Changes In Mental Health System Research Articles

Youth Wellness Hubs Ontario: Development and initial implementation of integrated youth services in Ontario, Canada.

The need for youth-friendly early intervention services to meet the mental health, substance use, primary care, and other social needs of adolescents and young adults is well-documented. This article describes Youth Wellness Hubs Ontario, a province-wide initiative in Ontario, Canada to build and implement a one-stop-shop model of integrated youth services. We describe the development of Youth Wellness Hubs Ontario, in the context of global youth mental health system transformation, as well as pan-Canadian youth mental health system change. We also describe Youth Wellness Hubs Ontario's values and services. The demonstration phase of Youth Wellness Hubs Ontario was initiated in 2017-2018. Youth Wellness Hubs Ontario is co-created with youth for youth aged 12-25 years old across diverse community contexts. Youth Wellness Hubs Ontario centres engagement and equity, and offers developmentally-appropriate services in an integrated, community-based walk-in format. As an initiative committed to continuous learning and quality improvement, Youth Wellness Hubs Ontario offers evidence-based and evidence-generating services, and measurement-based care. Youth Wellness Hubs Ontario is supported by backbone resources with expertise in implementation science, health equity, Indigenous practices, youth and family engagement, evaluation, and knowledge translation. In 2020 Youth Wellness Hubs Ontario secured sustainable funding for the first 10 locations and scale-up began in 2021, with 10 additional locations in development. Youth Wellness Hubs Ontario demonstrates the feasibility of integrated mental health and substance use early intervention services, offered in the context of a broad range of health and social services.

Mental health system change

Mental health is the psychological wellness of a person. Currently, mental health illnesses are treated by hospital and community. Due to the transition of this system from psychiatric institutes, the hospital and community are not necessarily well connected. It is essential that the hospital and community are connected since patients need to feel supported by their community at all stages of their recovery in order to make a network of wellness. In order to tackle the problem of connecting the hospital and community for the personal recovery of people with severe mental illness, my team, Re-MIND London, proposed an innovative solution suite, involving: a liaison between community and hospital; a shared menu of resources; information sharing through education and samplers; having patients engage on community outings; and providing peer mentor support. In installing this solution, we have re-kindled connection between Parkwood Institute for Mental Health and the Canadian Mental Health Association in London, ON, at an administrative level, as well as staffer and patient level. Patients report that they need to feel like they in the community to have hope towards a proper discharge plan. In installing sections of this innovative solution, our team learned self-empowerment to challenge the existing system, regardless of our position. We are connecting, at many levels, diverse individuals and organizations to leverage their strengths to form a strong and sustainable partnership that will insulate people with mental illness in a community throughout treatment.

Speaking our minds as clinical psychologists

A combination of international debates about psychiatric diagnosis, failure to find biomarkers to validate the ‘illness’ model, and emerging evidence on the role of trauma, abuse and social inequality in mental distress, is creating the possibility of fundamental change in mental health systems. However, despite the recent ‘Position Statement on Classification’, clinical psychologists have always had an ambivalent attitude to challenging psychiatric power and influence. This tension will be explored in relation to key areas of theory and practice.

임상심리전문가 교육수련제도 개선을 위한 제언

Clinical psychologists in Korea have continuously grown and becoming as leading experts in the field of mental health over the past fifty years. The number of clinical psychologists along with members of the Korean Clinical Psychology Association have increased. More importantly, recent changes in mental health system require expanded and broadened expertise of clinical psychologists from traditional psychiatric hospitals or University Counseling Centers based work. Accordingly, training systems for clinical psychologists should accommodate the changes in mental health system and societal needs. The present article aimed to critically evaluate the current clinical psychology training system, and to propose ideas to improve the training system. First, we defined expert areas of clinical psychologists in Korea based on theoretical underpinning of clinical psychology. Second, we suggested ways to expand the scope and number of training institutions to modify the selection process of clinical psychology trainees, and to protect the rights and responsibility of trainees. Third, we discussed the changes in required activities during the training, including contents of psychological assessments and treatments. Fourth, we discussed diversification of training models from a traditional scientist-practitioner model to a practitioner-scholar model and a clinical scientist model. Fifth, we discussed the necessity of continuing education beyond the requirement of acquiring a license to maintain the expertise and be up-to-date. Finally, we highlighted the importance of integration of science and clinical practice in the training system, and discussed how the goals could be achieved during the training. We expect that this article may pave the direction of further discussions for advancing the clinical psychology training system.

The Capabilities Approach, Transformative Measurement, and Housing First

Timothy MacLeod Peer Reviewed Transformative change to mental health systems involves transformation in how practices, policies, and research respond to the needs of individuals with psychiatric disabilities. This paper presents Amartya Sen’s capabilities approach as a promising framework for outcome measurement congruent with the aims of transformative change in mental health systems. In this paper, Sen’s capabilities approach is contrasted with therapeutic and citizenship values as well as the Housing First approach to housing.

Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress

Posttraumatic stress disorder (PTSD) poses monumental public health challenges because of its contribution to mental health, physical health, and both interpersonal and social problems. Recent military engagements in Iraq and Afghanistan and the multitude of resulting cases of PTSD have highlighted the public health significance of these conditions. There are now psychological treatments that can effectively treat most individuals with PTSD, including active duty military personnel, veterans, and civilians. We begin by reviewing the effectiveness of these treatments, with a focus on prolonged exposure (PE), a cognitive-behavioral therapy (CBT) for PTSD. Many studies conducted in independent research labs have demonstrated that PE is highly efficacious in treating PTSD across a wide range of trauma types, survivor characteristics, and cultures. Furthermore, therapists without prior CBT experience can readily learn and implement the treatment successfully. Despite the existence of highly effective treatments like PE, the majority of individuals with PTSD receive treatments of unknown efficacy. Thus, it is crucial to identify the barriers and challenges that must be addressed in order to promote the widespread dissemination of effective treatments for PTSD. In this review, we first discuss some of the major challenges, such as a professional culture that often is antagonistic to evidence-based treatments (EBTs), a lack of clinician training in EBTs, limited effectiveness of commonly used dissemination techniques, and the significant cost associated with effective dissemination models. Next, we review local, national, and international efforts to disseminate PE and similar treatments and illustrate the challenges and successes involved in promoting the adoption of EBTs in mental health systems. We then consider ways in which the barriers discussed earlier can be overcome, as well as the difficulties involved in effecting sustained organizational change in mental health systems. We also present examples of efforts to disseminate PE in developing countries and the attendant challenges when mental health systems are severely underdeveloped. Finally, we present future directions for the dissemination of EBTs for PTSD, including the use of newer technologies such as web-based therapy and telemedicine. We conclude by discussing the need for concerted action among multiple interacting systems in order to overcome existing barriers to dissemination and promote widespread access to effective treatment for PTSD. These systems include graduate training programs, government agencies, health insurers, professional organizations, healthcare delivery systems, clinical researchers, and public education systems like the media. Each of these entities can play a major role in reducing the personal suffering and public health burden associated with posttraumatic stress.

The balanced care model: the case for both hospital- and community-based mental healthcare

The balanced care model proposes that a comprehensive mental health system needs to include both community- and hospital-based care. The model is based on a structured review of scientific evidence, and is also informed by the experience of experts active in mental health system change in many countries worldwide.

The balanced care model for global mental health

For too long there have been heated debates between those who believe that mental health care should be largely or solely provided from hospitals and those who adhere to the view that community care should fully replace hospitals. The aim of this study was to propose a conceptual model relevant for mental health service development in low-, medium- and high-resource settings worldwide. Method We conducted a review of the relevant peer-reviewed evidence and a series of surveys including more than 170 individual experts with direct experience of mental health system change worldwide. We integrated data from these multiple sources to develop the balanced care model (BCM), framed in three sequential steps relevant to different resource settings. Low-resource settings need to focus on improving the recognition and treatment of people with mental illnesses in primary care. Medium-resource settings in addition can develop 'general adult mental health services', namely (i) out-patient clinics, (ii) community mental health teams (CMHTs), (iii) acute in-patient services, (iv) community residential care and (v) work/occupation. High-resource settings, in addition to primary care and general adult mental health services, can also provide specialized services in these same five categories. The BCM refers both to a balance between hospital and community care and to a balance between all of the service components (e.g. clinical teams) that are present in any system, whether this is in low-, medium- or high-resource settings. The BCM therefore indicates that a comprehensive mental health system includes both community- and hospital-based components of care.

P-590 - Situation of families of mentally ill persons in a context of change in mental health system: a time for stakeholders and families collaboration

Introduction In 2005, the Government of Quebec (Canada) published a Mental Health Action Plan (MHAP) that was based on organizing within a hierarchy of services: primary, secondary and tertiary care and was supposed to involve families of persons with mental illness in the process of services’ transformation. Objectives Knowing the perception of families of persons with mental illness of their situation, in a changing mental health system related to the Action Plan. Methods A randomized proportional sample of 1496 members of families in community organizations for families of people with mental disorders (T1) received a questionnaire and another one, 18 months later (T2).. Moreover, six groups of families (N = 54) were interviewed, and again 18 months later. Results 33% of families knew that there was an Action Plan. 20% of family members said they had the opportunity to be involved in decisions regarding their loved one. 53% of them showed with high psychological distress; in general population this score is 20%. In group interviews, families said that: it was difficult for them to obtain services for their loved one and to talk to the psychiatrist because of the privacy legislation. They also need help when their loved one showw with aggressive behaviours (30%). Conclusion This project helped the families to be heard by stakeholders. The government is currently working on a new Action Plan that will involve more thoroughly the patient and his family. Our research team is currently starting a new project to help families dealing with aggressive behaviours.

Embracing an Emerging Structure in Community Mental Health Services

This article investigates evidence of mental health system change at two community mental health organizations. Using ethnographic methods, the study explored the relationships, culture and characteristics of organizations employing consumer-survivors in designated positions, examining the ways in which they reflect traditional medically-based services and/or more recovery, partnership-oriented services. The data suggest that two structures of mental health services are evident at the organizations: the dominant structure and the emerging structure. It is argued that relationships based on hope, respect and affection appear to encourage the presence of the emerging structure.

What works for mental health system change: evolution or revolution?

The mental health system has realized significant metamorphoses in the standards and practices of quality care for people with psychiatric disability during the past decade. Now change agents are wrestling with effective strategies that help real-world systems to adopt programs reflecting these metamorphoses. Two fundamental approaches to systems change are compared and contrasted here: evolution and revolution. First, the authors compare the different ways in which evolution and revolution might approach change in the mental health system. They do this by showing how they might influence the transformation of day treatment into supported employment programs. Then, the authors present the two approaches as naturally occurring change processes that work in tandem to affect real-world adaptations. Finally, they summarize practical strategies that change agents might adopt to realize evolution and revolution. Clearly, all stakeholder groups need to become strategic about system change so that real-world practices keep up with the ideals emerging in practice guidelines and evidence-based practice reviews.

Loaded Dice: Reformism and Constraint in Contemporary U.S. Mental Health Policy

A number of important reforms are under way in contemporary U.S. mental health policy making. Innovations are occurring in such areas as parity for insurance coverage for mental health problems, children's mental health services, and the expansion of community support systems for individuals with severe and chronic mental illnesses. In each case, however, the scope and effectiveness of policy changes are limited by resource shortages, political ambivalence, and program structures that are decentralized, fragmented, and poorly co-ordinated. Thus, although innovation is a valuable engine of change in mental health systems, its impact depends largely on longstanding political, economic, and organizational forces that transcend the mental health sphere.

Evaluating performance and change in mental health systems serving children and youth: an interorganizational network approach.

Planning for the delivery of community mental health services has evolved from models of services within individual agencies to community-wide systems of care, but development of methodologies for assessing system performance has lagged behind. This article presents one approach to system-level assessment by viewing children's mental health systems as an interorganizational network. Data are presented on two county-based child mental health systems in North Carolina that participated in the Robert Wood Johnson Foundation Mental Health Services Program for Youth. Site-specific data on client referrals, fund exchanges, and information flows were collected at two time points (1991 and 1993) to measure the cohesiveness and concentration of the service system using network k-core analyses. In addition, stakeholder ratings of service adequacy, quality, availability, coordination, and overall demonstration project goal attainment were obtained at both time periods. Findings indicate that the rural system was outperforming the urban system at the time of the first survey, but the urban system caught up over the study interval. There was high agreement between the network and stakeholder ratings of system performance at both time periods. The method of data collection and analysis used in this study provides tools that can be used in a variety of settings to assess service system growth and development.

A framework for evaluating systems thinking interventions: an experimental approach to mental health system change

Researchers from the State University of New York at Albany and the New York State Office of Mental Health have been engaged in testing an experimental approach to evaluating systems thinking interventions. This research calls for a similar systems thinking intervention to be repeated in four counties with four control counties also selected and observed via pre- and post-intervention measures. The overall context of the project focuses on integration of mental health and vocational rehabilitation services. The experiment is designed to evaluate measurable outcomes, including shifts in goal structures and change strategies of the management team, shifts in relative alignment of the management team as a whole, perceived success of the intervention, and changes in systems and procedures necessary to improve client services. This article presents a framework for evaluating systems thinking interventions as well as preliminary findings from the pilot test. © 1997 by John Wiley & Sons, Ltd. Syst. Dyn. Rev. 13, 149‐169, 1997

Variation in civil commitment processes across jurisdictions: an approach for monitoring and managing change in mental health systems.

This article demonstrates how unique local factors affect implementation of commitment statutes and, consequently, the extent to which implementation supports fundamental treatment philosophies. Four local variations in the implementation of Ohio's commitment statute are examined with a methodology designed to describe commitment processes. Qualitative case studies highlight factors that appear to contribute to variability across these sites. The authors contend that this information can be used as a system management tool at the state and local levels to (1) suggest needed changes in local service systems, (2) identify specific options/interventions for effecting change in desired directions and (3) assess the extent to which changes affect commitment processes in predictable ways that are consistent with philosophical principles.

University-based continuing education and mental health system change.

University-based continuing education and mental health system change.

University-based continuing education and mental health system change.

University-based continuing education and mental health system change.