Experiences Of Mental Health Services Research Articles

Priority setting in research: user led mental health research

Plain English summaryInvolving people in health research is increasingly recognised as being important to make sure that research is focused more on the needs of people who use health services. At present, ideas about what should be researched most often comes from researchers and/or health professionals like doctors and nurses rather than people with a lived experience of mental illness. In this study, we will talk with this group of people from across Wales to explore what they think research into their health services should focus on. The findings from this work will help to influence the work of the National Centre for Mental Health Research Partnership Group; as well as` researchers and health professionals and others who concentrate on mental health research. The Research group is a partnership between people with a lived experience of mental ill health and professionals with an interest in mental ill health. The group plan to take forward the ideas that came from this research and some of the ideas have already been used to increase funding in the area of mental health research.Background This paper is the result of continued collaboration between members of the Service User and Carer Research Partnership, based in Wales and supported by the National Centre for Mental Health, Health and Care Research Wales, and Hafal. The aim of this study was to explore the research priorities of people with experience of mental health services which include people with a lived experience of mental ill health, their carers, and professionals.Method A nominal group technique was used to gather data. A one-day workshop ‘Getting Involved in Research: Priority Setting’ was held to gather the ideas and suggestions for research priorities from people who have experience of mental health services.Results Twenty-five participants attended the workshop. 5 were mental health professionals, 20 had a lived experience of mental ill health, (of which 3 were also carers). 11 were male and 14 were female. 120 research ideas were generated across 6 ‘Ideas Generating Workstations’. Participants took part in a 3 stage vote to narrow down the ideas to 2 main research priorities.Conclusion The two main research priority areas that were identified:‘Developing the knowledge of mental health issues amongst school-aged children’ as a vehicle to overcome stigma and discrimination, and to support young people to manage their own mental health.‘Developing education as a tool for recovery’, for example by peer support. In addition, participants engaged in a notable discussion over the research priority: ‘How are carers supported during the recovery of the person for whom they care?’

Experiences of mental health services for 'black' men with schizophrenia and a history of disengagement: A qualitative study.

Whilst mental disorders can be disabling they are also treatable, yet engagement with services is often poor and disengagement from treatment is a major concern for mental health nurses. Participants were service users typically perceived as the most disengaged from mental health services, yet they were willing to engage in the research interviews. The seven participants were all male with a diagnosis of schizophrenia, a history of disengagement from mental health services and described their ethnicity as 'black'. Participants were under the care of Assertive Outreach Teams and were recruited after the researcher was introduced to them by clinicians who were working with them. After ethical approval, in-depth, semi-structured interviews were used to elicit the experiences of participants. Through interpretative phenomenological analysis, themes were developed. Interpretative Phenomenological analysis generated four themes: (i) "People just keep hounding me", (ii) Antipathy to Medication, (iii) Choice and the value of services, (iv) Stigmatisation and identity. By rigorously examining how service users with schizophrenia make sense of their experience of their relationship with mental health services, there is potential to give voice to the experiences of the recipients of mental health services. This study uncovered the complex nature of disengagement and in view of this there may never be a straightforward mechanism developed to engage all people with schizophrenia with mental health services. When the participants' experiences are considered in a broader social context it may be possible to reflect on how services can be adapted to facilitate better engagement.

Beyond patient-centered care: Enhancing the patient experience in mental health services through patient-perspective care

Beyond patient-centered care: Enhancing the patient experience in mental health services through patient-perspective care

Art therapists with experience of mental distress: Implications for art therapy training and practice

ABSTRACTAs part of its ongoing work to support and value the contributions to art therapy from service users, the British Association of Art Therapists (BAAT) conducted a survey of art therapists with dual experience as professionals and mental health service users. The survey aimed to establish if art therapists disclosed their experiences as service users when applying to train, during their art therapy training and/or when qualified. Participants (N = 20) were also surveyed on their motivation for disclosure or non-disclosure, their experiences of the process and the quality of responses they met. They were additionally asked whether their experiences of mental health services had impacted on the quality of their art therapy practice and if so, how. The findings from this small sample suggest that disclosure was not easy. Reported responses to participants’ disclosures were mixed, with many experiencing both helpful and unhelpful responses. Emotional support appeared to be important for helping people both to normalise and to contain current distress. Another finding concerns self-reported increased empathy for service users. Awareness and management of one’s own limitations was another reported gain, since reflecting on oneself and one’s life was usually enforced through the ‘breakdown’, hospitalisation or disruption of career path.

Transitioning care-leavers with mental health needs: 'they set you up to fail!'

Children in the UK care system often face multiple disadvantages in terms of health, education and future employment. This is especially true of mental health where they present with greater mental health needs than other children. Although transition from care - the process of leaving the local authority as a child-in-care to independence - is a key juncture for young people, it is often experienced negatively with inconsistency in care and exacerbation of existing mental illness. Those receiving support from child and adolescent mental health services (CAMHS), often experience an additional, concurrent transfer to adult services (AMHS), which are guided by different service models which can create a care gap between services. This qualitative study explored care-leavers' experiences of mental illness, and transition in social care and mental health services. Twelve care-leavers with mental health needs were interviewed and data analysed using framework analysis. Sixteen individual themes were grouped into four superordinate themes: overarching attitudes towards the care journey, experience of social care, experience of mental health services and recommendations. Existing social care and mental health teams can improve the care of care-leavers navigating multiple personal, practical and service transitions. Recommendations include effective Pathway Planning, multiagency coordination, and stating who is responsible for mental health care and its coordination. Participants asked that youth mental health services span the social care transition; and provide continuity of mental health provision when care-leavers are at risk of feeling abandoned and isolated, suffering deteriorating mental health and struggling to establish new relationships with professionals. Young people say that the key to successful transition and achieving independence is maintaining trust and support from services.

The right location? Experiences of refugee adolescents seen by school-based mental health services.

Access to needed mental health services can be particularly difficult for newly arrived refugee and asylum-seeking adolescents, although many attend school. This study examined young refugees' impressions and experience of mental health services integrated within the school system. Semi-structured interviews were conducted with 40 adolescent refugees discharged by three school-based mental health services across the United Kingdom. Two-thirds preferred to be seen at school. Rumination and worry about insecurity in the asylum process had a negative impact particularly on the adolescents' social functioning and ability to focus at school. The important role played by teachers in supporting and mediating contact with mental health services was valued by those interviewed. The study confirms that schools offer an important location for mental health services for adolescent refugees and provide an important portal for integration of services.

Graduate nurses' experiences of mental health services in their first year of practice: An integrative review

New graduate nurses have reported negative experiences in mental health settings, particularly during the transitional period of practice. Previous research has focused on addressing the undergraduate preparation of nurses for practice instead of the experiences and outcomes of the transitional period. Recently, there has been growing interest in exploring the experiences of graduate nurses in transition and the implementation of promising interventions to facilitate new graduates' assimilation to practice. Despite these initiatives, the overall shortage of mental health nurses continues to rise, and graduates still report negative experiences in the mental health setting. The purpose of this study was to identify and explore the experiences of new graduate nurses in mental health services in their first year of clinical practice. An integrative review was conducted with 22 studies sourced from the CINAHL, PubMed, Scopus, and PsychINFO electronic databases, as well as through hand-searching the literature. Literature review findings have highlighted negative clinical experiences and increased attrition from mental health services for graduate nurses. These experiences were closely linked with the changes in the training of mental health nurses, role ambiguity, inadequate clinical preceptorship, encountering the reality of mental health services, and the role of health services in transitioning graduate nurses into clinical practice. Established research into organizational cultures demonstrates that negative organizational outcomes result from negative workplace experiences. Therefore, further research into new graduate nurses' experiences of mental health nursing and its culture might clarify the reasons why they might not be attracted to the discipline and/or are leaving early in their career.

Sharing Experience Learned Firsthand (SELF): Self-disclosure of lived experience in mental health services and supports.

Self-disclosure of lived experiences with mental health challenges is a central method for challenging stigma and promoting empowerment. Individuals are encouraged to share their stories yet little is known about the process of self-disclosure in this context. This article presents the results of an investigation of the role of lived experience in professional training and work. A mixed methods design was used in a sequential exploratory manner. A purposive sample of 35 individuals participated in interviews and focus groups. Based on their reports and a literature review, an anonymous online survey (N = 117) was developed and distributed through consumer networks and the SAMHSA funded Consumer Technical Assistance Centers. The qualitative data was subjected to thematic analysis. The survey data were statistically analyzed for differences in levels of disclosure and factors regarding risks, benefits, and guidance regarding self-disclosure. Participants valued their lived experience as a resource through which they could assist others and service delivery. Lived experience was foundational to building relationships with individuals in recovery. Disclosure was dependent on social context and perceptions of safety. Individuals expressed concerns regarding exclusion and discrimination. Project participants maintained that their lived experience was their greatest strengths in helping others. At the same time, decisions about disclosure were made in complex social contexts featuring power differentials. Sharing lived experience is essential to peer-delivered services and further exploration is needed to support service development. (PsycINFO Database Record

Logging into therapy: Parent attitudes and intentions to use computer-based therapies for youth mental health

ObjectivesThe first aim of this study was to describe parental attitudes towards and intentions to access, computer-based therapies for youth mental health problems. The second aim was to assess parental factors (demographic and clinical factors, personality, technology factors, mental health knowledge and attitudes, and knowledge of computer-based therapies) predicting attitudes and intentions to access computer-based therapies for youth. MethodThree hundred and seventy-three Australian parents completed an online survey measuring: demographics; mental health service experience; personality; technology factors; mental health knowledge and attitudes; perceived benefits, problems, and helpfulness of computer-based therapies; and intentions to access services. ResultsApproximately 50% of parents reported accessing support for their child's mental health, yet only 6% had used a computer-based therapy. The majority of parents strongly endorsed all benefits of computer-based therapies, and appeared relatively less concerned by potential service problems. Computer-based therapies were perceived as somewhat to extremely helpful by 87% of parents and 94% indicated that they would utilise a computer-based therapy if their child required support and one was offered to them. Parental knowledge of computer-based therapies significantly predicted perceived helpfulness (∆F=19.23 (1301), p=<.001) and intentions to access (∆F=10.91 (1288), p=.001) computer-based therapies, above that of parent demographic characteristics, clinical factors, and engagement with technology. ConclusionsAustralian parents hold positive attitudes to the use of computer-based therapies.

Prescribing for children and adolescents in mental health

The level of psychiatric prescribing in children and adolescents is increasing; however, rates of adherence in this group of patients range from only 34–54%. The possible consequences of untreated psychiatric problems include longer duration of the illness, increased severity of symptoms, higher relapse rates, greater risk of suicidal behaviour, academic difficulties and increased family conflict. Prescribers are often faced with difficulty if the parent or carer is not in agreement with the use of medication. This parental disagreement has implications for medication concordance and the relationship between clinicians, young people and their families. For prescribers, understanding parental and young people's attitudes towards medication and their experiences of mental health services is central to patient-centred care.

Improving Access to Mental Health Services for Racialized Immigrants, Refugees, and Non-Status People Living with HIV/AIDS.

The demographic characteristics of people living with HIV/AIDS (PHAs) in Canada are increasingly diverse. Despite literature suggesting a potentially heightened mental health burden borne by racialized immigrant, refugee, and non-status PHAs (IRN-PHAs), researchers have hitherto paid insufficient attention to whether existing services adequately address this need and how services might be improved. Employing community-based research methodology involving PHAs from five ethnoracial groups in Toronto, Ontario, this study explored IRN-PHAs' mental health service-seeking behaviors, service utilization experiences, and suggestions for service improvements. Results showed that while most IRN-PHAs were proactive in improving their mental health, their attempts to obtain support were commonly undermined by service provider mistreatment, unavailability of appropriate services, and multiple access barriers. A three-pronged approach involving IRN-PHA empowerment, anti-stigma and cultural competence promotion, and greater service integration is proposed for improving IRN-PHAs' mental health service experience.

G493 How can health services effectively improve the mental health of young people leaving public care? the lync study

Aim To explore the mental health needs and service use of young people transitioning out of local authority care. Methods A mixed-method study in one local authority. Qualitative methods included a thematic analysis of interviews with 12 care leavers with an identified mental health need and 12 relevant staff members from across the agencies involved with young people. Quantitative methods for analysing transition included screening social care and health service notes from age 15 of 40 care leavers aged 18–22 years. Analysis documented the completeness of pathway planning (adherence to national guidance), identified mental health needs (diagnoses, service involvement) and the effectiveness of CAMHS to AMHS transition (information continuity, joint working, transition planning and continuity of care). Results Qualitative analysis of care leaver interviews generated four superordinate themes: overarching attitudes towards the care journey, experience of social care, experience of mental health services and recommendations. Qualitative analysis of staff interviews produces six superordinate themes: young people’s lives, the transition process, system failure, professionals’ understanding of mental illness, inter-agency working, capacity and limited service. Initial quantitative analysis showed that during transition young people were very mobile, expressed high mental health needs and accessed multiple mental health services with a high rate of crisis pathways. Data on the quality of transition will be analysed in December 2014 and will be available for presentation at the ASM. Conclusion Care leavers with mental health problems face many transitions and felt abandoned with a poor experience of services during this time. Staff said transitions were often poorly delivered with care leavers ill-equipped to manage. They said that inter-agency working was weak, without a shared protocol or information sharing or a collaborative approach to care. Recommendations for improving transition include joint commissioning across the transition period, continuity between child and adult services, staff training, care-leavers active involvement, identification and evaluation of best practice models. Further research is needed to develop and rigorously evaluate models of transitional care that promote mental health and wellbeing.

Perceived Satisfaction With Mental Health Services in the Lesbian, Gay, Bisexual, Transgender, and Transsexual Communities in Ontario, Canada: An Internet-Based Survey

This study compared mental health service experiences of lesbian, gay, or bisexual (LGB), transidentified, and cisgender (nontrans) heterosexual people in Ontario. An Internet-based survey, derived from the Canadian community health survey—Mental health and well-being—Cycle 1.2 (Statistics Canada, 2003), was completed by 326 individuals (194 LGB, 71 trans-identified, 61 cisgender heterosexual). Hierarchical logistic regression models were used to examine group differences. All three groups reported high levels of satisfaction and positive experiences with the provider seen most often in the past 12 months. However, substantial proportions of LGB and trans-identified people reported unmet need for mental health services.

The experience of engaging with mental health services among young people who hear voices and their families: a mixed methods exploratory study.

BackgroundResearch shows us that auditory hallucinations or ‘hearing voices’ may be more common than previously thought, particularly in childhood and adolescents. Importantly, not all individuals are affected negatively by their voice hearing experiences, yet child and adolescent mental health services (CAMHS) have traditionally understood voice hearing as a symptom of psychosis and severe mental illness, with implications for the way interventions are offered. The purpose of the present study was to gain an understanding of how young people who hear voices and their families find engaging with mental health service, and to better understand their experience of mental health professionals.MethodsA two-stage, mixed methods study was used. In the first stage, semi-structured interviews were carried out with two young people and their parents who had engaged with mental health services, and the collected data were analysed using Interpretative Phenomenological Analysis (IPA). In the second stage, a questionnaire was designed to test the generalizability of the themes arising from the first stage, and was completed online by 32 young voice hearers and 27 parents.ResultsIPA analysis produced 4 themes: (1) The struggle to understand the hearing voices phenomenon; (2) Battle with the Mental Health Services; (3) ‘Stuck in a limbo’; and (4) The wish for a more holistic approach from mental health services and professionals. The survey partially confirmed the findings of study one, with young people and parents finding useful information difficult to come by, and many reported feeling lost in CAMHS. Additionally, young voice hearers and parents often felt not listened to, and many parents expressed the need for a holistic care, whilst young people wanted a more normalizing and less stigmatizing experience.ConclusionsYoung people and their families had varying experiences of mental health services. Whilst the survey showed that some young people and their families had more positive experiences, many expressed dissatisfaction. To fulfil the needs of young people and their families, mental health services would benefit from developing alternative approaches to voice hearing and running support groups that could form part of a ‘normalising’ and ‘holistic care’ package.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0527-z) contains supplementary material, which is available to authorized users.

Mental Health Beliefs and Barriers to Accessing Mental Health Services in Youth Aging out of Foster Care

ObjectiveTo examine the perspectives of youth on factors that influence mental health service use after aging out of foster care. MethodsFocus groups were conducted with youth with a history of mental health needs and previous service use who had aged out of foster care. Questions were informed by the Health Belief Model and addressed 4 domains: youth perceptions of the “threat of mental health problems,” treatment benefits versus barriers to accessing mental health services, self-efficacy, and “cues to action.” Data were analyzed using a modified grounded-theory approach. ResultsYouth (N = 28) reported ongoing mental health problems affecting their functioning; however, they articulated variable levels of reliance on formal mental health treatment versus their own ability to resolve these problems without treatment. Past mental health service experiences influenced whether youth viewed treatment options as beneficial. Youth identified limited self-efficacy and insufficient psychosocial supports “cueing action” during their transition out of foster care. Barriers to accessing mental health services included difficulties obtaining health insurance, finding a mental health provider, scheduling appointments, and transportation. ConclusionsYouths' perceptions of their mental health needs, self-efficacy, psychosocial supports during transition, and access barriers influence mental health service use after aging out of foster care. Results suggest that strategies are needed to 1) help youth and clinicians negotiate shared understanding of mental health treatment needs and options, 2) incorporate mental health into transition planning, and 3) address insurance and other systemic barriers to accessing mental health services after aging out of foster care.

Challenges to and opportunities for improving mental health services for lesbian, gay, bisexual, and transgender people in Ireland: a narrative account.

The views and opinions of people who use mental health services are being increasingly acknowledged in relation to rights-based, socially-inclusive, and recovery-oriented care. However, little is known of the experiences of lesbian, gay, bisexual, and transgender (LGBT) people in this respect. The aim of the present study was to explore the experiences and needs of LGBT people in relation to mental health services. The study was an exploratory design utilizing mixed methods. Both quantitative and qualitative data were collected using a survey instrument (n = 125) and in-depth semistructured interviews (n = 20) with a sample of people who had completed the survey. This paper will report on the findings from the interview data. The data were thematically analysed, and the main themes that emerged included accessing services, treatment choices, mental health service experiences, and other supports. The findings inform the discussion, and recommendations are made in terms of future mental health practice, education, and research.

Psychotic experiences as a predictor of the natural course of suicidal ideation: a Swedish cohort study

Psychotic experiences are far more prevalent in the population than psychotic disorders and are associated with a wide range of depressive, anxiety and behavioral disorders, as well as increased risk for psychotic disorder. Recently, psychotic experiences have been highlighted as a potentially valuable clinical marker of risk for suicidal behavior. There have been few studies to date, however, to assess psychotic experiences as a predictor of suicidality over time. We wished to assess whether young persons with suicidal ideation at baseline assessment who reported psychotic experiences were at higher risk for persistence of suicidal ideation at follow-up than young persons who also reported suicidal ideation at baseline but who did not report co-occurring psychotic experiences. A total of 2,263 adolescents were assessed at age 13 to 14 years for psychotic experiences, suicidal ideation and internalizing and externalizing psychopathology. Participants were re-assessed at ages 16 to 17 years and 19 to 20 years. Among 13- to 14-year olds with suicidal ideation, co-occurring psychotic experiences did not predict an increased odds of persistence of suicidal ideation to age 16 to 17 years (OR=0.94, 95% CI: 0.19-4.78). Among 16- to 17-year olds with suicidal ideation, however, co-occurring psychotic experiences predicted a 6-fold increased odds of persistence of suicidal ideation to age 19 to 20 years (OR=5.53, 95% CI: 1.33-23.00). Psychotic experiences are an important but under-recognized marker of risk for persistence of suicidal ideation, in particular from mid-adolescence. An increased emphasis on the clinical assessment of psychotic experiences in mental health services should be a priority.

Rise and fall

It's never easy to review a book that's already won a literary prize and is at the time of writing longlisted for a second. Nathan Filer's The Shock of the Fall was perhaps a surprising candidate for Costa Book of the Year, a first novel about psychiatric care from a creative writing lecturer who is also a mental health nurse. It's narrated by Matthew, a 19-year-old inpatient tapping out his life story on a psychiatric ward computer. We're made aware from the outset that Matthew might not be the most reliable of narrators since the first thing he tells us is that he is “not a nice person”, and the second is that he believes memory itself to be unreliable. We have to piece together the events of Matthew's childhood, in particular the death of his brother, but as we do so the ward environment begins to impinge. Filer reminds us of the boredom engendered by lack of therapeutic structure and notes how staff (the student social worker who reads over Matthew's shoulder; the chummy occupational therapist who permits Matthew short bursts of computer time) are often uncomfortable acknowledging the power they wield. The novel has a curiously light touch and a feel of the young adult market about it. Filer stated in an interview for The Guardian that he read both The Catcher in the Rye and The Curious Incident of The Night-Time while he was writing, so perhaps this is unsurprising. There is, however, a bitter edge to The Shock of the Fall as it explores Matthew's development within the jagged confines of a home irrevocably damaged by bereavement. The Shock of the Fall has been well received within the mental health community. Filer maintains his nursing registration by working occasional shifts and it shows; his depiction of the ward and tone of letters attempting to enforce Matthew's Community Treatment Order struck a chord with many service users. For me there is a slight sense of wanting more, engendered perhaps by such huge critical success. But there is much for professionals to reflect on regarding the purpose of inpatient treatment and the role of life experiences in psychosis, while those with no experience of mental health services should find a little light shed on the workings of “the system”. Amen to that.

Talking with Australian Indigenous Clients with a Borderline Personality Disorder Diagnosis: Finding the Context behind the Label

Indigenous participants who had been given the label Borderline Personality Disorder were engaged in informal interviewins in order to find out more about the contextual factors underlying the symptoms of their diagnosis. Five participants were interviewed at great length about their experiences of identity, their personal histories, and their understanding of their mental illness. A number of themes emerged from the interviews, including identity, racism, family issues, the feeling of walking in two worlds, and experiences of alternative care during childhood. Aspects of personal and collective trauma related to their symptoms and diagnosis were also examined. Finally, knowledge and personal experience of BPD and its symptoms, as well as experiences of mental health services, emerged as strong themes. Table 1 compares the nine DSM-IV symptoms with alternative interpretations based on historical and social contexts reported by participants. We conclude that practitioners need to explore a greater range of contexts for any symptoms, and that rather than thinking of individuals in terms of having a “borderline personality,” we suggest rethinking of them in terms of having had “borderline socializing environments.”

Improving Mental Health Care: The Global Challenge

Back to table of contents Previous article Next article Book ReviewsFull AccessImproving Mental Health Care: The Global ChallengeJeffrey L. Geller, M.D., M.P.H., , and Howard H. Goldman, M.D., Ph.D.Jeffrey L. GellerSearch for more papers by this author, M.D., M.P.H., Editor, and Howard H. GoldmanSearch for more papers by this author, M.D., Ph.D.Published Online:1 May 2014https://doi.org/10.1176/appi.ps.650511AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail edited by ThornicroftGrahamRuggeriMirellaand GoldbergDavid; Hoboken, NJ, Wiley-Blackwell, 2013, 462 pagesThe book Improving Mental Health Care: The Global Challenge is a valuable compendium, edited by a troika of outstanding experts and dedicated to an international leader in our field, Michele Tansella, M.D., on the occasion of his retirement. The volume ably addresses the question, “What types of mental health care are right for the 21st century?” It takes a global perspective that focuses on achieving the right balance between community and hospital services and between specialty and mainstream services. It examines the evidence and explores a range of methods. All in all it is a successful global excursion through our varied and complex field.The volume has 25 chapters organized into four sections: the global challenge, meeting the global challenge, new research methods, and delivering better care in the community. The authors are the leaders of mental health services research and practice throughout Europe, with a smattering of contributors from South America, Asia, and Australia. Almost entirely absent, however, are authors from North America. Some of these international authors have written in our services research journals in the United States; we have been encouraging it here, in Psychiatric Services. Some of the authors of our papers in the United States have published papers in journals elsewhere, but for the most part, our worlds have been too separated. This edited volume is an important bridge between these worlds.In an effort to strengthen the bridge between North Americans and the rest of the world, Psychiatric Services has entered into a simple agreement with the journal edited by our honored colleague, Dr. Tansella, Epidemiology and Psychiatric Sciences (EPS). Psychiatric Services links within ps.PsychiatryOnline.org, the online platform for the journal, to the current EPS table of contents; in return, EPS links to the current contents of Psychiatric Services. It is our hope that this exchange will stimulate more cross-national consideration of mental health services research, with the objective of improving services. This agreement is born of a recent personal and professional relationship that developed between the journal editors in which we recognized our common interests. It has been our intent to expand this collegiality to the readers of both of our journals and to bring the world together into a global community.One explanation for the separation among countries and continents is the inherently contextual nature of mental health services. Although biomedical and some psychosocial treatments can be expected to generalize to populations throughout the globe, mental health services are creatures of their own local context. Lessons learned in one country may not generalize to the experiences of mental health services in another. Improving Mental Health Care: The Global Challenge is an outstanding effort to learn from local experiences and an attempt to generalize lessons so that individuals burdened by mental disorders can recover and participate in their communities. This has been a lifelong goal of Dr. Tansella, whom this excellent book honors.Dr. Goldman, who is editor of this journal, is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore.The reviewer reports no competing interests. FiguresReferencesCited byDetailsCited byNone Volume 65Issue 5 May 2014Pages e02-e02 Metrics The reviewer reports no competing interests.PDF download History Published online 1 May 2014 Published in print 1 May 2014