Mental Health System Development Research Articles

Stepwise expansion of evidence-based care is needed for mental health reform.

Mortality from mental illnesses is increasing and, because they frequently occur early in the life cycle, they are the largest source of disability and reduced economic productivity of all non-communicable diseases. Successful mental health reform can reduce the mortality, morbidity, growing welfare costs and losses in economic productivity caused by mental illness. The government has largely adopted the recommendations of the National Mental Health Commission focusing on early intervention and stepwise care and will implement a reform plan that involves devolving commissioning of federally funded mental health services to primary health networks, along with a greater emphasis on e-mental health. Stepwise expanded investment in and structural support (data collection, evaluation, model fidelity, workforce training) for evidence-based care that rectifies high levels of undertreatment are essential for these reforms to succeed. However, the reforms are currently constrained by a cost-containment policy framework that envisages no additional funding. The early intervention reform aim requires financing for the next stage of development of Australia's youth mental health system, rather than redirecting funds from existing evidence-based programs. People with complex, enduring mental disorders need more comprehensive care. In the context of the National Disability Insurance Scheme, there is a risk that these already seriously underserved patients may paradoxically receive a reduction in coverage. E-health has a key role to play at all stages of illness but must be integrated in a complementary way, rather than as a barrier to access. Research and evaluation are the keys to cost-effective, sustainable reform.

Selection of assessment indicators for mental health service

Assessment of mental health service refers to the process of using the indicator system and methods to reflect the quality or performance of mental health. Mental health evaluation can effectively promote the development of mental health system and service quality. Scientific and comprehensive indicator system is key to assessment. After long-term practice and exploration, there have been many successful assessment schemes in foreign countries, which may be used in establishing the assessment system and screening indicators in China.

Armenia: Influences and Organization of Mental Health Services

Relatively little has been published on mental health care and counseling as they pertain to Armenia, a country of approximately three million residents that gained independence in 1991 from the former Soviet Union. Various influences, such as its history, economy, religious and family systems, and a major natural disaster in 1988, have affected the subsequent development of professional mental health systems. Though challenges exist, improvements have been evident in the past 15 years with the development of psychiatric facilities, laws protecting clients using mental health services, and professional associations to educate and advocate for mental healthcare issues. The development and possible role of counseling in this country are also discussed.

Mental Health Policy and Service System Development in the English-speaking Caribbean

The countries and territories comprising the English-speaking Caribbean (ESC) have made some strides in the development of mental health policy, services and systems with the expenditure in mental health as a percentage of health budgets ranging from 1% to 7%. The ESC countries have well developed primary healthcare systems. However mental health legislations in many countries are in need of reform. Some countries have developed an innovative community based, secondary care treatment model: treatment in the medical wards of general hospitals. These countries have made progress in integrating mental health into primary healthcare and have made psychotropic medication widely available at the primary care level. Notwithstanding the progress in some countries, greater effort is required in phasing out mental hospitals and integrating mental health into primary care in other ESC countries.

The Centre for International Mental Health approach to mental health system development.

Although mental disorders are a major public health problem, the development of mental health services has been a low priority everywhere, particularly in low- and middle-income countries. Recent years have seen a growing understanding of the importance of population mental health and increased attention to the need to developmental health systems for responding to population mental health service needs. In countries and regions where mental health services are all but nonexistent, and in postconflict and postdisaster settings, there are many impediments to establishing or scaling up mental health services. It is frequently necessary to act simultaneously on multiple fronts: generating local evidence that will inform decision makers; developing a policy framework; securing investment; determining the most appropriate service model for the context; training and supporting mental health workers; establishing or expanding existing services; putting in place systems for monitoring and evaluation; and strengthening leadership and governance capabilities. This article presents the approach of the Centre for International Mental Health in the Melbourne School of Population Health to mental health system development, and illustrates the way in which the elements of the program are integrated by giving a brief case example from Sri Lanka. (harv rev psychiatry 2012;20:37–46.)

Knowledge and attitude regarding recovery among mental health practitioners in Sweden

The aim was to investigate the knowledge and the attitude regarding recovery among practitioners working in the Swedish mental health system, Personligt Ombud (PO), Supported Housing Team (SHT) and Psychiatric Out Patient Service (POPS), to determine whether and how knowledge and attitude regarding recovery differ between the three services. A web-based questionnaire based on the Recovery Knowledge Inventory was sent to the participants. Participant selection ensured that different parts of Sweden were represented. A multiple linear regression was used to examine the result under control of Sex, Age, Educational Level, Further Education, Relevant Work Experience and Training in Recovery. The result of the regression showed that POs had higher scores than both SHT and POPS on the subscales, even under control of other variables. The SHT differed significantly from POs on two of the subscales and POPS differed significantly from POs on all subscales. Personnel with university education, more work experience or specific training in recovery also had a higher mean score. Swedish practitioners need to learn more about certain aspects of the recovery process. The differences between the services may possibly be due to the services' organization, assignment and role. Other important aspects were the level of education and having specific training in recovery; the combination of these elements could facilitate the development of a recovery-oriented mental health system.

Aceh Free Pasung: Releasing the mentally ill from physical restraint

BackgroundPhysical restraint and confinement of the mentally ill (called pasung in Indonesia) is common in Aceh. In early 2010, the local government initiated a program called Aceh Free Pasung 2010. The main goal of the program is to release the mentally ill in the province from restraint and to provide appropriate medical treatment and care. The aim of the paper is to report the findings of a preliminary investigation of the demographic and clinical characteristics of patients who have been admitted to the Banda Aceh Mental Hospital as part of the Aceh Free Pasung program.MethodsThis is a cross-sectional descriptive study conducted at the Banda Aceh Mental Hospital, where people who had been restrained or confined in the community are being admitted for psychiatric treatment and, where necessary, physical rehabilitation, as part of the Aceh Free Pasung program.ResultsFifty-nine of former ex-pasung patients were examined. The majority (88.1%) of the patients were male, aged 18 to 68 years. The duration of pasung varied from a few days to 20 years, with a mean duration of 4.0 years. The reasons for applying pasung are many, with concerns about dangerousness being most common. The great majority (89.8%) had a diagnosis of schizophrenia.DiscussionThe development of a community mental health system and the introduction of a health insurance system in Aceh (together with the national health insurance scheme for the poor) has enabled access to free hospital treatment for people with severe mental disorders, including those who have been in pasung. The demographic and clinical characteristics of this group of ex-pasung patients are broadly similar to those reported in previous studies.ConclusionsThe Aceh Free Pasung program is an important mental health and human rights initiative that can serve to inform similar efforts in other parts of Indonesia and other low and middle-income countries where restraint and confinement of the mentally ill is receiving insufficient attention.

Mental health policy process: a comparative study of Ghana, South Africa, Uganda and Zambia

BackgroundMental illnesses are increasingly recognised as a leading cause of disability worldwide, yet many countries lack a mental health policy or have an outdated, inappropriate policy. This paper explores the development of appropriate mental health policies and their effective implementation. It reports comparative findings on the processes for developing and implementing mental health policies in Ghana, South Africa, Uganda and Zambia as part of the Mental Health and Poverty Project.MethodsThe study countries and respondents were purposively selected to represent different levels of mental health policy and system development to allow comparative analysis of the factors underlying the different forms of mental health policy development and implementation. Data were collected using semi-structured interviews and document analysis. Data analysis was guided by conceptual framework that was developed for this purpose. A framework approach to analysis was used, incorporating themes that emerged from the data and from the conceptual framework.ResultsMental health policies in Ghana, South Africa, Uganda and Zambia are weak, in draft form or non-existent. Mental health remained low on the policy agenda due to stigma and a lack of information, as well as low prioritisation by donors, low political priority and grassroots demand. Progress with mental health policy development varied and respondents noted a lack of consultation and insufficient evidence to inform policy development. Furthermore, policies were poorly implemented, due to factors including insufficient dissemination and operationalisation of policies and a lack of resources.ConclusionsMental health policy processes in all four countries were inadequate, leading to either weak or non-existent policies, with an impact on mental health services. Recommendations are provided to strengthen mental health policy processes in these and other African countries.

The Development of a Recovery-Oriented Mental Health System in Canada: What the Experience of Commonwealth Countries Tells Us.

This article examines how the recovery concept has been introduced into national mental health policies in New Zealand, Australia and the England. Five overall themes are identified as critical in shifting to a recovery-oriented system: restructuring of mental health services; promoting mental health and preventing mental illness, developing and training the workforce; cultivating consumer participation and leadership and establishing outcome-oriented and measurable practices. These issues are vital in the uptake of recovery and should guide the overall direction of the Canadian Mental Health Commission's mental health strategy.

International observatory on mental health systems: structure and operation

IntroductionSustained cooperative action is required to improve the mental health of populations, particularly in low and middle-income countries where meagre mental health investment and insufficient human and other resources result in poorly performing mental health systems.The ObservatoryThe International Observatory on Mental Health Systems is a mental health systems research, education and development network that will contribute to the development of high quality mental health systems in low and middle-income countries. The work of the Observatory will be done by mental health systems research, education and development groups that are located in and managed by collaborating organisations. These groups will be supported by the IOMHS Secretariat, the International IOMHS Steering Group and a Technical Reference Group.SummaryThe International Observatory on Mental Health Systems is: 1) the mental health systems research, education and development groups; 2) the IOMHS Steering Group; 3) the IOMHS Technical Reference Group; and 4) the IOMHS Secretariat. The work of the Observatory will depend on free and open collaboration, sharing of knowledge and skills, and governance arrangements that are inclusive and that put the needs and interests of people with mental illness and their families at the centre of decision-making. We welcome contact from individuals and institutions that wish to contribute to achieving the goals of the Observatory.Now is the time to make it happen where it matters, by turning scientific knowledge into effective action for people's health. (J.W. Lee, in his acceptance speech on his appointment as the Director-General of the World Health Organization) [1].

State Mental Health Policy: Mental Health Transformation: Moving Toward a Public Health, Early-Intervention Approach in Texas

State Mental Health Policy: Mental Health Transformation: Moving Toward a Public Health, Early-Intervention Approach in Texas

Why focus on mental health systems?

The global situation for people with mental illness – in developing and developed countries – is dire. Legislative and human rights protections are frequently lacking. Mental health budgets are inadequate. There are insufficient numbers of skilled policy makers, managers and clinicians. Communities are poorly informed about mental health and illness and not well organised for purposes of advocacy. In most of the world, mental health services are inaccessible or of poor quality. Most people who would benefit from psychiatric treatment and rehabilitation do not have affordable access to such services. Leadership – at all levels – for mental health system development needs to be greatly strengthened.While mental health research attention and funds are devoted predominantly to neuroscience and clinical research, we believe that the highest global mental health research priority is mental health systems research. There is an urgent need to focus on the development of effective, appropriate, affordable mental health services. The evidence base for such development is currently weak.The International Journal of Mental Health Systems aims to stimulate greater attention to the central importance of building functioning mental health systems. Rapid publication and global reach through open access will make this journal a resource for all those who wish to contribute to such development.

Comparative mental health policy: Are there lessons to be learned?

The development of an excellent mental health system at the national level or even the state or provincial jurisdiction resembles the search for the Holy Grail. We are not there yet, and some stakeholders doubt we will ever get there. The last 20 years has seen an explosion of progressive mental health policy statements in a number of jurisdictions. However, it is difficult to find national mental health systems that are performing well. This paper reviews the status of national mental health policy in Australia, the UK, the USA and New Zealand. It examines the evolution of mental health policy in Ontario, Canada, and provides some commentary on how the Ontario experience is consistent with the experience of other jurisdictions. Finally it explores whether there are lessons to be learned that can be applied in Canada and elsewhere.

The Campaign for Mental Health Reform: a new advocacy partnership.

The Campaign for Mental Health Reform: a new advocacy partnership.

Why Do States Privatize Mental Health Services? Six State Experiences

State governments fund more than one-half of public mental health service system costs through mental health departments, other state agencies, and the Medicaid program. They use some of these resources to finance community-based mental health services through purchase-of-service contracts. I explored the reasons why states privatize mental health services and focused on political, economic, and organizational theories as possible frameworks for contracting. I gathered data during site visits to Massachusetts, Michigan, New York, Oregon, Tennessee, and Texas, where I interviewed more than one hundred individual stakeholders about mental health purchase-of-service contracting. I also examined relevant documents about contracting practices for mental health services in each state. My results suggest that state policy makers can use mental health contracting to effect multiple goals. Contracting helps states achieve political, economic, and organizational objectives, such as avoiding the influence of interest groups and leveraging state resources, while avoiding conflict. With contracting, state policy makers can also continue the ongoing mental health policy paradigm shift begun during deinstitutionalization, in which persons with serious and persistent mental illnesses receive services from community-based providers rather than in state hospitals. Finally, my results suggest that contracting will continue to be an important state policy tool in further development of state-supported mental health systems.

Human resource development: An underutilized tool of state mental health administration

Evidence from federally mandated plans suggests that state mental health administrators have not fully utilized human resource development as a management tool. The importance of human resource development interventions used in collaboration with other management strategies is discussed as an effective approach to mental health system development.

State and local collaboration in the development of Wisconsin's mental health system

Wisconsin dramatically transformed its public mental health system from inpatient treatment to a community-based service system in the 1970s. The resulting decentralized and community-based system used complementary clinical and operational strategies. This paper identifies key aspects of a multi-faceted state and local collaboration.

The Vermont longitudinal study of persons with severe mental illness, I: Methodology, study sample, and overall status 32 years later.

The authors report the latest findings from a 32-year longitudinal study of 269 back-ward patients from Vermont State Hospital. This intact cohort participated in a comprehensive rehabilitation program and was released to the community in a planned deinstitutionalization effort during the mid-1950s. At their 10-year follow-up mark, 70% of these patients remained out of the hospital but many were socially isolated and many were recidivists. Twenty to 25 years after their index release, 262 of these subjects were blindly assessed with structured and reliable protocols. One-half to two-thirds of them had achieved considerable improvement or recovery, which corroborates recent findings from Europe and elsewhere.