Mental Health Care Initiative Research Articles

Evaluating mental health care initiatives after Ghana’s mental health act: a systematic analysis

Abstract Mental health disorders affect 970 million people worldwide. Particularly in Africa, mental health is a growing concern, as it faces poverty and limited healthcare services. The Ghana Mental Health Act (GMHA 2012) marked a significant milestone in the development of a legislative framework supporting the provision of mental healthcare. However, evidence of progress since then is scarce. This systematic review examines the mental health initiatives that have been implemented since GMHA. Bronfenbrenner’s Socio-Ecological and Vygotsky’s Sociocultural Theory are used as frameworks to organize the interventions by ecological layers and cultural practices. All peer-reviewed articles published since the GMHA were retrieved from PubMed, Cochrane and Science Direct, using “mental health interventions,” “-collaborations,” “-health programs” and “Ghana” as keywords. The search yielded 3839 articles. Next, publications that were not conducted in Ghana or did not focus on mental health were excluded yielding a final sample of 69 articles for the review. Consistent with the GMHA’s guidelines interventions were conducted in communities (n = 56; 81%) rather than hospitals (n = 13; 19%). Most of them focused on institutional ecological levels (i.e., schools, health centers, traditional healing conventions; n = 29; 42%), followed by interpersonal (n = 14; 20%) and community-level (n = 14; 20%) approaches. Half (n = 33; 48%) entailed some form of cultural responsiveness, such as adapting educational tools to cultural contexts or accounting for spiritual beliefs. Only 23% (n = 16) of the interventions targeted children or adolescents. The findings of this review suggest three implications for future mental health research. First, stigma reduction and mental health literacy need to become a stronger focus. Second, research on children and adolescents needs to be increased. Third, interventions led by European partners must be tailored carefully to the Ghanaian beliefs system. Key messages • Assessing the community-based approach of mental health interventions following the Mental Health Act’s legalization in Ghana. • European partners need to understand the context and the local culture before planning to research or implement intervention materials. Adaptation is key in the effectiveness of the intervention.

Effect of mental health staffing inputs on initiation of care among recently separated Veterans.

To estimate a causal relationship between mental health staffing and time to initiation of mental health care for new patients. As the largest integrated health care delivery system in the United States, the Veterans Health Administration (VHA) provides a unique setting for isolating the effects of staffing on initiation of mental health care where demand is high and out-of-pocket costs are not a relevant confounder. We use data from the Department of Defense and VHA to obtain patient and facility characteristics and health care use. To isolate exogenous variation in mental health staffing, we used an instrumental variables approach-two-stage residual inclusion with a discrete time hazard model. Our outcome is time to initiation of mental health care after separation from active duty (first appointment) and our exposure is mental health staffing (standardized clinic time per 1000 VHA enrollees per pay period). Our cohort consists of all Veterans separating from active duty between July 2014 and September 2017, who were enrolled in the VHA, and had at least one diagnosis of post-traumatic stress disorder, major depressive disorder, and/or substance use disorder in the year prior to separation from active duty (N = 54,209). An increase of 1 standard deviation in mental health staffing results in a higher likelihood of initiating mental health care (adjusted hazard ratio: 3.17, 95% confidence interval: 2.62, 3.84, p < 0.001). Models stratified by tertile of mental health staffing exhibit decreasing returns to scale. Increases in mental health staffing led to faster initiation of care and are especially beneficial in facilities where staffing is lower, although initiation of care appears capacity-limited everywhere.

Factors related to depressive symptoms during the second year of COVID-19 pandemic in Brazil: A cross-sectional study with adolescents

PurposeThis study aimed to identify factors associated with depressive symptoms in adolescents during the COVID-19 pandemic in Brazil. Design and methodsA cross-sectional study was conducted in 2021 with a sample of 1303 students (50.96% females; mean age = 16.32 ± 1.1y) enrolled in high schools integrated with professional education. Depressive symptoms, socioeconomic variables (sex, age, skin color/ethnicity, and head of the household education level), body mass index categories, and adherence to the recommendations on physical activity, recreational screen time, and sleep were evaluated using an online survey. Linear regressions were used to test associations. ResultsFemale, older adolescents, those who self-identified as Black, and those whose head of household had an incomplete primary education were associated with depressive symptoms. Not doing any moderate to vigorous physical activity (0 min/week) and not meeting recommendations for recreational screen time (<2 h) and sleep (≥8 h) were associated with higher depressive symptoms (β = 3.04, 95%CI: 1.16;4.92; β = 4.54, 95%CI:1.99;7.10; β = 2.95, 95%CI:1.58;4.31; respectively). ConclusionDepressive symptomology during the COVID-19 pandemic is prominent in groups of adolescents who experience health inequities. Practical implicationsThe results suggest that and at-risk groups may benefit from mental health care initiatives, and additional research is needed to evaluate the long-term impacts of depression during the pandemic and global health crises.

School-based Evaluation Advancing Response for Child Health (SEARCH): a mixed longitudinal cohort study from multifaceted perspectives in Jiangsu, China

BackgroundSchools play a crucial role in providing mental health services to children and adolescents. However, the vastness of the student population and mental health workforce shortage in China severely limit...

Sixteen years of innovation in youth mental healthcare: Outcomes for young people attending Australia's headspace centre services.

Australia's headspace initiative is world-leading in nation-wide youth mental healthcare reform for young people aged 12 to 25 years, now with 16 years of implementation. This paper examines changes in the key outcomes of psychological distress, psychosocial functioning, and quality of life for young people accessing headspace centres across Australia for mental health problems. Routinely collected data from headspace clients commencing an episode of care within the data collection period, 1 April 2019 to 30 March 2020, and at 90-day follow-up were analysed. Participants came from the 108 fully-established headspace centres across Australia, and comprised 58,233 young people aged 12-25 years first accessing headspace centres for mental health problems during the data collection period. Main outcome measures were self-reported psychological distress and quality of life, and clinician-reported social and occupational functioning. Most headspace mental health clients presented with depression and anxiety issues (75.21%). There were 35.27% with a diagnosis: overall, 21.74% diagnosed with anxiety, 18.51% with depression, and 8.60% were sub-syndromal. Younger males were more likely to present for anger issues. Cognitive behavioural therapy was the most common treatment. There were significant improvements in all outcome scores over time (P<0.001). From presentation to last service rating, over one-third had significant improvements in psychological distress and a similar proportion in psychosocial functioning; just under half improved in self-reported quality of life. Significant improvement on any of the three outcomes was shown for 70.96% of headspace mental health clients. After 16 years of headspace implementation, positive outcomes are being achieved, particularly when multi-dimensional outcomes are considered. A suite of outcomes that capture meaningful change for young people's quality of life, distress and functioning, is critical for early intervention, primary care settings with diverse client presentations, such as the headspace youth mental healthcare initiative.

Predictors of Mental Health Service Utilization among Frontline Healthcare Workers during the COVID-19 Pandemic.

(1) Background: This study examined the prevalence and correlates of factors associated with self-reported mental health service use in a longitudinal cohort of frontline health care workers (FHCWs) providing care to patients with COVID-19 throughout 2020. (2) Methods: The study comprised a two-wave survey (n = 780) administered in April-May 2020 (T1) and November 2020-January 2021 (T2) to faculty, staff, and trainees in a large urban medical center. Factors associated with initiation, cessation, or continuation of mental health care over time were examined. (3) Results: A total of 19.1% of FHCWs endorsed currently utilizing mental health services, with 11.4% continuing, 4.2% initiating, and 3.5% ceasing services between T1 and T2. Predisposing and need-related factors, most notably a history of a mental health diagnosis and distress related to systemic racism, predicted service initiation and continuation. Among FHCWs with a prior mental health history, those with greater perceived resilience were less likely to initiate treatment at T2. Descriptive data highlighted the importance of services around basic and safety needs (e.g., reliable access to personal protective equipment) relative to mental health support in the acute phase of the pandemic. (4) Conclusions: Results may be helpful in identifying FHCWs who may benefit from mental health services.

Delivering collaborative mental health care within supportive housing: implementation evaluation of a community-hospital partnership

BackgroundApproaches to address unmet mental health care needs in supportive housing settings are needed. Collaborative approaches to delivering psychiatric care have robust evidence in multiple settings, however such approaches have not been adequately studied in housing settings. This study evaluates the implementation of a shifted outpatient collaborative care initiative in which a psychiatrist was added to existing housing, community mental health, and primary care supports in a women-centered supportive housing complex in Toronto, Canada.MethodsThe initiative was designed and implemented by stakeholders from an academic hospital and from community housing and mental health agencies. Program activities comprised multidisciplinary support for tenants (e.g. multidisciplinary care teams, case conferences), tenant engagement (psychoeducation sessions), and staff capacity-building (e.g. formal trainings, informal ad hoc questions). This mixed methods implementation evaluation sought to understand (1) program activity delivery including satisfaction with these activities, (2) consistency with team-based tenant-centered care and with pre-specified shared lenses (trauma-informed, culturally safe, harm reduction), and (3) facilitators and barriers to implementation over a one-year period. Quantitative data included reporting of program activity delivery (weekly and monthly), staff surveys, and tenant surveys (post-group surveys following tenant psychoeducation groups and an all-tenant survey). Qualitative data included focus groups with staff and stakeholders, program documents, and free-text survey responses.ResultsAll three program activity domains (multidisciplinary supports, tenant engagement, staff capacity-building) were successfully implemented. Main program activities were multidisciplinary case conferences, direct psychiatric consultation, tenant psychoeducation sessions, formal staff training, and informal staff support. Psychoeducation for tenants and informal/formal staff support were particularly valued. Most activities were team-based. Of the shared lenses, trauma-informed care was the most consistently implemented. Facilitators to implementation were shared lenses, psychiatrist characteristics, shared time/space, balance between structure and flexibility, building trust, logistical support, and the embedded evaluation. Barriers were that the initial model was driven by leadership, confusion in initial processes, different workflows across organizations, and staff turnover; where possible, iterative changes were implemented to address barriers.ConclusionsThis evaluation highlights the process of successfully implementing a shifted outpatient collaborative mental health care initiative in supportive housing. Further work is warranted to evaluate whether collaborative care adaptations in supportive housing settings lead to improvements in tenant- and program-level outcomes.

A Text Message Intervention for Adolescents With Depression and Their Parents or Caregivers to Overcome Cognitive Barriers to Mental Health Treatment Initiation: Focus Groups and Pilot Trial.

BackgroundMany adolescents with depression do not pursue mental health treatment following a health care provider referral. We developed a theory-based automated SMS text message intervention (Text to Connect [T2C]) that attempts to reduce cognitive barriers to the initiation of mental health care.ObjectiveIn this two-phase study, we seek to first understand the potential of T2C and then test its engagement, usability, and potential efficacy among adolescents with depression and their parents or caregivers.MethodsIn phase 1, we conducted focus groups with adolescents with depression (n=9) and their parents or caregivers (n=9) separately, and transcripts were examined to determine themes. In phase 2, we conducted an open trial of T2C comprising adolescents with depression referred to mental health care (n=43) and their parents or caregivers (n=28). We assessed usability by examining program engagement, usability ratings, and qualitative feedback at the 4-week follow-up. We also assessed potential effectiveness by examining changes in perceived barriers to treatment and mental health care initiation from baseline to 4 weeks.ResultsIn phase 1, we found that the themes supported the T2C approach. In phase 2, we observed high engagement with daily negative affect check-ins, high usability ratings, and decreased self-reported barriers to mental health treatment over time among adolescents. Overall, 52% (22/42) of the adolescents who completed follow-up reported that they had attended an appointment with a mental health care specialist. Of the 20 adolescents who had not attended a mental health care appointment, 5% (1/20) reported that it was scheduled for a future date, 10% (2/20) reported that the primary care site did not have the ability to help them schedule a mental health care appointment, and 15% (3/20) reported that they were no longer interested in receiving mental health care.ConclusionsThe findings from this study suggest that T2C is acceptable to adolescents with depression and most parents or caregivers; it is used at high rates; and it may be helpful to reduce cognitive barriers to mental health care initiation.

An examination of transdisciplinary implementation of measurement-based care in a Veterans Affairs Healthcare System.

Measurement-based care (MBC) is an effective pantheoretical practice framework that enhances mental health treatment outcome. MBC entails routine, systematic administration of standardized scales to measure patients' treatment response, inform clinical decisions, and tailor practice approaches and treatment planning to the individual needs of each patient. In 2016, the Office of Mental Health Operations and Mental Health Services in the Veterans Affairs Central Office launched the MBC in Mental Health Care Initiative. In accordance with this initiative, MBC was implemented within 2 mental health clinics at a large VA Health Care System in the southeastern United States. This program evaluation project examined the utilization of MBC measures across disciplines (i.e., psychiatry, psychology, social work) in the 2 clinics and clinicians' perspectives on MBC processes. Results suggested no significant differences between clinics in terms of rate of MBC measures administration. However, there were significant differences in the relative number of measures and the relative number of patients who were administered MBC measures across disciplines. Input from clinicians regarding their perspectives and experiences with the MBC implementation in their respective clinics were qualitatively and quantitatively evaluated, and barriers to MBC implementation were examined from the perspective of stakeholders. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Empirical analysis of COVID-19 induced socio cognitive factors and its impact on residents of Penang Island

PurposePandemic like coronavirus (COVID-19) poses a major challenge to countries like Malaysia where tourism is one of the major contributors to the national gross domestic product. Pandemics observed through the years have not only presented a medical challenge but also had a large impact on the psychological well-being of society. Overcoming these challenges required a strategically structured response on the medical and social front. To achieve the said goal on the social front, it is necessary to understand the cognitive appraisal and response of the public during this stressful environment. The restricted movement control used to curb the further spread of the disease drastically hampered tourism in Malaysia. This study aims to follow a statistical analysis based on the cognitive appraisal theory to understand the impact of COVID-19 on the public residing in Penang Island which is one of the most famous tourist destinations in the world.Design/methodology/approachA cross-sectional, observational study design was carried out for this research. Snowball sampling technique was used and the data was collected via a semi-structured online questionnaire measuring the psychological health of people present in Penang Island.FindingsThe study reports a positive response in terms of disease awareness and proper observation of preventive measures, yet a high level of pandemic induced anxiety was statistically estimated. The study proposes mental health care initiative to help those affected by the COVID-19 pandemic.Originality/valueThis study reports a possible link between the mental wellness of the residents and domestic tourism in Penang Island during the COVID-19 pandemic.

Factors associated with non-initiation of mental healthcare after detection of poor mental health at a scheduled health check: a cohort study

IntroductionPoor mental health is an important public health concern, but mental health problems are often under-recognised. Providing feedback to general practitioners (GPs) on their patients’ mental health status may improve...

Personal-recovery-oriented community mental healthcare: qualitative evaluation of a developmental project.

ObjectivesMental healthcare is commonly aimed at reducing symptoms in individual service users. When only symptomatic recovery is addressed, not all service users experience sufficient recovery, and when care is aimed only at individuals (instead of the neighbourhood), not all people in need of mental healthcare are reached. This study evaluated a project that aimed to improve mental healthcare in a neighbourhood, by improving healthcare providers’ outreach to the residents living in the neighbourhood, by improving collaboration among healthcare providers and focussing on the residents’ personal recovery. This project was carried out by several public health services. It aimed to change the goal of mental healthcare provided in the neighbourhood from symptom reduction to personal recovery.DesignThe study included qualitative focus groups and inductive content analysis.SettingPrimary and secondary mental healthcare that healthcare workers from different healthcare services provided.ParticipantsThe evaluation was conducted through three focus group interviews with services users, their friends and relatives, neighbourhood residents, neighbourhood representatives and the healthcare services that were involved (n = 24).ResultsEvaluation indicated that the most valued part of the project was the utilisation of peer workers at the initiation of mental healthcare. Improved communication among healthcare providers that the project fostered was also highly regarded. The aim of the project to align it with existing initiatives in the neighbourhood was also considered important, although it was difficult to achieve.ConclusionsThe project did not find a panacea for recovery-oriented community mental healthcare. A variety of its components did, however, contribute to the mental health of the community residents.

Initiation of evidence-based psychotherapies in Veterans with posttraumatic stress disorder

ABSTRACTThe Department of Veterans Affairs (VA) requires that all VA hospitals and clinics provide access to evidence-based psychotherapies (EBPs). Despite these widespread dissemination efforts, only a minority of Veterans receive EBP services. Reasons for these low rates of EBP utilization are largely unknown. This study examined the characteristics of Veterans with posttraumatic stress disorder (PTSD) who did (Initiation group) and did not (No-Initiation group) initiate a VA-approved EBP after participating in an information session. Veterans chose their preferred treatment from a menu of EBPs. Results demonstrated that Veterans in the No-Initiation group had longer periods of time between their referral and first EBP visit. Among Veterans in the Initiation group, the majority (68%) initiated a trauma-focused EBP as their first or second treatment, suggesting that providing a range of treatment options did not negatively impact their willingness to engage in PTSD treatment. Results are discussed in terms of VA initiatives to improve access to and initiation of mental health care for Veterans.

Childhood Mental Illness, Treatment Vary by State

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessChildhood Mental Illness, Treatment Vary by StateNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:5 Apr 2019https://doi.org/10.1176/appi.pn.2019.3b24AbstractOverall, 16.5 percent of school-age children were diagnosed with at least one mental illness according to 2016 data, but state-level prevalence varied from about 8 percent to 27 percent.A key element to successfully implementing broad mental health care initiatives for children is to understand where the greatest needs are and where resources are lacking. To that end, researchers at the University of Michigan have compiled state-level estimates of the prevalence of mental illness in children and their access to treatment for these disorders.Daniel Whitney, Ph.D., and Mark Petersen, Ph.D., of Michigan’s Department of Physical Health and Rehabilitation found that about 16.5 percent of school-age children in the United States have at least one mental health disorder. About half of these children did not receive treatment in the past year. The study, published in the February 11 JAMA Pediatrics, also revealed variability in the estimates from state to state.The researchers analyzed data from the 2016 National Survey of Children’s Health. As part of the survey, which included information on over 50,000 children aged 0 to 17, parents were asked whether they had ever been told by a doctor or other health care provider that their child has a mental health disorder and, if yes, whether the child currently had the condition. The survey also asked parents whether the child had received any treatment or counseling from a mental health professional during the past 12 months. According to the survey, mental health professionals include psychiatrists, psychologists, psychiatric nurses, and clinical social workers.The analysis by Whitney and Petersen excluded children without health insurance and younger than 6 years old.Extrapolating to a national population of 46.6 million children in this age range, Whitney and Petersen estimated that 7.7 million children (16.5 percent) had at least one mental disorder in 2016. Children living with a single parent, children who had public insurance, children with special needs, and children who did not have a regular doctor or place of care were more likely to have a mental disorder. The prevalence ranged from a low of 7.6 percent in Hawaii to 27.2 percent in Maine.The researchers estimated that 49.4 percent of the children with at least one mental disorder did not receive treatment or counseling from a mental health professional in the prior 12 months. Again, state-level rates varied from a low of 29.5 percent in the District of Columbia to 72.2 percent in North Carolina.Whitney and Petersen then divided the states into quartiles based on prevalence or treatment rates. They found that states with higher prevalence of children with at least one mental health disorder did not necessarily have higher numbers of children not receiving needed treatment; of the 13 states in the top quartile of the prevalence of children with mental health disorders, four states—Alabama, Mississippi, Oklahoma, and Utah—were also in the top quartile for children who were not receiving needed treatment. Colorado and Georgia, which had lower than average rates of children with mental health disorders, had a remarkably high prevalence of children not receiving needed treatment. In contrast, Virginia and Wyoming had higher than average rates of children with mental health disorders but lower than average rates of children not receiving needed treatment compared with other states.Whitney told Psychiatric News that despite some differences between the states, he still believes national policies aimed at improving pediatric mental health care can be effective. “To maximize the impact of national level policies, there may be a need for some states to do some tweaking,” he said.This study was supported by a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research. ■“U.S. National and State-Level Prevalence of Mental Health Disorders and Disparities of Mental Health Care Use in Children” can be accessed here. ISSUES NewArchived

Initiation and cessation of mental healthcare after mental health screening in primary care: a prospective cohort study

BackgroundMental health (MH) problems have considerable personal and societal implications. Systematic MH screening may raise general practitioners’ (GP) awareness of the current need of treatment in their listed patients. The focus of MH screening has so far been on increasing diagnostic rates and treatment of mental disorders, whereas cessation of MH treatment after normal test results has rarely been studied. This study aims to examine the mental healthcare trajectories after MH screening combined with feedback on both positive and negative screening results to the GP.MethodsThis prospective cohort study is based on data from 11,714 randomly selected individuals aged 30–49 years, who were invited to a preventive health check in Denmark during 2012–2015. A total of 5970 (51%) were included. MH status was assessed using the SF-12 Health Survey Mental Component Summary score, and scores were categorised into poor, moderate, and good MH. ‘Mental healthcare’ within 1 year of follow-up covered the following MH support: psychometric testing by GP, talk therapy by GP, contact to psychologist, contact to psychiatrist, and psychotropic medication.ResultsMH was found to be poor in 9%, moderate in 25%, and good in 66% of participants. After 1 year, mental healthcare was initiated in 29% of the participants with poor MH who did not receive mental healthcare at baseline, and mental healthcare was ceased in 44% of the participants with good MH who received mental healthcare at baseline. Odds ratio (OR) for initiation of mental healthcare was associated with worse MH screening status: poor MH: OR 7.1 (5.4–9.4), moderate MH: OR 2.4 (1.9–3.1), compared to those with good MH. OR for cessation of mental healthcare was associated with better MH screening status: good MH: OR 1.6 (1.1–2.6), moderate MH: OR 1.6 (1.0–2.4), compared to those with poor MH. Initiation and cessation of mental healthcare appeared to be time-related to the MH screening.ConclusionsMH screening combined with feedback on both positive and negative screening results to the GP may contribute to relevant initiation and cessation of mental healthcare.Trial registrationRegistration of the Check Your Health-trial: ClinicalTrials.gov (NCT02028195), 7 March 2014.

Collaborative Practices Among Australian School Psychologists, Guidance Officers and School Counsellors: Important Lessons for School Psychological Practice

In Australia, policies such as the Better Outcomes in Mental Health Care initiative have been the impetus for improved collaboration between medical practitioners and psychologists in general. However, policies that promote collaboration between school psychologists and community mental health, health, justice and/or human services professionals are yet to occur. This is despite known benefits arising from integrated service delivery to people with complex needs, including young people. School psychologists are an integral part of the service mix and are in an excellent position to promote collaborative practices and to assist students and families to navigate and access school-based and community-based support. This study, conducted in Queensland, Australia, investigated school psychologists’, guidance officers’ and school counsellors’ current and preferred levels of collaboration, their perceptions of the drivers and barriers to collaborative practices, and their views on how collaborative practices affect students. Results revealed that participants engaged more fully in within-school collaboration than collaboration with professionals and agencies outside of the school; they had a desire to collaborate more fully both internally and externally; and that concerns regarding confidentiality, time restrictions, and lack of access to appropriate services can sometimes make collaboration and information sharing difficult. Implications for school psychological practice are discussed.

A Systematic Review of Interventions to Improve Initiation of Mental Health Care Among Racial-Ethnic Minority Groups.

The objective of this systematic review was to identify interventions to improve the initiation of mental health care among racial-ethnic minority groups. The authors searched three electronic databases in February 2016 and independently assessed eligibility of 2,065 titles and abstracts on the basis of three criteria: the study design included an intervention, the participants were members of racial-ethnic minority groups and lived in the United States, and the outcome measures included initial access to or attitudes toward mental health care. The qualitative synthesis involved 29 studies. Interventions identified included collaborative care (N=10), psychoeducation (N=7), case management (N=5), colocation of mental health services within existing services (N=4), screening and referral (N=2), and a change in Medicare medication reimbursement policy that served as a natural experiment (N=1). Reduction of disparities in the initiation of antidepressants or psychotherapy was noted in seven interventions (four involving collaborative care, two involving colocation of mental health services, and one involving screening and referral). Five of these disparities-reducing interventions were tested among older adults only. Most (N=23) interventions incorporated adaptations designed to address social or cultural barriers to care. Interventions that used a model of integrated care reduced racial-ethnic disparities in the initiation of mental health care.

Looking for Help: Primary Care Providers’ Need for Collaboration to Deliver Primary Mental Healthcare Services

Primary care providers deliver the majority of mental health care to individual Canadians. Researchers suggest that these practitioners are not prepared to deliver these services and require collaboration with mental health specialists to better meet patients’ needs. This study describes family physicians’ and nurse practitioners’ perceptions of the need for consultation and collaboration from mental healthcare specialists. The theme, Looking for Help, is explained by three categories: My Comfort Zone, I Lack the Education, and Not Enough Time. Findings from this study may inform future collaborative mental healthcare initiatives and primary care networks.

The unfulfilled promise of the antidepressant medications.

Australia has one of the highest rates of antidepressant use in the world; it has more than doubled since 2000, despite evidence showing that the effectiveness of these medications is lower than previously thought. An increasing placebo response rate is a key reason for falling effectiveness, with the gap between response to medications and placebo narrowing. Psychotherapies are effective treatments, but recent evidence from high-quality studies suggests that their effectiveness is also modest. Combined treatment with medication and psychotherapy provides greater effectiveness than either alone. The number of patients receiving psychotherapy had been declining, although this trend is probably reversing with the Medicare Better Access to Mental Health Care initiative. Antidepressant medications still have an important role in the treatment of moderate to severe depression; they should be provided as part of an overall treatment plan that includes psychotherapy and lifestyle strategies to improve diet and increase exercise. When medications are prescribed, they should be used in a way that maximises their chance of effectiveness.

The More We Are Together, The Happier We Are: Peer Music in Mental Health Treatment in Zimbabwe

Ruth Verhey is a clinical psychologist involved in developing and running the Friendship Bench, a comprehensive, group based mental healthcare initiative in Harare, Zimbabwe. In 2013, she invited Jeffrey Angell, a music therapist from New York City, to facilitate one of weekly Zeebag support groups at Harare Hospital. The Zeebag group is comprised of eight women who suffer from depression. The essay provides Jeffrey's first person accounts of this experience, as well as describing the music, music process, and how these intergrate into the peer empowerment model of the Frienship Bench.