The setting of priorities in mental health care evaluation requires considering future trends in mental health services. Three areas of change are mentioned in this paper: the development of services, the increase of the burden of illness, and reform processes in health care systems. Economic evaluation of mental health services has to consider the different roles of the agents acting in mental health care, policy-makers, companies, researchers and care professionals, and patients and their relatives.

Despite the increasing work done, most mental health care interventions have either not been evaluated or have been ill evaluated. There is a sense of paucity of measurement that has to be enriched with more and better evaluative research. Some unresolved methodological issues are commented on in this paper. In particular, direct costs outside the health care sector, indirect costs and quality of life measurement are briefly analysed.

In 1984 all Member States of the European Region agreed on a Pan European Health Policy, popularly known as Targets for Health for All (Health for all targets, 1991).

Among the 38 targets agreed, Target 31 states (table I).

More recently the first meeting of national directors/officials of mental health services in the European Member States stated that “there should be greater concern about the quality of mental health care in each Member State, and mechanisms must be established to guarantee a quality service. These include:

1. a. encouraging mental health care professionals to develop systems to monitor the quality of care;

2. b. independent inspection of services;

3. c. the participation of consumers and relatives;

4. d. improving the basic and continuing training of mental health professionals as well as their working conditions;

Special attention should be paid to the quality of care provided to those with severe long-term mental disorder, the elderly, children and adolescents. Barriers to care should be avoided, particularly for people with long-term mental disabilities.”

The need for quality development and evaluation differ quite significantly across the European Region as a result of the existing differences in the pattern of mental health services and priority policies to be implemented.

It is tempting to suppose that changes in the mental illness service in one's own part of Europe are taking place elsewhere as well. The asylum era is drawing to a close, and politicians everywhere are closing mental illness beds in order to re-distribute health costs in order to pay for new treatments needing expensive technology, as well as to allow for the needs of a population that is now living longer.

In an attempt to become independent of official figures, key figures with a reputation for epidemiological psychiatry were approached in each European country, and asked to complete a brief questionnaire describing the mental health services in their country. Whether this method produces figures that are more or less accurate than official government figures is a question that cannot be addressed at present.

The policy of any organisation is a setting out of the purposes for which it exists - its mission statement. Governments spend money on mental health services and therefore need a coherent mission statement for the use and goals to which that money is put. Moreover, the consequences of mental illness pervade all aspects of a nation's existence. Therefore a mission statement is needed to tackle mental illness and its consequences, not only by developing and using specialist mental health services to best effect, but also by using other relevant organisations as appropriate.

Mental health policy is formulated at all levels from the community mental health team to the national government and thence to the World Health Organisation and the United Nations. Indeed national and international mental health policies have generally been led by local innovative best clinical practice. At local level, the policy of a community mental health team will identify the types of patients to which it seeks to provide a service, the channels through which referrals will be accepted, the type and nature of assessment and decision making about consequent interventions which will be used and a range of quality standards within which it will seek to operate. It may set out a set of desired goals in terms of the improvement in the health status of clients and the degree of consumer satisfaction it seeks to achieve. Some adverse consequences may be set out. For example, it may seek to minimise readmissions to hospital within a specified period of time or the frequency of violent or self-destructive behaviour on behalf of its clients.

Evaluations of mental health services are much in demand. Their results are supposed to help in improving the quality of mental health care and in making them economically better viable.

Yet, world-wide there is:

1. 1) little agreement about the content of terms such as evaluation, mental health service, outcome of an activity although these and other terms are widely used;

2. 2) uncertainty about the best use of results of evaluative research;

3. 3) lack of consensus about who should evaluate what and by what method.