A Longer Queue to Psychiatrists: A Perspective on the Impact of the Economic Crisis on Mental Health in Sri Lanka

Nurses suffering in silence: Addressing the stigma of mental health in nursing and healthcare.

Meeting the UN Sustainable Development Goals for mental health: why greater prioritization and adequately tracking progress are critical.

The COVID-19 pandemic has taken a significant mental and emotional toll on critical care nurses. High patient acuity, staffing shortages, and increased care needs both in the hospital and in the community are contributing to increases in depression, anxiety, and overall burnout. Nurses who perceive, internalize, anticipate, and experience stigma may be hesitant to engage in mental health care and self-stewardship. Resultingly, stigma is a detriment to the mental health and overall well-being of critical care nurses. The American Nurses Association recognizes this stigma and is committed to dismantling stigma as a barrier to mental health care. Nurses may fear social and professional consequences associated with receiving mental health care. Nursing leaders and organizations can take steps to reduce stigma related to mental health care and support self-stewardship among critical care nurses.

Opportunities in mental health services research.

The World Health Organization (WHO) is revising the ICD-10 classification of mental and behavioural disorders, under the leadership of the Department of Mental Health and Substance Abuse and within the framework of the overall revision framework as directed by the World Health Assembly. This article describes WHO's perspective and priorities for mental and behavioural disorders classification in ICD-11, based on the recommendations of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. The WHO considers that the classification should be developed in consultation with stakeholders, which include WHO member countries, multidisciplinary health professionals, and users of mental health services and their families. Attention to the cultural framework must be a key element in defining future classification concepts. Uses of the ICD that must be considered include clinical applications, research, teaching and training, health statistics, and public health. The Advisory Group has determined that the current revision represents a particular opportunity to improve the classification's clinical utility, particularly in global primary care settings where there is the greatest opportunity to identify people who need mental health treatment. Based on WHO's mission and constitution, the usefulness of the classification in helping WHO member countries, particularly low- and middle-income countries, to reduce the disease burden associated with mental disorders is among the highest priorities for the revision. This article describes the foundation provided by the recommendations of the Advisory Group for the current phase of work.

Mitigating the Impact of Coronavirus Disease-2019 on Child and Family Behavioral Health: Suggested Policy Approaches

Caitlyn Donaldson, Policy Officer at the Royal Society for Public Health, looks at positive mental wellbeing and how it is being promoted through the work of the RSPH.Mental health and wellbeing is increasingly becoming key topic for the RSPH, and we support the recent NHS Mandate for England1 which states that there needs to be parity between mental and physical health, acknowledging that there can be 'No health without mental health'2The WHO defines mental health as a state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make contribution to his or her community. As in the WHO's definition of health (a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity) mental health is not just the absence of illness, but requires an additional positive 'something' to be present in the individual. Thus, the concept of an individual's mental health state is increasingly being uncoupled from mental illness, and being seen to consist of psychological, emotional and social components.The highest state of subjective wellbeing is seen by many experts as the place where emotional, psychological and social wellbeing are combined, enabling individuals to flourish.3 Thus, rather than simply focusing on preventing and treating mental illness, there is potential to actively promote positive mental health.Mental health and wellbeing impacts upon an individual's physical health, relationships, education, work and ability to reach their potential. At population level, it has consequences for the country's economy, levels of crime, drug and alcohol dependence and homelessness,4 and as Friedli states: health is also key pathway through which social inequality impacts on health.5Many of the key determinants of mental health are located within social and economic domains,6 which provides opportunity for intervention.In 2011 nef published report to address the question of how flourishing mental health could be promoted and increased.7 The result was their five ways to wellbeing: 'connect'; 'be active'; 'take notice'; 'keep learning'; and 'give'. These five ways are easily applied at individual, community, organizational and strategic levels; and evidence suggests that they are being used in many different settings to encourage improved mental wellbeing.The RSPH believes that policymakers at national and local level have responsibility to ensure that policies help address, not increase, inequalities in mental health and wellbeing. The Department of Health's mental health implementation framework8 provides an important perspective on translating policy into practical actions for improving mental health and we support the use of mental wellbeing impact assessment (MWIA), to ensure that policy, programme, service or project has maximum equitable impact on people's mental wellbeing - at individual, community or national level. We also endorse the Guidance for Commissioning Public Mental Health Services,9 which provides the rationale for spending on mental health and also explains what good quality public mental health interventions look like. …

Previous analyses demonstrated an elevated occurrence of perceived unmet need for mental health care among persons with co-occurring mental and substance use disorders in comparison with those with either disorder. This study built on previous work to examine these associations and underlying reasons in more detail. Secondary data analyses were performed on a subset of respondents to the 2002 Canadian Community Health Survey (unweighted N=4,052). Diagnostic algorithms classified respondents by past-year substance dependence and selected mood and anxiety disorders. Logistic regressions examined the associations between diagnoses and unmet need in the previous year, accounting for recent service use and potential predisposing, enabling, and need factors often associated with help seeking. Self-reported reasons underlying unmet need were also tabulated across diagnostic groups. Of persons with a disorder, 22% reported a 12-month unmet need for care. With controls for service use and other potential confounders, the odds of unmet need were significantly elevated among persons with co-occurring disorders (adjusted odds ratio=3.25; 95% confidence interval=1.96-5.37). Most commonly, the underlying reason involved a preference to self-manage symptoms or not getting around to seeking care, with some variation by diagnosis. The findings highlight potential problems for individuals with mental and substance use disorders in accessing services. The elevated occurrence of perceived unmet need appeared to be relatively less affected by contact with the health care system than by generalized distress and problem severity. Issues such as stigma, motivation, and satisfaction with past services may influence help-seeking patterns and perceptions of unmet need and should be examined in future work.

Mental health encompasses both mental health problems and well-being (Uphill et al., 2016). In recent years, world-renowned athletes, including Simone Biles, Michael Phelps, and Naomi Osaka, have directed public attention to the issue of mental health in elite sport by talking openly about their own problems in this regard. Empirical data on levels of well-being and the extent of common mental disorders among current Swiss elite athletes is limited, as previous studies were based on small samples and confined to certain age groups, sports, and/or a single disorder and did not include well-being (e.g., Gerber et al., 2022). In addition, the efforts of Swiss sport federations to support or promote athletes’ mental health have not been investigated or evaluated. A representative sample of Swiss athletes (N = 1003, Mage = 21.69, SDage = 7.09, 54% women, 37% team sports, 10% injured) answered questions about symptoms of mental health problems (i.e., PHQ-9, GAD7, SCOFF, ASSQ; Bender et al., 2018; Hill et al., 2010; Kroenke et al., 2001; Spitzer et al., 2006) and their well-being (MHC-SF). We also asked about the extent of basic need satisfaction (Heissel et al., 2018) and perceived organizational support. Overall, the numbers on symptoms of mental health problems (17% depression, 10% anxiety, 22% eating disorders, 18% sleep disorders) and well-being are comparable to other elite sport samples (Reardon et al., 2019) and the general Swiss population. However, we found large group differences. For example, 52% of women athletes were affected by at least one mental disorder symptom, compared with 30% of men athletes. Injured athletes were most affected in terms of depressive symptoms (28%). The study also shows that need satisfaction and frustration in conjunction with demographic factors is related to well-being and symptoms of mental health problems. Furthermore, the more support athletes perceive from their federations, the better their mental health. We conclude that a substantial proportion of athletes are affected by mental problems and more measures are needed to improve this situation, for example through supporting need satisfaction in the sport setting.

Primary process: why psychiatry and general practice should collaborate

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

BackgroundIt has been argued that though correlated with mental health, mental well-being is a distinct entity. Despite the wealth of literature on mental health, less is known about mental well-being. Mental health is something experienced by individuals, whereas mental well-being can be assessed at the population level. Accordingly it is important to differentiate the individual and population level factors (environmental and social) that could be associated with mental health and well-being, and as people living in deprived areas have a higher prevalence of poor mental health, these relationships should be compared across different levels of neighbourhood deprivation.MethodsA cross-sectional representative random sample of 1,209 adults from 62 Super Output Areas (SOAs) in Belfast, Northern Ireland (Feb 2010 – Jan 2011) were recruited in the PARC Study. Interview-administered questionnaires recorded data on socio-demographic characteristics, health-related behaviours, individual social capital, self-rated health, mental health (SF-8) and mental well-being (WEMWBS). Multi-variable linear regression analyses, with inclusion of clustering by SOAs, were used to explore the associations between individual and perceived community characteristics and mental health and mental well-being, and to investigate how these associations differed by the level of neighbourhood deprivation.ResultsThirty-eight and 30 % of variability in the measures of mental well-being and mental health, respectively, could be explained by individual factors and the perceived community characteristics. In the total sample and stratified by neighbourhood deprivation, age, marital status and self-rated health were associated with both mental health and well-being, with the ‘social connections’ and local area satisfaction elements of social capital also emerging as explanatory variables. An increase of +1 in EQ-5D-3 L was associated with +1SD of the population mean in both mental health and well-being. Similarly, a change from ‘very dissatisfied’ to ‘very satisfied’ for local area satisfaction would result in +8.75 for mental well-being, but only in the more affluent of areas.ConclusionsSelf-rated health was associated with both mental health and mental well-being. Of the individual social capital explanatory variables, ‘social connections’ was more important for mental well-being. Although similarities in the explanatory variables of mental health and mental well-being exist, socio-ecological interventions designed to improve them may not have equivalent impacts in rich and poor neighbourhoods.

The central place of psychiatry in health care worldwide.

Une etude des sels nutritifs dans l'ocean est menee sur deux plans. L'un, est la modelisation de leur regeneration et de leur melange entre les masses d'eau suivant des horizons isopycnaux ; l'autre est l'analyse et l'acquisition de nouvelles donnees. Un lien tres etroit entre les sels nutritifs et l'oxygene d'une part et l'activite biologique d'autre part, caracterise par les rapports biochimiques P/N/-O2 = 1/16/138, a ete defini par Redfield (1934) et Redfield et al. (1963). Tout recemment Takahashi et al. (1985) et Broecker et al. (1985) ont propose des valeurs differentes des rapports de P/N/-O2 = 1/17/175 pour l'ocean mondial. Cette suggestion est etudiee d'une facon critique. L'etude de ces rapports est menee a l'aide d'une analyse isopycnale detaillee, a plusieurs profondeurs de la colonne d'eau de mer : suivant 4 niveaux dans les oceans Atlantique et Indien et suivant 5 niveaux dans l'Ocean Pacifique. Les donnees TTO ont ete selectionnees pour l'etude du Bassin Nord Atlantique et les donnees Geosecs pour les autres domaines consideres. On montre que le rapport P/-O2 decroit systematiquement en fonction de la profondeur d'une valeur de 160-200 en surface a une valeur de l'ordre de 108-127 en profondeur. L rapport N/-O2, qui semble altere par la denitrification dans le Pacifique Nord et equatorial, est constant geographiquement et dans la colonne d'eau. Le rapport d'abondance N/P decroit systematiquement avec la profondeur dans tous les domaines explores. Ces resultats pourraient etre expliques par un recyclage plus lent et plus en profondeur du phosphore par rapport a celui de l'azote. L'analyse automatisee des sels nutritifs a ete amelioree par une saisie et un depouillement en ligne par microordinateur pendant le programme Indigo dans l'Ocean Indien. De nouvelles donnees ont ete obtenues, d'une reproductibilite meilleure que le pourcent pour les nitrates et la silice. Les donnees Indigo, apres calibration, sont tres coherentes avec les donnees Geosecs dans l'Ocean Indien et confirment les resultats de l'analyse isopycnale dans cet ocean. Dans le bassin de Somalie, ces donnees tracent une remontee locale d'eau avec un flux estime a 7. 5 10⁶ m3/s. Ce resultat est en bon accord avec les descriptions dynamiques des courants dans la region et avec les donnees de traceurs transitoires (freons).

Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers.