Formal Mental Health Services Research Articles

Current Status of Mental Health Services at the Primary Healthcare Level in Northern Nigeria.

Mental health services at the primary healthcare level remain critical in most developing countries, especially in resource-poor and crisis-stricken communities. This study explored the erstwhile mental health services, with particular reference to their availability, at the 47 primary healthcare centres in three selected states in northern Nigeria, with a view to drawing for action. Qualitative data were collected from a purposive sample of 13 participants through in-depth interviews. Additional data were also collected from observations during the visits (a checklist based on minimum standards for primary healthcare services) and clinic records at the centres. The data were analysed using content analysis and thematic clustering to indicate the status of the mental health services at the primary healthcare centres. Despite having the mental health units on the service delivery charts of the primary healthcare centres studied, none was providing any formal mental health services. There were only few but uncoordinated services in some centres essentially provided by individual primary healthcare service providers and a non-governmental organization found in one of the 47 primary healthcare centres in one of the three states investigated. In conclusion, mental health services at all primary healthcare centres in all the Local Government Areas in all the states visited are at best scarce, poorly and haphazardly rendered in a few places or completely absent in most centres. There is an urgent need to stimulate the primary healthcare system and other levels of government and their partners, to initiate or activate policies in favour of community-based mental health services to make these important services available at the community (primary healthcare) level for the promotion of mental health and treatment of mental illnesses.

The structure and psychosocial correlates of complicated bereavement amongst refugees from West Papua.

Refugees may be at risk of experiencing a complicated form of bereavement. As yet, however, the nosological status of this putative category across cultures remains in question. We apply qualitative and quantitative methods to investigate the manifestations, prevalence, factorial structure and psychosocial correlates of complicated bereavement amongst refugees from West Papua, a population with no past exposure to western concepts of grief or to formal mental health services. Qualitative methods (focus groups and informant interviews) were used to identify cultural expressions of complicated bereavement derived from international classification systems, that is, DSM 5 persistent complex bereavement disorder (PCBD) and ICD-11 prolonged grief disorder (PGD) in developing a structured interview applied by trained field workers. Participants were adult West Papuan refugees and their offspring recruited from households (n = 486, response 85.8%) across nine villages in a remote town in Papua New Guinea. The qualitative data obtained from focus groups (n = 20) and informant interviews (n = 4) with local psychiatrists supported the cultural validity of complicated bereavement. 16% (n = 78) of the sample met criteria for PCBD based on DSM-5 criteria and 103 (21%) met criteria for PGD based on ICD-11 criteria. Confirmatory factor analysis yielded a six-factor model of complicated bereavement with a moderately good fit to the data. The model included dimensions of anger/negative appraisal (AN), avoidance/giving up, estrangement from others, and confusion and diminished identity. In contrast, the DSM-5 three-factor model and the ICD-11 two-factor model each yielded a poor fit. Cumulative traumatic losses (β = 0.16, P = 0.03), duration since displacement [(β = 0.10, P = 0.02)] and postmigration living difficulties (β = 0.20, P = 0.01) were associated with an aggregated index of complicated bereavement, supporting the concurrent validity of the structure identified. Culture and exposure to persecution and displacement may contribute to the content and configuration of the complicated bereavement reaction, an issue that requires recognition in international classification systems and clinical practice.

Beliefs About Etiology and Treatment of Mental Illness Among Korean Presbyterian Pastors

This descriptive study explored pastors' beliefs about etiology and treatment of mental illness. Surveys were completed by mail by 202 Korean and Euro-American Presbyterian clergy. Nearly one-third of Korean pastors viewed bad parenting and demon possession as very important causes of mental illness, in contrast to the more than two-thirds of Euro-American pastors who viewed genetics and chemical imbalances as the most important causes. Compared with their Euro-American counterparts, Korean pastors soundly endorsed spiritual treatment of mental illness. The findings of this study suggest the value of understanding the views of pastors working with populations that underutilize formal mental health services.

Ethnic Differences in Teacher–Student Relationship Quality and Associations With Teachers’ Informal Help for Adolescents’ Internalizing Problems

Ethnic minority adolescents receive not only less formal mental health services than their ethnic majority peers but also less school-based mental health services. Little is known about the extent to which adolescents indicate their teachers help them with their mental health problems. The aim of the current study was to investigate ethnic differences in teacher-provided informal help for adolescents’ internalizing problems, and whether these could be explained by differences in teacher-reported internalizing problems and teacher–adolescent relationship quality. A sample of adolescents at risk of internalizing problems and their teachers participated in the study ( n = 229). Adolescents originated from four ethnic groups in the Netherlands: three ethnic minority groups (Surinamese Dutch, Turkish Dutch, Moroccan Dutch) and the ethnic majority (native Dutch). Results showed that only Moroccan Dutch adolescents reported considerably less informal help from their teachers for their internalizing problems than native Dutch adolescents, whereas Turkish Dutch and Surinamese Dutch adolescents were not found to differ from native Dutch adolescents. Teacher–student relationship quality and teacher-reported internalizing problems could not explain the differences in informal help between Moroccan Dutch and Dutch adolescents. Teachers reported significantly higher levels of conflict in their relationships with Moroccan Dutch than native Dutch adolescents, and for Moroccan Dutch adolescents, higher levels of conflict were associated with lower levels of informal help by the teacher.

Implications of healing power and positioning for collaboration between formal mental health services and traditional/alternative medicine: the case of Ghana

ABSTRACTBackground: Many current debates about global mental health have increasingly called for collaboration between biomedical and traditional medical health systems. Despite these calls, not much has been written about the variables that would influence such collaboration. To a large extent, collaboration dialogues have considered biomedicine on the one hand, and a wide range of traditional and faith-based treatments on the other hand. However, this dualistic bifurcation does not reflect the plurality of healing systems in operation in many contexts, and the diverse investments that different non-biomedical healing approaches may have in their own power to heal.Objective: We set out to explore the diversity of different healers’ perceptions of power, and the relationship between that power and the perceived power of biomedical approaches.Methods: Through a qualitative design, and using the case of medical pluralism in urban Ghana as an example, we conducted interviews among different categories of traditional and alternative medicine (TAM) practitioners living and/or working in the Greater Accra Region of Ghana.Results: Through thematic analyses, differences in the notions about collaboration between the different categories of healers were identified. Their perceptions of whether collaboration would be beneficial seemed, from this study, to co-occur with their perceptions of their own power.Conclusions: We suggest that an important way to move debates forward about collaboration amongst different sectors is to examine the notions of power and positioning of different categories of TAM healers in relation to biomedicine, and the attendant implications of those notions for integrative mental healthcare.

Use of Mental Health Services in Primary Health Care Delivery Systems in a Developing Country: A Survey of Selected General Hospitals in Delta State Nigeria

Studies on the use of mental health services in Nigeria are scarce. Most of the existing studies have focused on psychiatric illnesses. However the context for the assessment and treatment of many mental health disorders in developing countries including Nigeria is moving from mental hospitals to primary health care providers (PHC). This present study was conducted in Delta State Nigeria to assess the use and provision of mental health services in PHCs (General Hospitals). Two sets of questionnaires were used for the study; one set was given to health practitioners (15), while the other was given to 50 community respondents who were patients in these facilities. The results show that there is low utilization of mental health services in PHCs. In addition, patients do not have a positive attitude towards the use of formal mental health services and also lack an awareness of the availability of these services in PHC settings.

The Impact of Perceived Need and Relational Factors on Mental Health Service Use Among Generations of Asian Americans.

The present study examined generational differences in the patterns and predictors of formal and informal mental health service utilization among a nationally representative sample of 1850 Asian Americans from the National Latino and Asian American Study. We focused on the effects of perceived need and relational factors on service utilization among 1st-, 1.5-, and 2nd-generation Asian Americans. Results of hierarchical logistic regression showed significant intergenerational differences. Specifically, 1.5-generation Asian Americans exhibited distinctive pattern of service use, with perceived need being associated with a higher likelihood of using formal mental health services, but only for those with high level of social support. First- and second-generation Asian Americans, on the other hand, perceived need was independently associated with formal service use, and a significant predictor of informal service use for first generation. Greater family conflict was also associated with greater use of formal and informal services for both first- and second generations. However, family cohesion was associated with only informal service use among first -generation Asian Americans. Implications for mental health service policy were discussed.

Mental Health Care for Elderly People at Formal Mental Health Systems and Buddhist Temples in Vietnam: Making a Case for Mindful Elder Care in Vietnam

Despite being one of the fastest aging countries in the world, Vietnam lacks systemic and comprehensive policies and programs to manage the physical and mental health needs of its elderly population. In this paper, I will review the formal, biomedical system for mental health care and present preliminary results of an ethnographic study on formal mental health services provided through Buddhist temples. Results of the study show that while Vietnamese formal mental health system is under-developed, Buddhist temples serve effectively as a source of help to Vietnamese elderly with mental health problems. In that light, Vietnam should incorporate Buddhist concepts of existence—most importantly, the concept of mindful aging—into its developing system of elder care.

Evaluating the Prosper peer-led peer support network: a participatory, coproduced evaluation

Purpose – A range of one-to-one, group and online approaches to peer support are increasingly complementing formal mental health service delivery. Evidence is emerging of the potential benefits and challenges of peer support for individuals, communities and organisations. There is more limited evidence describing peer-led peer support networks. The paper aims to discuss these issues. Design/methodology/approach – In an evaluation of Prosper, a peer-led, peer support network and social movement, members of the network played a participatory role in the design, conduct and interpretative work of the evaluation. An online survey, one-to-one interviews and group discussions were used. Findings – The evaluation describes an evolving network with planning and development meetings constituting core activity for many members alongside a monthly training programme supporting people to set up their own activities. There were strong shared values, and consensus that Prosper could strengthen social networks, improve individual well-being and impact on the way people used mental health services. Challenges were identified around feelings of uncertainty and vulnerability in relation to involvement in the network. Research limitations/implications – The participatory nature of the evaluation adds value to the learning offered. This was a descriptive evaluation; potential is indicated for the more formal modelling and testing of peer-led network and social movement initiatives. Practical implications – Clarity is needed on the relationship of the network to statutory mental health services – specifically around taking on a “service provider” role – and on the advantages and challenges of a “hybrid” organisational model that combines traditional, hierarchical and new distributed forms of leadership and structure. Social implications – Prosper demonstrated potential to create a sense of common culture based on sharing lived experience and mutual peer support, providing an alternative to the traditional culture of mental health services. Originality/value – This paper offers wider learning derived from evaluation of a highly original initiative in peer leadership, network structure and interface with statutory mental health services.

Black Church Leaders’ Attitudes About Mental Health Services: Role of Racial Discrimination

Black church leaders are often first responders to mental health issues in the Black community, yet few researchers have examined their attitudes about seeking outside mental health services. In order to fill this gap, we surveyed 112 church leaders in a northeastern urban Baptist Black mega-church (22 associate pastors, 34 deacons, and 56 congregation care givers) using The National Survey of American Life. Findings suggest church leaders more often relied on the church community and alternative health services, leaders who attended church more often tended to report not receiving any outside mental health treatment, the closer church leaders felt to all Black people, the less satisfied they were with help received from formal mental health services, and leaders who experienced more racial discrimination tended to report worse overall mental and physical health. Clinical providers and Black churches should develop collaborative partnerships to better meet the needs of this community.

Child and Adolescent Mental Health in Haiti

This article presents an overview of child and adolescent mental health in Haiti, emphasizing the role of structural violence and the factors shaping child protection. The 2010 Haiti earthquake is discussed as an acute on chronic event that highlighted the lack of pre-existing formal biomedical mental health services and worsened the impact of structural violence. Considerations for long-term, sustainable, culturally relevant child and adolescent mental health care in Haiti are also provided.

Social Participation Interventions for Adults with Mental Health Problems: A Review and Narrative Synthesis

People with mental health problems remain a highly socially excluded group despite international efforts to facilitate their inclusion. Enhancing their social participation—building trusting relationships and engaging in community activities—is an important role for mental health social workers, but there is a lack of evidence-informed interventions to enable workers to achieve this goal. This article fills a gap in knowledge by systematically reviewing evidence of the effectiveness of interventions that aim to enhance the social participation of adults with mental health problems in their wider communities, outside of formal mental health services. A systematic review and modified narrative synthesis methodology was used. Sixteen articles reporting 14 unique interventions met the inclusion criteria, and findings across the studies were categorized by delivery mode and intervention strategy. Positive outcomes were found in asset-based approaches, social skills development, building trusting relationships between workers and service users, and resource finding to enhance community participation. However, only four studies were found to have a low overall risk of bias. The findings of this review suggest further evidence-informed interventions, and robust evaluations, are needed as current evidence is limited to inform mental health social work practice.

Peer to Peer – Support in Severe Mental Disorders: Affective Disorders, Psychosis and Personality Disorder – a Randomized Controlled Trial

Introduction Individuals with serious mental illness (SMI) are at considerably higher risk for morbidity and mortality than those in the general population. In these diagnoses – a refinement of intervention is required, the user perspective overall is still underrepresented. Objectives In mental health Services there is an international trend toward recovery-orientated interventions, like Peer-support (PS) in formal mental health services. There is a raising but still insufficient evidence for it's benefits Aims In Germany this is the first try to implement and research peer support services area-wide in psychiatric facilities to provide a low-threshold service that aims individual recovery. This project forms a part of 'psychenet ', a project supported by the Federal Ministry of Education and Research of Germany during 2011 – 2014 and investigates the effect of peer support on psychosocial factors, functioning and hospital admissions. Methods In a controlled multi-centre-trial involving 10 hospital facilities in Hamburg − 216 in- and outpatients suffering from affective disorders, psychoses or personality disorders get randomized to either receive additional Peer-Support at most half a year aligned to individual requirements or treatment as usual. A mixed method repeated measurement analysis is conducted. Results Subjects refill questionnaires and get rated by clinicians at three points of measurement: Entry of the half year of intervention, after the intervention and in a six month follow up. Psychosocial Outcomes, global functioning, and in and outpatient days were assessed. There is a significant positive Effect for the PS of the primary outcome. Results will be presented

Mental health services and public mental health: challenges and opportunities.

Mental health services and public mental health: challenges and opportunities.

Patterns of individual coping, engagement with social supports and use of formal services among a five-country sample of resilient youth.

Although resilience among victims of child abuse is commonly understood as a process of interaction between individuals and their environments, there have been very few studies of how children's individual coping strategies, social supports and formal services combine to promote well-being. For this study, we conducted a multi-phase analysis of a qualitative dataset of 608 interviews with young people from five countries using grounded theory strategies to build a substantive theory of young people's service and support use patterns. We started with an analysis of ten interviews (two from each country) and then compared these findings to patterns found in each country's full dataset. The substantive theory that emerged explains young people's transience between individual coping strategies (cognitive and behavioral), reliance on social supports (family members, peers and teachers), and engagement with formal service providers whose roles are to provide interventions and case management. Young people's patterns of navigation were shown to be contingent upon the individual's risk exposure, his or her individual capacity to cope, and the quality of the formal and informal supports and services that are available and accessible. Differing amounts of formal resources in low-, middle- and high-income countries influence patterns of service use. Implications for better coordination between formal mental health services and social supports are discussed.

Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis.

In resource-limited contexts in low- and middle-income countries (LMICs), a considerable proportion of individuals seeking care for mental disorders consult traditional and religious healers in their pathway to mental health care. Reports from Africa suggest that early involvement of healers may result in delays in the care pathway; a potential barrier to early identification and intervention. A systematic review was conducted to evaluate the proportion of patients attending formal health services after making first contact for treatment of mental disorders with traditional or religious healers or other informal and formal care providers within published research in Africa. Electronic databases were searched for the period from January 1990 to February 2014. Quality assessment of included studies was conducted the SAQOR tool. Fourteen papers were identified with data on category of first care provider. Utilizing random effects modelling with inverse variance method, the pooled proportion of participants making first contact for treatment of mental disorders with two broadly categorised providers (informal and formal) was 48.1 % (95 % CI 36.4-60.0 %) and 49.2 % (95 % CI 38.0-60.4 %), respectively. The pooled proportion of participants making first contact with specific providers was: traditional healers (17.0 %, 95 % CI 10.9-24.1 %); religious healers (26.2 %, 95 % CI 18.1-35.1 %); general health services (24.3 %, 95 % CI 16.9-32.5 %); and mental health services (13.0 %, 95 % CI 5.1-23.5 %). Substantial regional variation in patterns of first provider choice was evident. Conclusions of this review must be qualified in the light of several limitations. Approximately half of individuals seeking formal health care for mental disorders in Africa, choose traditional and religious healers as their first care provider. Previous reports suggest that this choice is associated with delays in accessing formal mental health services. Strategies to improve pathways to mental health care in Africa must include innovative programmes aimed at fostering collaboration between biomedical mental health services and these key community-based providers.

Stigma and mental health treatment of adolescents with depression in jordan.

Stigma is a fundamental barrier to seeking and engaging in mental health treatment for individuals managing depression. This study examines stigma perceptions of mental health treatment for Arab adolescents managing depression using a vignette survey completed by adults in public spaces in Amman, Jordan (n=108). The vignette was systematically changedacross four different conditions that varied the described youth's gender and whether or not they were receiving treatment for their depression. Two-way ANOVAs found that gender and receipt of mental health treatment influenced perceptions of stigma. Seeking treatment, however, did not increase perceived stigma, and receiving mental health treatment rather than no treatment was found as more likely to be a helpful approach for both males and females. Findings indicate that personal level stigma may have greater effects on females whereas public stigma may exert more influence on males. Participants endorsed that adolescents with depression are most likely to be helped when a family sought treatment ratherthan not seeking treatment. Findings also indicate that the community seems to appreciate the need for treatment and the likelihood of benefiting from formal mental health services.

Buddhism-Based Exorcism and Spirit-Calling as a Form of Healing for Mental Problems: Stories from Vietnam

With nearly 80% of Vietnamese people holding Buddhist beliefs in some form, Buddhism-based healing is popular in Vietnam. Coupled with cultural stigma against seeking formal mental health services, Vietnamese people with psychological needs frequently seek different forms of healing at Buddhist temples, including exorcism and spirit-calling. In this article, I present case vignettes of exorcism and spirit-calling that I documented during my ethnographic study in Vietnam. Based on these cases, I will discuss the healing impact of spiritual activities like Buddhism-based exorcism and spirit-calling for Vietnamese people and implications for social work in Vietnam and elsewhere.

Mental healthcare in the community

During the last decade or so, there has been a growing international recognition of the high burden of disease associated with mental health problems, with local research that supports this view. The most comprehensive study of common mental disorders in South Africa, the South African Stress and Health Study, carried out in 1999, showed a lifetime prevalence for these disorders of 30.3%. Of those who had had a mental disorder in the past year, only 25.2% sought treatment and a tiny number, 5.7%, used any formal mental health service. In the years since that study, the HIV/AIDS and substance abuse epidemics have contributed further to this burden, while at the same time mental health services have seen a reduction in hospital beds with de-institutionalisation, yet little growth in community-based services.

Commentary on suicide and homelessness: What differentiates homeless persons who died by suicide from other suicides in Australia? A comparative analysis using a unique mortality registry

Several years ago I published an essay lamenting the lack of research addressing the issue of suicide within the homeless population [1]. As an academic community psychiatrist in the United States (US) I have spent over 25 years providing clinical care to homeless persons who are experiencing the effects of mental illness and/or substance use disorders. What prompted my plea for more research was the suicide of a young adult male patient who was under my care for schizophrenia and polysubstance abuse. His name was Thomas. He had spent much of his adult life on the streets and in shelters. He was in his late 20s when he suicided, just a day after I had seen him in my clinic. Incredulously, prior to taking his own life he had appeared to be doing very well from the rough clinical and social measures we use in this imprecise practice of medicine and rehabilitation. His suicide forced me to ask those painful questions every clinician performs through a selfadministered cross-examination following such a tragic event: what forces conspired that to led to this final act of self-destruction? What risk factors went undetected? What did I miss? What could I have done better? My search of the literature provided a wealth of information on suicide among patients with psychiatric illness, as well as comorbid substance use disorders, but I found precious little on the impact homelessness might have upon the risk of suicide. The piece published in this issue of Social Psychiatry and Psychiatric Epidemiology, entitled, ‘‘What differentiates homeless persons who died by suicide from other suicides in Australia? A comparative analysis using a unique mortality registry’’, is a tremendous first step in bridging a long-neglected gap in the body of health care research for persons experiencing homelessness [2]. This study by Arnautovska, Sveticic and De Leo is an interesting, timely and well-written endeavor to identify the most prominent demographic and clinical characteristics of homeless people who died by suicide in Queensland, Australia, over a 20-year period (1990–2009). Utilizing a mortality dataset derived from the Queensland Suicide Registry, the investigators determined that homeless persons had a suicide rate that was nearly twice higher than their non-homeless counterparts. The risk profile that emerged among this cohort of homeless persons was one that identified gender as significant (males completed more suicides than females), being of young age, unemployed, being single or never married, and having at least one physical illness. Not surprisingly, substance use disorders and untreated mental illness were prominent characteristics among those who took their own lives. In the US, on any given night, there are nearly 650, 000 individuals who live in shelters, on the streets, in abandoned buildings, or move from one unstable residence to another as ‘‘couch surfers’’ [3]. Nearly 25–28 % have a serious mental illness and it has been estimated that 50 % suffer from a substance use disorder [4]. In the large Florida city within which I practice, 70 % of the population of homeless persons is male, unmarried, and have an average age of 40 years. 90 % of our local homeless population report being unemployed [5]. Like so many others in this country who live in extreme poverty, persons who are homeless have little access to formal primary and mental health services since they lack employer-based or public health care insurance. Hence, when I reflect upon the implications of this study in my own clinical practice I recognize that nearly all my patients are at increased risk for suicide compared to their counterparts in the general R. C. Christensen (&) Department of Psychiatry, University of Florida College of Medicine, Gainesville, USA e-mail: rchris@ufl.edu