurement programmes are recommended to look across the borders of their own healthcare systems as there are many ways to assess performance and many ways to feedback results to service providers. No evidence is available whether one of these methods is superior to the others in improving the quality of mental healthcare.
authors.affiliation: AQUA Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany; Institute for Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany. Electronic address: anke.bramesfeld@aqua-institut.de.
authors.forename: Anke
authors.initials: A
authors.lastname: Bramesfeld
authors.affiliation: Department of Neurological, Biomedical and Movement Sciences, Section of Psychiatry, Ospedale Policlinico "G.B. Rossi", Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Amaddeo
authors.affiliation: CEDOC Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Caldas-de-Almeida
authors.affiliation: CEDOC Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Graça
authors.initials: G
authors.lastname: Cardoso
authors.affiliation: Direction de l'Amélioration de la Qualité et de la Sécurité des Soins, Haute Autorité de Santé, Saint-Denis La Plaine Cedex, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Depaigne-Loth
authors.affiliation: Direction de l'Amélioration de la Qualité et de la Sécurité des Soins, Haute Autorité de Santé, Saint-Denis La Plaine Cedex, France.
authors.forename: Rose
authors.initials: R
authors.lastname: Derenne
authors.affiliation: Department of Neurological, Biomedical and Movement Sciences, Section of Psychiatry, Ospedale Policlinico "G.B. Rossi", Verona, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Donisi
authors.affiliation: Aalborg University Hospital, Psychiatry Region North Denmark, Aalborg, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Jørgensen
authors.affiliation: National Board of Health and Welfare, Stockholm, Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Lindelius
authors.affiliation: Department of Mental Health, Lecco General Hospital, Lecco, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lora
authors.affiliation: Aalborg University Hospital, Psychiatry Region North Denmark, Aalborg, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Mainz
authors.affiliation: Epidemiological and Social Psychiatric Research Institute, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Cornelis Lambert
authors.initials: CL
authors.lastname: Mulder
authors.affiliation: AQUA Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany; Department of General Practice and Health Services Research, Heidelberg University Hospital, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
authors.affiliation: Division of Psychiatry, University College London, London, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Killaspy
mesh_terms: D000068:Accreditation / Q000592:standards; D019985:Benchmarking / Q000458:organization & administration*; D005060:Europe; D006291:Health Policy; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration* / Q000592:standards
keywords: Country comparison; Health policy; Mental health services; Performance monitoring; Quality assurance