Role of Pharmacists in Enhancing Mental Healthcare in South Africa: A Narrative Review

Focus on Transformation: A Public Health Model of Mental Health for the 21st Century

Rethinking India's psychiatric care

Opportunities in mental health services research.

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

Concern over rising health care costs has put pressure on providers to reduce costs, purportedly by reducing inpatient care and increasing outpatient care. Inpatient and outpatient claims were analyzed for adult users of mental health services (180,000/year on average) from a national study group of 3.9 million privately insured individuals per year from 1993 to 1995. Costs and treatment days per patient were compared across diagnostic groups and stratified by whether patients were hospitalized. Inpatient mental health costs fell $2,507 (30.4%) over the period, driven primarily by decreases in hospital days per patient per year (19.9%), with smaller changes in the proportion of enrollees who received inpatient care (increase of 0.8%) and a decrease in per diem costs (9.1%). Outpatient mental health costs also declined over the period, falling 13.6% for patients also using inpatient services and 14.6% for patients receiving only outpatient care. Patients whose primary diagnosis was mild to moderate depression saw the largest decreases in inpatient cost per patient (42.8%); those diagnosed with schizophrenia experienced the smallest decrease (23.5%). For patients using outpatient services only, those diagnosed with substance abuse experienced the largest decrease in costs (23.5%); those diagnosed with schizophrenia experienced the smallest decrease (8.6%). Substantial cost reductions for mental health services are primarily a result of reductions in inpatient and outpatient treatment days. Declines in inpatient service use were not accompanied by increases in outpatient service use, even for severely ill patients requiring hospitalization. Managed care has not caused a shift in the pattern of care but an overall reduction of care.

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).

Mental health care among marginalized populations in the United States

In April 2003 the Alberta government integrated specialized mental health services, formerly organized independently, with the health regions, which are responsible for general health services. The objective of this article is to determine whether the transfer was associated with an increase or decrease in the share of resources in the region allocated to mental health care relative to total spending for health care. The measure of the share for mental health care is the total costs for mental health care resources as a percentage of total health care spending. Resources and spending examined were those that were actually or potentially under the regions' control. Annual costs for mental health services in the province were obtained for a seven-year period (fiscal year [FY] 2000 through FY 2006) from provincial utilization records for all residents in the province. Unit costs were assigned to each visit. The trend in the share measure was plotted for each year. The share for mental health care increased overall from FY 2000 (7.6%) to FY 2003 (8.2%), but returned to pre-FY 2003 levels in the three years after the transfer (7.6%). Despite concerns expressed before the transfer by federal and provincial reports over the level of expenditures devoted to mental health care, the integration of mental health services with other health services did not result in an increase of the share for mental health care.

Impact of Intimate Partner Violence on Unmet Need for Mental Health Care: Results From the NSDUH

Lessons learned in developing community mental health care in Australasia and the South Pacific

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

Byline: Choudhary. Narayan, Deep. Shikha, Mridula. Narayan After India signed and ratified the United Nations' Convention on Rights of Persons with Disability, 2006 (UNCRPD), Ministry of Health and Family Welfare (MOHFW) initiated the exercise of revising the Mental Health Act - 1987 (MHA-1987) to bring it in harmony with the UNCRPD in 2010. After about 31/2 years long drafting and consultation process, the proposed legislation named Mental Health Care Bill, 2013 (MHCB) was introduced in the Rajya Sabha in August 2013. The Parliamentary Standing Committee on Health Related Matters submitted its report with suggestions of some minor changes in November 2013. [sup][1] Though invited to the consultation process at different stages, Indian Psychiatry Society (IPS) was not assigned any role in drafting of the current Bill. IPS and other professional bodies of psychiatrists have expressed apprehensions about a number of provisions in the Bill, which are not considered to be in the interest of persons with mental illness (PMI). IPS has submitted its representations at various stages expressing these concerns. Antony (2014) said that the Bill has an over-inclusive definition for mental illness, which will hurt a huge number of victims of even minor mental illnesses and their families, because of the wide prevalence of stigma. [sup][2] Though there are provisions of emergency admission on any bed anywhere in the country for a maximum period of 72 h (96 h in NE states), all the hospitals or nursing homes who admit PMI have been brought under the purview of the Bill and are required to be registered as mental health establishments (MHEs). All involuntary admissions in MHE even for a day may be subject to review by Mental Health Review Board to be established throughout the country by the Mental Health Review Commission. Kala (2013) said that the provision is undoubtedly progressive, but expressed his doubt that whether we as a society, are ready for this large scale countrywide post-admission review in almost all cases of involuntary admissions. [sup][3] Unmodified electroconvulsive therapy (ECT) has been totally banned, and ECT to minors can be given only after approval from the board. Many other provisions like those of nominated representative, advance directive etc., are supposed to create an obstacle in the treatment of PMI. The Bill has many positive features as well which, if properly and genuinely implemented, are set to revolutionize mental health care services in our country. The Bill ensures the right of every person to access affordable and good quality mental health services funded by the government. All PMI have the right to equality of treatment, protection from inhuman and degrading treatment, free legal services, right to access their medical records, and right to complain regarding deficiencies in provisions of mental health care. [sup][4] Special emphasis has been given to human rights of PMI, and there is a separate chapter in the Bill for this purpose. The government is mandated to establish good quality mental health services at all levels so as to ensure everyone to have access to mental health care services. Decriminalizing suicide is another welcome feature of the Bill. The single provision, which is supposed to inflict greatest damage to the system of mental health care delivery, is that of bringing all the general hospital psychiatry unit (GHPU) within the ambit of definition of MHE. It will result in moving the clock backwards, so far as the development of psychiatry and mental health care in our country is concerned. In Indian Lunacy Act, 1912, there was no mention of the GHPU. In MHA-1987, "any general hospital or general nursing home established or maintained by the government and which provides also for psychiatric services" were excluded from the ambit of definition "psychiatric hospital/ psychiatric nursing home". Thus, the GHPU established or maintained by the government were exempted from obtaining a "license" for running psychiatric inpatient services. …

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.

OBJECTIVE: This study examined characteristics of suicides among mental health care users reported between 1996 and 2006 to the Dutch Health Care Inspectorate and the inspectorate's follow-up responses. The aims were to determine whether follow-up was associated with particular characteristics and whether the responses could be improved in accordance with guidelines for treatment of suicidal patients. METHODS: Information about patient and treatment characteristics was collected from a sample of 505 of the 5,483 suicide notifications between 1996 and 2006. The 1996–2005 sample included an equal number of cases to which the inspectorate did and did not respond. The 2006 sample included the first 205 notifications in that year. RESULTS: For 2006 notifications the response rate was 37%. The responses most frequently addressed how and whether the suicide was evaluated and the adequacy of treatment for the psychiatric disorder. A follow-up response was more likely when the suicide involved a young patient or a patient treated in a mental health care setting for less than a year or when the notification was accompanied by the mental health institution's plans for improving its policies. A response was less likely when the patient was discharged from inpatient care in the three months before the suicide. Since 2002 responses have more frequently emphasized the importance of suicide risk assessment, in accordance with guidelines. CONCLUSIONS: The inspectorate might improve its supervision system by placing greater emphasis on addressing suicidal impulses and treating older and chronically suicidal patients and patients soon after inpatient discharge.

The Mental Health Parity and Addiction Equity Act (MHPAEA) mandates equity in insurance coverage, including both treatment limits (caps on inpatient days and out-patient visits) and financial requirements (cost sharing, deductibles, and out-of-pocket limits), for behavioral health and medical/surgical services.Some insurers and employers, however, have voiced concerns that implementation of the MHPAEA will lead to larger cost increases than those found in previous studies of parity.Generally, these studies have found that parity can be achieved with few if any increases in total health care costs (1).The new federal law goes further than most previous laws by extending parity to managed care techniques that may not be expressed numerically but may nevertheless limit the scope or duration of services-so-called nonquantitative treatment limitations.These management techniques include requirements such as prior authorization, utilization review, or standards for provider participation in a network.Under the new federal law, insurance plans must use the same processes or strategies that they use for medical/surgical benefits to determine how nonquantitative treatment limitations are set.Because some studies suggest that these management techniques are what allowed parity to occur without large cost increases in the past (2), there are concerns that the new federal law would lead to relatively large cost increases.However, there is no published direct evidence to date on the effect of the MHPAEA on health care costs.