The recession in Europe has dramatically impacted the public mental health system. States have cut vital services for tens of thousands of youth and adults living with mental health problems. These services include community mental health, primary care and access to medications.

In Ireland, it was decided recently that more than €50 million allocated by the Government to develop mental health and primary care services this year was to be used to offset the deficit in the Health Service Executive. Under the original plans €35 million was to be invested in mental health services to allow for the recruitment of about 400 staff and the opening of new units. About 200 personnel were to have been recruited as part of a €20 million investment in primary care. The deferral of the €50 million programme is among additional cuts to be announced shortly by the Ministry for Health. This means that up to 600 public nursing home beds will close and there will be cuts in patient mental health beds.

In Spain, significant changes have recently been introduced in the Personal Autonomy and Dependent Care Law, which will have a direct impact on users of mental health services. The budget has been reduced 13% among an additional cut of €283 million. Co-payment (for up to 90% of the service) has been established for those earning more than €532 per month. Carers have seen their salary reduced a minimum of 15% to 85% (depending on the region). Users will be able to claim late payments only after 2 years. In addition, users will not be able to combine services; for example, it will not be possible to go to a day centre and at the same time receive home care or an economic allowance for informal care.

In the face of budget pressures, national governments are facing increasingly difficult decisions. However, as shown in the examples above, it is difficult for communities to withstand further cuts to public mental health systems, which may have dramatic consequences. At the same time, legislators and taxpayers have the right to expect that resources spent on mental health services are spent wisely on services that work in preventing or alleviating mental health crises and in fostering recovery and independence. Cost-effectiveness evidence in mental health suggests that early intervention can provide an economic return of up to £7 per £1 expenditure.