The main goal is to compare, share and jointly develop best practices and guidelines for diagnostic tools and cost-effective therapeutic interventions in public healthcare. The primary focus will be on mental health care research (i.e. cost-benefit analysis of psychological therapies in different public health systems across European countries). According to the World Health Organization (WHO, 2011) mental ill health accounts for almost 20% of the burden of disease in the WHO European Region and mental health problems affect one in four people at some time in life. Around 20% of the world's children and adolescents are estimated to have mental disorders or problems, with similar types of disorders being reported across cultures. The numbers of affected are huge, just as human and social costs. Roughly 40 per cent of incapacity benefits and sick leaves are due to mental illness. Depression alone is ranked as the leading cause of disability worldwide, as the WHO estimates that at least 73 million people are suffering from depression and about eight million in Italy, but only 40% of these are treated.

Moreover, nine of the ten countries with the highest rates of suicide in the world are in the European Region. In the last few years another problem worsened the situation and calls for major innovations, as WHO (2009) warns us: "The economic crisis is expected to produce secondary mental health effects that may increase suicide and alcohol death rates. However, the mental health effects of the economic crisis can be offset by social welfare and other policy measures". The London School of Economics (Bell et al. 2006) study made it possible to assess that the most cost-effective intervention for the British National Healthcare System was to hire new clinical psychologists to cut down the costs and get better outcomes. Nevertheless, in most Countries, drugs are still prescribed as the (only) treatment of choice, despite the serious side-effects and questionable advantages.

Although much is now known about what works for whom in mental health promotion, prevention, care and treatment, the actual challenge is still how to implement this knowledge in real and different local setting. Accessible, up-to-date and responsive primary care services in fact can support people at risk and prevent and/or reduce mental health effects. In many Countries across Europe services and practice still do not always reflect the cost-effective evidence in mental health care and treatment. Possibly, one difficulty is due to the fact that Evidence-based Practices (EBP) is often very distant and lacks external validity and therefore should be integrated by Practice-based Evidence (PBE), developed and studied directly in real public health services. Countries like UK or Germany have applied these EBP findings in a rigid way: they produced strict national guidelines that define which treatments can be provided or not; whereas others, like Italy, have still more degrees of freedom but also lots to learn from evidence gathered both inside and abroad. Though, cross-cultures and multi-centers clinical trials are difficult to conduct, also due to lack of funding and/or grants. This is one of the main issue that we aim to overcome through the CCSE. Some research studies have investigated what determines differential resilience to economic shocks across EU countries (Stuckler et al., 2009), i.e. different dynamic processes by which individuals, communities, and societies adapt and react to significant adversities. Thus, investigation on resilience involves both the crisis or problems/constraints, like the financial ones, and the skills/resources activated or created to cope with it.

The main areas of interest in our research programmes will focus on the five key barriers that - according to the WHO (2011) - need to be overcome in order to increase the availability of mental health services with skilled human resources: the absence of mental health from the public health agenda and the implications for funding; the current organization of mental health services; the lack of integration within primary care; inadequate human resources for mental health; and lack of public mental health leadership. Within this frame, we aim to run comparative studies for skill-share purposes and to exchange ideas, practices and guidelines across European countries in order to improve the quality of health services in time of limited resources and increasing demands.

The secondary topic of our research group takes into account diagnosis and treatment of other diseases and medical conditions (such as obesity, diabetes, cardiovascular diseases, disabilities, tabagism...) for which the psychological aspects can play a key role both in the aetiology and in the recovery and therefore in the implementation of cost-effective interventions in healthcare services. For instance, obesity is a growing global epidemic affecting almost all parts of the world and therefore a top priority in agendas of all healthcare systems. The proportion of obesity has increased by around 50% in USA from the early 90s to the late 90s. In Italy, around 35% of the population are either overweight or obese according to the WHO criteria. The problem not only occurs in adults, but also in children and teenagers. Obesity is associated with significantly higher cardiovascular risk factors, hence causing increase in morbidity and mortality. These diseases together lead to a shorter life expectancy, with a poorer quality of life, increased medical expenses and increased sick leaves. Because of their high prevalence and various impacts on general health, in fact they pose a major threat and burden on public health. Our research topic will involve the analysis of comparative cost-efficacy of different interventions within an integrated approach to obesity, taking into account differences in life-styles and healthcare organizations across different Countries.