The iceberg tip and the rest. Mental health care for people with schizophrenia in five European centres

The ‘iceberg’ analogy was used by Rose (1993) to describe the limitations, in preventive psychiatry, of concentrating on high-risk groups only. As symptom levels are distributed continuously in populations prevalence rates are likely to be best reduced by affecting overall symptom levels in the whole population. Similarly, when the aim is to get rid of an iceberg to prevent ships from sinking heating the sea water to melt down all its parts would be more effective than shooting off its visible portions. Mental health care, in its complexity, could be compared to an iceberg, and a cross-sectional analysis such as the EPSILON study provides limited glimpses at a multi-faceted reality most of which remains submerged. This has been acknowledged in a recent set of papers which emphasised the shortcomings of research methodology in describing psychiatric services across countries (Beecham & Munizza, 2000). The design of the EPSILON study, a cross-sectional investigation of care for people with schizophrenia in five urban European centres (Amsterdam, Copenhagen, London, Santander, Verona) is described in an accompanying editorial (Thornicroft et al., 2002). The study was aimed at instrument adaptation and service comparison across centres. What, then, were the results of the EPSILON study? NEEDS