Lack Of Mental Health Professionals Research Articles

Barriers and facilitators to mental health promotion for Mexican immigrants in the U.S. through the Ventanillas de Salud program.

Mental health promotion and screenings are recommended as part of standard preventive care. Mexican immigrants in the U.S. are at high risk for mental health illness especially after the COVID-19 pandemic, however access to mental health prevention for this population has been limited, which results in important implementation and equity gaps. The Ventanilla de Salud (VDS) program provides preventive services through Mexican consulates in the U.S. The objective of this study was to assess capability, opportunity, and motivation for promotores to implement mental health programming through the VDS, leveraging early experiences of ongoing mental health prevention efforts. This was a qualitative study using the Capability, Opportunity, and Motivation for Behavior Change model (COM-B). We conducted 9 focus groups with 40 VDS promotores and 6 semi-structured interviews with program stakeholders. Data were analyzed using inductive and deductive coding. We found high levels of interest from the leadership, partners, and promotores to provide mental health services through the VDS. Early implementation of a mental health strategy that included training sessions for promotores and mental health promotion, screenings and referrals for VDS users was ongoing. We identified facilitators and barriers that could affect capability, opportunity, and motivation to provide mental health services. Facilitators included promotores' extensive knowledge about the importance of mental health, promotores service mindset and commitment to provide services to VDS users, and general support from the VDS network and partners. Barriers included promotores' turnover, need for additional economic compensation, burnout, competing priorities, and lack of mental health professionals to provide clinical services or supervision. Additional investments are recommended to support promotores' well-being. The main lesson learned from this study was that investing in VDS promotores' training, resources, and well-being is key to their capability, opportunity and motivation to provide mental health services for Mexican immigrants in the US. Results from this study can be applied to improve the ongoing VDS mental health strategy and increase its impact on the mental health of Mexican immigrants.

What Is Causing the Ongoing Youth MH Crisis?

What Is Causing the Ongoing Youth MH Crisis?

Talk-based approaches to support people who are distressed by their experience of hearing voices: A scoping review

BackgroundThe positive effects of both antipsychotic medication and cognitive behavioral therapy in psychosis (CBTp) for people who are distressed by their experience of hearing voices remain limited. As a result, there has been a recent surge in talk-based individual approaches. Many of these continue not to be very well known nor implemented in practice. Some of the approaches may focus more on understanding and dealing constructively with voices, an element that has been identified as potentially helpful by voice hearers. Existing barriers to a wider implementation include both the widespread pathologization of hearing voices and a lack of mental health professionals who have been trained and trusted to carry out these new interventions.MethodsThis scoping review aimed to identify and describe a current synthesis of talk-based individual approaches for people who hear voices, including studies independently of method of study or approach, diagnosis of voice hearers nor of the professional background of interventionists.ResultsNine different talk-based approaches were identified. These included: (1) Cognitive Behavioral Therapy for Psychosis (CBTp); (2) AVATAR therapy; (3) Making Sense of Voices (MsV) aka Experience Focused Counselling (EFC); (4) Relating Therapy; (5) Acceptance and Commitment Therapy; (6) Smartphone-based Coping-focused Intervention; (7) Prolonged and Virtual Reality Exposure Therapy; (8) Eye Movement Desensitization and Reprocessing, and (9) Individual Mindfulness-based Program for Voice Hearing. The different approaches differed greatly in relation to the number of sessions, length of time offered and the scientific evidence on efficacy. Psychologists represented the main professional group of interventionists. CBTp and the MsV/EFC approach also included health professionals, like nurses, as implementers. Most of the approaches showed positive outcomes in relation to voice related distress levels. None identified overall or voice specific deteriorations.ConclusionThere appears to be a strong case for the implementation of a broader heterogeneity of approaches in practice. This would also be in line with recommendations for recovery focused services and requirements of voice hearers. A greater emphasis on whole systems implementation and thus the involvement of frontline staff, like nurses, in the delivery of these approaches would likely reduce the research-practice implementation gap.

Application of unified protocol as a transdiagnostic treatment for emotional disorders during COVID-19: An internet-delivered randomized controlled trial.

BACKGROUNDThe coronavirus disease 2019 (COVID-19) pandemic has been an emotionally challenging time, especially for young adults. It is associated with a substantial increase in the prevalence of mental health problems, negative symptoms, and stressful experiences that compromise well-being. In low-income countries, internet-delivered psychological services could have a remarkable impact on the population’s mental health, given the lack of mental health professionals. AIMTo investigate the efficacy of internet-delivered cognitive-behavior therapy (CBT)-transdiagnostic intervention for adults with emotional disorders. METHODSIn this internet-delivered randomized controlled trial, 102 students with an emotional disorder (mean age = 28.20 years, standard deviation = 5.07) were randomly allocated to receive unified protocol (UP) (n = 51) or treatment as the usual intervention. Following a semi-structured clinical interview, participants completed an online survey including the Overall Anxiety Severity and Impairment Scale, Overall Depression Severity and Impairment Scale, Difficulties in Emotion Regulation Scale, Positive and Negative Affect Schedule, and Emotional Style Questionnaire. RESULTSThe participants showed a high degree of adherence. In total, 78% (n = 40) of the experimental group participants completed the UP treatment. Considering the intention to treat procedure, the results of the analysis of covariance indicated that participants who received UP showed statistically significant changes in depression symptoms [Cohen’s d = -1.50 with 95% confidence interval (CI): -1.90 to -1.10], anxiety (Cohen’s d = -1.06 with 95%CI: -1.48 to -0.65), difficulties with emotion regulation (Cohen’s d = -0.33 with 95%CI: -0.7 to -0.06), positive affect (Cohen's d = 1.27 with 95%CI: 0.85 to 1.68), negative affect (Cohen’s d= -1.04 with 95%CI: -1.46 to -0.63), and healthy emotionality (Cohen’s d = 0.53 with 95%CI: 0.09 to 0.13) compared with the control group. CONCLUSIONThis study’s findings highlight the potential value of transdiagnostic internet-delivered programs for young adults with an emotional disorder during the COVID-19 pandemic, and expand the research examining emotional well-being improvements resulting from CBT-transdiagnostic interventions. The findings suggest that UP, which generally concentrates on reducing negative effects, can increase positive effects.

Psychological Distress and Access to Mental Health Services Among Undergraduate Students During the COVID-19 Lockdown in Uganda

BackgroundLockdown is an important public health approach aimed at curbing the raging effect of the coronavirus disease-2019 (COVID-19). This study aimed at determining the impact of prolonged lockdown on mental health and access to mental health services among undergraduate students in Uganda.MethodsAn online cross-sectional study was conducted anonymously among undergraduates across 10 universities in Uganda. The Distress Questionnaire-5 (DQ-5) and the Patient Health Questionnaire-2 (PHQ-2) were used. Logistic regression analysis was conducted to determine factors associated with psychological distress.ResultsWe enrolled 366 participants with a mean age of 24.5 ± 4.6 years. The prevalence of psychological distress was 40.2% (n = 147) (cut off 14/25 based on DQ-5) while depression stood at 25.7% (n = 94; cut off 3/6 based on PHQ-2) with mean scores of 12.1 ± 4.6 and 1.7 ± 1.6 respectively. Female gender (aOR: 1.6, 95%CI: 1.0–2.6, p = 0.032), pursuing a non-medical program (aOR: 2.2, 95%CI: 1.3–3.7, p = 0.005) were factors associated with psychological distress while non-medical program (aOR: 2.2, 95%CI: 1.3–3.7, p = 0.005) was associated with increased depression. Access to mental health services was associated with both reduced distress (aOR: 0.5, 95%CI: 0.3–0.8, p = 0.005) and depression (aOR: 0.6, 95%CI: 0.3–0.9, p = 0.034). A majority (65.3%) of the participants reported knowing how to access mental health care and 188 (51.4%) reported having needed emotional support but, only 67 (18.3%) ever sought care from a mental health professional. Of those who had access, only 10 (7%), and 13 (9%) accessed a counselor or a mental health unit, respectively. The barriers to accessibility of mental health care included financial limitations (49.5%), lack of awareness (32.5%), lack of mental health professionals (28.4%), and stigma (13.9%).ConclusionAmong university students in Uganda during the COVID- 19 lockdown, the burden of psychological distress and depression was substantial. However, access to mental health services was limited by several factors.

Long-term health outcomes of adolescent character strength interventions: 3- to 4-year outcomes of three randomized controlled trials of the Shamiri program

BackgroundAdolescents in low- and middle-income countries in need of mental health care often do not receive it due to stigma, cost, and lack of mental health professionals. Culturally appropriate, brief, and low-cost interventions delivered by lay-providers can help overcome these barriers and appear effective at reducing symptoms of depression and anxiety until several months post-intervention. However, little is known about whether these interventions may have long-term effects on health, mental health, social, or academic outcomes.MethodsThree previous randomized controlled trials of the Shamiri intervention, a 4-week, group-delivered, lay-provider-led intervention, have been conducted in Kenyan high schools. Shamiri teaches positively focused intervention elements (i.e., growth mindset and strategies for growth, gratitude, and value affirmation) to target symptoms of depression and anxiety and to improve academic performance and social relationships, by fostering character strengths. In this long-term follow-up study, we will test whether these mental health, academic, social, and character-strength outcomes, along with related health outcomes (e.g., sleep quality, heart-rate variability and activity level measured via wearables, HIV risk behaviors, alcohol and substance use), differ between the intervention and control group at 3–4-year follow-up. For primary analyses (Nanticipated = 432), youths who participated in the three previous trials will be contacted again to assess whether outcomes at 3–4-year-follow-up differ for those in the Shamiri Intervention group compared to those in the study-skills active control group. Multi-level models will be used to model trajectories over time of primary outcomes and secondary outcomes that were collected in previous trials. For outcomes only collected at 3–4-year follow-up, tests of location difference (e.g., t-tests) will be used to assess group differences in metric outcomes and difference tests (e.g., odds ratios) will be used to assess differences in categorical outcomes. Finally, standardized effect sizes will be used to compare groups on all measures.DiscussionThis follow-up study of participants from three randomized controlled trials of the Shamiri intervention will provide evidence bearing on the long-term and health and mental health effects of brief, lay-provider-delivered character strength interventions for youth in low- and middle-income countries.Trial registrationPACTR Trial ID: PACTR202201600200783. Approved on January 21, 2022.

Challenges of the development of mental health care in Slovenia

With the implementation of The Mental Health Act in 2008 and The National Mental Health Programme in 2018, Slovenia made important progressive steps in the development of mental health care in the direction of community-based multidisciplinary approach on the primary level of the health and social care system. One of the main obstacles in the realization is the lack of mental health professionals – psychiatrists, psychologists and psyhotherapists. The increase of mental health problems during COVID-19 pandemic, like increased number of suicidal attempts, alcohol abuse, number of criminal attempts of domestic violence and mental health problems of children and adolescents, have further increased the need for the development of various forms of community-based multidisciplinary mental health services on the primary level.

Online resilience support groups during the COVID-19 pandemic: the Philippine experience

PurposeThe purpose of this paper is to examine the outcomes of an online resilience support group during the COVID-19 pandemic in the Philippines. Specifically, it described the extent to which the program improved adaptive coping, non-reactivity, resilience and well-being and decreased stress, depression and anxiety symptoms of participants.Design/methodology/approachThis study used a pretest–posttest design with 53 participants. A majority of participants were female (74%) who participated in the program for 6–8 weeks. Scales measuring adaptive coping, non-reactivity, resilience, well-being, stress, depression and anxiety were administered before and after the completion of the modules.FindingsResults revealed significant improvements in adaptive coping particularly seeking emotional and instrumental support, active coping, and religious coping. The results also showed significant improvements in nonreactivity, psychological well-being and resilience and decrease in depression symptoms. Effect size estimates indicate medium effect sizes for well-being and nonreactivity with the other outcomes having small effect sizes.Research limitations/implicationsA limitation of this study is the lack of a randomized control trial design and the lack of control for extraneous variables. Future studies using rigorous and longitudinal designs are recommended. Future studies may also examine program implementation factors such as using homogenous groups.Practical implicationsIn most low-income countries, the provision of mental health and psychosocial support during the COVID-19 pandemic has been hampered by the lack of mental health professionals, issues of internet connectivity and a lack of resources and access. Online resilience support groups may provide a means to address these challenges by making mental health support more accessible and available.Social implicationsThe COVID-19 pandemic has caused isolation and a means to bridge this is through peer support groups. This may be especially important in collectivist cultures where social relationships serve as recovery capital.Originality/valueAlthough there has been a rise in the use of technology, most are in the form of individual or self-help interventions. This paper examines the feasibility of an online structured peer support group that focuses on building resilience skills. It fills a gap in the literature on online peer support groups that may be most relevant for low-income countries with a dearth of mental health specialists.

Persuasive Technology for Mental Health: One Step Closer to (Mental Health Care) Equality?

The increasing trend of mental health issues, especially among younger people, is not a new phenomenon. World organizations, leaders, and decision-makers are recognizing its devastating effect, resulting in mental health well-being appearing in goal 3 of the 17 UN sustainable development goals (SDGs) [1] . Among mental health issues, stress, anxiety, and depression (SAD) seem to be on the forefront—reaching 74% for disabling stress [2] , 28% for anxiety disorder [3] , and 48% for depression [4] , in some groups. What is more, between 76% and 85% of people in low- and middle-income countries receive no treatment for their disorder [5] , whereas the treatment coverage for, for example, depression is only 33% in high-income countries [6] . Mental health issues have large, multifaceted effects on the patient, on their immediate surroundings (family or caretakers), and on the wider society [7] . Individuals face decreased quality of life, poor educational outcomes, lowered productivity and potential poverty, social problems, abuse vulnerabilities, and additional health problems. Caretakers face increased emotional and physical challenges as well as decreased household income and increased financial costs. Society faces the loss of several gross domestic product (GDP) percentage points and billions of dollars annually, alongside with exacerbating public health issues and corrosion of social cohesion. All these lead to an increasingly stronger positive reinforcement loop—SAD increasingly perpetuates SAD. Too often, mental health issues directly result in the worst possible outcome and loss of human life, as many countries struggle with a high suicide rate [8] . It has been recognized that the reasons for increasing SAD include a severe lack of mental health professionals and regulations [9] as well as unequal access to mental health care [10] . These factors make the field ripe for technological and other scientific therapy-based interventions, as individuals with mental health issues prefer therapies to medication [11] .

Mapping evidence of depression in HIV-seropositive MSM in sub-Saharan Africa: a scoping review protocol

BackgroundDepression is one of the most prevalent mental disorders among an estimated 25.6 million people living with HIV (PLHIV) in sub-Saharan Africa (SSA). The depression rate is higher in HIV-seropositive men who have sex with men (MSM) regardless of their sexual orientation, identity or romantic attraction. This is due to various types of stigma including HIV-related stigma, social stigma, self-stigma and mental health stigma. Opportunistic infections, unemployment, poverty and food insecurity also predispose HIV-seropositive MSM to depression. Moreover, depression in heterosexual and sexual minority groups challenges and additionally burdens SSA health care systems due to inadequate economic developments, lack of mental health professionals who specialise in the treatment of depression, few MSM-centred facilities, inadequate mental health infrastructure (hospitals and clinics) and complimentary resources. Although studies have highlighted links between mental health disorder, an HIV diagnosis and sexual minority groups, there is limited research that focusses on depression and its causal factors in MSM living with HIV in SSA. Hence, the relevance of conducting this scoping review.MethodsA scoping review guided by Arksey and O’Malley’s framework, the enhancements and recommendations of Levac, Colquhoun and O’Brien, Daudt and associates and the 2015 Johanna Briggs Institute’s guidelines will be conducted. Systematic electronic searches of databases and search engines such as Google, Google Scholar, CINAHL (EBSCOhost), MEDLINE (Ovid), and PsycInfo (Ovid) will be conducted to attain published peer-reviewed articles of all study designs. Grey literature will be sourced from media and conference abstracts and reports, governmental reports and unpublished dissertations and theses. Additionally, websites of humanitarian organisations and other relevant departmental websites will also be searched. Literature published between 2010 and 2020 that meets the review’s inclusion criteria, research question and sub-question will be included in this review. All the retrieved literature will be exported to an Endnote X9.2 library after duplicates have been removed.DiscussionWe anticipate mapping relevant literature on depression and the causal factors in HIV-seropositive MSM living in SSA. Once analysed and summarised, the data will be useful in identifying literature gaps, informing systematic reviews and future research. The findings could also assist in depression and sexuality dialogues, and awareness campaigns that address mental health issues, stigma and discrimination among this key population living in SSA.

Offre de soins et recours aux hospitalisations psychiatriques en milieu pénitentiaire : une étude observationnelle dans le Nord de la France

BackgroundIn French prisons, psychiatric care for inmates is organized into three levels: ambulatory care within each jail in "unités sanitaires en milieu pénitentiaire" (USMP: sanitary units in correctional settings), day hospitalizations in the 28 services médico-psychologiques régionaux (SMPR, "regional medical-psychological services") and full-time hospitalizations in one of the nine "unités d'hospitalisation spécialement aménagées" (UHSA: specially equipped hospital units). Despite high prevalence of mental disorders among French prisoners, the efficiency of these specialized psychiatric care units has been insufficiently studied. The main goal of this study is to describe full-time psychiatric hospitalizations for inmates in the twenty prisons located in the North of France. MethodsWe conducted a descriptive study based on medical and administrative data and survey results. The following data were collected for each prison regarding 2016: 1) number and occupancy rates for mental health professionals and 2) psychiatric hospitalization rates (in the UHSA of Lille-Seclin and the general psychiatric hospitals). ResultsProvision of care is incomplete: the vacancy rate in the health units studied reaches 40 %. Moreover, access to UHSA is unequal: it varies pronouncedly according to the location of the prison; only inmates in prisons close to the UHSA benefit from satisfactory access. ConclusionAccess to psychiatric care for inmates remains problematic in France, particularly due to a lack of mental health professionals in USMPs, the overload of patients in UHSAs and the distance of theses facilities from certain prisons and jails.

Prevalence and characteristics of universal depression screening in U.S. college health centers.

Whereas universal depression screening has potential to increase identification of mental health concerns among college students, the prevalence of universal screening in college health centers is unknown. This study provides an estimate of the prevalence of universal depression screening at public, 4-year universities in the United States. It also documents systems-level facilitators and correlates of universal screening, as well as reasons for not screening. Online cross-sectional survey of college health center directors and student health personnel of public 4-year universities. There were 131 participants who responded to the survey (25% response): 64.2% (54-74%; 95% confidence interval [CI]) of respondents reported that their clinics use universal depression screening. Characteristics associated with universal depression screening use clustered around systems-level resources, including larger student populations and health care staff, greater perceived financial resources, and shorter estimates of time required for screening. Universal screening use was also associated with respondents' awareness of the U.S. Preventive Services Task Force (USPSTF) recommendation, agreement with the evidence base supporting universal depression screening, and beliefs that codified standards support effective care. Leading reasons for not screening included: lack of mental health professionals, provider reluctance, liability concerns, and lack of clinic space. Universal depression screening is reasonably common among college health centers. Care planner discussions regarding depression screening initiatives should address resource concerns, awareness of the USPSTF recommendation and evidence base, and information about the average time it takes to screen. Future research should examine functional outcomes and implementation experiences of college health centers that have adopted universal depression screening. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A screening tool for psychological difficulties in children aged 6 to 36\u2009months: cross-cultural validation in Kenya, Cambodia and Uganda

BackgroundIn low-resource settings, the lack of mental health professionals and cross-culturally validated screening instruments complicates mental health care delivery. This is especially the case for very young children. Here, we aimed to develop and cross-culturally validate a simple and rapid tool, the PSYCa 6–36, that can be administered by non-professionals to screen for psychological difficulties among children aged six to 36 months.MethodsA primary validation of the PSYCa 6–36 was conducted in Kenya (n = 319 children aged 6 to 36 months; 2014), followed by additional validations in Kenya (n = 215; 2014) Cambodia (n = 189; 2015) and Uganda (n = 182; 2016). After informed consent, trained interviewers administered the PSYCa 6–36 to caregivers participating in the study. We assessed the psychometric properties of the PSYCa 6–36 and external validity was assessed by comparing the results of the PSYCa 6–36 against a clinical global impression severity [CGIS] score rated by an independent psychologist after a structured clinical interview with each participant.ResultsThe PSYCa 6–36 showed satisfactory psychometric properties (Cronbach’s alpha > 0.60 in Uganda and > 0.70 in Kenya and Cambodia), temporal stability (intra-class correlation coefficient [ICC] > 0.8), and inter-rater reliability (ICC from 0.6 in Uganda to 0.8 in Kenya). Psychologists identified psychological difficulties (CGIS score > 1) in 11 children (5.1%) in Kenya, 13 children (8.7%) in Cambodia and 15 (10.5%) in Uganda, with an area under the receiver operating characteristic curve of 0.65 in Uganda and 0.80 in Kenya and Cambodia.ConclusionsThe PSYCa 6–36 allowed for rapid screening of psychological difficulties among children aged 6 to 36 months among the populations studied. Use of the tool also increased awareness of children’s psychological difficulties and the importance of early recognition to prevent long-term consequences. The PSYCa 6–36 would benefit from further use and validation studies in popula`tions with higher prevalence of psychological difficulties.

Process evaluation of the systematic medical appraisal, referral and treatment (SMART) mental health project in rural India

BackgroundAvailability of basic mental health services is limited in rural areas of India. Health system and individual level factors such as lack of mental health professionals and infrastructure, poor awareness about mental health, stigma related to help seeking, are responsible for poor awareness and use of mental health services. We implemented a mental health services delivery model that leveraged technology and task sharing to facilitate identification and treatment of common mental disorders (CMDs) such as stress, depression, anxiety and suicide risk in rural areas of the state of Andhra Pradesh, India. The intervention was delivered by lay village health workers (Accredited Social Health Activists – ASHAs) and primary care doctors. An anti-stigma campaign was implemented prior to this activity. This paper reports the process evaluation of the intervention using mixed methods.MethodsA mixed methods pre-post evaluation assessed the intervention using quantitative service usage analytics from the server, and qualitative interviews with different stakeholders. Barriers and facilitators in implementing the intervention were identified.ResultsHealth service use increased significantly at post-intervention, ASHAs could followup 78.6% of those who had screened positive, and 78.6% of the 1243 Interactive Voice Response System calls made, were successful. Most respondents were aware of the intervention. They indicated that knowledge received through the intervention empowered them to approach ASHAs and share their mental health symptoms. ASHAs and doctors opined that EDSS was useful and easy to use. Medical camps organized in villages to increase access to the doctor were received positively by all. However, some aspects or facilitators of the intervention need to be improved, including network connectivity, booster training, anti-stigma campaigns, quality of mental health services provided by doctors, provision of psychotropic medications at primary health centers and frequency of health camps.ConclusionThe respondents’ views helped to understand the barriers and facilitators for improving the likely effectiveness of the intervention using Andersen’s Modified Behavioral Model of Health Services Use, and identify the mechanisms by which those factors affected mental health services uptake in the community.Trial registrationThe study is registered with Clinical Trials Registry India (Applied - 16/07/14-Ref2014/07/007256; registration received - 04/10/17-CTRI/2017/10/009992).

Evaluation of outcomes for psychosis and epilepsy treatment delivered by primary health care workers in Nepal: a cohort study

BackgroundMost evaluations of task-shifting have focused on common mental disorders. Much less work has been done on severe mental neurological and substance use (MNS) disorders, such as chronic psychosis and epilepsy. Given the high burden associated with severe MNS and the lack of mental health professionals in low and middle income countries, evaluations on the impact of task-shifting for these disorders are important.MethodsIn a rural district of Nepal, a community mental health program, based on World Health Organization’s Mental Health Gap Action Programme guidelines, was evaluated using a cohort study design. People with epilepsy and psychotic disorders were interviewed at treatment initiation and at 12-month follow-up. We also compared a group that was offered a comprehensive package of care (medication combined with psychosocial interventions, such as counselling and peer support groups) to a group that received medication only.ResultsOne-hundred nineteen persons were enrolled in the epilepsy cohort (EC) and 85 in the psychosis cohort (PC). The patients were enrolled in either the comprehensive package (n = 157) or medication only (n = 47). There was significant improvement (P < 0.0001) in psychosis symptoms (PC: Z = 6.78, r = 0.80) and depressive symptoms (EC: Z = 7.43, r = 0.73; PC: Z = 6.02, r = 0.70), seizures (EC: Z = 6.78), functional disability (EC: Z = 6.38, r = 0.67; PC: Z = 4.60, r = 0.57), family and caregiver burden (EC: Z = 8.09, r = 0.85; PC: Z = 6.81, r = 0.84), and social behaviour (PC: Z = 5.94, r = 0.84). There was greater risk reduction for recent seizures among people with epilepsy in the comprehensive treatment package vs. medication only (risk ratio = 0.52, 95% CI 0.29–0.95; P = 0.03); no other significant differences were observed between treatment arms.ConclusionsA community mental health program in Nepal, implemented by non-specialists, resulted in moderate to large effects among people with epilepsy or psychosis. A comprehensive package of care, including counselling and patient support groups, appears to offer added clinical benefits for patients with epilepsy. For people with psychosis, the basic package of care (i.e., psychotropic medications) performed similar to the comprehensive package, suggesting a less resource-intensive package may offer comparable results.

Professionals' views on mental health service users' education: challenges and support.

Introduction Studies show the importance of providing support for mental health service users' (MHSUs') education. However, none of these studies explored this support in the community mental health centre setting. The range of MHSUs' educational activities identified in this study varied from participation in courses at the mental health centres to independent studies at different levels of education outside the centres. Aim (1) How do mental health professionals perceive the challenges that may limit service users' potential when they apply for, and complete, their education? (2) How do the professionals describe the methods of rehabilitation aimed at supporting the service users in achieving their educational goals? Method The data were collected from 14 mental health professionals using focus group interviews. Inductive content analysis was then performed. Results Professionals perceive that the predominance of disease and marginalization may be barriers to MHSUs' success in education. Strengthening the MHSUs' internal resources, creating a supportive environment with professional expertise available and service user-centred education appeared to support the MHSUs' educational achievements. Our findings confirm previous knowledge of a recovery-oriented approach to support MHSUs' education. However, professionals' views on this topic in the context of community mental health centres have not been investigated previously. Discussion Professionals perceive that a recovery-oriented approach to rehabilitation may support MHSUs in their educational efforts. Implications for practice A recovery-oriented approach should be adopted by all levels of the community mental health centres. MHSUs and professionals need to have a shared opinion on the definition of recovery orientation. This requires mutual discussion and a more active involvement of MHSUs in the design of their own rehabilitation process.

Depression in rural adolescents: relationships with gender and availability of mental health services

There is growing evidence in the literature which indicates that the prevalence of depression is similar in both non-metropolitan and metropolitan areas. However, it is generally perceived that factors associated with compromised mental health in rural residents include deprivation and lack of access to healthcare services. This study examines the relationship between depression and possible determinants of mental health among rural adolescents. The determinants identified were degree of remoteness, gender, socioeconomic status and the perception of rural community characteristics. Rural community characteristics examined were long waiting lists and lack of mental health professionals. Respondents were 531 South Australian adolescents (55.7% female) aged 13 to 18 years, living outside the Adelaide (state capital) metropolitan area. Respondents completed a questionnaire including: demographic questions; the Kutcher Adolescent Depression Scale (KADS); and questions regarding individual perceptions of community characteristics. The data were obtained by self-report, degree of remoteness was measured using the Accessibility and Remoteness Index of Australia Plus, and socio-economic status was determined from the Australian Bureau of Statistics (ABS) Socio-Economic Index of Relative Socio-Economic Advantage and Disadvantage (SEIFA). The rate of depression obtained from this sample of rural adolescents is concerning; 18% screened positive for depression on the KADS, 41% reported low mood much of the time or more often, and 20% experienced occasional or more frequent self-harm or suicidal thoughts, plans or actions. Depression was related to gender, with more females (23%) screening positive for depression than males (11.8%). Prevalence of depression was unrelated to degree of remoteness or the socioeconomic status of the participants. This finding is not consistent with other research that identifies socioeconomic status as a psychosocial determinant of mental health. It is noteworthy that the perception of long waiting lists and a lack of mental health professionals were related to depression but that this relationship was only significant for females. This may be because those who experience symptoms of depression are more likely to be aware of service availability due to help-seeking behaviour. That this finding is significant for females is consistent with research that identifies females as being better able to identify symptoms of depression and more willing to seek help. Efforts to enhance the mental health of rural Australian adolescents should focus on improving the availability of mental health services, improving mental health literacy and promoting help-seeking behaviour for mental health difficulties. Consideration should be given to the gender differences identified when developing future mental health initiatives.

Depression risks in mothers of children with developmental disabilities: A cross-cultural comparison of Brazil, Colombia, Malaysia and Thailand

Compared with US or European countries, there are fewer mental health services for mothers of children with developmental disabilities in Latin American and/or Southeast Asian countries. To explore the risk of depression in mothers of children with developmental disabilities in countries with a lack of mental health professionals, we conducted cross-cultural comparisons for four countries: Brazil, Colombia, Malaysia and Thailand. Using the CES-D, we compared the participants' depressive symptoms, by which we also estimated the probability of morbid depression. In every country, participants tended to show depressive symptoms. In the CES-D total scores and the numbers of mothers who were observed to have a high level of depressive symptoms, there were significant differences among countries (F = 4.36, p = .006; χ2 = 10.3, p = .015). Considering cultural models, we could apply evidence-based intervention to depressive mothers of children, and conduct intervention and treatment for those mothers and evaluate ways of providing better mental health services to these individuals.

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

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

Female Juvenile Offenders Incarcerated as Adults

• Summary: A pilot study was conducted which examined the development and implementation of a psychoeducational group intervention for young female offenders incarcerated in adult jail. The purpose of the group intervention was to reduce levels of depression, anxiety and trauma symptoms among the female juveniles. T-test analyses were utilized to examine differences between pre-tests and post-tests on the three outcome variables. • Findings: Findings indicated that the group intervention may be effective in alleviating depression and trauma symptoms among young female offenders. No significant differences between pre-test and post-test were found for anxiety. • Applications: Due to large caseloads and lack of mental health professionals in the jails and prisons in the United States, young offenders receive little or no mental health treatment when they are incarcerated in the adult jail system. The group intervention described in the current study holds promise for providing a cost-effective and efficient technique for delivering mental health services to this young population of offenders incarcerated in adult jail. If we are concerned about curbing the rising tide of violence among juveniles, we must develop innovative rehabilitation programs to meet the needs of this population of inmates in our jail and prison systems.