Development Of Mental Health Services Research Articles

Service User Experiences of Occupational Therapy in Acute Mental Health Settings: A Qualitative Evidence Synthesis

The inclusion of service user perspectives in the development of acute mental health services is recommended in policy. Therefore exploration of their experiences in this setting is merited. This study synthesized qualitative research on service user experiences of occupational therapy in the acute mental health setting using thematic synthesis. The synthesis shows the unique role of occupational therapists in the setting. Service users identified the impact of the profession through environmental transformation, therapeutic relationships, and occupation-focused interventions. Issues of accessibility and availability of interventions were identified. Further research on this topic in a wider range of cultural contexts is recommended.

Teaching Justice in Health Care

Back to table of contents Previous article Next article Ethics CornerFull AccessTeaching Justice in Health CareCharles C. Dike, M.D., M.P.H.Charles C. DikeSearch for more papers by this author, M.D., M.P.H.Published Online:29 Mar 2022https://doi.org/10.1176/appi.pn.2022.04.4.34“I will keep them [the sick] from harm and injustice. … Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves. …” —Hippocratic Oath, 400 B.C.This well-known pledge, the foundation of medical ethics, is repeated in one form or another by graduating medical students as they take on the sacred privilege of caring for others. Out of it flows the ethical injunctions of beneficence, nonmaleficence, and justice. As a graduating physician, I did not fully comprehend the sophistication of this age-old oath. It was easy enough to understand that the goal of treatment was to make patients better and cause no harm. But what exactly is “justice” in the field of medicine? Some have understood it to mean equitable distribution of available resources while providing care for our patients. Or being just or fair in the treatment of patients.Physicians are quick to state that their actions in therapeutic contexts are in the best interest of their patients, and they try their best to avoid harm. Physicians cannot, however, lay the same claim to justice. African Americans and other people of color have often borne the brunt of unjust physician practices. The COVID-19 pandemic exposed what has historically been the experience of people of color—that is, White patients are prioritized over Black patients. There were reports that Black patients did not have widespread access to COVID tests and were passed over for being placed on a ventilator or an EMCO despite having similar clinical presentations. In psychiatry, Black patients are more likely to be diagnosed with a psychotic illness even when the symptoms suggest otherwise, given intramuscular antipsychotic medications, and mechanically restrained, to mention only a few inequities, than their White peers.The public and gruesome killing of George Floyd and subsequent global protests led to a long-delayed awakening. Suddenly physician groups began to profess an awareness of the inherent injustice of the U.S. health care system and of their historical maltreatment of their non-White physician colleagues. Dr. Jeffrey Geller, former president of APA, convened the Task Force on Structural Racism Throughout Psychiatry to study the issue in depth, educate the public, and make amends. The APA Ethics Committee gave an opinion thus: “To provide competent care, a psychiatrist should cultivate an awareness of the adverse effects on mental health that result from racism and ethnoracial discrimination. … A treating psychiatrist should be mindful of the impact that racism and ethnoracial and other kinds of discrimination may have in the lives of patients and their families, in clinical encounters, and in the development of mental health services. ...”Despite the apparent awakening, psychiatry residents’ training on social (health care) justice remains sorely lacking. Concerned by this reality in their residency programs, several APA/APAF fellows took on the challenge and, under the auspices of the task force’s Workgroup on Fellow Projects and Leadership, created “A Primer of Online Resources on Structural Racism in Psychiatry for Medical Students & Trainees in Psychiatry.”The effort to educate our residents will flounder without sustained attention at developing a formal and structured educational process in residency programs. Equal attention should be placed on training faculty, not just faculty of color, to teach this material. Combating injustice in our health care system requires all hands to be on deck. Future physicians and psychiatrists—and their patients—deserve no less. We should hold ourselves accountable to all the elements of our code of ethics: beneficence, nonmaleficence, autonomy (respect for persons), and, yes, justice. ■APA’s ethics opinions related to COVID-19 is posted here.“A Primer of Online Resources on Structural Racism in Psychiatry for Medical Students & Trainees in Psychiatry” is posted here.Charles C. Dike, M.D., M.P.H., is chair of the APA Ethics Committee and former chair of the Ethics Committee of the American Academy of Psychiatry and the Law. He is also an associate professor of psychiatry and co-director of the Law and Psychiatry Division at the Yale University School of Medicine. ISSUES NewArchived

User-Focused Monitoring as a Strategy for Involvement and Mental Health Service Development: An Analysis of Swedish Monitoring Reports

User-focused monitoring (UFM) is a method of evaluating mental health services, conducted by people with lived experience of mental ill health. Research on UFM and on user involvement focused on service monitoring and evaluation is lacking. This study addresses this knowledge gap by examining UFM as a strategy for user involvement. More specifically, this study aims to synthesize patterns in UFM reports to characterize the phenomenon, as well as to further discuss negotiation processes and political opportunities in UFM. The empirical material consists of 136 Swedish UFM reports that have been analyzed in two steps: All reports were mapped according to general characteristics and a sample of 20 reports were selected to provide additional information on the method. This study has been conducted in collaboration with actors representing the user movement and municipality-based mental health services. Our analysis shows that long-term contracts between user organizations and service providers are important to create a sustainable implementation of UFM. However, strategies to protect user autonomy must be carefully considered and employed in relation to such collaborations. We further highlight the risks of a restricted focus on consumer satisfaction, and discuss the current development towards including follow-ups in the UFM process as a strategy for counteracting tokenism.

Measuring the quality of mental health services from the patient perspective in China: psychometric evaluation of the Chinese version of the World Health Organization responsiveness performance questionnaire

ABSTRACT Background Despite the large population of patients with mental disorders and the rapid development of mental health services in China, there are few evaluations of Chinese mental health services from the patient perspective. Relevant instruments with robust psychometric properties are lacking. Objective This study aimed to translate, adapt and validate the WHO responsiveness performance questionnaire for measuring the quality of hospital mental health services among Chinese patients. Methods The adaption of the translated questionnaire incorporated experts’ and patients’ opinions. For psychometric testing, 193 outpatients and 168 inpatients completed outpatient and inpatient modules, respectively. Results The adapted questionnaire adhered to the WHO framework of responsiveness domains, and just four items had some wording changes. Item missing rates were below 6%. Both the outpatient and inpatient modules had acceptable internal reliability (Cronbach’s α = 0.837 and 0.730) and most domains had desirable average inter-item correlation coefficients. The confirmatory factor analysis indicated an acceptable model fit for the inpatient module, while some goodness-of-fit indices for the outpatient module were a little outside of the recommended ranges. Except for ‘talking privately’ from the domain of confidentiality (both outpatient and inpatient modules) and ‘waiting time’ from the domain of prompt attention (the inpatient module), factor loadings of all other items were above 0.5. Conclusions The Chinese version of the responsiveness performance questionnaire has acceptable feasibility, reliability, and validity in general and it can be used to measure, assess and improve the quality of mental health services in China.

Breaking out of the citadel: social theory and psychiatry.

British psychiatry has tended to hold itself aloof from social theory. Nonetheless, these ideas have influenced the development of mental health services. Alongside this, the biopsychosocial model cannot reconcile contradictions in the scientific evidence regarding mental illness. We need to develop a more constructive understanding of the implications of social theory.

The Essential Network (TEN): Protocol for an Implementation Study of a Digital-First Mental Health Solution for Australian Health Care Workers During COVID-19.

BackgroundThe COVID-19 pandemic has placed health care workers (HCWs) under severe stress, compounded by barriers to seeking mental health support among HCWs. The Essential Network (TEN) is a blend of digital and person-to-person (blended care) mental health support services for HCWs, funded by the Australian Federal Department of Health as part of their national COVID-19 response strategy. TEN is designed as both a preventative measure and treatment for common mental health problems faced by HCWs. New blended services need to demonstrate improvements in mental health symptoms and test acceptability in their target audience, as well as review implementation strategies to improve engagement.ObjectiveThe primary objective of this implementation study is to design and test an implementation strategy to improve uptake of TEN. The secondary objectives are examining the acceptability of TEN among HCWs, changes in mental health outcomes associated with the use of TEN, and reductions in mental health stigma among HCWs following the use of TEN.MethodsThe implementation study contains 3 components: (1) a consultation study with up to 39 stakeholders or researchers with implementation experience to design an implementation strategy, (1) a longitudinal observational study of at least 105 HCWs to examine the acceptability of TEN and the effectiveness of TEN at 1 and 6 months in improving mental health (as assessed by the Distress Questionnaire [DQ-5], Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder [GAD-7], Oldenburg Burnout Inventory [OBI-16], and Work and Social Adjustment Scale [WSAS]) and reducing mental health stigma (the Endorsed and Anticipated Stigma Inventory [EASI]), and (3) an implementation study where TEN service uptake analytics will be examined for 3 months before and after the introduction of the implementation strategy.ResultsThe implementation strategy, designed with input from the consultation and observational studies, is expected to lead to an increased number of unique visits to the TEN website in the 3 months following the introduction of the implementation strategy. The observational study is expected to observe high service acceptability. Moderate improvements to general mental health (DQ-5, WSAS) and a reduction in workplace- and treatment-related mental health stigma (EASI) between the baseline and 1-month time points are expected.ConclusionsTEN is a first-of-a-kind blended mental health service available to Australian HCWs. The results of this project have the potential to inform the implementation and development of blended care mental health services, as well as how such services can be effectively implemented during a crisis.International Registered Report Identifier (IRRID)DERR1-10.2196/34601

The state of mental health care in China.

Over the past few years there have been considerable changes in China's mental health service system. This review provides an overview of the development of mental health services in China, including epidemiological data on psychiatric disorders, utilisation of mental health services, models of mental health service delivery, mental health resources and workforce, mental health policy framework and financial issues. We consider cultural and social factors including the involvement of family members in patient care, urbanisation and internal migration as well as the application of traditional Chinese medicine, which provides implications for mental health research and practice. Additionally, we also discuss major challenges and conclude by providing some specific recommendations on improving mental health services in China.

An Empirical Study on the Relationship between Community Sports Activities and Community Residents' Mental Health.

A full understanding of mental health can improve people's ability to identify mental diseases and cope with psychological problems, so as to improve the ability of the whole community to resist mental diseases. Community health education is particularly important in community mental health service. The traditional health education mode is carried out through lectures or paper brochures, and the effect is not significant, so we need to constantly improve the health education mode. Through the development of community mental health education and service, we can improve people's mental health quality and promote family happiness and social stability. Based on this, this study mainly analyzes the relationship between community sports activities and mental health of community residents. Physical exercise can reduce stress reaction, regulate emotion, enhance mental health, prevent, and treat mental diseases. Therefore, physical exercise has been used not only as a method to enhance physical fitness but also as an important means to regulate psychology.

Perinatal mental health in Malaysia: understanding the treatment gap and recommendations for the future.

Maternal mental health problems are widespread worldwide, especially against the backdrop of population growth. There is an increasing prevalence of perinatal mental illness in low- and middle-income countries, and Malaysia is no exception. Despite significant improvements in the Malaysian mental health system over the past decade, there are substantial gaps in the delivery of perinatal health services in Malaysia. This article seeks to give a general overview of perinatal mental health in Malaysia and provide recommendations for the development of Malaysia's perinatal mental health services.

Perinatal mental health service development across the UK - many achievements, growing challenges.

Perinatal mental health service development had early beginnings in the UK, and there has been rapid expansion over the past decade. As individual nations address need in their own jurisdictions, differences in service models and priorities have emerged. Innovative opportunities for addressing maternal and infant mental health needs must be balanced against the demands brought about by societal change and the COVID-19 pandemic. With such significant change, there is a unique opportunity for services and service planners to share good practice and learn from others' successes and challenges.

Developing a gender sensitive women's mental health service in Qatar: A rewarding challenge.

Investigations into gender differences in the epidemiology of common mental disorders have highlighted the fundamental role of socio-economic factors as the key determinants in experiencing mental ill health and access to treatment. Women are almost always at a socio-economic disadvantage across cultures throughout the world and as a result experience mental health inequality. This disparity in control over their socio-economic determinants is even more stark in the Middle Eastern and North African region. This region has additionally also cultural and legal conditions that make women empowerment and access to health difficult. Qatar launched an ambitious National Health Strategic program and identified women's mental health as a priority. This paper describes the development of a gender aware mental health service in Qatar, first of its kind in the region. It describes the challenges that exist in the region when attempting to develop such a service and some challenges that are unique to Qatar. This paper sets out a template of important principles that will be valuable for countries in the MENA region and beyond to develop evidence-based gender aware service that focuses on female empowerment and better mental health outcomes.

Historical Highlights on Electroconvulsive Therapy Practice in Iraq: A Brief Narrative.

Electroconvulsive therapy (ECT) is an established treatment option for severe psychiatric disorders. Electroconvulsive therapy practice began in Iraq in 1946, primarily to treat patients with schizophrenia. Since then, it has developed and expanded to treat mood disorders and major depression. Initially, both modified and unmodified ECT was administered to patients in Ibn Rushd and Al Rashad mental hospitals in Baghdad. The ongoing political turmoil from 3 wars, economic sanctions, and internal conflicts halted the development of mental health services across the country; ECT provision was not an exception. The practice of unmodified ECT-without general anesthesia-ceased in 2009, after the recommendations of the Royal College of Psychiatrists' Iraq Subcommittee. This closure reduced the availability and accessibility of ECT clinics nationwide because of limited access to general anesthesia. This article explores the nature of ECT services, in the context of Iraq's health care system, sociocultural norms, instability, and international codes of practice. This brief report uses the first author's work experience, few available data, and personal communication to describe the brief history of ECT practice in Iraq. This report is a baseline document for future ECT practice regulation in Iraq.

The effects of national mental health plans on mental health services development in Chile: retrospective interrupted time series analyses of national databases between 1990 and 2017

AimsTo describe changes in mental health services in Chile between 1990 and 2017, and to retrospectively assess the effects of national mental health plans (NMHPs) on mental health services development during this period.MethodsService data (beds in psychiatric hospitals, psychiatric beds in general hospitals, forensic psychiatric beds, beds in protected housing facilities, psychiatric day hospital places, and outpatient mental health care centers) were retrieved from government sources in Chile. Data were reported as rates per 100,000 population. We conducted interrupted time series analyses, using ordinary least-square regressions with Newey-West standard errors, to assess the effects of the 1993 and 2000 NMPHs on mental health services development.ResultsRates of short- and long-stay beds in psychiatric hospitals (per 100,000 population) were reduced from 4.3 to 3.2 and from 19.0 to 2.0 over the entire time span, respectively. The strongest reduction of short- and long-stay beds in psychiatric hospitals was seen between the 1993 and 2000 NMHPs (annual removal of − 0.14 and − 1.03, respectively). We observed increased rates of psychiatric beds in general hospitals from 1.8 to 4.0, beds in protected housing facilities from 0.4 to 10.2, psychiatric day hospital places from 0.4 to 5.0, outpatient mental health care centers from 0.1 to 0.8 and forensic psychiatric beds from 0.3 to 1.1 over the entire time span. The strongest annual increase of rates of psychiatric beds in general hospitals (0.09), beds in protected housing facilities (0.50), psychiatric day hospital places (0.16) and outpatient mental health care centers (0.04) were observed after the 2000 NMHP. Forensic psychiatric beds increased in the year 2007 (0.58) due to the opening of a new facility.ConclusionsThe majority of acute care psychiatric beds in Chile now are based in general hospitals. The strong removal of short- and long-stay beds from psychiatric hospitals after the 1993 NMHP preceded substantial expansion of more modern mental health services in general hospitals and in the community. Only after the 2000 NMHP, the implementation of new mental health services gained momentum. Reiterative policies are needed to readjust mental health services development.

Community-Based Mental Health Services in Azerbaijan: a Course Toward Development: Развитие внебольничной психиатрической службы Азербайджана.

Community mental health care in Azerbaijan was established in 2011 in the line with the country's mental health reform. The main directions of the reform, as described in the National Mental Health Strategy, were deinstitutionalization, improving quality of care, integration of mental health into primary healthcare, and implementation of modern community-based services. Over the last decade, the number of beds in psychiatric hospitals has significantly decreased, and many psychiatrists and psychiatric nurses have been transferred to primary care facilities. At the same time, programs focusing on comprehensive care have been implemented in different regions of the country. Community mental health services currently employ various kinds of mental health professional including psychiatrists, clinical psychologists, social workers, occupational therapists, and nurses to ensure a multidisciplinary approach to care provision. Team-based care may focus on crisis resolution, psychosocial rehabilitation, case management, family support, and early intervention for psychosis. Among the barriers preventing development of community mental health services, one should note, in particular, stigma belittling the priority of mental healthcare, uncertainty in distribution of authority between the Ministry of Health and the State Agency for Mandatory Health Insurance, and a general scarcity of human resources, especially in the rural regions. Nevertheless, the mental health care in Azerbaijan is continuing its transition from an institutional model to community-based services.

Journey from seclusion to inclusion: Development of mental health services in India since independence

Mental health is an integral and essential component of “Health”. It is more than the mere absence of mental disorders or disabilities. It determines the quality of life of the individuals. The progress and prosperity of a nation depend on the overall quality of health of its citizens. However, until early twentieth century the issues of mental health and well-being were inadequately addressed. Often people with psychological ailments were considered to be non-productive people, confined in asylums, received inhumane treatment and were completely secluded from the mainstream society. Since independence initiatives have been taken by individuals and by the central government and the state governments, to develop the mental health services in India. This paper reviewed published articles, book-chapters and books to explore the development of mental health services in India since Independence. It was observed that measures were taken to improve the conditions of the mental hospitals. A trend towards deinstitutionalization was set by the Government of India and that initiated the creation of general hospital psychiatric units and community mental health services. Humanistic approach in treatment, development of psychotropic drugs and psychotherapies facilitated the management and care of the patients with psychiatric diseases, thereby improving their quality of life.

The 1996 TheMHS Conference, Brisbane: A Reflection on Consumer Involvement in Mental Health and the Birth of the Australian National Consumer Network

The 1996 TheMHS Conference, Brisbane: A Reflection on Consumer Involvement in Mental Health and the Birth of the Australian National Consumer Network Melanie Schuth (née Scott) (bio), Helen Glover (bio), and V. Kalyansundarum (bio) As compared to the rest of Australia, deinstitutionalisation and the development of community mental health services commenced relatively late in Queensland. Yet, once it started in the mid-1990s, there was a time of exceptional innovation and change in the state’s mental health sector. After the publication of the influential Burdekin report (1993) and with the momentum of the first National Mental Health Strategy, there was an openness among government officials and policymakers to explore new ideas and explore new ways of working.1 Consumer voices were being heard—many dared not only to speak, but to speak loudly. Many people are able to ignore the history of the Australian consumer movement until it is told boldly and loudly. During the early 1990s, the involvement of lived experience in mental health was still novel in Australia. In 1994, The Mental Health Services conference (TheMHS; one of the most progressive organisations in Australia and New Zealand in mental health), responding to then prominent consumer advocacy voices, advanced consumer involvement by dedicating a day to consumers.2 This spearheaded opportunities that would not have occurred as early, organically, or as genuinely as they did during this period. The organisers were convinced that consumer involvement should not be merely tokenistic: if lived experience voices were to be incorporated in the planning and running of mental health services, they had to be incorporated in an authentic and genuine way. We, the authors of this paper—Dr Kalyansandarum (Kaly in everyday life), Helen Glover, and Melanie Scott—were involved in the planning of the 1996 TheMHS conference and in various initiatives in mental health afterwards. We came together nearly thirty years later to reflect on what transpired during that time. We realised that much time had passed since the mid-1990s and that our memories were somewhat patchy as to the finer details of how the three of us joined forces and how both lived and learned experiences participated to co-create the 1996 TheMHS [End Page 135] conference and attempted to advance the ‘consumer’ movement. To this end, we recorded interviews about our recollections with each other about the conference and what emerged afterwards. Three key themes emerged from the discussions about our recollections. These themes, we think, remain pertinent today: 1. A strong desire to do things differently 2. Thinking big and well outside the box 3. An openness to experimentation A note on language: In the 1990s, the term ‘consumer’ indicated a radical shift from the term ‘patient’ or ‘ex-patient’. We acknowledge that we use the term in the context of the time it originated, noting that a broader range of person-first language is currently widely accepted in the sector’s linguistic lexicon and preferred by individuals who access services. 1. A Strong Desire to do Things Differently In our conversations with Dr Kaly, we inquired about his motivation to engage and include people with a lived experience of mental ill-health in the work he did in mental health. As this was during the post-Burdekin era, we anticipated that he would emphasise the importance of upholding people’s human rights, and their right to be heard and taken seriously in matters of service delivery. Whilst this was important to him, it was not his main motivation: Dr. Kaly: I was not so much interested in lived experience involvement in itself, but much more interested in the notion of personal recovery and learning from that to improve both my own practice and how we delivered services. Involvement and participation was the method we utilised. Instead of reading books about it I wanted to hear from their hearts. I wanted to learn from people who knew, based on their experiences. I firmly believed in the potential that people with serious mental illness and institutionalisation can lead good and fulfilling lives. Dr Kaly’s ethos about being led, informed, and, very often, challenged by lived experience wisdom extended well beyond mere consultation. His genuine desire...

The Quality of Care Provided by Outpatient Mental Health Services in Georgia.

Georgia has recently made a commendable effort to reform mental health care. The "Concept on Mental Health Care" adopted by the Government and the two strategic plans for 2014-2020 and 2021-2031, which aimed to develop comprehensive evidence-based, culturally appropriate, and human rights-oriented mental health care, have promoted the deinstitutionalization and development of community mental health services. Since 2018, new standards of care for mental health ambulatories and mobile teams have been imposed and implemented in the state programme and funded accordingly. The study aimed to investigate the quality of care in community mental health services. As a result, we monitored the mental health ambulatories in all major cities and regional centres of the country (in total, 16 ambulatories) and the mobile teams which had at least two years of experience (in total, 14 mobile teams). The data analyses showed that the new standards for ambulatories and mobile teams increased access to and coverage of mental health care across the country. However, further effort is still needed to achieve comprehensive treatment by mental health care services.

Evidence-based Methods in Rural Areas – Knowledge and National Guideline Utilization in Mental Health Service Development

ABSTRACT Purpose To examine how rural municipalities develop services to people with serious mental illness in relation to evidence-based practice and national guidelines. Additional sources of knowledge and strategies used by the municipalities in relation to their development needs were explored as well. Method Qualitative multiple-case approach, with 43 deep-interviews involving 84 informants representing selected social psychiatric services from 11 sites. Results National guidelines and evidence-based practices have a limited impact on how rural municipalities develop services to the target group. The municipalities favor other sources of knowledge, including regional networks, pragmatic problem-solving approaches and community-based knowledge. Discussion and conclusion Most of the informants expressed a need for more systematic and evidence-based knowledge in order to meet their clients’ needs. A major challenge to improve the utilization of these methods, is to make adaptions to match the rural municipalities’ needs and actual resources without risking the quality of these evidence-based services.

Mental Health Services in the Northeastern Province of British India: Tezpur Lunatic Asylum, 1876–1947

Colonialism in the nineteenth century brought a new ‘space’ for lunatics in British India. The Northeastern province witnessed the establishment of a lunatic asylum in 1876 at Tezpur in present-day Assam. The article explores the historical development of mental health services by the British in this particular region and constructs a history of colonial control of the natives through employing a strict system under the lunatic asylum service. The methods of confinement of inmates, mainly from poor sections of society, and treatment patterns that focussed more on profits and disciplining of inmates, suggest that the asylum was more custodial rather than curative.

Community-Based Mental Health Services in India: Current Status and Roadmap for the Future

An estimated 197.3 million people have mental disorders in India, and majority of the population have either no or limited access to mental health services. Thus, the country has a huge burden of mental disorders, and there is a significant treatment gap. Public mental health measures have become a developmental priority so that sustainable gains may be made in this regard. The National Mental Health Program (NMHP) was launched in 1982 as a major step forward for mental health services in India, but it has only been able to partially achieve the desired mental health outcomes. Despite efforts to energize and scale up the program from time to time, progress with development of community-based mental health services and achievement of the desired outcomes in India has been slow. Public health measures, along with integration of mental health services in primary healthcare systems, offer the most sustainable and effective model given the limited mental health resources. The main barriers to this integration include already overburdened primary health centres (PHCs), which face the following challenges: limited staff; multiple tasks; a high patient load; multiple, concurrent programs; lack of training, supervision, and referral services; and non-availability of psychotropic medications in the primary healthcare system. Thus, there is an urgent need for a fresh look at implementation of the NMHP, with a focus on achieving sustainable improvements in a timely manner.