Mental Health System Reform Research Articles

JA ImpleMENTAL Implementing the Belgian Best Practice on Community Mental Health system Reform

Abstract Mental health challenges affect more than one in six people across the EU. In order to support Member States to proceed with mental health care system transformation and suicide prevention JA ImpleMENTAL, was initiated on the request of Member States, on October 2021 under the European Union 3rd Health Program. The JA consists of 39 organizations from 21 countries, more than 180 persons are working. Two advisory bodies support the consortium and provide their insights and expertise, a stakeholder forum with 10 key European Organizations in Mental Health including EUPHA Mental Health Section and WHO Europe and OECD, and the Member State Policy Committee which ensures the involvement of ministries and enables the practices to be embedded in health systems. Within the 11 countries implementing pilots under the Belgium model using a common Implementation Strategy, a total 163 activities are implemented under the 5 following key areas: 62 on structural measures needed for the establishment of local networks promoting a user’s centered, human’s right based recovery approach, 43 for the development and/or transformation of mental health services, 22 on training & capacity building in support of the reform and cultural change, 22 on continuous communication, information and awareness raising, and 13 on data collection, monitoring and evaluation. An analysis of MS pilot action plans shows that most service transformation efforts have concentrated on: defining care pathways for people at risk and for those with mild to severe mental health conditions including smooth transition from child and adolescent to Adult Mental Health services, as well as from inpatient to community services, the nomination of case managers for assisting individuals to their recovery process the development of individual service plans, the Involvement of users in various layers of service delivery including peer support and the provision of assertive treatment through mobile units.

COVID-19 Pandemic Lessons for Creating Effective Mental Health Safety Nets in Lower Middle-Income Countries.

The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to mental health globally, particularly in low- and middle-income countries (LMICs) such as Pakistan. This narrative review aims to synthesize the literature on the impact of the pandemic on mental health in LMICs, the challenges and opportunities for mental health system reform, and the role of safety nets in promoting mental health.A comprehensive search was conducted in several electronic databases, resulting in 35 articles being included for review. Data were extracted and analyzed to identify key themes and trends.The COVID-19 pandemic has led to a significant increase in the prevalence of mental health problems in LMICs, particularly anxiety and depression. This burden is disproportionately borne by vulnerable populations, including women, front-line workers, and those living in poverty. The pandemic has highlighted pre-existing weaknesses in mental health systems in LMICs, including inadequate funding, lack of trained mental health professionals, and stigmatization of mental illness. However, it has also presented opportunities for reform, such as increased awareness and political will, and the use of technology to expand access to mental health services. Building effective safety nets, including social protection programs and community-based interventions, can promote mental health and address social determinants of mental illness.The COVID-19 pandemic has underscored the urgent need for mental health system reform and the development of effective safety nets in LMICs. Policymakers should prioritize investment in mental health and address the social determinants of mental illness to build more resilient societies.

Towards Youth Mental Health System Reform: An Evaluation of Participatory Systems Modelling in the Australian Capital Territory

Australia’s mental health system is failing young people. Calls for accountability, strategic long-term policy planning, and regional leadership have been identified as solutions to guide mental health reform. Developing system dynamics models using a participatory approach (participatory systems modelling (PSM)) is recognized as a useful method that can support decision-making for strategic reform. This paper reports evaluation findings of a youth mental health PSM process conducted in the Australian Capital Territory (ACT). Baseline and follow-up mixed-methods evaluation data were collected in 2022 across diverse stakeholder groups to investigate the feasibility, value, impact, and sustainability of PSM. Although youth mental health system reform was viewed as desirable and a necessity across all stakeholder groups, shared perceptions of disabling powerless was observed regarding their ability to influence current decision-making processes to improve the youth mental health system. This suggests greater accountability is required to support systemic reform in youth mental health. PSM offers promise in improving transparency and accountability of decision-making for youth mental health, as exemplified in the ACT. However, more support and time are required to facilitate transformational change. Future research should investigate empowerment strategies to complement the implementation of findings from dynamic models developed through PSM, as well as the effectiveness of regional youth mental health policy decision-making supported by systems modelling.

“These are people just like us who can work”: Overcoming clinical resistance and shifting views in the implementation of Individual Placement and Support (IPS)

PurposeIndividual Placement and Support (IPS) is a recovery-based approach to support people with mental health difficulties back into employment. Embedding of IPS within the mental health Multi-Disciplinary Team (MDT) is a key component of IPS fidelity; however, few studies have examined how those involved with IPS implementation navigate this process. This article explores how IPS Employment Specialists (ES) and Occupational Therapist (OT) Managers integrated and embedded IPS within traditionally-oriented MDTs as part of a national reform program in the Republic of Ireland.MethodsThe study design was qualitative, descriptive with data collected through three focus groups with 17 IPS ESs and 11 OT Managers. Data were analyzed using thematic synthesis.ResultsThree key themes emerged from analysis. The first characterizes the context into which IPS landed, described as one marked by clinical resistance, doubt, and fear of risk. The second explores the strategies and factors that helped with the introduction of IPS into Irish mental health services. These included strategies, such as providing education and information about IPS and reassuring the MDT about IPS governance and IPS ES’ competencies. The evidenced-based nature of IPS and its attached accountabilities through IPS fidelity measures were perceived to be an important factor in its acceptance. The final theme encapsulates perceptions of how IPS impacted on the MDTs’ views of people with mental health difficulties. Findings suggest a shift in the ways in which MDTs view their clients. Initial fears about work capacity and risk shifted towards seeing people beyond the label of ‘service user’ and their diagnosis.ConclusionsIt is contended that IPS is an approach that allows practitioners to engage with real recovery-practice and may be one key to unlocking how a recovery approach can truly trickle down and embed itself within mental health service provision and support mental health system reform.

Personal Experience, Involvement and Activism for the Reform of Uganda's Mental Health System.

This Fresh Focus commentary describes the author's grassroots perspective on and advocacy efforts to bring about change within the mental health system in Uganda. The essay draws on personal narrative, first-hand description of human rights violations, grassroots efforts to bring about change through legal advocacy and development of peer support and service user leadership initiatives, and ultimately charts a course for deeper change.

Applying the national mental health policy in conflict-affected regions: towards better social inclusion (Ukrainian case)

PurposeThe ongoing armed conflict in Ukraine has had wide-ranging health, social and economic consequences for the civilian population. It has emphasised the need for comprehensive and sustainable reform of the Ukrainian mental health system. The Ukrainian Government has approved a vision for national mental health reform. This study aims to draw on the lessons of mental health reform in other conflict-affected settings to identify areas of priority for applying the national mental health policy in conflict-affected regions in the direction of better social inclusion of people with mental health conditions (Donetsk and Luhansk regions, directly affected by the conflict).Design/methodology/approachA literature review was conducted to identify lessons from implementing mental health reform in other conflict-affected settings. Findings were summarized, and best practices were applied to the national and regional policy context.FindingsThe literature described emergencies as an opportunity to build sustainable mental health systems. A systematic and long-term view for reform is required to capitalise on this opportunity. For better social inclusion, implementation of the concept for mental health and mental health action plans in Donetsk and Luhansk regions should prioritise raising mental health awareness and reducing stigma; developing the capacity of local authorities in the development and coordination of services; tailoring mental health service provision according to the availability of services and population need; targeting the needs of particularly vulnerable groups and embedding the activities of humanitarian actors in local care pathways.Research limitations/implicationsThis study summarises the literature on mental health reform in conflict-affected settings and applies key findings to Eastern Ukraine. This study has drawn on various sources, including peer-reviewed journals and grey literature and made several practical recommendations. Nevertheless, potentially relevant information could have been contained in sources that were excluded based on their publication in another language (i.e. not in English). Indeed, while the included studies provided rich examples of mental health reform implemented in conflict-affected settings, further research is required to better understand the mechanisms for effecting sustainable mental health reform in conflict-affected settingsOriginality/valueThe paper describes opportunities for developing a local community-based mental health-care system in Ukraine, despite the devastating effects of the ongoing war.

Hrayr Terzian (1925-1988): a life between experimental neurophysiology and clinical neurology.

This article provides a biographic and scientific profile of prof. Hrayr Terzian (Addis Abeba 1925-Verona 1988). In 1966, Terzian was appointed professor of the clinic of nervous and mental diseases in Cagliari, and in 1970 moved to Verona, where until his death he led the Neurology Clinic serving as the first rector of the local university. As a close friend of the psychiatrist Franco Basaglia (1924-1980), Terzian contributed to the reform of the Italian mental health system. His interests and scientific contributions were extremely broad. He was the first to describe the electroencephalographic changes induced by the antipsychotic chlorpromazine and, together with Henri Gastaut (1915-1995) and his wife Yvette, to describe the rolandic arched ("mu") rhythm. He contributed to elucidate the inhibitory mechanisms of the cerebellum on the antigravity postural tone and provided the first description of Klüver-Bucy syndrome in humans. Always attentive to the social and political aspects of medical practice, prof. Terzian achieved outstanding results both in experimental neurophysiology and in clinical neurology. Besides offering a tribute to Hrayr Terzian, this article provides a brief historical overview of the different clinical pictures caused by bilateral temporal lesions: from the first animal observations by Sanger Brown (1852-1928) and sir Edward Albert Sharpey-Schäfer (1850-1935), later confirmed and expanded upon by Heinrich Klüver (1897-1979) and Paul C. Bucy (1904-1992), to the first cases of bitemporal lesions in humans, including that of the famous patient H.M. (Henry Gustav Molaison, 1926-2008).

‘Unknowing’ and mental health system reform in Palestine

In this Think Piece we argue that mental health system reforms are not mainly driven by scientific evidence and international standards, but rather by concrete political constellations, national and international development agendas, local and global socioeconomic contexts, and the interactions between differently positioned actors. We further argue that these forces gain their influence not by being openly discussed, but precisely because they are rendered invisible and turned into what Geissler (2013) calls ‘unknown knowns’. To illustrate these complex processes, we present a case study that examines how mental health system reform processes in the West Bank are shaped by the Israeli occupation, particular political events, and unequal power relations between international and local institutional actors. Furthermore, we present critical reflections by mental health providers related to these processes, and their visions for a more sustainable mental health system. We end with an appeal to aid providers to stop characterising their work with abstract catchphrases such as ‘evidence-based’ or ‘best practice’, and call on them to be transparent about how political, economic, and social contexts shape their work on the ground.

Towards mental health friendly cities during and after COVID-19

ABSTRACT COVID-19 and the resultant stringent control measures have increased social isolation, loneliness, and domestic violence, and generated feelings of uncertainty, fear, anxiety, and hopelessness. Over the past two years, citiesRISE, a global platform that engages youth leadership in mental health system reform, has developed a holistic model for youth mental health and operationalized it through the Mental Health Friendly Cities (MHFC) framework. Using this framework, we surveyed youth from the five cities early in the COVID-19 pandemic, and identified critical needs, based on which we recommend research and programming priorities towards post-COVID-19 Mental Health Friendly Cities.

Massachusetts Senate sees opportunity for true reform of mental health system

The Massachusetts state Senate this month unanimously approved comprehensive legislation that leading proponents consider a first step toward true system reform in the state. One particular target of the legislation is a long‐standing promise of insurance parity protections that advocates say has gone largely unrealized.

Mental Health System Reform in Contexts of Humanitarian Emergencies: Toward a Theory of \u201cPractice-Based Evidence\u201d

Humanitarian emergencies such as armed conflicts are increasingly perceived as opportunities to improve mental health systems in fragile states. Research has been conducted into what building blocks are required to reform mental health systems in states emerging from wars and into the barriers to reform. What is less well known is what work and activities are actually performed when mental health systems in war-affected resource-poor countries are reformed. Questions that remain unanswered are: What is it that international humanitarian aid workers and local experts do on the ground? What are the actual activities they perform in order to enable and sustain system reform? This article begins to answer these questions through ethnographic case studies of mental health system reform in Kosovo and Palestine. Based on the findings, a theory of “practice-based evidence” is developed. Practice-based evidence assumes that knowledge is derived from practice, rather than the other way around where practice is believed to be informed by systematic evidence. It is argued that a focus on practice rather than evidence can improving system reform processes as well as the provision of mental health care in a way that is sensitive to local contexts, structural realities, culture, and history.

Field weighs in on Trump's call to bring back mental health institutions

More than 50 years ago, President John F. Kennedy signed the Community Mental Health Centers Act of 1963, which provided $150 million for new mental health center programs and a reform of this country's mental health system. People were no longer confined to institutions, and programs were available for them to be a part of the community.

Assessing the need for a mental health services reform in Moldova: a situation analysis

BackgroundThis study describes the Moldovan mental health system and reform needs before and during the initial phase of the MENSANA project (2014–2022) over the period 2007–2017.MethodsA situation analysis was performed on: (1) the comparative need based on a country comparison using publicly available mental health system data; (2) the normative need based on a document review comparing the Moldovan mental health services structure with the norms of the WHO on the ideal mix of services, and a content analysis of interview and survey data from professionals (n = 93); (3) the felt need based on a content analysis of survey data from service users and carers (n = 52).ResultsThe main finding from the comparative analysis is that mental health care remains largely institutionalized with little alternative care options in the community. Moldova has large mental hospitals and a high number of psychiatric beds per 100.000 population (59.8) in comparison with the South-eastern European Health Network and EU15 average in 2014 (47.63 and 36.61). The country also shows an inversion of the ideal mix of services. This points to the potential need for a mental health system reform which was confirmed by the perspectives of the professionals, service users and carers. The majority of respondents favour a mental services reform (82.8% of the professionals and 92.3% of the care recipients) and express numerous issues and reform needs with the most frequently mentioned being the need to: (1) reintegrate service users in society, community and family; (2) deinstitutionalise and implement CBMHS; (3) improve the accessibility and quality of services, and; and 4) address health workforce issues.ConclusionAll three types of need explored in the situation analysis (e.g. comparative, normative and felt) point towards the necessity to reform the mental health system in Moldova. However, it is emphasized that this will only materialize when underlying socio-economic challenges that both constrain the implementation of community-based mental health services and foster the dependence of people with a mental illness on inpatient services are addressed.

A Call for Better Data to Guide ACT Policy and Programs

A Call for Better Data to Guide ACT Policy and Programs

Lebanon: mental health system reform and the Syrian crisis.

The Lebanese Ministry of Public Health has launched a National Mental Health Programme, which in turn has established the Mental Health and Substance Use Strategy for Lebanon 2015-2020. In parallel, research involving refugees has been conducted since the onset of the Syrian crisis. The findings point to an increase in mental health disorders in the Syrian refugee population, which now numbers more than 1 million.

NYC First Lady Describes Ambitious Plan to Improve City’s Mental Health Care

Back to table of contents Previous article Next article Professional NewsFull AccessNYC First Lady Describes Ambitious Plan to Improve City’s Mental Health CareMark MoranMark MoranSearch for more papers by this authorPublished Online:13 Oct 2016https://doi.org/10.1176/appi.pn.2016.10b50AbstractChirlane McCray shares her family’s experience with mental illness and how the difficulty in finding care gave birth to the ThriveNYC program.“Our mental health moment is now,” said New York City First Lady Chirlane McCray in a passionate Opening Session address at APA’s fall meeting, IPS: The Mental Health Services Conference, held earlier this month in Washington, D.C.She said support for improving mental health access and services has never been stronger. “Across the country, communities large and small are coming together to shatter the stigma of mental illness and develop real solutions.” McCray, who received the APA Patient Advocacy Award from APA President Maria A. Oquendo, M.D., described ThriveNYC: Mental Health Roadmap, an ambitious program in New York City to improve access to care to citizens of New York City with mental illness. The program, a signature achievement of the First Lady’s, is founded on six principles as described on the ThriveNYC website.Change the culture: It’s time for New Yorkers to have an open conversation about mental health.Act early: New Yorkers need more tools to weather challenges and capitalize on opportunities. We can make that happen by investing in prevention and early intervention.Close treatment gaps: We can address disparities in care by providing New Yorkers in every neighborhood with care in their own communities. We will address not only gaps in access and availability, but in effectiveness and impact.Partner with communities: By embracing the wisdom and strength of local communities, we can collaborate to create effective and culturally competent solutions.Use better data: Better data mean better treatment, better policies, and better interventions.Strengthen government’s ability to lead: Your government has a responsibility to support mental health. We’re taking that seriously by serving as the clearinghouse to drive change.New York City First Lady Chirlane McCray describes the city’s plan to increase access to mental health care for its citizens earlier this month at the Opening Session of APA’s fall meeting, IPS: The Mental Health Services Conference.David HathcoxMcCray said that within those six principles, ThriveNYC encompasses 54 separate initiatives. “It’s our roadmap to changing the way people think about mental health and the way the city and its partners deliver services,” she said. “Our goal is to change the culture around mental health and approach it like physical health because people need to know that mental illness is treatable, and they can do something about it.”McCray especially emphasized the importance of advocacy and the growing consensus—across political lines—for fundamental mental health system reform. “Over the last months, I’ve traveled down to D.C. twice to speak with leaders about the need for federal action. And I’m pleased to note that we’re starting to see progress,” she said. “Secretary Hillary Clinton recently released a mental health policy agenda, which reflects many of the principles embedded in ThriveNYC. Needless to say, it is unprecedented for mental health to receive this kind of attention.”She also noted that “there is exciting bipartisan movement in Congress” around two versions of a mental health reform bill—the Helping Families in Mental Health Crisis Act of 2016 (HR 2646) and The Mental Health Reform Act of 2016 (S 2680).“I am eager to partner with all of you to push Washington to do right by the millions of Americans who have been touched by mental illness and substance misuse,” she said. McCray also spoke of her own family’s experience with mental illness when her 18-year-old daughter required treatment for depression, anxiety, and addiction. “Here was our child, in terrible pain. And I wished I could love her into wellness. But I didn’t know where to turn. … Thankfully, our family got lucky. We connected with wonderfully caring professionals and found enough of what we were looking for. I’m proud to say that our daughter is doing well and recently graduated from college. But even after our own family’s crisis subsided, I could not forget how difficult her journey was, and how difficult it must be for other families. … And that is how ThriveNYC was born.”In comments to Psychiatric News following her remarks, McCray said the single most important role psychiatrists can plan in assisting the goals of ThriveNYC is advocacy. “The APA has so much power.” ■ ISSUES NewArchived

House Approves Comprehensive Mental Health Reform Bill

House Approves Comprehensive Mental Health Reform Bill

Cambodia's Hidden Scars: Trauma Psychology in the Wake of the Khmer Rouge

This text explores the profound impact of war and genocide on human psychology with a focus on Cambodia and the work of the Extraordinary Chambers in the Courts of Cambodia (ECCC). Interdisciplinary in nature, this edited volume presents the current research on the impact of trauma not only on survivors' mental health processes but also on the ability of survivors to participate in legal processes, such as the trials of surviving members of the Khmer Rouge before the ECCC. Chapters address post-traumatic stress disorder and the inter-generational transmission of trauma, civil party participation and reparations, and gaps in Cambodia's mental health services. It closes with concrete proposals for reform of Cambodia's mental health system. Volume II, which adds chapters on the way in which mental health evidence been reflected in the jurisprudence of the ECCC, is forthcoming.

Senate Passes Two Bills Aimed at Mental Health System Reform

Senate Passes Two Bills Aimed at Mental Health System Reform

Institutionalization of deinstitutionalization: a cross-national analysis of mental health system reform.

BackgroundPolicies generate accountability in that they offer a standard against which government performance can be assessed. A central question of this study is whether ideological imprint left by policy is realized in the time following its adoption. National mental health policy expressly promotes the notion of deinstitutionalization, which mandates that individuals be cared for in the community rather than in institutional environments.MethodsWe investigate whether mental health policy adoption induced a transformation in the structure of mental health systems, namely psychiatric beds, using panel data on 193 countries between 2001 and 2011.ResultsOur striking regression results demonstrate that late-adopters of mental health policy are more likely to reduce psychiatric beds in mental hospitals and other biomedical settings than innovators, whereas they are less likely than non-adopters to reduce psychiatric beds in general hospitals.ConclusionsIt can be inferred late adopters are motivated to implement deinstitutionalization for technical efficiency rather than social legitimacy reasons.Electronic supplementary materialThe online version of this article (doi:10.1186/1752-4458-8-47) contains supplementary material, which is available to authorized users.