Public Mental Health Approach Research Articles

Young adults, particularly young women, account for an increasingly large share of Dutch mental healthcare expenditure over the period between 2015 and 2021.

There is increasing concern over the mental distress of youth in recent years, which may impact mental healthcare utilisation. Here we aim to examine temporal patterns of mental healthcare expenditures in the Netherlands by age and sex in the period between 2015 and 2021. Comprehensive data from health insurers in the Netherlands at the 3-number postal code level were used for cluster weighted linear regressions to examine temporal patterns of mental healthcare expenditure by age group (18-34 vs 35-65). The same was done for medical specialist and general practitioner costs. Additionally, we examined interactions with gender, by adding the interaction between age, year and sex to the model. Mental healthcare costs for younger adults (18-34) were higher than those for older adults (35-65) at all time points (β = 0.22, 95%-CI = 0.19; 0.25). Furthermore there was an increase in the strength of the association between younger age and mental healthcare costs from β = 0.22 (95%-CI = 0.19; 0.25) in 2015 to β = 0.37 (95%-CI = 0.35; 0.40) in 2021 (p < 0.0001) and this was most evident in women (p < 0.0001). Younger age was associated with lower general practitioner costs at all time points, but this association weakened over time. Younger age was also associated with lower medical specialist costs, which did not weaken over time. Young adults, particularly young women, account for an increasing share of mental healthcare expenditure in the Netherlands. This suggests that mental distress in young people is increasingly met by a response from the medical system. To mitigate this trend a public mental health approach is needed.

OP33 Child And Adolescent Mental Health Care Models: A Scoping Review

IntroductionMental illnesses are among the most common health problems in children and adolescents worldwide, and their prevalence has recently increased. At the same time, many countries face gaps in care and a shortage of services. To address these challenges, countries are developing child and adolescent mental health (CAMH) strategies and adopting their models of care. This paper aimed to give an international overview of these strategies and care models to support decision makers and stimulate mutual learning and improved CAMH care.MethodsWe identified core topics within published CAMH strategies and care model documents from seven selected countries within the Global North, which represented different healthcare systems, geographical regions, and public health traditions to maximize variety. We systematically extracted data on the identified topics and summarized them narratively by applying qualitative content analyses.ResultsThe documents addressed the following core topics: awareness raising activities; prevention and promotion; detection; treatment; telemedicine; care pathways; transitional psychiatry; vulnerable patient groups; user participation; infrastructure; workforce development; implementation; digital tools for case management; and data acquisition and research. A stand-alone CAMH strategy exists in most countries.Recommendations on CAMH care often followed a public mental health approach and placed a high priority on mental health promotion and cross-sectional organization and funding of CAMH care services. Key principles of future CAMH care included: increased flexibility of care settings; early intervention; an open and non-judgmental attitude among staff; and strengths orientation instead of focusing on deficits and diagnoses.ConclusionsReducing the prevalence of mental illness and current shortcomings in care requires action at the policy level (e.g., developing a CAMH strategy with a focus on mental health promotion and installing cross-sectoral governance), organizational level (e.g., reorganizing treatment settings and pathways of care), and individual level (e.g., strengthening user involvement and workforce development). Applying the recommended approaches in other countries will likely require redesign, ideally with a participatory approach and evaluation alongside piloting.

Rethinking Public Mental Health – Personal Reflections

We are facing a mental health crisis all over the world. For too long, the focus has been on delivering of mental health care. There is sufficient evidence to support the promotion of mental health, prevention of mental disorders by initiatives by individuals, families, and communities. The public mental health approach should move from for the people to by the people and of the people. Social psychiatry has a vital role in this transformation of mental health.

Collaborating with Traditional and Faith Healers in Mental Health: A Public Health Approach

There is an increasing interest in collaboration between biomedical services and traditional and faith healers for mental health care. In this article, we briefly outline recent research in this area and discuss some of the challenges to collaboration, particularly in relation to the care of people living with serious mental illness (SMI). Several approaches to collaborative mental health care have been attempted primarily in Africa, but also in Asia. Challenges to these collaborations include mutual distrust, power differentials, conceptual and methodological problems, and a lack of organizational support and resources. Importantly, the perspectives of people with lived experiences of mental illness are seldom considered. Research suggests that “bottom-up” approaches using community engagement, dialogue, and mutual learning may enable more effective and sustainable collaboration. We identify a need for greater involvement of people with lived experience of mental illness and their families and consider the potential of a public mental health approach in which collaborations are embedded within communities and existing support structures and accompanied by policies and interventions to address social as well as spiritual and medical needs.

Nosology of behavioral addictions: Intersections with philosophy of psychiatry •.

Writing in this journal, Brand and colleagues have proposed criteria for other specified disorders due to addictive behaviors. Their proposal intersects with key debates in philosophy of psychiatry, including how best to define mental disorders, to validate them, and to optimize their meta-structure. Review of these debates in the context of behavioral addictions suggests several conclusions. First, these debates involve “essentially contested” constructs that require ongoing consideration and judgment. Second, the complexity of psychopathology suggests multiple legitimate approaches to delineating traits and explicating mechanisms. Third, in optimizing meta-structure, non-psychobiological considerations are crucial - the overlapping public mental health approach to addictive disorders is paramount.

Mental disorders and COVID-19: Towards a precision public mental health approach

Mental disorders and COVID-19: Towards a precision public mental health approach

Therapist-supported online remote behavioural intervention for tics in children and adolescents in England (ORBIT): a multicentre, parallel group, single-blind, randomised controlled trial

SummaryBackgroundExposure and Response Prevention (ERP) is a form of behavioural therapy for tics; however, its effectiveness remains uncertain. We aimed to evaluate the effectiveness of internet-delivered, therapist-supported, and parent-assisted ERP for treatment of tics in children and young people with Tourette syndrome or chronic tic disorder.MethodsThis multicentre, parallel group, single-blind, randomised controlled trial was conducted across two study sites in England. Participants were recruited via 16 patient identification centres, two study sites in England (Nottingham and London), or online self-referral. Eligible participants were aged 9–17 years, had Tourette syndrome or chronic tic disorder, had not received behavioural therapy for tics in the past 12 months or were about to start, and had a Yale Global Tic Severity Scale (YGTSS) Total Tic Severity Score (TTSS) of more than 15 or more than 10 if they had only motor or vocal tics. Patients were excluded if they had started or stopped medication for tics within the past 2 months; had current alcohol or substance dependence, psychosis, suicidality, anorexia nervosa, or suspected moderate to severe intellectual disability; or presented an immediate risk to self or others; or the parent or carer was unable to speak, read, or write in English. Eligible patients were randomly assigned (1:1) by masked outcome assessors to receive 10 weeks of online, remotely delivered, therapist-supported ERP or psychoeducation (active control). Outcome assessors, statisticians, health economists, the trial manager, and the chief investigator were masked to group allocation. Patients were not directly informed of their allocation, but this could be established from the content once treatment commenced and the patients were not, therefore, considered masked to treatment. The primary outcome was YGTSS-TTSS 3 months after randomisation, and analysis was done in all randomised patients for whom data were available for each timepoint and outcome. Safety analysis was by intention to treat. Longer term follow-up is ongoing. This trial is registered with ISRCTN (ISRCTN70758207) and ClinicalTrials.gov (NCT03483493).FindingsBetween May 8, 2018, and Sept 30, 2019, we assessed 445 candidates for inclusion in the study. 221 potential participants were excluded (90 did not meet inclusion criteria, 84 declined to participate, and 47 unable to contact family). 224 participants were enrolled and randomly assigned to ERP (n=112) or psychoeducation (n=112). The enrolled patients were mostly male (n=177; 79%) and of White ethnicity (n=195; 87%). 11 patients were lost to follow-up 3 months after randomisation in the ERP group, compared with 12 patients in the psychoeducation group. Mean YGTSS-TTSS at 3 months after randomisation was 23·9 (SD 8·2) in the ERP group and 26·8 (7·3) in the psychoeducation group. The mean total decrease in YGTSS-TTSS at 3 months was 4·5 (16%, SD 1·1) in the ERP group versus 1·6 (6%, 1·0) in the psychoeducation group. The estimated mean difference in YGTSS-TTSS change between the groups adjusted for baseline and site was –2·29 points (95% CI –3·86 to –0·71) in favour of ERP, with an effect size of –0·31 (95% CI –0·52 to –0·10). Two serious adverse events occurred (one collapse and one tic attack), both in the psychoeducation group, neither of which were related to study treatment.InterpretationERP is an effective behavioural therapy for tics. Remotely delivered, online ERP with minimal therapist contact time represents an efficient public mental health approach to improve access to behavioural therapy for tics in children and adolescents.FundingNational Institute for Health Research and Health and Technology Assessment.

Factors contributing to emotional distress in Sierra Leone: a socio-ecological analysis

BackgroundThere is increasing global evidence that mental health is strongly determined by social, economic and environmental factors, and that strategic action in these areas has considerable potential for improving mental health and preventing and alleviating mental disorders. Prevention and promotion activities in mental health must address the needs prioritised by local actors. The aim of this study was to identify stressors with the potential to influence emotional wellbeing and distress within the general population of Sierra Leone, in order to contribute to an inter-sectoral public mental health approach to improving mental health within the country.MethodologyRespondents were a convenience sample of 153 respondents (60 women, 93 men) from five districts of Sierra Leone. Using freelisting methodology, respondents were asked to respond to the open question ‘What kind of problems do women/men have in your community?’. Data analysis involved consolidation of elicited problems into a single list. These were then organised thematically using an adaptation of the socio-ecological model, facilitating exploration of the interactions between problems at individual, family, community and societal levelsResultsOverall, respondents located problems predominantly at community and societal levels. Although few respondents identified individual-level issues, they frequently described how problems at other levels contributed to physical health difficulties and emotional distress. Women identified significantly more problems at the family level than men, particularly related to relationships with an intimate partner. Men identified significantly more problems at the societal level than women, primarily related to lack of infrastructure. Men and women were equally focused on problems related to poverty and lack of income generating opportunities.ConclusionPoverty and inability to earn an income underpinned many of the problems described at individual, family and community level. Actions to address livelihoods, together with improving infrastructure and addressing gender norms which are harmful to both men and women, are likely key to improving the wellbeing of the Sierra Leone population.

Strengthening of district mental health services in Gauteng Province, South Africa.

In response to the Life Esidimeni tragedy, the Gauteng Department of Health established a task team to advise on the implementation of the Health Ombud's recommendations and to develop a mental health recovery plan. Consistent with international human rights and South African legislation and policy, the plan focused on making mental healthcare more accessible, incorporating a strategy to strengthen district mental health services to deliver community-based care for people with any type and severity of mental illness. The strategy included an organogram with three new human resource teams integrated into the district health system: a district specialist mental health team to develop a public mental health approach, a clinical community psychiatry team for service delivery, and a team to support non-governmental organisation governance. This article discusses the strategy in terms of guiding policies and legislation, the roles and responsibilities of the various teams in the proposed organogram, and its sustainability.

The Need for a Public Mental Health Approach to COVID-19

Mental disorder is responsible for at least 20% of global disease burden which COVID-19 is likely to increase. Effective public mental health (PMH) interventions exist to treat mental disorder, prevent associated impacts, prevent mental disorder from arising and promote mental wellbeing. However, implementation is poor with only a minority with mental disorder receiving treatment even in high-income countries, far fewer receiving interventions to prevent associated impacts, and negligible coverage of interventions to prevent mental disorder or promote mental wellbeing. There is an urgent need to address this implementation failure which contravenes the right to health, results in broad population scale impacts and preventable suffering, and is further amplified by COVID-19. PMH practice including during COVID-19 can prepare for and address the implementation gap in the following ways: assessment of size, impact, and cost of the current and future PMH intervention implementation gap taking into account COVID-19; estimation of impact and associated economic returns from improved coverage of PMH interventions; use of this information to inform national policy and transparent decisions about acceptable levels of national coverage of different PMH interventions which then informs level of provision, required resource and commissioning; operationalization of intervention implementation nationally and locally; evaluation of coverage and outcomes; and communication to the population and different professional groups. Coverage of PMH interventions can be increased including during quarantine/lockdown through appropriate professional training, improving population knowledge, digital technology, settings and integrated approaches, maximizing existing resources and application of relevant legislation. PMH practice should be an integral part of the response to COVID-19.

Prevalence and sociodemographic correlates of common mental disorders among first-year university students in post-apartheid South Africa: implications for a public mental health approach to student wellness

BackgroundThere is growing awareness of the need for effective prevention, early detection, and novel treatment approaches for common mental disorders (CMDs) among university students. Reliable epidemiological data on prevalence and correlates are the cornerstones of planning and implementing effective health services and adopting a public health approach to student wellness. Yet, there is a comparative lack of sound psychiatric epidemiological studies on CMDs among university students in low- and middle-income countries, like South Africa (SA). It is also unclear if historically marginalised groups of students are at increased risk for mental health problems in post-apartheid SA. The objective of the study was to investigate the prevalence and sociodemographic correlates of lifetime and 12-month CMDs among university students in SA, with a particular focus on vulnerability among students in historically excluded and marginalised segments of the population.MethodsData were collected via self-report measures in an online survey of first-year students registered at two large universities (n = 1402). CMDs were assessed with previously-validated screening scales. Data were weighted and analysed using multivariate statistical methods.ResultsA total of 38.5% of respondents reported at least one lifetime CMD, the most common being major depressive disorder (24.7%). Twelve-month prevalence of any CMD was 31.5%, with generalised anxiety disorder being the most common (20.8%). The median age of onset for any disorder was 15 years. The median proportional annual persistence of any disorder was 80.0%. Female students, students who reported an atypical sexual orientation, and students with disabilities were at significantly higher risk of any lifetime or 12-month disorder. Female gender, atypical sexual orientation, and disability were associated with elevated risk of internalising disorders, whereas male gender, identifying as White, and reporting an atypical sexual orientation were associated with elevated risk of externalising disorders. Older age, atypical sexual orientation, and disability were associated with elevated risk of bipolar spectrum disorder.ConclusionsDespite advances to promote greater social inclusion in post-apartheid SA, students who identify as female, students with atypical sexual orientations, and students with disabilities are nonetheless at increased risk of CMDs, although students who identify as Black and first-generation students are not.

Improving Public Mental Health: Four Secrets in Plain Sight

Back to table of contents Previous article Next article From the ExpertsFull AccessImproving Public Mental Health: Four Secrets in Plain SightLloyd Sederer,M.D.Lloyd Sederer,Search for more papers by this authorM.D.Published Online:13 Dec 2016https://doi.org/10.1176/appi.pn.2016.12b2AbstractWe read about 40 million Americans affected by mental health problems every year. That means if you walk into a room with five or more people, on average one of them will have an active mental condition impacting their functioning and eroding the quality of their life and that of their family. We know too that more than half of people in “psychological distress” (a term used in public health surveys) do not seek care, and of those who do try to access a psychiatrist or mental health clinician, they find that it is daunting, difficult, and often too expensive in terms of money and time. Concerns about being labeled mentally ill and the discrimination that ensues further impede seeking help.What might be a public mental health approach to improving the emotional status of this country? What population-based approach could address broad groups of people and provide prevention, disease mitigation, and even healing (or recovery)? There are four ways we can do so, hiding in plain sight. They are universal in their application: they are not just for people with serious mental conditions (including bipolar disorder, major depression, and posttraumatic stress disorder [PTSD]—though they are for these conditions as well). In fact, these four secrets are actions that the vast majority of people in emotional distress as well as those with a variety of illnesses (mental, substance use, and chronic physical illnesses) can take—with no new money from state or federal treasuries or out of pocket either. These are ways to serve those who will not and cannot seek professional services—or to guide them if they do. These foundational ideas and actions stand to reduce disease incidence, social and economic burden, and suffering. These are the four secrets: Behavior serves a purpose. Often behaviors we see as self-defeating, as destructive, as “crazy,” or as simply inexplicable are the result of our not understanding that these behaviors serve a purpose—not very well, but the best a person has developed so far. The power of attachment. We know that human relationships and support are among the greatest protective factors against human distress and disease development. Relationships are the royal road to remedying human suffering—both individual and collective. As a rule, less is more. Primum non nocere—first, do no harm—is the first law of medicine. With this secret in mind, we can reduce treatment complications and mitigate the progression of some diseases in behavioral health care because good treatment will have had its chance. Chronic stress is the enemy. This is perhaps the most important and universal secret of all. From adverse childhood experiences (such as trauma and neglect) to depression, diabetes, autoimmune diseases, and PTSD, chronic stress can be an underlying and powerful factor in the development and worsening of many mental (and physical) disorders. As a public health doctor for over 14 years, these “secrets” became clear to me when I started to ask the right questions about what we all can do now that will make a difference. We have at our command four secrets to improving public mental health. They are there for us to see and to use. They don’t require prior approval from an insurance company. They don’t require a prescription. And yet they are all ways to better manage our lives, our health, and our health care. ■Lloyd I. Sederer, M.D., is an adjunct professor at the Columbia University Mailman School of Public Health, chief medical officer of the New York State Office of Mental Health, and medical editor for mental health for the Huffington Post. He is the author of Improving Mental Health: Four Secrets in Plain Sight from APA Publishing. Members can purchase the book at a discount. ISSUES NewArchived

A public mental health approach in humanitarian settings is worthy of consideration, with evidence.

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Mental health and psychosocial support in humanitarian settings: a public mental health perspective.

To discuss the potential usefulness of a public health approach for 'mental health and psychosocial support' (MHPSS) interventions in humanitarian settings. Building on public mental health terminology in accordance with recent literature on this topic and considering existing international consensus guidelines on MHPSS interventions in humanitarian settings, this paper reflects on the relevance of the language of promotion and prevention for supporting the rationale, design and evaluation of interventions, with a particular focus on populations affected by disasters and conflicts in low- and middle-income countries. A public mental health approach and associated terminology can form a useful framework in the design and evaluation of MHPSS interventions, and may contribute to reducing a divisive split between 'mental health' and 'psychosocial' practice in the humanitarian field. Many of the most commonly implemented MHPSS interventions in humanitarian settings can be described in terms of promotion and prevention terminology. The use of a common terminology across health, protection, education, nutrition and other relevant sectors providing humanitarian interventions has the potential to allow for integration of MHPSS activities in one overall framework, with diverse humanitarian practitioners working to achieve a common goal.

The effectiveness of public mental health policies: stressing the return on investment.

In recent years, public mental health has become an essential part of mental health, as convincingly pointed out in the paper by K. Wahlbeck (1). Public mental health is conceived as a theoretical framework, as an academic field or medical discipline, or as an integral part of health service provision. This conceptual flexibility contributes both to the strengths and to the weaknesses of the public mental health approach.

Applied public mental health: bridging the gap between evidence and clinical practice.

Applied public mental health: bridging the gap between evidence and clinical practice.

Are we training our psychiatrists adequately as public mental health practitioners?

No abstract available.

School‐based intervention for prevention and treatment of elementary‐students' terror‐related distress in Israel: A quasi‐randomized controlled trial

A school-based intervention for preventing and reducing children's posttraumatic stress-related symptoms, somatic complaints, functional impairment, and anxiety due to exposure to terrorism was evaluated. In a quasi-randomized controlled trial, elementary school students were randomly assigned to an eight-session structured program, "Overshadowing the Threat of Terrorism" or to a waiting list control comparison group. Two months postintervention, the study group reported significant improvement on all measures. The authors conclude that a school-based universal intervention may significantly reduce posttraumatic stress disorder- (PTSD-) related symptoms in children repeatedly exposed to terrorist attacks and propose that it serve as a component of a public mental health approach dealing with children exposed to ongoing terrorism in a country ravaged by war and terrorism.

A Dynamic Model for Wellbeing

This paper presents a public health model of mental health which places wellbeing at its centre and illustrates how wellbeing is influenced by the inter-relationship between risk, protective and environmental factors. This model should encourage a more comprehensive approach to wellbeing promotion and will assist in developing appropriate mental health public health initiatives. The model considers how different social and individual risk factors impact negatively upon mental health and how these risk factors can be addressed. It explores the need for active development of protective factors in order to increase an individual's resilience to deal with stresses of life and the additional input required to promote resilience in those with existing mental health problems. This approach to wellbeing balances addressing risk factors with promoting protective factors and uses a public mental health approach to wellbeing promotion within particular settings and the wider environment, supported by both local-level and regional policy. It also suggests that considerable economic savings could be achieved by implementing such integrated management programmes.

A 15-year open study on a cohort of West-African out-patients with a chronic psychosis

We wanted to find out if the additional costs of depot neuroleptic in comparison to oral medication was justified by a decrease in admission days. An open study on a cohort of chronic psychotic out-patients (n=45) consisting of a retrospective 10-year period on oral medication followed by a prospective 5-year period of treatment with haloperidol decanoate. After recording socio-demographic characteristics and a DSM-III-R diagnosis, patients were assessed before and after the administration of depot neuroleptic with the BPRS, the NOSIE, the SDRS and a list of side effects. A semi-structured interview was conducted with the patients and their families to ask about the change in social relationships with family members and other people after starting the depot treatment. Social intervention was limited to involvement of the family in the monthly depot medication outpatient clinic and to an explanation of the rationale of follow-up treatment and deinstitutionalisation of psychiatric care in the village of origin. The number of admission days decreased from an average of 100 days a year on oral medication to 5 days a year on depot neuroleptic. Patients report a sharp decrease in symptoms paralleled by an increase in social functioning over the first 3 months. After 6-9 months this pattern stabilised and was maintained over the period from 1 to 5 years whereas the dosage was further decreased to an average of 1 cc decanoate or 20 haldol equivalents monthly. This study suggests that depot neuroleptic in the context of a public mental health approach is a highly effective and feasible treatment for West African patients suffering from a chronic functional psychosis.