Planning Of Mental Health Services Research Articles

Predictive factors of depression symptoms among adolescents in the 18-month follow-up after Wenchuan earthquake in China

Background: It is unclear about the change and risk factors of depression among adolescent survivors after earthquake.Aims: This study aimed to explore the change of depression, and identify the predictive factors of depression among adolescent survivors after the 2008 Wenchuan earthquake in China.Methods: The depression among high school students at 6, 12 and 18 months after the Wenchuan earthquake were investigated. The Beck Depression Inventory (BDI) was used in this study to assess the severity of depression.Results: Subjects included 548 student survivors in an affected high school. The rates of depression among the adolescent survivors at 6-, 12- and 18-month after the earthquake were 27.3%, 42.9% and 33.3%, respectively, for males, and 42.9%, 61.9% and 53.4%, respectively, for females. Depression symptoms, trauma-related self-injury, suicidal ideation and PTSD symptoms at the 6-month follow-up were significant predictive factors for depression at the 18-month time interval following the earthquake.Conclusions: This study highlights the need for considering disaster-related psychological sequela and risk factors of depression symptoms in the planning and implementation of mental health services. Long-term mental and psychological supports for victims of natural disasters are imperative.

Estimating the number of adults with severe and persistent mental illness who have complex, multi-agency needs.

A population health approach to mental health service planning requires estimates that align interventions with the needs of people with mental illness. The primary objective was to estimate the number of people in Australia living with severe and persistent mental illness who have complex, multi-agency needs. The secondary objective was to describe the possible service needs of individuals with severe mental illness. We disaggregated the estimated 12-month prevalence of adults with severe mental illness into needs-based sub-groups, using multiple data sources. Possible service needs of 1825 adults with psychotic disorders and 334 adults with severe past-year affective and/or anxiety disorders were described using data from the 2010 Survey of High Impact Psychosis and 2007 National Survey of Mental Health and Wellbeing, respectively. Using best available data, we estimated that 3.3% of adults experience a severe mental illness each year, of whom one-third (1.1% of adults) experience a persistent mental illness that requires ongoing services to address residual disability. Among those with severe and persistent mental illness, one-third of adults (0.4% or 59,000 adults in 2015) have complex needs requiring multi-agency support to maximise their health, housing, social participation and personal functioning. Survey of High Impact Psychosis data indicated that among adults with psychotic disorders, use of accommodation (40%), non-government (30%) services and receipt of income support (85%) services were common, as were possible needs for support with socialising, personal care and employment. National Survey of Mental Health and Wellbeing data indicated that among individuals with severe affective and anxiety disorders, receipt of income support (37%) was common (information on accommodation and non-government support services was not available), as were possible needs for financial management and employment support. Agreed indicators of complex, multi-agency needs are required to refine these estimates. Closer alignment of information collected about possible service needs across epidemiological surveys is needed.

Ontological security and connectivity provided by pets: a study in the self-management of the everyday lives of people diagnosed with a long-term mental health condition.

BackgroundDespite evidence that connecting people to relevant wellbeing-related resources brings therapeutic benefit, there is limited understanding, in the context of mental health recovery, of the potential value and contribution of pet ownership to personal support networks for self-management. This study aimed to explore the role of pets in the support and management activities in the personal networks of people with long-term mental health problems.MethodsSemi-structured interviews centred on ‘ego’ network mapping were conducted in two locations (in the North West and in the South of England) with 54 participants with a diagnosis of a long-term mental health problem. Interviews explored the day-to-day experience of living with a mental illness, informed by the notion of illness work undertaken by social network members within personal networks. Narratives were elicited that explored the relationship, value, utility and meaning of pets in the context of the provision of social support and management provided by other network members. Interviews were recorded, then transcribed verbatim before being analysed using a framework analysis.ResultsThe majority of pets were placed in the central, most valued circle of support within the network diagrams. Pets were implicated in relational work through the provision of secure and intimate relationships not available elsewhere. Pets constituted a valuable source of illness work in managing feelings through distraction from symptoms and upsetting experiences, and provided a form of encouragement for activity. Pets were of enhanced salience where relationships with other network members were limited or difficult. Despite these benefits, pets were unanimously neither considered nor incorporated into individual mental health care plans.ConclusionsDrawing on a conceptual framework built on Corbin and Strauss’s notion of illness ‘work’ and notions of a personal workforce of support undertaken within whole networks of individuals, this study contributes to our understanding of the role of pets in the daily management of long-term mental health problems. Pets should be considered a main rather than a marginal source of support in the management of long-term mental health problems, and this has implications for the planning and delivery of mental health services.

Developing a broad categorisation scheme to describe risk factors for mental illness, for use in prevention policy and planning.

The prevention of mental illness involves identifying and modifying those characteristics and exposures of an individual that threaten their mental health - commonly referred to as risk factors. Existing categorisations of risk factors for mental illness are either limited in their scope or oversimplified in their description. As part of a large mental health workforce and service planning project, we set out to develop a more detailed and comprehensive categorisation scheme to describe risk factors for mental illness. We conducted a rapid review of MEDLINE and Google Scholar for meta-analytic studies that examined the characteristics and exposures that typify the population with mental illness in order to identify and categorise potential risk factors. The search uncovered 1628 relevant studies, from which 10 primary and 23 secondary categories of risk factors were identified, ranging from genetic and biomedical to psychological and sociocultural. The review revealed interesting distortions in the focus of the literature, with the majority of studies focused on a few disorders (schizophrenia, depression and neurodegenerative disorders) and genetic, psychological and physiological risks. In contrast, environmental (e.g. media exposure) and occupational (e.g. employee health) were under-represented. The categorisation scheme developed in this paper is a step towards a more detailed taxonomy of risk factors for mental illness; this will be most useful in guiding clinicians, researchers and policy-makers in driving the prevention agenda forward.

How do consumer leaders co-create value in mental health organisations?

Objectives Contemporary mental health policies call for consumers to be involved in decision-making processes within mental health organisations. Some organisations have embraced leadership roles for consumers, but research suggests consumers remain disempowered within mental health services. Drawing on a service-dominant logic, which emphasises the co-creation of value of services, the present study provides an overview of consumer leadership within mental health organisations in the Australian Capital Territory. Methods Mental health organisations subscribing to the local peak body mailing list were invited to complete a survey about consumer leadership. Survey data were summarised using descriptive statistics and interpreted through the lens of service-dominant logic. Results Ways in which organisations may create opportunities for consumers to co-create value within their mental health services included soliciting feedback, involving consumer leaders in service design, having consumer leaders involved in hiring decisions and employing consumer leaders as staff or on boards. Strategies that organisations used to develop consumer leaders included induction, workshops and training in a variety of organisational processes and skills. Conclusions The findings of the present study extend the application of a service-dominant logic framework to consumer leadership within mental health organisations through consideration of the diverse opportunities that organisations can provide for consumer co-creation of service offerings. What is known about the topic? Policy calls for consumer involvement in all levels of mental health service planning, implementation and delivery. The extent to which service organisations have included consumer leaders varies, but research suggests that this inclusion can be tokenistic or that organisations choose to work with consumers who are less likely to challenge the status quo. Service literature has explored the way consumers can co-create value of their own health care, but is yet to explore consumers' co-creation of value at a systemic level. What does the paper add? This paper outlines ways in which mental health organisations report involving consumers in leadership positions, including having consumers on boards, having consumers on recruitment panels and providing leadership training for consumers. These initiatives are considered in terms of the potential value co-created within mental health services by consumers in leadership, suggesting that consumer leaders are a resource to mental health organisations in terms of the value brought to service offerings. What are the implications for practitioners? Research suggests that medical professionals have been resistant to increased consumer leadership within mental health services. The findings of the present study emphasise the value that can be brought to service organisations by consumer leaders, suggesting that mental health practitioners may reconsider their approach and attitudes towards consumer leadership in the sector.

Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs.

BackgroundPerinatal mental illness is a common and important public health problem, especially in low and middle-income countries (LMICs). This study aims to explore the barriers and facilitators, as well as perceptions about the feasibility and acceptability of plans to deliver perinatal mental health care in primary care settings in a low income, rural district in Uganda.MethodsSix focus group discussions comprising separate groups of pregnant and postpartum women and village health teams as well as eight key informant interviews were conducted in the local language using a topic guide. Transcribed data were translated into English, analyzed, and coded. Key themes were identified using a thematic analysis approach.ResultsParticipants perceived that there was an important unmet need for perinatal mental health care in the district. There was evidence of significant gaps in knowledge about mental health problems as well as negative attitudes amongst mothers and health care providers towards sufferers. Poverty and inability to afford transport to services, poor partner support and stigma were thought to add to the difficulties of perinatal women accessing care. There was an awareness of the need for interventions to respond to this neglected public health problem and a willingness of both community- and facility-based health care providers to provide care for mothers with mental health problems if equipped to do so by adequate training.ConclusionThis study highlights the acceptability and relevance of perinatal mental health care in a rural, low-income country community. It also underscores some of the key barriers and potential facilitators to delivery of such care in primary care settings. The results of this study have implications for mental health service planning and development for perinatal populations in Uganda and will be useful in informing the development of integrated maternal mental health care in this rural district and in similar settings in other low and middle income countries.

Key findings from the second Australian Child and Adolescent Survey of Mental Health and Wellbeing.

To estimate the prevalence of mental disorders in children and adolescents in Australia, and the severity and impact of those mental disorders. Seven mental disorders were assessed using the parent- or carer-completed version of the Diagnostic Interview Schedule for Children Version IV, and major depressive disorder was also assessed using the youth self-report version of the Diagnostic Interview Schedule for Children Version IV. Severity and impact were assessed using an extended version of the Diagnostic Interview Schedule for Children Version IV impact on functioning questions, and days absent from school due to symptoms of mental disorders. Data were collected in a national face-to-face survey of 6310 parents or carers of children and adolescents aged 4-17 years, with 2969 young people aged 11-17 years also completing a self-report questionnaire. Twelve-month prevalence of mental disorders was 13.9%, with 2.1% of children and adolescents having severe disorders, 3.5% having moderate disorders and 8.3% having mild disorders. The most common class of disorders was attention-deficit/hyperactivity disorder followed by anxiety disorders. Mental disorders were more common in step-, blended- or one-parent families, in families living in rented accommodation and families where one or both carers were not in employment. Mental disorders were associated with a substantial number of days absent from school particularly in adolescents. Mental disorders are common in children and adolescents, often have significant impact and are associated with substantial absences from school. Child and adolescent mental disorders remain an important public health problem in Australia. Accurate information about prevalence and severity of child and adolescent mental disorders is an essential prerequisite for effective mental health policy and service planning.

A multi-level analysis of the relationship between spatial clusters of outpatient-treated depression, risk factors and mental health service planning in Catalonia (Spain)

BackgroundPrevious research identified high/low clusters of prevalence of outpatient-treated depression at municipal level in Catalonia (Spain). This study aims to analyse potential risk factors, both socioeconomic and related to the mental health service planning, which could influence the occurrence of hot/cold spots of depressed outpatients at two geographical levels: municipalities and service catchment areas. MethodHot/cold spots were examined in relation to socioeconomic indicators at municipal level, such as population density, unemployment, university education, personal income, and also those related to service planning at catchment area level, such as adequacy of healthcare, urbanicity, accessibility and the availability of mental health community centres. The analysis has been carried out through multilevel logistic regression models in order to consider the two different scales. ResultsHot spots are related to high population density, unemployment, urbanicity, the adequacy of provision of mental health services, and accessibility to mental health community centres at both study levels. On the other hand, the multilevel model weakly explains cold spots, associating them with high personal incomes. LimitationsThe dependent variables of the multi-level models are binary. This limits the interpretation of the results, since they cannot provide information about the variance of the dependent variables explained by the models. ConclusionsThe results described diverse risk factors at two levels which are related to a high likelihood of hot and cold spots of depression. The findings show the relevance of health planning in the distribution of diseases and the utilisation of healthcare services.

Towards understanding governance issues in integration of mental health into primary health care in Uganda.

BackgroundThere is a growing burden of mental illness in low income countries. The situation is further worsened by the high poverty levels in these countries, resulting in difficult choices for their health sectors as regards to responding to the burden of mental health problems. In Uganda, integration of mental health into primary health care (PHC) has been adopted as the most vital strategy for ensuring mental health service delivery to the general population.ObjectivesTo identify governance related factors that promote/or hinder integration of mental health into PHC in Uganda.MethodsA qualitative research design was adopted at national and district level. A total of 18 Key informant interviews were conducted at both levels. Content thematic analysis was the main method of data analysis.FindingsThere were positive gains in working on relevant laws and policies. However, both the mental health law and policy are still in draft form. There is also increased responsiveness/participation of key stakeholders; especially at national level in the planning and budgeting for mental health services. This however seems to be a challenge at both district and community level. In terms of efficiency, human resources, finances, medicines and technologies constitute a major drawback to the integration of mental health into PHC. Ethics, oversight, information and monitoring functions though reported to be in place, become weaker at the district level than at national level due to limited finances, human resources gaps and limited technical capacity. Other governance related issues are also reported in this study.ConclusionsThere is some progress especially in the legal and policy arena to support integration of mental health into PHC in Uganda. However, adequate resources are still required to facilitate the effective functioning of all governance pillars that make integration of mental health into PHC feasible in Uganda.

Comparison of Frequency and Intensity of Stressors in Infertile Couples Undergoing Intrauterine Insemination Treatment, Intra-Cytoplasmic Sperm Injection Treatment and without Treatment

Introduction: Infertility is a personal crisis. There are different assisted reproductive techniques in the treatment of infertility. Anxiety and stress have been shown to be markedly higher in infertile couples. This study was aimed to compare the frequency and intensity of stressors in infertile couples undergoing intrauterine insemination (IUI) treatment, Intra-cytoplasmic sperm injection (ICSI) treatment and without treatment (control group). Materials and Methods: Thirty seven infertile couples undergoing IUI, ICSI and without treatment were selected by non-random convenient sampling from the cases admitted to Rooyan Infertility Clinic. They completed demographic information sheet, and the Stressors Scale. Results: The results showed that there was no significant correlation between duration of infertility with frequency and intensity of stressors. There was no significant correlation between frequency and intensity of stressors with infertility factors. There was also no significant difference in the frequency and intensity of stressors between men and women. There were no differences in the frequency and intensity of stressors between ICSI and IUI with control group. Data showed that there was a significant difference in the frequency of stressors with the group of IUI treatment as well as in the frequency of stressors between ICSI and IUI with control group. Findings demonstrated that there was significant difference between IUI with and without ICSI groups in the frequency and intensity of stress. Conclusion: IUI, ICSI and control groups as the assisted reproductive techniques can be stressful. Long-term planning of mental health services for infertile couples, identifying couples at risk, convincing couples to refer for psychological assessment, psychotherapy by clinical psychologists, and drug therapy by psychiatrists are suggested.

Traumatic pre-migration experiences: A population-based study of Russian, Somali and Kurdish origin migrants in Finland

Introduction Ongoing mass conflicts and the resulting flow of displaced persons have increased interest on pre-migration experiences of migrants, but population-based studies of entire migrant groups are still scarce. Objective We aim to assess the prevalence of a variety of possibly traumatic pre-migration experiences among Russian, Somali and Kurdish origin migrants in Finland and to determine which socio-demographic factors are associated with traumatic pre-migration experiences. Methods We used data from the Finnish Migrant Health and Wellbeing Study (Maamu). The survey sample comprised of Russian, Somali and Kurdish origin migrants, aged 18–64 years ( n =1000 per group). The data specified eight different traumatic events common to those exposed to war and conflict. The age-adjusted prevalence of traumatic pre-migration experiences were calculated in the ethnic groups by gender using predicted margins. Results Seventy-seven percent of Kurdish, 58% of Somali, and 21% of Russian origin migrants had experienced at least one traumatic event in the former host country. One third of the Kurdish men had been subject to torture. Surprisingly, migrating as a refugee or asylum seeker was not found to be associated with traumatic pre-migration experiences. Conclusion Results indicated an alarmingly high overall trauma exposure among Kurdish and Somali migrants in Finland. This should be taken into account in the planning of mental health services in the new host country.

Service transformation plans in the Eastern Cape informed by a needs-based gap analysis

Objectives. Part I of this research paper presented a needs and gap analysis for the management of schizophrenia, bipolar mood disorder and major depression for the Eastern Cape Province, South Africa. It identified deficits and inequitable distribution of human resources and beds in the province. In this article, Part II, the authors propose a plan for public sector mental health services to address the human resource needs in the poorer eastern regions of the province. The plan focuses on human resource training and development. Methods. Evidence-based data on staff development in mental health from low-middle income countries were utilised to develop strategies to increase staff capacity to address unmet need. A financing model with a poverty index was developed to sustain a needs-based plan. Databases searched included Pubmed, Medline, Google and Google Scholar. The key words used included: mental health, mental health training, mental health resources, mental health in low-middle-income countries, mental health policy and plans, mental health needs- based planning, primary healthcare, primary mental healthcare, mental health financing. In addition the websites of the World Health Organization and the World Psychiatric Association were searched for similar resources. Conclusions. It is feasible, with careful attention to planning and implementation of evidence-based tools, to improve public mental health service delivery in this province. Sustained political will and professional commitment will ensure successful delivery of mental health services in a resource-limited province.

On the Employment of Persons With Mental Health Issues.

More andmore, I am hearing that people with mental health issues aspire to work in the professional sector, possibly as a manager, an executive, or a technician. Many are not interested in more mundane work, such as data entry. Yet, for various reasons, finding work as a professional is difficult for people with mental health problems, especially if they have recently been discharged from a psychiatric hospitalization.

Service transformation plans in the Eastern Cape informed by a needs-based gap analysis

<p><strong>Objectives.</strong> Part I of this research paper presented a needs and gap analysis for the management of schizophrenia, bipolar mood disorder and major depression for the Eastern Cape Province, South Africa. It identified deficits and inequitable distribution of human resources and beds in the province. In this article, Part II, the authors propose a plan for public sector mental health services to address the human resource needs in the poorer eastern regions of the province. The plan focuses on human resource training and development. </p><p><strong>Methods.</strong> Evidence-based data on staff development in mental health from low-middle income countries were utilised to develop strategies to increase staff capacity to address unmet need. A financing model with a poverty index was developed to sustain a needs-based plan. Databases searched included Pubmed, Medline, Google and Google Scholar. The key words used included: mental health, mental health training, mental health resources, mental health in low-middle-income countries, mental health policy and plans, mental health needs- based planning, primary healthcare, primary mental healthcare, mental health financing. In addition the websites of the World Health Organization and the World Psychiatric Association were searched for similar resources.</p><p><strong>Conclusions.</strong> It is feasible, with careful attention to planning and implementation of evidence-based tools, to improve public mental health service delivery in this province. Sustained political will and professional commitment will ensure successful delivery of mental health services in a resource-limited province.</p>

Unmet Needs in Outpatients with Psychotic Disorders in Brazil

Introduction The assessment of needs among patients with severe mental disorders is one of the most studied measures in treatment planning and monitoring of mental health services. Nevertheless, studies on this subject are scarce in Brazil, even following the recent expansion of community services. Objectives To investigate the prevalence and correlates of unmet needs among outpatients with psychotic disorders in Brazilian community mental health services. Methods This is a cross-sectional study with a random sample of 401 outpatients with psychotic disorders in the city of Santos, Brazil. Needs were assessed through interviews with patients using the Camberwell Assessment of Needs (CAN), which investigates 22 clinical, social and basic needs. The Positive and Negative Symptom Scale (PANSS) was used to assess symptoms. Data were analyzed with multiple linear regression, using p Results The most reported needs were psychotic symptoms (67.0%), information needs (55.0%), psychological distress (41.8%) and money (41.5%). The mean number of unmet needs was 2.91 (+-2.56). A greater number of unmet needs was significantly associated to lower education, more negative symptoms and general psychopathology, all with p = 0.001. Conclusions The most reported needs were clinical and social. The number of unmet needs was consistent with the results of international studies. Furthermore, the association of greater unmet needs with lower education and higher symptoms severity may indicate the need for further and comprehensive psychosocial interventions.

Women and schizophrenia.

Women's mental health is closely linked to their status in society. This paper outlines the clinical features of women with schizophrenia and highlights the interpersonal and social ramifications on their lives. There is no significant gender difference in the incidence and prevalence of schizophrenia. There is no clear trend in mortality, although suicides seem to be more in women with schizophrenia. In India, women face a lot of problems, especially in relation to marriage, pregnancy, childbirth, and menopause. Most studies have shown better premorbid functioning, and social adjustment for women compared with men. There is a great need to plan for gender-sensitive mental health services targeting the special needs of these women. Women caregivers also deserve due attention.

Examining Disaster Mental Health Workforce Capacity

Objective: We examined the capacity of the disaster mental health workforce in Victoria, Australia, to provide the three evidence-supported intervention types of psychological first aid, skills for psychological recovery, and intensive mental health treatments.Method: Utilizing data from a cross-professional, state-level disaster mental health workforce survey (n = 791), we developed composite capacity indicators (CCI) for each intervention and performed logistic regression analyses to examine key predictors of disaster mental health workforce capacity.Results: CCI profiles highlighted significant gaps in the disaster mental health capacity of Victorian providers, with only 32—42% able to deliver current best practice interventions. Key predictors of workforce capacity common and unique to interventions were highlighted.Conclusions: Key strategies to raise Victoria’s disaster mental health workforce capacity should focus on targeted multilevel training in best practice interventions, creation of practice opportunities, and structural provider support/engagement. CCIs focused on best practice interventions provide a methodology for rapid workforce capacity assessment that can facilitate disaster preparedness planning, capacity building, and delivery of quality disaster mental health services.

Borderline Personality Disorder and High Utilization of Inpatient Psychiatric Hospitalization: Concordance Between Research and Clinical Diagnosis.

The goals of this study were to (1) assess prevalence rates of borderline personality disorder (BPD) in public mental health patients and (2) compare research assessment rates to clinical record rates in those with and without a history of high utilization of inpatient psychiatric hospitalization. One hundred and sixty participants randomly selected from county mental health centers were fully assessed. Among the non-high utilizers, 10% met criteria for BPD on research diagnosis, 4.5% on clinical record diagnosis, and 1.5% on both. Among high utilizers, 42% met criteria for BPD on research diagnosis, 19% on clinical record diagnosis, and 19% on both. For the non-high utilizers, the sensitivity of the clinical record diagnosis (compared to the gold standard of the research diagnosis) was 15% and the specificity was 97%. For the high utilizer group, the sensitivity of the clinical record diagnosis was 45% and specificity was 100% indicating that there was never an incorrect clinical diagnosis of BPD among the high utilizers. Thus, while the specificity of the clinical record was high, the sensitivity of the clinical record diagnosis was quite low, and the clinical record greatly underestimated the prevalence of BPD in this sample. Further, since effective outpatient treatment has been developed for these expensive high utilizers with BPD, the under-recognition of BPD has significant implications for the planning of outpatient mental health services in public sector settings.

The workload of a psychiatric clinic at a general hospital in a post conflict area: a model from Iraq

Purpose – The purpose of this paper is to demonstrate how a psychiatric clinic in a general hospital can function in conflict-ridden Iraq through the easing of patient access to services. Design/methodology/approach – The workload of psychiatrists was analyzed for one year (2010) at the psychiatry consultation clinic located in the campus of the Medical City Hospital in Central Baghdad which is also a training center. Findings – A total of 2,997 consultations (both adults and children) occurred in 2010. In total, 96 percent were self or family referrals. Patient services were provided by five consulting psychiatrists for a variety of psychiatric disorders. The main therapeutic intervention was the prescription of psychotropics. Research limitations/implications – Despite the turbulent circumstances and limited mental health resources in Iraq, this clinic was established as a model to attract patients for consultation and triage management to reduce appointment defaults and delayed care. Practical implications – The data can contribute to the planning and development of mental health services in Iraq, contributing to the current body of literature and serving as a model for other conflict areas. Originality/value – To best of the understanding this study is the first in the country.

A prediction algorithm for first onset of major depression in the general population: development and validation

ObjectivePrediction algorithms are useful for making clinical decisions and for population health planning. However, such prediction algorithms for first onset of major depression do not exist. The objective of this...