Study protocol

To achieve the objectives of this project, PROMO will use the following methodologies to achieve the specific objectives:

1. Identify and review policies and legislations. Using document research and contact with governmental agencies, relevant policies and legislations will be collected by each participating partner. These will be described and qualitatively reviewed to obtain an in-depth view of the content and practical implications of the policies and legislations.

2. Develop assessment tools for services and systems of services to describe and compare services in terms of their organisational characteristics, type of clients, components of care, and funding arrangements, etc., and of how services in systems inter-connect. The assessment will refer to the distinction between the three levels of health care suggested by the WHO: a) defined and confined single intervention as they are described in professional textbooks and evaluated in randomised controlled trials, b) programmes or services which combine different interventions in practice often in a complex manner, and c) care systems which are the sum of all programmes for a defined target group in a given catchment area, plus the way the programmes are co-ordinated. The new tools will focus on programmes and systems. The availability and utilisation of individual interventions may influence the description of programmes, but are not the target of the new tools, as much other research has focused on such interventions. Even if the boundary between these levels may be blurred in specific cases, the distinction will be important as a guiding principle. The development of the tools will be done using the Delphi technique with participating partners. The principal partners will be sent by email a questionnaire using open-ended questions in order to obtain their opinions on what information should be used to describe services and systems of services. This will be followed by cycles of feedback from partners and experts by email until a sufficient consensus is reached on these tools. They will be piloted and modified to ensure that they capture all aspects of services and systems of services in these capitals. The tools will be designed to contain performance indicators that will be used to inform on best practice.

3. Identification of two geographic areas in participating capitals where services and systems of services will be described and compared. These areas will be selected using public health indicators of deprivation. We will select one area that scores in the lower, and another one in the upper, third of deprivation indices in each capital. It will be the responsibility of participating partners to select these areas in their capitals. However, information on which areas were selected, their deprivation levels, and type of indices used for selection, will be disseminated to and discussed with participating partners to ensure consensus that the selected areas are suitable for comparisons.

4. Identification of experts in non-participating capitals: An expert in social marginalization and promotion of mental health in non-participants capitals will be identified through the European Mental Health Care Network and the EUPHA Mental Health Section. Through personal communications, these experts will be asked for feedback on whether, in their own capital, the existing system(s) differs or conforms to the ones identified.

5. Identification of best practice through analysis of quantitative and qualitative data collected on policies, legislations, services and systems of services.

6. Dissemination of findings. This will be done electronically through the website and through publications and presentations in seminars, conferences, and workshops to a wide and varied audience of service users and professionals. Guidelines on best practice will be disseminated to governmental organisations by participating partners and experts appointed to the study in non-participating states.