Mental Health Reform Research Articles

Adapting Group Model Building for Mental Healthcare: A Participatory Co-Design Approach.

Countries around the world are experiencing both a growing need for mental health services and major gaps in the delivery of mental healthcare. The World Health Organisation's 2022 report on mental health emphasised co-designed and systems-level innovations responsive to the voice of those with lived experience. However, evidence for implementing such methodologies is sparse. Group model building (GMB), a participatory systems-based approach, has been used in various fields, but its application is limited within mental healthcare settings. It is recognised as a valuable tool for engaging stakeholders, including those with lived experience, in understanding and redesigning health systems and services. The participatory approach aligns with the mental health sector's shift towards co-design and person-centred care. This study assessed the acceptability of GMB as a method for co-design within mental healthcare, aiming to explore its potential for meaningful collaborative improvement and systems-level insights. Participants from a regional Mental Health and Drug and Alcohol Service (MHDAS) engaged in GMB workshops and focus groups. Eighteen individuals, including lived experience workers and healthcare professionals, provided feedback that informed adjustments to the workshops' design, language, timing and facilitation techniques, enhancing GMB's relevance for mental health co-design. The findings demonstrate the value and acceptability of the adapted GMB process in acute mental healthcare, marking a significant step towards evidence-based, person-centred service improvement. This study highlights the potential effectiveness of participatory methods in identifying and addressing systemic challenges, paving the way for future mental health reforms. Future work will focus on implementing and evaluating co-designed interventions, aiming for more inclusive and effective mental healthcare and advancing innovation and reform in the field.

The Effects of a Large-Scale Mental Health Reform: Evidence from Brazil

This paper studies the Brazilian Psychiatric Reform, which reorganized the public mental health care provision by introducing mental health centers (CAPS) as a community-based substitute for inpatient care. Our research design exploits the rollout of CAPS in a difference-in-differences framework. We show that these centers increased outpatient mental health care production and reduced psychiatric hospitalizations. These reductions were more pronounced for long-stay admissions and among patients with schizophrenia. We find that the savings implied by fewer admissions do not offset the cost of the policy. Also, the reform did not reduce mental health mortality and it increased violent crimes. (JEL H51, I12, I18, O15)

EXPRESS: Advancing employees’ mental health and psychological wellbeing research in hospitality and tourism: Systematic review, critical reflections, and future prospects

This study conducts a systematic review and analysis of the research landscape concerning the mental health and psychological wellbeing (MHPW) of employees in the hospitality and tourism sector. Comprehensive bibliometric analysis, intellectual network mapping, and critical qualitative content analysis were performed utilizing a dataset of 184 relevant articles. From these analyses, eight critical reflections were derived, and future research agenda were outlined. These agenda include exploring positive enhancers of MHPW, advocating for holistic conceptualizations of MHPW, encouraging cross-cultural and interdisciplinary collaborations, assessing the impacts of technology on mental health, developing industry-specific assessments, diversifying research methodologies with multidisciplinary theories, conducting multi-level analyses of influencing factors, and investigating the pandemic's long-term impact on career perceptions and mental health reforms within the industry. Findings offer pivotal directions for future research and aim to advance the understanding and enhancement of MHPW in the global hospitality and tourism workforce through impactful scholarship.

Spatial patterns of Mental Health Act apprehensions in Toronto, Canada, 2014-2022.

This research examines the temporal rates and spatial patterns of police-involved Mental Health Act (MHA) apprehensions in Toronto, Canada, from 2014 to 2022. Building from the work of Toronto Police Services (TPS), the goal of this research is to deepen our understanding of MHA apprehensions and provide insights which may be used to guide local mental health reform efforts. Using data collected by TPS, an exploratory, descriptive analysis of spatial patterns of MHA apprehension events between 2014 and 2022 at the neighbourhood level was conducted. To identify high-rate clusters, we used a discrete Poisson model in SaTScan, with a circular moving window. Primary and secondary clusters with a relative risk of 1.5 or greater are reported. From 2014 to 2022, 93,932 MHA apprehensions occurred in Toronto. Apprehension rates were found to vary substantially between neighbourhoods, with approximately 91% of Toronto's 140 neighbourhoods experiencing a net positive increase in rates during the study period after adjusting for population growth. Repeated spatial cluster analysis for each year revealed a range of 4 to 7 clusters annually, with the downtown core consistently emerging as an area of elevated risk (RR range 1.58-1.99). Rising MHA apprehensions within Toronto highlight the pressing need to confront the city's intensifying mental health needs. These findings offer valuable insights into the patterns and nature of police-involved MHA apprehensions, outline reproducible analysis methods that can be used by others, and support targeted evaluation, expansion, and implementation of downstream initiatives to improve mental health responses.

Psychiatric Experiments with "Community" Under Dictatorship and Authoritarianism: The Case of the Protected Commune Experience, 1980-1989.

In Chile, a long and oppressive military regime (1973-1990) dismantled emergent initiatives for the deinstitutionalisation of psychiatric care, imposing a neoliberal constitution that opened public services to market forces and limited the state's role in health and social care. After being associated with communism and socialism, community-based mental health work was banned, and socialist psychiatrists were silenced through torture or exile. However, some therapeutic initiatives persisted, such as the "Protected Commune" (PC) initiative within the El Peral psychiatric asylum. The PC attempted to mimic a real town inside the asylum's gated perimeter. It featured an ecumenical chapel, a school, and various "council" departments like recreation, education, waste, economy, and health. Paths received names, wards became districts, and patients and workers were assigned new, democratic roles, all while the authoritarian regime entirely controlled the "outside" world. The initiative ceased with the return of democracy in 1990. Deemed an eccentric and negligible episode, the PC is often seen as an interruption to the radical community-based experiences of the pre-dictatorial era. Drawing on archival research and oral history interviews with participants, this paper examines how the PC harnessed the notion of community to navigate the complex socio-political landscape of the dictatorship. Differing from established accounts of the political uses of psychiatry under authoritarianism, the study positions the PC as a prism for understanding the contradictory ways in which the idea of 'community' has been able to transcend radically opposed social and political regimes, becoming a core feature in the vocabulary of mental health reform, despite its ambiguities.

Mental Health Social Work Practice: Navigating Tensions

Abstract The United Nations Special Rapporteur has called for ‘a revolution in mental health care to end decades of neglect, abuse and violence…enabl[ing] a long overdue shift to a rights-based approach’ (United Nations Human Rights Office of the High Commissioner, 2017). Principles underpinning social work practice with people living with mental distress who receive diagnoses such as schizophrenia, personality disorders and bipolar disorder, align with sought after changes. Using Cooperative Inquiry and referring to the Model of Holistic Competence in Social Work, this study investigated mental health social work seeking to foster this shift. Findings confirmed inherent discordance between social work values and mental health care dominated by biomedical and neoliberal views. Upholding social work values in this context involves complex practice, integrating procedural and meta-competencies. By incorporating skills in relational practice and advocacy; knowledge of multiple explanatory frameworks for mental health and mental health systems literacy; self-regulation; fostering tenacity whilst addressing ‘othering’; and judgement informing choices around conformity and confrontation, social work navigates tensions associated with this discordance. This paper highlights the nature of values-based social work practice as aligned with mental health reforms.

Arizona legislator Amish Shah, M.D., M.P.H., receives APA's Javits Award for Public Service

Amish Shah, M.D., M.P.H., an emergency medicine physician and former member of the Arizona House of Representatives, was awarded the 2024 APA Jacob K. Javits Public Service Award for his dedication to improving access to quality care, and his advocacy for mental health reform. The Javits Award is the American Psychiatric Association's (APA) highest honor for contributions to the field of mental health by a federal or state public official. “Not only in hospitals, but also in the Arizona House of Representatives, Dr. Shah has left his mark as a distinctly skilled and dedicated voice for mental health,” said APA President Petros Levounis, M.D., M.A., in a statement. “His tireless efforts include working across the aisle to pass legislation like ‘Jake's Law,’ promoting important mental health interventions such as the Collaborative Care Model and advocating for youth to more easily access mental health care services.” APA established the award in 1986 in honor of Sen. Jacob K. Javits, who represented New York state in the U.S. Senate from 1957 to 1981.

Multidisciplinary users oriented approach in the community mental health care

Introduction For more than 25 years, Bosnia and Herzegovina (BH) has maintained and improved reform processes in the field of mental health (MH) care. In the last 13 years, the results of the reform are visible, and they focused on the quality of services oriented to people with mental disorders (PMD), as well as raising the quality of specific services to the general population. The developed network of community mental health centers (CMHC) as the leading concept of the reform (community psychiatry) enabled affordable, timely and adequate protection of mental health in whole country, while relying on other resources, primarily clinical and hospital capacities and centers for social work.ObjectivesReform orientation had several directions: broad promotion and prevention, protection of the rights of the people with mental health disorders, quality education and more specific qualifications and competencies of mental health professionals and public promotion as a part of destigmatization.MethodsOverview of the mental health reform in last two decades.Results In last more than 25 years reforming processes were focused mainly to users of mental health services. Specific legislative was created and recently upgraded trough Mental Health Protection Law, as unique document focused to users, mental health professionals and services, and general population as well. Users organization were formed and have important role in creation of further directions in the reform. Main principles in daily care for users are community based with case management and intersectoral collaboration trough joint discharge planning. Also, special focus is given to media reporting about mental health as well as to children and adolescents, prenatal psychiatry and elderly.Conclusions Republic of Srpska and Bosnia and Herzegovina made significant steps and visible changes in the quaity of mental health services focused to users needs. Further activities will be oriented to continuous destigmatization of the people with mental health disorders, psychiatry and mental health professionals and further implementation of results achieved in reforming processes in our county.Disclosure of InterestNone Declared

Recovery-oriented practice in a hospital mental health service.

As part of mental health reform in Australia, new policies were introduced to support recovery-oriented practice; however, little has changed in hospital settings focused on managing risk and remediating acute symptoms. Previous studies have indicated that patients' experiences of personal recovery, during a hospital admission, may not mirror that of people living in the community, with patients being more likely to experience disconnection, hopelessness and disempowerment. Using a Participatory Health Research approach, eight mental health professionals, a patient advocate and an external researcher formed a research partnership to answer the question: How can staff enhance recovery-oriented practice in a hospital-based mental health service? The COREQ checklist was used for reporting the methods, analysis and findings. The methods comprised patient focus groups (n = 16 participants), interviews with managers (n = 7) and an online survey for staff (n = 17). Researchers analysed the feedback from the consultations using inductive thematic analysis, identifying two themes: relational recovery and recovery interventions. The findings indicate that relational recovery is key to recovery during a hospital admission and interventions that increase connectedness or reduce the impact of symptoms enhance personal recovery.

Choosing a nursing specialty: connection to nursing students’ personality traits, clinical self-efficacy, adoption of technology changes, and specialty prestige; a cross-sectional study

BackgroundChoosing a field of specialization within the nursing profession is affected by nurses’ personality traits, self-confidence in performing clinical skills, and the field’s prestige. A successful choice of area of expertise may improve nurses’ job satisfaction and reduce job mobility. This study aims to examine the relationship between personality traits, clinical self-efficacy, perceived prestige, adoption of technological changes, and choice of specialty field among nursing students.MethodsA cross-sectional study was conducted. One-hundred-twenty-seven undergraduate nursing students in their fourth year of studies at a large university in Israel participated in the study. The questionnaire administered was comprised of six parts: demographic data, personality traits, adoption of technological changes, clinical self-efficacy, perceived prestige, and intention to select a field of specialization.ResultsAcute disciplines were rated more prestigious than chronic disciplines, with intensive care and emergency medicine considered the most prestigious, while mental health and geriatrics were the least prestigious. Students’ mean perceived confidence in performing nursing clinical skills was high and more than half considered themselves open to technology changes. Positive correlations were found between prestige and intention to choose a field of expertise (r = 0.41, p < 0.001) and the personality trait of openness and the intention to choose an acute care area (r = 0.26, p < 0.01).ConclusionsDespite the gradual aging of the population and the increase in chronic morbidity, which demand a greater nursing focus on older adults, and notwithstanding the mental health reforms, nursing students perceive geriatrics and mental health as less prestigious fields. A career development path can be applied by developing a tool for occupational guidance designed to rank students’ suitability for specialty fields and thus help them choose the area that best suits them.

Mental health reform: where are we in 2024?

What is known about the topic? Little is known about the state of mental health reform in Australia. This article describes the struggle to develop the systems of accountability necessary to assess national progress. What does this paper add? We provide some historical context regarding mental health reform and consider recent efforts in particular, before then describing current key opportunities. What are the implications for practitioners? Many people working in mental health are struggling to deliver quality services to Australians. This paper considers the broad policy issues which have led to this situation. This is useful for practitioners who can then better respond and participate in processes of systemic reform. Opportunities to engage now in key policy formulation are identified in the article.

Cuidado em saúde ao adolescente em vulnerabilidade ao uso de drogas

ABSTRACT This article deals with adolescences, in the plural, as a socio-historical construction of a dynamic process and with the experience of adolescents with their lifestyle and self-expression in a unique socio-historical context. It assumes that purely prescriptive measures are insufficient to address the complexity of mental illness processes in contemporary society. This study aims to understand the context of health care practices for vulnerable youth, particularly those involved in substance use, through the lens of tensions in health practice domains. This is an exploratory, descriptive study using a qualitative approach, with interviews conducted with health professionals (in Basic Health Unit and Psychosocial Care Center for Children and Adolescents). The study highlights the tensions within health practice between the biomedical model and the war on drugs and a community-based psychosocial approach; it underlines the need for reducing stigmatization, improving access, harm reduction, and individualized care. It also emphasizes the importance of considering and promoting a shift in mentality towards mental illness in order to develop care strategies. This process was carried out in line with the principles of the Brazilian Mental Health Reform, with advances and setbacks that affect the updating of health practices, which are more oriented towards proposals for psychosocial and vulnerability-reducing actions.

In their own words: Mental health nurses' experiences of trauma-informed care in acute mental health settings or hospitals.

Trauma-informed care has emerged as a prominent strategy to eliminate coercive practices and improve experiences of care in mental health settings, with advocacy from international bodies for mental health reform. Despite this, there remains a significant gap in research understanding the integration of trauma-informed care in mental health nursing practice, particularly when applied to the acute mental health or hospital-based setting. The study aimed to explore the experiences of mental health nurses employed in acute hospital-based settings from a trauma-informed care perspective. The study design was qualitative, using a phenomenological approach to research. A total of 29 nurses employed in acute mental health or hospital-based environments participated. Three over-arching themes were uncovered: 'Embodied Awareness': highlighting mental health nursing emotional capabilities are deeply rooted in bodily awareness. 'Navigating Safety': signifying spatial elements of fear and how some mental health nurses' resort to coercive or restrictive practices for self-preservation. 'Caring Amidst Uncertainty': revealing the relational influences of security guards in mental health nursing. The study reveals a significant gap in trauma-informed care implementation when applied to the context of mental health nursing practice in this setting. Limited evidence on trauma-informed care for mental health nurses, coupled with inadequate workforce preparation and challenging work environments, hinder the effective integration of it. To genuinely embed TIC in acute mental health settings, the study emphasises the need for a thorough exploration of what this entails for mental health nurses.

"It has to be better, otherwise we will get stuck." A Review of Novel Directions for Mental Health Reform and Introducing Pilot Work in the Netherlands.

The current state of mental health care in the Netherlands faces challenges such as fragmentation, inequality, inaccessibility, and a narrow specialist focus on individual diagnosis and symptom reduction. A review suggests that in order to address these challenges, an integrated public health approach to mental health care that encompasses the broader social, cultural, and existential context of mental distress is required. A Mental Health Ecosystem social trial seeks to pilot such an approach in the Netherlands, focusing on empowering patients and promoting collaboration among various healthcare providers, social care organizations, and peer-support community organizations, working together in a regional ecosystem of care and committed to a set of shared values. In the ecosystem, mental health problems are examined through the prism of mental variation in context whilst scaling up the capacity of group-based treatment and introducing a flexible and modular approach of (2nd order) treatment by specialists across the ecosystem. The approach is to empower naturally available resources in the community beyond professionally run care facilities. Digital platforms such as psychosenet.nl and proud2bme.nl, which complement traditional mental health care services and enhance public mental health, will be expanded. The capacity of recovery colleges will be increased, forming a national network covering the entire country. GEM will be evaluated using a population-based approach, encompassing a broad range of small-area indicators related to mental health care consumption, social predictors, and clinical outcomes. The success of GEM relies heavily on bottom-up development backed by stakeholder involvement, including insurers and policy-making institutions, and cocreation. By embracing a social trial and leveraging digital platforms, the Dutch mental health care system can overcome challenges and provide more equitable, accessible, and high-quality care to individuals.

Riding the tides: Directions in mental health rehabilitation in NSW.

This paper outlines the evolution of mental health rehabilitation in NSW, where allocation of health resources has repeatedly contradicted the policy intention to reorient services from inpatient to community-based services, leaving community rehabilitation the poor and disconnected cousin of inpatient services. The expanding role of community-managed organisations (CMOs) in psychosocial rehabilitation, the introduction of the National Disability Insurance Scheme (NDIS), and emerging service models have helped foster a maturing housing and social care environment, but present reality and the integration of health and social care services remains at a distance from best evidence practice. The challenge of the next decade of mental health reform is to embrace and consolidate greater service diversity and complexity. Understanding what factors influenced present reality is important in providing guardrails for the future, enabling the current wave of renewal and reinvestment in NSW to build on the strengths of past developments and steer a course around their weaknesses.

The United Nations Convention on the Rights of Persons with Disabilities and Social Work: Evidence for Impact?

The United Nations Convention on the Rights of Persons with Disabilities (hereafter CRPD) has provided a radical imperative for the reform of mental health and capacity legislation around the world. The interpretation of the CRPD has been controversial, ranging from the complete abolition of detention, forcible treatment, and substitute decision-making to accepting that elements of these measures need to be retained based on non-discriminatory criteria, additional safeguards, and a comprehensive shift towards supported decision-making. While the potential effects of the CRPD on mental health social work and social work generally are considerable given their shared commitment towards social justice, to date there has been no review of research evidence exploring their relationship. In addressing this knowledge gap, this study held a preliminary discussion with practitioners and academics at the European Association of Social Work Mental Health Special Interest Group in Amsterdam 2022, followed by a scoping literature review on the question: What impact, if any, has the CRPD had on social work practice? The review produced four main findings: impact on legislation; positive impact on practice; limited impact on practice; and impact on social work education and research. In sum, while there were some positive indications of social work and mental health social work practice being influenced by the CRPD, these were scant. Barriers to change included tendencies among some social workers to practise substitute decision-making, in part related to resourcing and policy contexts, and understandings of disability aligned to individualised/medical rather than social perspectives. The results indicate that legal reform on its own is insufficient to impact social work practice, and that realising the potential of the CRPD will necessitate good quality training, as well as improving social workers' knowledge of the human rights of people with mental impairment.

Impact of the mental health reform in Israel on health care and mortality among people with severe mental illness.

Reports show disparities in the health care of people with severe mental illness (SMI). Yet, the moderating effect of mental health reforms on the health care disparities remain unexplored. The current study aimed to investigate the outcomes of the mental health reform in Israel on the use of health services among people with SMI. A case-control epidemiological study comparing the use of health services 3.5 years before and after the mental health reform for service users diagnosed with schizophrenia, schizoaffective disorder, and bipolar disorder. Data on health services included: blood cholesterol test (LDL), hemogalobin-A1C test, and visits to general practitioners (GPs) and specialists. Mortality was recorded. Following the reform the number of visits to GPs was decreased among service users of the three SMI groups, as well as visits to specialists among service users with a schizoaffective or bipolar disorder. Following the reform service users of the three SMI groups showed no-change in the performance of LDL test. Complex findings were noted with regard to the performance of Hemoglobin-A1C test. Mortality rates were higher among service users with SMI and the relative risk were similar before and after the reform. Users of the three SMI groups showed no benefits of the mental health reform in terms of use of health services. Improved health care can be attained by a closer collaboration between the primary physicians and community mental health services.

Advancements in mental health reform in Argentina: towards comprehensive and human rights-respecting care

Advancements in mental health reform in Argentina: towards comprehensive and human rights-respecting care

Norcia and the central italian earthquake: Challenges and lessons learned from the italian psychiatric reform movement

Salvatore and colleagues wrote a brilliant Target Article (2022) in this journal on the state of Italian psychology and recommendations for change.&amp;nbsp; In this contribution, we look at the failure of Italian psychology to address the suffering of the affected population of the Central Italian earthquake in Norcia in 2016.&amp;nbsp; The Italian National Trauma Center centered in Orvieto, Umbria has been on the ground assisting local health care practitioners in caring for the mental health impact of the earthquake and the COVID pandemic lockdown.&amp;nbsp; Absent Italian psychologists walk hand in hand with a political system that has had limited response to the mental health needs of earthquake survivors.&amp;nbsp; Lessons learned from the historic revolution in Italian Psychiatry led by Professor Franco Basaglia are presented to help understand the current reality in Norcia.&amp;nbsp; Many of the barriers to mental health reform that existed for Basaglia and his colleagues still exist today.&amp;nbsp; This contribution strongly supports Salvatore and colleagues' recommendations for the transformation of Italian psychology.

Moulding student mental health in Singapore’s Character and Citizenship Education: projected pedagogic identities

ABSTRACTThis paper examines the official pedagogic discourse communicating the explicit inclusion of Mental Health (MH) education in Singapore’s revised 2021 Character and Citizenship (CCE2021) curriculum within Singapore’s state-driven educational context of decentralised centralism. By adapting Basil Bernstein’s theoretical work on pedagogic discourse – using William Tyler’s typology of Bernstein’s ‘Pedagogic Codes’ and ‘Official Pedagogic Identities’ – our findings reveal how MH in CCE2021 projects different, simultaneous student identities. These include retrospective identities of students as resilient, community-minded citizens; prospective identities of students as vulnerable cyber users requiring explicit guidance for their future-readiness; de-centred therapeutic identities of students as reflective, self-actualising students requiring psychological safety; and de-centred market identities of students as trained advocates and community first responders. Together, they generate a tension where therapeutic identities are positioned as prerequisite to the other identities, subsuming individual well-being within community well-being, and conflating the intrinsic good of personal resilience with instrumental notions of future-readiness. This expresses a paradox where state-student social relations are both transformed and continued, as concerns of student confidentiality and efficacy of help-seeking efforts persist. Overall, we contend the educational reform of MH in CCE2021 accommodates rather than reconciles progressive concerns of youth mental health with neoliberal state imperatives.