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Europees Gezondheidsprogramma: Pilot Project: Severe mental disorders and the risk of violence: pathways through care and effective treatment strategies



Mental disorders represent an important problem in Europe; they affect both the lives ofpeople living with mental health problems, their careers, and the productivity of society as awhole. In many Western countries, mental disorders are the leading cause of disability,responsible for 30-40% of chronic sick leave and costing some 3% of GDP.

Positive mental health and wellbeing result in a broad range of impacts across differentsectors and result in improved social cohesion, economic progress and sustainabledevelopment in the EU.

Significant efforts have been made but despite the existence of cost-effective interventionsto both treat and prevent mental disorders, only about half of people with a severe mentaldisorder, and far less with a mild-to moderate mental disorder, in the EU, receive adequatetreatment, while there is far less coverage of interventions to prevent mental disorders.Factors which contribute to this treatment gap are the still existing stigma surroundingmental health, the reluctance of people experiencing mental health problems to seek help,deficits in the quality of treatment, the fact that a significant share of treatment is providedthrough outdated and themselves stigmatized institutional infrastructures, and the lack oftraining of health professionals and knowledge across society about mental health.The WHO’s comprehensive mental health action plan 2013-2020, adopted in 2013, sets outfour global targets to be achieved by 2020, one of them is a service coverage for severemental disorders will have increased by 20%.Very significant advances were made in the development of short-stay inpatient care ingeneral hospitals. Although in a less systematic and variable way, residential facilities in thecommunity were also developed in most EU countries, contributing to provide residentialsupport and psychosocial rehabilitation in the community to people with severe mentaldisorders who have not the possibility to live independently. Yet, in some countries, thesepatients were also transferred to large residential facilities that present the risk of replicatingthe institutional model of traditional psychiatric institutions.The risk of violence by patients with severe mental disorders and the perception of such risk

is a problem, not only because of the potential for injury and death to patients, staff,relatives and strangers, but also because of the counter-therapeutic effects that both violenceand the measures deployed to prevent violence entail.The stigma of mental illness is intimately linked to the public's fear of violence by thementally ill. This fear can in turn influence clinicians and even policy makers’ decisionmaking.Although the risks of violence are small in absolute terms and make a smallcontribution to societal violence, clarification of rates and trends should help address publicmyths about the perceived dangerousness of psychiatric patients. In contrast, the risk of selfviolenceis higher in mentally-ill patients than it is in the general population: it is estimatedthat more than half of all suicides in European countries are in people with underlyingmental disorders. For this reason it is interesting to examine suicide and also suicideattempts in forensic psychiatric patients on release. 

The perceived threat of violence results in greater use of coercive measures such asinvoluntary hospitalization, restraint, seclusion, and enforced medication, which patientsand their careers almost unanimously perceive as traumatic and even counter-therapeuticand can, in turn, trigger aggressive responses from patients instead of engagement andcooperation. Furthermore, involuntary admission to secure forensic units or psychiatricunits in general hospitals after rare but serious acts of violence linked to severe mentaldisorders can lead to prolonged, costly hospital stay.Forensic psychiatric services in some European countries are the first and foremost care forthose patients with a mental disorder and who pose a risk to others, though who also haveincreased rates of suicide.

New out- and inpatient services for the management of such patients are growing in manybut not all European states. New models of treatment for this often marginalized group ofpatients are developing, including for example outpatient forensic assertive communitytreatment teams and specialized forensic clinics but also general psychiatric units in generalhospitals. However, service design, intervention strategies and legal frameworks for patientsat risk of violence, or who have acted violently, vary greatly across Europe. These aspectshave never been comparatively evaluated in terms of patient satisfaction, therapeuticeffectiveness, risk reduction, recovery and costs: yet such services in some countriesconsume 20% of resources to care for less than 1% of psychiatric patients. This lack ofreliable comparative data has prevented many European countries from benefitting from theinnovative strategies developed in those states which have been able to deploy greaterresources in innovation and research, and have tested potentially more efficient models ofservice delivery.

The EU-Member States and the EU as a whole have signed the UN Convention on theRights of Persons with Disabilities, which guarantees to people with long-standing mentaldisorders important rights, such as the right for independent living, social inclusion and toreceive no treatment without their consent.

The proposed action will build on knowledge generated by research projects supported bythe Seventh Framework Programme for Research and Technological Development andHorizon 2020 – the EU Framework Programme for Research and Innovation. Proposedaction need also consider achievements, findings and recommendations in the context of theEuropean Framework for Mental Health and WellBeing, the developments in the EuropeanCompass on Mental Health and the policy of the European Commission related to mentalhealth.

Different pathways in European countries, different approaches to these patients call for the development of a European project combining a relevant set of representative countries to develop tools and recommendations for decision-making related to this topic. 

Priority areas:

  • To identify factors associated with risk of violence to self and others in patients with severe mental disorders,
  • To assess tools capable of predicting violence risk, for decision-making,
  • To evaluate effective in-patient and out-patient treatments in order to assist in the planning of services (clinicians, managers, lawmakers and governments) in the development of preventative and supportive measures,
  • To compare national variations in pathways into and out of care, including specialized secure services in different countries.



The total budget earmarked for the co-financing of projects is estimated at EUR 1 200 000.The maximum possible rate of co-financing of the eligible total costs is 60%.


Grant applications are eligible if submitted by legal persons. More specifically, the applicants12 mustbe legally established organisations, public authorities, public sector bodies, in particular researchand health institutions, universities and higher education establishments.

The application shall state the legal status of the applicant.

Proposals must be submitted by consortia of legal entities (with or without legal personality)established in at least 2 different EU Member States. Applicants participating in a project proposalhave to be different legal entities (i.e. independent from each other). Proposals which do not involveapplicants from 2 different Member States fulfilling the above conditions will be rejected.

Actions that have already commenced by the date on which the grant application is registered will beexcluded from participation.

Only applications from entities established in one the following countries are eligible:- One of the 28 EU Member States;

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Europees Gezondheidsprogramma


In het derde Europese gezondheidsprogramma staat de goede gezondheid van de burgers van de Unie centraal. Dit programma ondersteunt de lidstaten om hun zorgsector te innoveren en gezondheidsongelijkheid weg te werken. Daarnaast is er ook steun voor de promotie van  duurzame gezondheidssystemen en beschermt het programmaburgers tegen grensoverschrijdende gezondheidsbedreigingen.


Specifieke doelstellingen:

  • Innovatie in het gezondheidszorgstelsel, gezondheidspreventie en het beheer van gezondheidszorg door gezamenlijke Europese instrumenten en mechanismen die inspelen op tekorten en overschotten aan personeel en financiële middelen
  • Betere (grensoverschrijdende) toegang tot medische deskundigheid, meer onderzoek naar specifieke aandoeningen met bijzondere aandacht voor kwaliteit van de gezondheidszorg (vergelijkend onderzoek tussen nationale zorgsystemen) en patiëntenveiligheid
  • Verspreiding en implementatie van goede praktijken voor kostenefficiënte preventiemaatregelen door een grensoverschrijdende aanpak met aandacht voor genderverschillen en de belangrijkste risicofactoren, zoals roken, alcoholmisbruik, slechte voedingsgewoonten, obesitas, hiv/aids en een zittende levensstijl 
  • Gezamenlijke aanpak en coördinatie van noodsituaties door grensoverschrijdende gezondheidsbedreigingen


Het totale budget van het Europese gezondheidsprogramma bedraagt 449,4 miljoen euro.


Wie maakt kans op subsidies uit het Europese gezondheidsprogramma?

  • Openbare administraties en lidstaten
  • Ngo’s in ontwikkelingssamenwerking
  • Internationale organisaties
  • Ondernemingen
  • Onderzoekscentra 
  • Universiteiten

Welke landen komen in aanmerking voor subsidies uit het Europese gezondheidsprogramma?  

  • EU-lidstaten
  • Europese Economische Ruimte
  • Kandidaat-lidstaten
  • Nieuwe onafhankelijke lidstaten
  • Begunstigde landen van het Europees Nabuurschapsinstrument

Info & contact

Belgisch contactpunt

Laurence Ballieux
laurence.ballieux@health.belgium.be of ibri@health.belgium.be
T 02 524 90 38

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