Mental Health Policy Formulation Research Articles

MENTAL HEALTH POLICIES: A COMPARATIVE REVIEW BETWEEN THE USA AND AFRICAN NATIONS

This comparative review examines mental health policies in the United States and various African nations, shedding light on the divergent approaches taken to address the complex challenges posed by mental health disorders. The analysis underscores the contextual nuances that shape mental health policy formulation and implementation in these distinct regions. In the United States, a comprehensive mental health policy framework has evolved over the years, characterized by a combination of federal and state initiatives. The Mental Health Parity and Addiction Equity Act, alongside the Affordable Care Act, has sought to integrate mental health services into mainstream healthcare, promoting accessibility and reducing stigma. Additionally, the National Institute of Mental Health plays a pivotal role in advancing research and evidence-based interventions. Contrastingly, African nations exhibit a wide spectrum of mental health policy landscapes, reflecting the diverse socioeconomic and cultural contexts across the continent. Some countries have made significant strides in policy development, emphasizing community-based approaches and integration with primary healthcare systems. However, challenges persist, including limited resources, mental health workforce shortages, and stigma associated with mental health conditions. The review explores the role of cultural factors in shaping mental health policies, emphasizing the need for culturally sensitive approaches in African nations. It also highlights the disparities in resource allocation and mental health infrastructure between the USA and African countries, contributing to variations in service accessibility and quality of care. Furthermore, the study emphasizes the importance of ongoing efforts to destigmatize mental health issues, improve public awareness, and strengthen community support systems. The review concludes by calling for increased international collaboration, knowledge exchange, and resource mobilization to address the mental health disparities between the USA and African nations, fostering a global commitment to holistic mental healthcare.
 Keywords: Health, Policies, Mental, Care, Stigmatize.

Factors That Influences Mental Health Policy In Albania

Mental health policy is a major challenge in every government engagement. Human wellbeing is threatened by mental health issue, and this is why it is necessary to position mental health as a health priority (WHO, 2001). The reduction of human and economic cost of mental health problems can be achieved by providing equitable and evidence-based mental healthcare and treatment. In Albania, the organization of mental health policy has experienced changes in the past half century, especially after the 90’s. This was driven by political commitment at national and intergovernmental levels in response to the challenges posed by mental health problems. The purpose of this paper is to analyze, present factors, and circulates what affects and prepossess the adoption of new mental health policy. The methodology used for this paper was based on two main elements. The first was the analyzing of Albanian conceptual framework, which is derived from two grounded elements: policy content and health policy process. The second element involves data collection using semistructured interview (12) with three levels of policy: policymakers, health policy administrator, and mental health care provider. Also, we consulted a wide range of electronic databases before underpinning the research with additional search. This search includes the scanning of a range of websites, reference lists of included studies, the legal mental health framework, and the respective documents. The activities stipulated in the First Component of the South-Eastern European Mental Health Project under the Stability Pact urged the process of a new mental health policy formulation and adoption of mental health legislation stressing human rights of patients. The WHO has influenced the whole mental health policy framework. They have instructed the National Policy Document for the Mental Health and the recpective action plans. In addition, they have supervised the impemention of this Documents and has trained mental health experts at all levels. Albanian policymaker are concerned with having an adequate map of mental health facilities. This is because many of the dedicated program are far way to be reached from persons in need. All policymaker actors are focused on the need for identification. In this trend of increase in the number of persons with mental health problems and their need for a more holistic care, finances has a crucial role to play.

The age of onset of anxiety disorders in samples from the general population: A meta-analysis

WorkshopAge of onset of mental disorders: etiopathogenetic and treatment implications.BackgroundAge of onset (AOO) of anxiety disorders could serve as a vital statistic in the formulation of mental health policy. Previous reviews have reported on the AOO of anxiety disorders in the general population. However, these review studies did not systematically estimate the AOO of different anxiety disorder subtypes, and did not examine factors that might have influenced reported AOO.ObjectiveThe aims of the present study were (1) to estimate the AOO for all anxiety disorders and for specific subtypes, (2) to examine gender differences in AOO of anxiety disorders, and (3) to examine the influence of study characteristics on reported AOO.MethodSeven electronic databases were searched with keywords representing anxiety disorder subtypes, AOO and study design. The inclusion criteria were studies using a general population sample that provided data on AOO for all anxiety disorders, or specific anxiety disorders, according to DSM-III-R, DSM-IV or ICD-10 criteria. Meta-analysis was used to estimate AOO and gender differences, while meta-regression was used to examine the influence of study characteristics.ResultsA total of 1028 titles were examined, which yielded 24 studies meeting the inclusion criteria. Meta-analysis found an average AOO of all anxiety disorders of 21.3 years (95% CI: 17.46 to 25.07). Separation anxiety disorder, specific phobia and social phobia had their mean onset before the age of 15 years, whereas AOO of agoraphobia, obsessive compulsive disorder, post-traumatic stress disorder, panic disorder and generalized anxiety disorder began on average between 21.1 and 34.9 years. Anxiety disorder is more common in women, but meta-analysis revealed no difference in AOO between genders. Prospective study design and higher developmental level of the study country were associated with earlier AOO.ConclusionResults from this meta-analysis indicate that anxiety disorder subtypes differ in mean AOO, with onsets ranging from early adolescence to young adulthood. These findings suggest that prevention strategies of anxiety disorders should be directed towards the factors associated with the development of subtypes of anxiety disorder in the age groups with the greatest vulnerability for developing those disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Prevalence, types, distribution and associations of psychosocial problems among university students in Uganda

The prevalence of psychosocial problems and their associations among University students in Uganda has received very little research attention. Yet, this information is important to provide data to assist in mental health policy formulation for counseling intervention among the vulnerable university students populations in Uganda. The study objective was to investigate the prevalence, types, distribution and associations of psychosocial problems among university students in Uganda. It was part of a larger PhD study that validated an instrument for assessing university students’ psychosocial problems in Uganda. This study employed a descriptive cross sectional survey technique. Five universities participated in a survey conducted during the 2012/13 academic year. Out of 1101 approached students, 976 (88.6%) completed the survey which included a socio-demographic questionnaire, study program characteristics, medical health questionnaire and the University Students Evaluation of Psychosocial Problems (USEPP) instrument which was used to evaluate the psychosocial problems. The prevalence, types and distribution of psychosocial problems among the students was established using descriptive statistics and regression analysis established the relationship between psychosocial problems and the correlates of interest. The estimated prevalence of psychosocial problems among the university students was 36.5%. Students living in off- campus hostels, having chronic medical conditions, and those with a previous history of mental health problems and who perceived their health as poor/fair were at a higher risk of psychosocial problems. These findings highlight to the need to initiate policies to address the students’ psychosocial problems.

Mental health policy in Eastern Europe: a comparative analysis of seven mental health systems.

BackgroundThe objective of this international comparative study is to describe and compare the mental health policies in seven countries of Eastern Europe that share their common communist history: Bulgaria, the Czech Republic, Hungary, Moldova, Poland, Romania, and Slovakia.MethodsThe health policy questionnaire was developed and the country-specific information was gathered by local experts. The questionnaire includes both qualitative and quantitative information on various aspects of mental health policy: (1) basic country information (demography, health, and economic indicators), (2) health care financing, (3) mental health services (capacities and utilisation, ownership), (4) health service purchasing (purchasing organisations, contracting, reimbursement of services), and (5) mental health policy (policy documents, legislation, civic society).ResultsThe social and economic transition in the 1990s initiated the process of new mental health policy formulation, adoption of mental health legislation stressing human rights of patients, and a strong call for a pragmatic balance of community and hospital services. In contrast to the development in the Western Europe, the civic society was suppressed and NGOs and similar organizations were practically non-existent or under governmental control. Mental health services are financed from the public health insurance as any other health services. There is no separate budget for mental health. We can observe that the know-how about modern mental health care and about direction of needed reforms is available in documents, policies and programmes. However, this does not mean real implementation.ConclusionsThe burden of totalitarian history still influences many areas of social and economic life, which also has to be taken into account in mental health policy. We may observe that after twenty years of health reforms and reforms of health reforms, the transition of the mental health systems still continues. In spite of many reform efforts in the past, a balance of community and hospital mental health services has not been achieved in this part of the world yet.

Socio-cultural factors surrounding mental distress during the perinatal period in Zambia: a qualitative investigation.

BackgroundThe presence of mental distress during pregnancy and after childbirth imposes detrimental developmental and health consequences for families in all nations. In Zambia, the Ministry of Health (MoH) has proposed a more comprehensive approach towards mental health care, recognizing the importance of the mental health of women during the perinatal period.AimThe study explores factors contributing to mental distress during the perinatal period of motherhood in Zambia.MethodsA qualitative study was conducted in Lusaka, Zambia with nineteen focus groups comprising 149 women and men from primary health facilities and schools respectively.FindingsThere are high levels of mental distress in four domains: worry about HIV status and testing; uncertainty about survival from childbirth; lack of social support; and vulnerability/oppression.ConclusionIdentifying mental distress and prompt referral for interventions is critical to improving the mental health of the mother and prevent the effects of mental distress on the baby.RecommendationStrategies should be put in place to ensure pregnant women are screened for possible perinatal mental health problems during their visit to antenatal clinic and referral made to qualified mental health professionals. In addition further research is recommended in order to facilitate evidence based mental health policy formulation and implementation in Zambia.

Mental health training of primary health care workers

Evidence suggests that providingsupport to primary health carewith training, assistance and supervision by available mental health professionals is the best way to extend mental health care to the population. Three cases of mental health training programmes for primary health care workers were implemented in diierent countries, and are described in this article.The objective was to share the lessons learnt in diierent settings. Relevant primary and secondary data were used to present the cases.The mental health trainings generally improved the mental health knowledge of primary health care workers. More sustainable changes in theirmental health care practices were achieved only as a result ofseveralfactors combined together: a) professionally designed and implemented mental health training; b) motivation by all key players to develop community mental health services; c) political will by the government followed by formulation of mental health policy promoting integration of mental health into primary care; d) good timingof the programme; and e) in£ux of funding and professional expertise.The ¢ndings of this article support the viewpoint of the World Health Organization that mental health training for primary health care workers is just one of the factors necessary for the successful integration of mental health care into primary health care.

Putting Values into Practice: Public Policy and the Future of Mental Health Consumer‐run Organizations

The purpose of the paper is to reflect on value dilemmas in mental health consumer-run organizations and to discuss implications for research, policy, and practice. We review the roots of consumer-run organizations in the self-help movement and the psychiatric survivor liberation movement, focusing on the distinctive values espoused by consumer-run organizations. We also discuss evidence-based and value-based approaches to mental health policy formulation and mental health reform, noting the particular importance of value-based approaches and the role that consumer-run organizations can play in mental health reform. Based on our experiences conducting a participatory action research study of four mental health consumer-run organizations, we identify and examine several value dilemmas, discuss the lessons that we learned about these value dilemmas, and note their implications for future directions in research, policy, and practice.

Depression in multicultural Australia: policies, research and services.

BackgroundDepression is one of the leading causes of disability in Australia. The cultural and linguistic diversity of the Australian population poses a significant challenge to health policy development, service provision, professional education, and research. The purpose of this study is to explore the extent to which the fact of cultural and linguistic diversity has influenced the formulation of mental health policy, the conduct of mental health research and the development of mental health services for people with depression from ethnic minority communities.MethodsThe methods used for the different components of the study included surveys and document-based content and thematic analyses.ResultsPolicy is comprehensive but its translation into programs is inadequate. Across Australia, there were few specific programs on depression in ethnic minority communities and they are confronted with a variety of implementation difficulties. The scope and scale of research on depression in Ethnic minority communities is extremely limited.ConclusionA key problem is that the research that is necessary to provide evidence for policy and service delivery is lacking. If depression in Ethnic minority communities is to be addressed effectively the gaps between policy intentions and policy implementation, and between information needs for policies and practice and the actual research that is being done, have to be narrowed.

The Mental Health Policy Template: domains and elements for mental health policy formulation

Mental disorders are a major and rising cause of disease burden in all countries. Even when resources are available, many countries do not have the policy and planning frameworks in place to identify and deliver effective interventions. The World Health Organization (WHO) and the World Bank have emphasized the need for ready access to the basic tools for mental health policy formulation, implementation and sustained development. The Analytical Studies on Mental Health Policy and Service Project, undertaken in 1999–2001 by the International Consortium for Mental Health Services and funded by the Global Forum for Health Research aims to address this need through the development of a template for mental health policy formulation. A mental health policy template has been developed based on an inventory of the key elements of a successful mental health policy. These elements have been validated against a review of international literature, a study of existing mental health policies and the results of extensive consultations with experts in the six WHO regions of the world. The Mental Health Policy Template has been revised and its applicability will be tested in a number of developing countries during 2001–2002. The Mental Health Policy Template and the work of the Consortium for Mental Health Services will be presented and the future role of the template in mental health policy development and reform in developing countries will be discussed.

Policy implications of the biological model of mental disorder.

The current dominant paradigm of mental disorder is that psychopathology is a deviation from normal physiological functioning of the brain. This paradigm is closely allied to the identity theory of mind in philosophy, which holds that mental phenomena are identical with the physical state of the brain. The assumptions of the biological model have policy implications, regardless of the utility or 'truth' of the paradigm, which should be made explicit for the assessment of ethics in mental health policy formulation. The nature of mental phenomena has been debated throughout history, without consensus. Several critiques of the biological model are offered to encourage enquiring scepticism. The policy implications discussed are political conservatism, broadened rationales for forced treatment, utility in managed care, and the use of medical necessity criteria to allocate treatment.

Policy Implications of the Biological Model of Mental Disorder

The current dominant paradigm of mental disorder is that psychopathology is a deviation from normal physiological functioning of the brain. This paradigm is closely allied to the identity theory of mind in philosophy, which holds that mental phenomena are identical with the physical state of the brain. The assumptions of the biological model have policy implications, regardless of the utility or ‘truth’ of the paradigm, which should be made explicit for the assessment of ethics in mental health policy formulation. The nature of mental phenomena has been debated throughout history, without consensus. Several critiques of the biological model are offered to encourage enquiring scepticism. The policy implications discussed are political conservatism, broadened rationales for forced treatment, utility in managed care, and the use of medical necessity criteria to allocate treatment.

Severe mental illness, statutory supervision and mental health nursing in the United Kingdom: meeting the challenge.

Within the United Kingdom a combination of limited resources and public fears about the behaviour of mentally ill people living in the community has led the government to prioritize those with severe mental illness. In support of this legislation has been passed which provides for those mentally ill deemed 'at risk' to be supervized in the community against their will. This supervisory role will be mainly undertaken by mental health nurses. Through examination of relevant British and American literature, this paper argues that mental health nursing at a national level lacks a defined role which the new legislation may provide, thereby enhancing the profession's voice in overall mental health policy formulation. Such a role, however, also poses important questions for mental health nurses' practice, their relationships with users, colleagues and the wider society. Such issues may have unforeseen negative consequences for users. It is argued that the legislation will pose important dilemmas for mental health nurses in these domains. It is argued that a proactive research agenda needs to be established which is relevant and of use to practitioners when confronted with issues in their supervision role. Areas for future research are suggested.

The Making of Mental Health Policy: The 1980s and the Challenge of Sanity in Quebec and Ontario

This paper examines the current socio-political language in the formulation of mental health policy in Ontario and Quebec. “Before long,” coherent and rational policy has been promised in each province to “solve” today's mental health crisis—often identified as that of “deinstitutionaliztion.” However, there is not just one view. Here, we examine the arguments presented in the form of briefs, reports, and working documents on the part of mental health professionals, governments and unions, patient groups, and volunteer organizations in both provinces. We analyze the areas of convergence and divergence and attempt to make sense of this mass of material so important in the formulation of a sensible and sensitive government policy of action.

Shaping Decisions with Reading-Based Information

Previous research has documented the fact that policy makers underutilize social science research literature in shaping their decisions. The two factors most often identified as accounting for this utilization gap are quality of research and organizational/political constraints. A third factor that has received relatively less attention is barriers to accessing relevant literature. To determine the importance ofaccessproblems among mental health professionals, a national sample (N = 367) of community mental health center (CMHC) executives was surveyed regarding attitudes and practices with respect to published social science research. Thefindings revealed that CMHC policy makers (1) consider published literature as important relative to other sources of information; (2) have difficulty accessing desired information via traditional means (e.g., personal and institutional librariesf, and (3) are generally unfamiliar with currently available information accessing technologies (i.e., computer-based bibliographic retrieval systems). Thesefindings suggest the need for greater emphasis on access barriers in a model predicting utilization of social science research in mental health policy formulation.