Mental Health Reform Research Articles

Reorientation of the Rural Adversity Mental Health Program: the value of a program logic model.

The Rural Adversity Mental Health Program (RAMHP) was founded in 2007 with the specific focus of responding to drought-related mental health needs among farmers in rural and remote New South Wales (NSW), Australia. Successive re-funding enabled the program to evolve strategically and increase its reach. Over a decade, the program's focus has expanded to include all people in rural and remote NSW in need of mental health assistance, and not just in times of adversity such as drought. The program's longest re-funding period, 2016-2020, provided the opportunity for a comprehensive review and longer term planning. Several priorities influencing program renewal were evident at this time: the need to improve data collection and evaluation methods, a reassessment of the program's primary focus and the need to align with significant government mental health reforms. A program logic model (PLM) was developed, in collaboration with frontline RAMHP coordinators, to steer reorientation, clarify objectives, activities and outcomes, and improve data collection. A PLM is a graphic depiction of a program, showing the rationale of how inputs and activities lead to outcomes. Four key lessons were identified. (1) The development of the PLM in collaboration with the RAMHP coordinators (frontline staff) was found to be an important vehicle for ensuring their acceptance and adoption of strategic changes. (2) The collaborative development process also provided the opportunity to decide upon consistent terminology to describe the program, facilitating communication of the value of RAMHP to external stakeholders. (3) The PLM enabled a clear but flexible program structure that aligned with changes in the mental health system to be described. (4) The PLM provided the foundation for the development of an evaluation framework, including a mobile app, to aid data collection to underpin accountability. Investing in the development of a PLM early in program reorientation provided many benefits for RAMHP, including improved role clarity and communication, staff commitment to program changes and a foundation for comprehensive program evaluation that integrates with program planning. The PLM proved a key foundational tool to reorient RAMHP by producing a clear program structure that was agreed upon by all staff.

Perceptions of Community Involvement in the Peruvian Mental Health Reform Process Among Clinicians and Policy-Makers: A Qualitative Study.

Background: The global burden of mental health conditions has led to the implementation of new models of care for persons with mental illness. Recent mental health reforms in Peru include the implementation of a community mental health model (CMHM) that, among its core objectives, aims to provide care in the community through specialized facilities, the community mental health centers (CMHCs). Community involvement is a key component of this model. This study aims to describe perceptions of community engagement activities in the current model of care in three CMHCs and identify barriers and potential solutions to implementation.Methods: A qualitative research study using in-depth semi-structured interviews with clinicians from three CMHCs and with policy-makers involved in the implementation of the mental health reforms was conducted in two regions of Peru. The interviews, conducted in Spanish, were digitally recorded with consent, transcribed and analyzed using principles of grounded theory applying a framework approach. Community engagement activities are described at different stages of patient care.Results: Twenty-five full-time employees (17 women, 8 men) were interviewed, of which 21 were clinicians (diverse health professions) from CMHCs, and 4 were policy-makers. Interviews elucidated community engagement activities currently being utilized including: (1) employing community mental health workers (CMHWs); (2) home visits; (3) psychosocial clubs; (4) mental health workshops and campaigns; and (5) peer support groups. Inadequate infrastructure and financial resources, lack of knowledge about the CMHM, poorly defined catchment areas, stigma, and inadequate productivity approach were identified as barriers to program implementation. Solutions suggested by participants included increasing knowledge and awareness about mental health and the new model, implementation of peer-training, and improving productivity evaluation and research initiatives.Conclusion: Community engagement activities are being conducted in Peru as part of a new model of care. However, their structure, frequency, and content are perceived by clinicians and policy-makers as highly variable due to a lack of consistent training and resources across CMHCs. Barriers to implementation should be quickly addressed and potential solutions executed, so that scale-up best optimizes the utilization of resources in the implementation process.

Mental health financing challenges, opportunities and strategies in low- and middle-income countries: findings from the Emerald project.

Current coverage of mental healthcare in low- and middle-income countries is very limited, not only in terms of access to services but also in terms of financial protection of individuals in need of care and treatment. To identify the challenges, opportunities and strategies for more equitable and sustainable mental health financing in six sub-Saharan African and South Asian countries, namely Ethiopia, India, Nepal, Nigeria, South Africa and Uganda. In the context of a mental health systems research project (Emerald), a multi-methods approach was implemented consisting of three steps: a quantitative and narrative assessment of each country's disease burden profile, health system and macro-fiscal situation; in-depth interviews with expert stakeholders; and a policy analysis of sustainable financing options. Key challenges identified for sustainable mental health financing include the low level of funding accorded to mental health services, widespread inequalities in access and poverty, although opportunities exist in the form of new political interest in mental health and ongoing reforms to national insurance schemes. Inclusion of mental health within planned or nascent national health insurance schemes was identified as a key strategy for moving towards more equitable and sustainable mental health financing in all six countries. Including mental health in ongoing national health insurance reforms represent the most important strategic opportunity in the six participating countries to secure enhanced service provision and financial protection for individuals and households affected by mental disorders and psychosocial disabilities. D.C. is a staff member of the World Health Organization.

Optimizing the Resources of Psychotherapy as a Tool for Implementing the Mental Health Reform

Optimizing the Resources of Psychotherapy as a Tool for Implementing the Mental Health Reform

Implementation, initial results, and sustainability of the mental health services reform in Peru, 2013-2018

This paper analyzes the implementation, initial results, and sustainability of innovations in the provision, financing, and management of mental health services in Peru, carried out during 2013-2018. By applying new financing mechanisms and public management strategies, 104 Community Mental Health Centers and eight Protected Homes were implemented, which prove to be more efficient than psychiatric hospitals. The set of 29 centers created between 2015 and 2017 produced in 2018 an equivalent number in consultations (244,000 vs. 246,000) and patients attended (46,000 vs. 48,000) than the set of three psychiatric hospitals, but with 11% of financing and 43% of psychiatrists. The way mental health care is being provided is changing in Peru by involving citizens and communities in ongoing care and creating better conditions for the exercise of mental health rights. Community mental health reform has gained broad support from political, international, and academic sectors, and from the media. We conclude that the reform of community-based mental health services in Peru is viable and sustainable. It is in a position to scale up the entire health sector throughout the country, subject to the commitment of the authorities, the progressive increase in public financing, and national and international collaborative strategies.

Compreendo o processo de medicalização contemporânea no contexto da saúde mental

Purpose: Medicalization is understood as a process that occurs as a transformation of socialissues to individual and organic problems that require medical intervention. This research proposed to analyze the scientific literature on medicalization related to the context of mental health. Method: Articles search was carried out on Scielo and Pepsic databases, raging dates from 2000 to 2015, using the following descriptors: medicalization, mental health and psychiatric reform. The analysis of the data was envisaged by the analytical-institutional reference, assisting in the composition of two analytical lines. Results: In the first one, we sought to identify the understandings about medicalization, while discussing the differences between medicalization and medicamentalization. In the second line we seek to map the forces that permeate the process ofmedicalization, highlighting biomedical knowledge, biological psychiatry and pharmaceutical industry, social participation and attention models. Conclusion: We conclude that the concept of medicalization, in its different nuances, allows denaturalization movements of mental health practices, allowing to interrogate the relationships of established knowledge and power.

Disparities in Access to Health Care Among US-Born and Foreign-Born US Adults by Mental Health Status, 2013–2016

Objectives. To compare access to care between US-born and foreign-born US adults by mental health status. Methods. We analyzed data on nonelderly adults (n = 100 428) from the 2013-2016 National Health Interview Survey. We used prevalence estimates and multivariable logistic regression models to compare issues of affordability and accessibility between US-born and foreign-born individuals. Results. Approximately 22.2% of US-born adults and 18.1% of foreign-born adults had symptoms of moderate to severe psychological distress. Compared with US-born adults with no psychological distress, and after adjustment for sociodemographic characteristics, US-born and foreign-born adults with psychological distress were much more likely to report multiple emergency room visits and unmet medical care, mental health care, and prescription medications because of cost. Conclusions. Our study found that adults with moderate to severe psychological distress, regardless of their immigration status, were at greater risk for reporting issues of affordability when accessing health care compared with US-born adults with no psychological distress. Public Health Implications. Health care and mental health reforms should focus on reducing health care costs and establishing innovative efforts to broaden access to care to diverse populations.

ThriveNYC Is Ambitious—Lessons From the International Experience With Mental Health Reform Can Make It Successful

ThriveNYC Is Ambitious—Lessons From the International Experience With Mental Health Reform Can Make It Successful

Psychiatric Hospitalizations of Chronic Psychotic Disorder Patients With and Without Dual Diagnosis, Israel, 1963–2016

Objective: A significant proportion of patients with severe mental illness also experience substance use disorder. For these dual diagnosis (DD) patients, treatment is more complicated and prognosis is worse. Despite the introduction of the Community Rehabilitation of Persons With Mental Health Disability Law in 2000 and ongoing national mental health reforms, psychiatric services in Israel are not meeting the needs of an increasing number of DD patients. This study examines, for the first time in Israel, the prevalence of DD and patterns of psychiatric hospitalizations of chronic psychotic disorder patients with and without substance use disorder. Methods: The National Psychiatric Case Registry provided data on 18,684 persons with schizophrenia/schizoaffective disorders, aged 18–65, with a psychiatric hospitalization during the period 1963–2016 (with at least one hospitalization in 2010–15). Patients were considered as having DD if their substance use disorder was indicated in at least two, or 20%, of hospitalizations. Regression modeling predicted hospitalization measures (number of hospitalizations, total days hospitalized, length of stay). Results were also analyzed by legal status of admission (voluntary or involuntary; psychiatrist-ordered and court-ordered). Results: One-third of patients with chronic psychotic disorder met DD criteria, with a threefold higher rate among males (37.1%) than females (12.8%). Particularly high rates of DD (nearly 50%) were noted among male immigrants from Ethiopia. Compared with non–substance use disorder patients, DD patients had a significantly younger mean age at first hospitalization and shorter average length of stay per hospitalization but a greater number of hospitalizations and total hospital days (p < .0001 for all comparisons). The associations between DD status and hospitalization characteristics remained significant even after accounting for the effects of confounding factors. Hospitalization characteristics were also associated significantly with sex, population group, age, age at first hospitalization, and country of origin. The rate of court-ordered observation or hospitalization was threefold higher in the DD group. Conclusions: These findings, which broadly align with other countries, reflect a scarcity of outpatient services for DD patients with schizophrenia/schizoaffective disorder and substance use disorder. To achieve long-term mental health improvements, an expansion of community-based integrative treatment and rehabilitation services is needed in Israel.

Modern going near creation of in-hospital comfort for patients and medical personnel in psychiatric establishments of health protection

Today requires an important focus on providing psychological comfort both for health care professionals in preventing emotional burnout syndrome and inpatient comfort for patients in these settings. The purpose of the work is to carry out a comparative analysis of European experience on the principles of functional and aesthetic organization of interiors and decoration materials of premises of psychiatric health care institutions, to determine the characteristics of the influence of natural and artificial lighting on the psychophysiological state of the body of patients and medical professionals. The material of the study was Form № 18 of the Ministry of Health of Ukraine "Report on work on control of environmental factors affecting the state of health of the population" of the State Institution "Vinnytsia Regional Laboratory Center of the Ministry of Health of Ukraine" for the period 2016-2019. Content analysis of domestic and foreign scientific sources, as well as bibliosemantic, theoretical and analytical methods of research were used in the work. The statistical processing of the study results was performed in a licensed standardized package "Statistica 6.1 for Windows". As a result of studying the experience of European countries on the creation of in- hospital comfort for patients and medical staff of psychiatric health care institutions, the following has been established: taking into account the sanitary and hygienic requirements in the design and arrangement of facilities for mentally ill persons should correspond to the therapeutic environment and promote the establishment of security regimen, improving treatment and prevention work, preventing hospital-acquired infections and therefore being one and the same priorities reform of mental health in Ukraine. According to the results of studying foreign experience on the basis of a systematic and ergo design approach to the re-profiling and reconstruction of existing psychoneurological hospitals in Ukraine, it is determined that its main purpose is to provide comfortable conditions for patients stay and create conditions for conducting psychosocial therapy and rehabilitation of persons with mental disorders. Therefore, the adaptation of hygiene requirements during the design and arrangement of the premises of psychiatric health care facilities should be aimed at ensuring the optimal individual and psychological status of patients and the appropriate parameters of the hospital environment and its sanitary and hygienic characteristics, which must correspond to the latest technology in providing high quality medical care using a biopsychosocial approach that will facilitate the transition to European standards.

Building the momentum and blueprint for reform in youth mental health

Building the momentum and blueprint for reform in youth mental health

Challenges for psychosocial rehabilitation services in the Lisbon Metropolitan Area: A qualitative approach.

In Portugal, a mental health reform process is in place aiming to redefine the model of service provision. In 2008, a National Mental Health Plan (NMHP) was approved to provide policy guidance over the transition period. The NMHP intended, among others, to develop community-based services, with a specific focus on rehabilitation and deinstitutionalization. This study aims to explore the perspectives of service managers of psychosocial rehabilitation services regarding the main challenges to support the community living of persons with severe mental illnesses (PWSMI) in the Lisbon Metropolitan Area (LMA). The paper also contextualises the provision of psychosocial services within the country's mental health reform process and characterises the profile of service users in socio-occupational units (SOUs) of the LMA. Semi-structured interviews were performed with all SOUs' managers of the LMA (n=13). Information regarding service user characteristics was collected based on service records (n=344). Interviews were analysed according to the framework methodology. The results of the interviews were triangulated using document analysis. Fieldwork took place between June and July 2016. The findings suggest that the development of the mental health reform ensured significant changes to service delivery. Community-based mental health organisations are an important actor for service provision. However, important asymmetries were identified in the provision of psychosocial care within the LMA. At the same time, family carers are perceived as responsible for ensuring a large part of the social needs of the PWSMI but there is an increasing concern with their own ageing processes. As a conclusion, it is highlighted the current inequality between services and the need to contemplate a life-course perspective that comprehends the ageing process of caregivers poses an emerging challenge for psychosocial rehabilitation. These findings are also important for other low- and middle-income countries passing through similar reforms.

Mental health care system and reform efforts in Ukraine

The abstract purpose is identifying the key goals of the Ukrainian MH transformation efforts according to the national legislation and the WHO trends

Child and adolescent mental health policy: history and paths to participation.

People with mental disorders play an important role in the mental health reform process, which involves the creation of new public policies, practices, knowledge, and ways of relating to this experience. Using a guiding question addressing the history of child and adolescent mental health in Brazil and the participation of child and adolescent mental health service users in the policy construction process, a narrative literature review was undertaken framing the main policy developments and advances in this area within the overall context of the Brazilian mental health reform. A search of technical, institutional, and legal documents in the thematic area Mental Health was conducted using a national database. The material analyzed addressed milestones in child and adolescent mental healthcare, highlighting the paths taken in building this field. The article also discusses the participation of child and adolescent mental health service usersin this process in the form of a commentary. Finally, the article highlights the need to guarantee the participation of this group to enable them to play a leading role in the struggle for the construction and realization of rights.

Right Care, Right Place, Right Time: The Atlantic Canada Art Therapy Roadshow (Bon soin, bon endroit, bon moment : tournée d’art-thérapie au Canada atlantique)

Despite a growing number of art therapists in some areas of Atlantic Canada, a significant percentage of the general population is currently not aware of art therapy as a clinical mental health intervention. With the exception of a few larger hospitals, it is often not a practice incorporated into mental health organizations, educational institutions, or community agencies. Misinformation about the term art therapy has limited people in their understanding of its inherent benefits. Atlantic Canada’s geography, climate, and cultural and language differences have created additional barriers for residents in accessing these services. Inspired by the art hive movement, the history of the Grenfell traveling missions, and the present state of mental health reform in Newfoundland, three art therapists set out to connect with community professionals in an “on the road” approach to art therapy outreach in smaller towns, remote locations and with other marginalized groups. These collaborations resulted in open art studios for each visited community. These studios have the potential to become ongoing and permanent mental health resources for the region.

Time for structural reform in mental health: who is up for the challenge?

Time for structural reform in mental health: who is up for the challenge?

Community attitudes towards the mentally ill in Serbia

Introduction. Integration of the mentally ill into the community is one of the essential objectives of social rehabilitation. Deinstitutionalization is one of the central points of contemporary mental health reforms across the world. The acceptance of people with mental health problems in the general population is an important factor in determining the success of implementing deinstitutionalization strategies. Furthermore, medical students during their education attain knowledge about mental health problems as standard part of their curriculum. Quantifying the outlook towards people with mental health problems in future doctors is an important determinant of prospective community-based care. Aim. Assessment of community attitudes towards the mentally ill in a representative sample of General Population, as well as in future medical doctors in Serbia. Method. This cross-sectional study involved 1068 Serbian speaking adult subjects: 562 medical students and 506 subjects from the general population. Assessment of attitudes was measured by Community Attitudes Towards the Mentally Ill. Four dimensions of attitudes were extracted: Authoritarianism, Benevolence, Social Restrictiveness and Community Mental Health Ideology. Results. Medical Students showed more favorable attitudes across all dimensions when compared to the representative sample of General Population. In the General Population, less years of education were associated with higher levels of Authoritarian attitudes towards the mentally ill. Female gender was consistently associated with greater Benevolence, irrespective of group affiliation. Conclusion. Existing positive attitudes towards the mentally ill in the Serbian community suggest that once legislative proceedings for better integration of the mentally ill in the broader society are initiated, we can expect fast and admirable effects in the community management. Focused educational and anti-stigma interventions targeting the general population should be devised.

Variables associated with job satisfaction among mental health professionals.

Recent mental health (MH) reforms have had a sharp impact on practices among MH professionals. A deeper understanding of factors contributing to their job satisfaction, in this context, may help improve quality and continuity of care. The purpose of this study was to identify variables associated with job satisfaction for 315 MH professionals in Quebec (Canada) after implementation of wide-ranging MH reforms. Job satisfaction was measured with the Job Satisfaction Survey. Independent variables were conceptualized within five domains: 1) Professional Characteristics, 2) Team Attributes, 3) Team Processes, 4) Team Emergent States, and 5) Organizational Culture. Univariate, bivariate and multivariate analyses were performed. Job satisfaction was significantly associated with absence of team conflict, stronger team support, better team collaboration, greater member involvement in the decision-making process (Team Processes), Affective commitment toward the team (Team Emergent States), as well as lack of a market/rational culture (Organizational Culture). Job satisfaction was strongly related to team processes and, to a lesser extent, team emergent states.

Virginia Lawmakers Urged to Support Pipeline for Mental Health Workers

Back to table of contents Previous article Next article Government NewsFull AccessVirginia Lawmakers Urged to Support Pipeline for Mental Health WorkersMark MoranMark MoranSearch for more papers by this authorPublished Online:28 Sep 2018https://doi.org/10.1176/appi.pn.2018.10a7AbstractA recent commitment by the Virginia legislature to expand Medicaid access as part of the ACA represents an opportunity to advance the integration of primary care and mental health care, psychiatrist Peter Buckley, M.D., tells legislators.Now is our moment in the Commonwealth of Virginia,” said psychiatrist Peter Buckley, M.D., dean of the Virginia Commonwealth University (VCU) School of Medicine, in an address last month before Virginia legislators and mental health advocates during the “Mental Health Mini-University.”Citing the decision by the Virginia General Assembly earlier this year to expand Medicaid to some 400,000 people in the state under the Affordable Care Act, as well as the election last year of physician Ralph Northam as governor, Buckley told legislators that the state is in a unique position to address mental health workforce needs, access to care, and the opioid epidemic. “Medicaid expansion will further focus attention on mental health as a priority, as will the ongoing integration of mental health and general medical care,” Buckley said. “We have an opportunity and an obligation to make the most of it.”Virginia Sen. Creigh Deeds, chair of an advisory commission on mental health reform in Virginia, listens as Mishka Terplan, M.D., M.P.H., describes the history of alcohol and alcohol abuse in the United States.Mark MoranBuckley’s remarks were part of an address titled “Mental Health and Workforce Development Solutions,” delivered during a day-long educational session for members of the Virginia General Assembly and a special mental health advisory commission. The brainchild of VCU psychiatry chair Joel Silverman, M.D., the mini-university for legislators was designed to provide lawmakers up-to-date information about mental health public policy issues. The event was attended by 11 members of the General Assembly and members of the Deeds Commission, a mental health system reform advisory group formed by Virginia Sen. Creigh Deeds in 2013 after the suicide of his son.Buckley was joined at the event by Mishka Terplan, M.D., M.P.H., a professor of obstetrics, gynecology, and psychiatry and associate director of addiction medicine at VCU. He discussed problems associated with alcohol, marijuana, and opioid use. Terplan emphasized that while the opioid crisis is attracting nationwide attention, alcohol abuse continues to exact an enormous public health toll.Buckley urged lawmakers to pay special attention to the pipeline of students choosing a career in mental health and to the use of allied professionals, including psychiatric nurses and social workers. With regard to future psychiatrists, Buckley said lawmakers should focus on providing resources for training in high-need specialty areas: forensic/correctional psychology and psychiatry, child psychiatry and developmental pediatrics, and consultation-liaison psychiatry. He also urged support for use of peer support specialists—patients with mental illness or substance use disorders who are in recovery and can assist in helping others to recovery—as a way to extend the expertise of clinicians. Leveraging technological innovations such as telemedicine is crucial, as is the need for adequate reimbursement for physicians providing telemedicine services. “The magnitude of need is compelling, especially when one also considers medical-psychiatric comorbidity,” Buckley said. He noted that last year, the National Alliance for Mental Illness (NAMI) ranked Virginia’s mental health system 42nd among the states for access to care. He also cited a 2017 report by NAMI Virginia, which stated that the problem of access to care is tied to “lack of trained professionals working in Virginia, particularly for youth.”Despite the bad news, Buckley told Psychiatric News after the presentation that he chooses to be optimistic because a number of key factors are coalescing. “We have a governor who is a physician with a particular interest in mental health. The secretary of Health and Human Services [Daniel Carey, M.D.] is a cardiologist who brings a preventative approach to health care as well as a real interest in mental health. And the commissioner of the Department of Behavioral Health and Developmental Disabilities [Hughes Melton, M.D.] is a family physician who really gets the importance of integrating psychiatry, mental health, and primary care,” Buckley said. “Combined with Medicaid expansion and the compelling mental health needs in the state, I really think all of these things coming together means that this is our moment of opportunity.” ■See related article: Mini-University at VCU Preps Lawmakers on Workforce, Substance Use Disorders . ISSUES NewArchived

Psychosis and Psychotic Disorders: Prediction and Prevention

Experiencing symptoms of psychosis is concerning for current and future mental illnesses and increases the possibility of developing a psychosis in the future. This Clinical Perspectives session will emphasize the importance of screening for symptoms of psychosis, monitoring for risk factors particular to conversion to psychosis, and treatment interventions based on 2 important national studies on psychosis. The broad impact of large-scale studies, such as the North American Prodrome Longitudinal Study (NAPLS) and Recovery After an Initial Schizophrenia Episode (RAISE), and global application of these findings and those from other international studies on early psychosis to youth mental health reform will also be a focus.