Current Mental Health Policy Research Articles

Inclusion in Indian Society: A Review of Mental Health Policies in India

This paper presents a critical review of mental health policies in India within the broader context of social inclusion. Mental health is a crucial but often neglected aspect of well-being, with policies in India historically lacking a comprehensive, inclusive framework. The paper aims to examine the current mental health policies, their effectiveness in promoting inclusion, and the systemic challenges in their implementation. It also discusses the role of various stakeholders, including the government, non-governmental organizations (NGOs), and international bodies, in fostering a more inclusive mental health care system. Through this review, the paper provides insights into the current landscape, the gaps, and future recommendations for achieving an inclusive mental health ecosystem in India.

The association of social capital and mental well‐being among older residents living in public housing in Macau Special Administrative Region (S.A.R.) – A qualitative case study of Seac Pai Van

AbstractMacau is a rapidly aging city, with 13.8% of the population aged over 65. Social capital has been identified as a crucial protective factor for negative mental health outcomes, yet its relationship with mental health among older adults in Macau remains unclear. This study thematically analyzed the narratives of 19 in‐depth face‐to‐face interviews of Cantonese‐speaking elderly aged 60 or above residing in the Seac Pai Van public housing project, the largest public housing project in Macau. This study aimed to collect information on how social networks and social participation impact their mental well‐being that may shed light on the promotion of resident mental health in future public housing developments. Results revealed shallow social capital in the community and a high prevalence of loneliness among senior residents who resided in the studied estate. The study also shed light on the participants' thoughts on death, including suicidal ideation, and how they are shaped by their mental health situation and environment. The findings highlight the need to revisit the current mental health policy in Macau and address the urban and architectural design and social organization in new communities, empowering communities to build a friendly environment.

Patients languishing in emergency departments: A descriptive analysis of mental health-related emergency department presentations in Australia between 2016-17 and 2020-21.

In the context of concerns regarding hospital access block, this paper provides a descriptive longitudinal analysis of mental health-related ED episodes in Australian public hospitals between 2016-17 and 2020-21. We descriptively analysed Australian Institute of Health and Welfare data for mental health-related ED presentations, outcomes and 5-year trends for Australian public hospitals. There were more than 300,000 Australian mental health-related ED presentations in 2020-21. Presentations increased by an average annual rate of 2.8% between 2016-17 and 2020-21, commonly involving first responder (police, paramedic) attendance. From 2016-17 to 2020-21, the average annual rate of mental health-related ED presentations receiving a triage category of resuscitation increased by 13.7%, emergency by 9.4% and urgent by 4.7%. 90% of MH-related ED presentations were completed within 14h, which was longer than the 90th percentile for all ED presentations (up to 8h). Current mental health policies have not stemmed the rising tide of ED presentations. Mental health-related ED presentations are increasing in number and severity, likely due to health systemic and societal factors. Psychiatry patients stay longer in EDs than other patients. Healthcare reforms should be targeted to provide the best outcome based on principles of equity of access.

Mental health law, policy & program in India – A fragmented narrative of change, contradictions and possibilities

There has been a long-standing history of over 150 years of mental health legislation in the Indian sub-continent. India formulated its National Mental Health Program (NMHP) in 1982 and National Mental Health Policy (MHP) only in 2014. In this paper we mark significant influences on the evolution of mental health law, policy and program in India starting from colonial laws. We suggest that discursive continuities from these colonial laws have existed for a few decades in post-independence India. International influences of deinstitutionalization and growth in community psychiatry took root in India by the late 1970s and considerably shaped mental health program thinking. The decade of 2000s with two major international developments, the UN Convention on Rights of Persons with Disabilities (CRPD) as well as Movement for Global Mental Health (MGMH) have had a significant impact on the mental health sector in India. We comment on a disjuncture between the progressive frames of the current mental health law and policy framework on the one hand and the national and district mental health programs in the country on the other. We then focus on technology assisted solutions for mental health care and their promise as widely promoted by the state and the market and what these mean for a country like India. Throughout the paper, we raise critical questions regarding dominance of western bio medical psychiatry as the epistemic frame guiding policy imagination at the cost of diverse, community resources and practices.

Stigmatization of people diagnosed with a mental disorder in secondary mental health centers in Chile: An ethnographic study.

To understand how stigmatization of people diagnosed with a mental disorder occurs in secondary mental healthcare staff in mental healthcare centers in Chile was the objective of the study. A descriptive qualitative and interpretative design with an ethnographic approach was used. Participants' observations, ethnographic, and semi-structured interviews were conducted with professionals at three secondary mental health centers. Qualitative descriptive and interpretative content analysis was used. Stigmatization of users is shaping up in their trajectory in the health center. Identity changes from person to "patient," which generates dependence on the expert role of healthcare professionals. Stigma is expressed in the interactions between a health institution, a professional team, and a user, reproducing power and control relationships associated with the biomedical model and reinforcing a cycle of chronification in the user. Health teams are stressed by discrepancies between the current mental health policy and the user's biomedical understanding.

The impact of excluded providers on Medicare beneficiaries’ mental health care

AbstractMental health conditions are relatively common among Medicare beneficiaries. Yet, Medicare provider eligibility was last updated in 1989, raising concerns about beneficiaries’ access to mental health care in the United States. Beneficiaries are currently restricted from accessing mental health services provided by licensed professional counselors and licensed marriage and family therapists. Little is known about the impact of this Medicare mental health coverage gap (MMHCG) on Medicare beneficiaries. Hermeneutic phenomenology was used to analyze semistructured interviews with 18 beneficiaries who had attempted to access mental health care but were limited due to the MMHCG. Three themes emerged: (a) exasperating experiences with the MMHCG, (b) the MMHCG compounds barriers to mental health care, and (c) Medicare as a flawed system. These findings suggest current Medicare mental health policy interferes with beneficiaries’ access to needed mental health services. Implications for the counseling profession are described.

History of psychiatry in Nepal.

The history of psychiatry as a discipline in Nepal has been poorly studied. We have attempted to summarise historical landmarks to explore how it began and its evolution over time in relation to contemporary political events. Although Nepal has achieved several milestones, from establishing a psychiatric out-patient department with one psychiatrist in 1961 to having more than 500 psychiatric in-patient beds with 200 psychiatrists by 2020, the pace, commitment and dedication seem to be slower than necessary: the current national mental health policy dates back to 1996 and has not been updated since; there is no Mental Health Act; the number of psychiatric nurses and in-patient psychiatric beds has increased only slowly; and there is a dearth of professional supervision in rehabilitation centres. Thus, despite making significant progress, much more is required, at greater intensity and speed, and with wide collaboration and political commitment in order to improve the mental health of all Nepali citizens, including those living in rural areas and or in deprived conditions.

Logical structure of acceptance and exclusion in the history of mental health and welfare

Early traditional mental health policies in Japan did not protect the rights of patients with mental illnesses, with public safety prioritised over human rights. The situation has since improved, but these early perceptions have impacted on current mental health policies in Japan. Dr Minori Utsunomiya, Aichi Prefectural University, Japan, believes past policies are the root of many challenges facing people with mental illness and she is exploring Japan's complex history of mental health and psychiatric care to shed light on the correlation between past and present mental health policies. Key foci for Utsunomiya are the Psychiatric Custody Law of 1900, the Psychiatric Hospital Law of 1919 and the Mental Health Act of 1950 and she is exploring these laws from two perspectives: pre-World War II to post-war continuity/discontinuity and the structure of acceptance and exclusion for people with mental illnesses. As such, Utsunomiya embarked on an exploration of the process of the revision and abolition of laws and deliberation with respect to bills related to mental illness, investigated the roles and functions of public psychiatric hospitals and analysed the causal relationship between the revision of laws related to mental illness and social incident.

Mental health data: A case for the African communities in New South Wales

This paper examines mental health policies in relation to African communities residing in New South Wales, Australia and the attitudes of African communities toward mental disorders and mental health services. Current mental health policy frameworks have shown an inadequate inclusion of African communities. This may negatively affect the design of mental health interventions and how African communities engage with mental health services. The available mental health literature on African communities showed disjointed and uncoordinated data which focuses on specific community-groups within African communities. Insufficient mental health or suicide data, combined with African community members’ perception toward mental disorders and mental health services, makes it very difficult to progress engagement and interventions. There is a need for proper and sizable data on mental health related to people of African descent in NSW and Australia wide, if positive outcomes are to be realised.

Educators' perceived mental health literacy and capacity to support students' mental health: associations with school-level characteristics and provision in England.

Conceptual frameworks for school-based, preventive interventions recognise that educators’ capacity is, in part, dependent on school-level characteristics. This study aimed to (i) examine the factor structure and internal consistency of the Mental Health Literacy and Capacity Survey for Educators (MHLCSE); (ii) assess responses in relation to supporting students’ mental health; (iii) describe schools’ mental health provision in terms of designated roles, training offered, and perceived barriers; (iv) investigate variance in MHLCSE outcomes explained by schools; and, (v) explore school-level predictors of educators’ perceived MHL and capacity after controlling for individual-level characteristics. A multi-level, cross-sectional design involving 710 educators across 248 schools in England was used, and secondary analyses of baseline data collected as part of the Education for Wellbeing Programme were conducted. Mental health provision data was available for 206 schools, of which 95% offered training to some staff, and 71% had a designated mental health lead. Secondary schools offered significantly more training than primary schools. Significant barriers included lack of capacity in Child and Adolescent Mental Health Services (CAMHS) and within school, and communication challenges between agencies. The amount of training offered by schools significantly predicted educators’ awareness and knowledge of mental health issues, treatments and services, legislation and processes for supporting students’ mental health and comfort providing active support, with increased training predicting higher scores. However, little variance was explained by schools (1.7–12.1%) and school-level variables (0.7–1.2%). Results are discussed in relation to current mental health and education policy in England.

Preparing student paramedics for the mental health challenges of the profession by using the wisdom of the experienced

Given the significant mental health issues affecting our paramedics, there exists an urgent need to promote positive mental health and well-being among future cohorts of student paramedics. This study investigated the preparedness of student paramedics for the mental health challenges of the profession and explored the coping strategies used by experienced paramedics.The study was conducted in two parts. Part A comprised of two surveys which were developed and administered to 16 course coordinators and 302 students of the 16 accredited undergraduate paramedicine courses across Australia and New Zealand. The survey aimed to identify the perceived need for preparation within the curriculum. In addition, the anticipations, confidence and fears of student paramedics, Course Coordinators and paramedics were also collected as a means to explore the preparedness through self-evaluation, reflection and discussion.Part B included twenty semi-structured interviews with experienced paramedics, from Australia and New Zealand. The interviews were conducted to gain an understanding of their experiences and the mental health coping strategies they employed, as well as capture the advice they would give to student paramedics. Results from the interviews were validated by three focus groups comprised of six paramedics each, representative of the geographic spread.Results suggest there is widespread recognition for the need to include preparation for the mental health challenges of the profession, within accredited undergraduate paramedic courses, with 100% of course coordinators and 97% of students recognising this need.The interviews with paramedics provided valuable insights into the experiences and strategies used to aid the survival of the paramedics throughout their careers. Within the interviews, 70% of participants expressed a sincere love for the paramedic role, and 70% identified black humour as the coping strategy most used by themselves and colleagues. In addition, extensive advice was given to students based upon the paramedics’ lived experiences. This advice comprised of three themes; support, health and the profession. These findings were mapped against the aims of Australia’s current Mental Health Policy to provide evidence-based and policy-informed guidelines for the integration of positive mental health strategies into undergraduate paramedicine curricula.Preparing student paramedics for the mental health challenges of the profession could be advantageous. One way to achieve this is through the inclusion of key content within the undergraduate curriculum by utilising the relatable data collected on anticipation, confidence, fears and the advice offered by the veteran paramedics can be integrated. These lived experiences are highly credible and an opportunity for veterans to contribute positively to the future of paramedicine.

What influences practitioners\u2019 readiness to deliver psychological interventions by telephone? A qualitative study of behaviour change using the Theoretical Domains Framework

BackgroundContemporary health policy is shifting towards remotely delivered care. A growing need to provide effective and accessible services, with maximal population reach has stimulated demand for flexible and efficient service models. The implementation of evidence-based practice has been slow, leaving many services ill equipped to respond to requests for non-face-to-face delivery. To address this translation gap, and provide empirically derived evidence to support large-scale practice change, our study aimed to explore practitioners’ perspectives of the factors that enhance the delivery of a NICE-recommended psychological intervention, i.e. guided self-help by telephone (GSH-T), in routine care. We used the Theoretical Domains Framework (TDF) to analyse our data, identify essential behaviour change processes and encourage the successful implementation of remote working in clinical practice.MethodThirty-four psychological wellbeing practitioners (PWPs) from the UK NHS Improving Access to Psychological Therapies (IAPT) services were interviewed. Data were first analysed inductively, with codes cross-matched deductively to the TDF.ResultsAnalysis identified barriers to the delivery, engagement and implementation of GSH-T, within eight domains from the TDF: (i) Deficits in practitioner knowledge, (ii) Sub-optimal practitioner telephone skills, (iii) Practitioners’ lack of beliefs in telephone capabilities and self-confidence, (iv) Practitioners’ negative beliefs about consequences, (v) Negative emotions, (vi) Professional role expectations (vii) Negative social influences, and (viii) Challenges in the environmental context and resources. A degree of interdependence was observed between the TDF domains, such that improvements in one domain were often reported to confer secondary advantages in another.ConclusionsMultiple TDF domains emerge as relevant to improve delivery of GSH-T; and these domains are theoretically and practically interlinked. A multicomponent approach is recommended to facilitate the shift from in-person to telephone-based service delivery models, and prompt behaviour change at practitioner, patient and service levels. At a minimum, the development of practitioners’ telephone skills, an increase in clients’ awareness of telephone-based treatment, dilution of negative preconceptions about telephone treatment, and robust service level guidance and standards for implementation are required. This is the first study that provides clear direction on how to improve telephone delivery and optimise implementation, aligning with current mental health policy and service improvement.

Living in quiet desperation: The mental health epidemic in Australia’s higher education

Objective: This study sought to investigate the relationship between personal, university, home and community influences on Australia’s university students’ mental health status. Design: Positioned within a qualitative, interpretivist paradigm, the study collected data from participants ( n = 934) by means of an online survey requesting lived or witnessed experiences concerning mental health concerns. Bronfenbrenner’s socio-ecological model informed the design of the study. Setting: Five major Australian higher educational settings. Method: Leximancer software was used for concept development. Data were analysed using thematic coding. Results: Findings provide qualitative data of university students’ experiences concerning mental health status, as measured across four domains. Themes identified include personal (stress, anxiety, life skills), university (grades/free physical activity) and home (closer to home, support networks) dimensions. There was no unprompted reference to the community domain. Results reinforce the need to ensure that current and future student mental health policies and initiatives are implemented within each of the domains addressed – to ensure a more holistic approach to students’ well-being and care. Conclusion: Findings highlight challenges concerning Australia’s university students’ mental health status. Findings present an opportunity for the university sector, community health services, and sports and fitness organisations to develop and implement future collaborative health promotion in higher education settings.

The Development of a Programme of Mental Health Services for People with Intellectual Disability in Ireland

Introduction: Within the current mental health policy in Ireland, Vision for Change (HSE, 2006), people with intellectual disabilities (I.D.) (target population) should have access to high quality mental health services, including an I.D. specific multi-disciplinary community mental health team. Historically mental health services for this population were poorly developed, without a clear policy or implementation strategy. Services that did exist were often embedded within social care services, with unclear pathways and models of care. Resources are being allocated to Mental Health of Intellectual Disability (MHID) services on an ongoing basis. Therefore the requirement to develop a clear strategy of implementing Vision for Change (HSE, 2006) for MHID was clear. Aim: To develop a clear programme of development of MHID services for children and adults, for full national implementation across mental health and social care services (key stakeholders). The timeline for the programme is 2 years beginning July 2016. The programme involves a number of key stages including: Scoping and mapping of existing resources Defining a clear pathway to care Developing clear governance arrangements Developing clinical activity metrics Key initial results from this programme will be presented including key service mapping data, as well as planned governance and care pathway arrangements. As this is a national programme, it is envisaged that there will be full be transferability of services achieved through collaboration and partnership across the relevant key divisions, organisations, disciplines and with Service Users and their families. Given the inclusive nature of the design of the programme, it’s sustainability potential is strong Developing a complex programme of service development involving existing and new resources across different service divisions requires services to be planned in an integrated manner. The intended impact of this programme is to improve the quality of mental health care and service experience.

Carers' involvement in decision making about antipsychotic medication: A qualitative study.

BackgroundCurrent Australian mental health policy recommends that carers should be involved in the provision of mental health services. Carers often provide intensive support to mental health consumers and gain detailed insight into their lives. As such, carers could make valuable contributions to well‐informed decisions about mental health consumers' use of antipsychotic medication.ObjectivesThe aim of this study was to explore carers' participation in antipsychotic medication decision making.MethodsSnowball sampling was used to enrol 29 carers in this study. Of these carers, 19 participated in semi‐structured interviews, and ten participated in a focus group. Data were analysed thematically.ResultsFour main themes emerged from the analysis. The findings highlighted that carers typically received little or no information about antipsychotic medication. Carers commonly addressed the shortfall in information by obtaining additional information through online sources or distributing among carer networks material that they had developed themselves. Almost all carers emphasized that they should be involved in decisions about antipsychotic medication, but noted that they were typically excluded. The lack of involvement in medication decisions was a source of frustration, as carers could contribute saliently through sharing detailed knowledge about mental health consumers' lives, address communication gaps that resulted from disjointed care and improve communication between health professionals and mental health consumers.ConclusionHealth professionals could consider improving the extent to which they collaborate with carers in medication decisions.

Views on Antipsychotic Medication in Jordan: From the People Diagnosed with Schizophrenia Perspectives

Background: Antipsychotic medications are commonly used to ameliorate symptoms associated with psychotic disorders such as schizophrenia. The aim of this study was to investigate of the People Diagnosed with Schizophrenia (PDwS) experiences towards antipsychotic medication. Methods: A qualitative semi-structured interview was conducted with PDwS (n=22) to elicit their perspectives about antipsychotic medication. Results: Interviewees perceived antipsychotic medication is a source of threat to their wellbeing and identified several reasons for non-compliance, including lack of insight, dissatisfaction with mental health services and the illness nature and treatment. The participants attributed lack of family support as a reason for noncompliance. Moreover, many of these factors in Jordan are similar to noncompliance reasons in high income countries Conclusion: PDwS reported wide range of experiences and attitudes towards antipsychotic medication and this study identified the major factors for noncompliance with medication in low-income country. Therefore, the current mental health policy should be revised to address these factors in order to enhance adherence rate.

Gender Sensitivity, Mental Health Care Provision and Minority Communities in Ireland: A Realist Analysis

The Irish Government has adopted “Gender Mainstreaming” as a strategy to promote equal opportunities between women and men in its National Development Plan. While current mental health policy addresses the principle of partnership and social inclusiveness as a way forward for mental health service provision, it still does not explicitly deal with the notion of gender and gender sensitivity. For some minority groups a lack of trust is a key issue that affects their uptake and meaningful use of services resulting in inadequate and gender insensitive care provision. Aim: The aim of this paper is to describe and analyse service providers’ views in relation to the gender sensitivity of mental health care provision particularly as it relates to minority (Traveller and gay) communities. Method: A qualitative social realist design was used guided by Layder’s adaptive theory and ontological theory of the social world – ‘social domains theory’. In-depth interviews with twenty eight service providers were conducted within one mental health service in Ireland. Data was analysed using NVivo software. Results: The findings are presented in relation to tolerance and responsiveness of service providers towards the gay and Traveller communities. Service providers suggested that prejudices were held in relation to both indigenous and immigrant minority groups and this impacted upon care provision. Categorical intersectional understandings of gender were used by service providers to describe Travellers. Conclusion: Belonging to a minority group was a potential or actual threat to gender sensitive care and service providers managed such threats within a lay socialisation context. Arguably, a move towards developing gender-sensitive mental health care provision requires greater collaboration, education and understandings in relation to minority groups, their cultural differences and gendered identities.

The Role of Cultural Psychiatry in Improving the Policy Response to Central America's Unaccompanied Minors at the American Border: Local and Global Implications.

Since 2014, children from El Salvador, Guatemala, and Honduras unaccompanied by their parents have fled in large numbers to the United States to escape violent crime and social disadvantage. Current mental health policies in the U.S. government's response can be improved based on guidelines from professional psychiatric and psychological organizations. These guidelines emphasize the importance of immigration and culture, raising questions into how the field of cultural psychiatry can offer conceptual frameworks and methods to research unaccompanied minor migration as a humanitarian problem. This paper conducts a policy analysis by reviewing shortcomings in the U.S. response and explores the potential contributions of cultural psychiatrists in optimizing services to address the needs of these children in the U.S. and their countries of origin.

Cocreation or Collusion: The Dark Side of Consumer Narrative in Qualitative Health Research

Health, mental health, and social care policy are dominated by the imperative of employing person-centered approaches. Such involvement of the “consumer” is generally claimed to provide a counter-narrative to the psychiatric and medical paradigm of illness. Taking a critical and reflexive standpoint, we find ourselves asking: Is there a dark side to employing person-centered approaches and potential loss and risk to participants themselves? To explore these questions further, we undertook a condensed critique of the current mental health, health, and social care policy arena. We then move to methodological concerns about ways in which person-centered research, including our own, can inadvertently reproduce the neoliberalist agenda. To conclude, we offer our own lived experiences as a cautionary tale. We also posit that a post-Foucauldian governmentality framework can assist researchers to avoid contributing to the very problems we wish to resolve.

Development of a mental health smartphone app: perspectives of mental health service users

Background: Current mental health policy emphasises the importance of service user involvement in the delivery of care. Information Technology can have an effect on quality and efficiency of care.Aims: The aim of this study is to gain the viewpoint of service users from a local mental health service in developing a mental health app.Method: A qualitative descriptive approach was used. Eight volunteers aged 18–49 years were interviewed with the aid of a semi-structured questionnaire.Results: Interviewees defined a good app by its ease of use. Common themes included availability of contact information, identifying triggers, the ability to rate mood/anxiety levels on a scale, guided relaxation techniques, and the option to personalise the app. The researchers will aim to produce an app that is easily accessible, highly personalisable and will include functions highlighted as important (i.e. contact information, etc.).Conclusions: This research will assist in the development of an easy-to-use app that could increase access to services, and allow service users to take an active role in their care. In previous studies, apps were developed without the involvement of service users. This study recognises the important role of service users in this area.