Illness Services Research Articles

HIV Infection in Attendees of Psychiatric Clinics in Harare, Zimbabwe; Prevalence, Associated Factors and HIV Care Uptake.

Determination of HIV prevalence among people with mental illness is necessary for developing integrated services for HIV and mental illness. This study determined HIV prevalence and uptake of HIV care among outpatients of psychiatric hospitals in Harare, Zimbabwe. HIV status was determined using open testing of 270 randomly selected consenting adult outpatients. HIV prevalence was 14.4% and the risk of acquiring HIV was similar to the general population of adults in Zimbabwe. Females were six times more likely to have HIV infection than males. Although a relatively high proportion of patients had been tested for HIV in the past (77.2%), fewer were recently tested (27.8%). Access to HIV care was high (94%) amongst patients previously diagnosed to be HIV positive. Tertiary mental health services should offer similar HIV care packages as other points of care and there is need for interventions that reduce the risk of HIV in women with mental disorders.

Predictors of help-seeking in unemployed people with mental health problems.

Unemployment and mental ill health often contribute to each other and lead to social exclusion with negative consequences for individuals and society. Yet, unemployed people with mental health problems often do not seek care. The aim of this study was to assess predictors of help-seeking among unemployed people with mental health problems. At baseline, 301 unemployed participants with mental health problems reported potential predictors of help-seeking in terms of mental health literacy, perceived barriers to care, self-concept as having a mental illness and current mental health service use. At 6-month follow-up, 240 participants reported whether or not they had started new mental health treatment since baseline. Adjusted for symptoms, sociodemographic and work-related variables, help-seeking was predicted by previous mental health service use and by fewer non-stigma-related barriers, not by stigma-related barriers. Implications for interventions to increase help-seeking among this vulnerable group are discussed.

Experiences of Children Undergoing Dental Treatment under General Anesthesia: A Qualitative Study in Canada

With the current move in childhood medicine away from a disease-centered approach to a child-centered approach, an interest in involving children in all aspects of their medical care has emerged. This requires healthcare providers to listen to children’s (and families’) opinions regarding illness, treatment, and health services. Dental treatment under general anesthesia (DTGA) is a common yet problematic (due to cost and safety concerns) approach for managing severe dental caries in children. The purpose of this qualitative inquiry was to explore children’s and caregivers’ experiences of having DTGA, with a focus on emotional and psychological impacts of DTGA from the child’s perspective. …

The governance of primary mental health planning by Primary Health Networks

AbstractThe establishment of Primary Health Networks (PHNs) was accompanied by assignment of responsibility for funding for primary mental healthcare. To ensure this funding is spent in line with government priorities, the Federal government developed a planning document with established priorities and guidance documents for how the planning document should be completed. This paper examines how these documents shape service delivery through enabling some activities and excluding others and identifies the assumptions that underpin these documents. Data were drawn from discourse and content analysis of completed planning documents from the PHNs and of the guidance documents and from reflection upon mental health planning from 55 interviews with key personnel from six PHNs. Service delivery is shaped by outcome measures that promote service access, cost‐effectiveness and clinical effectiveness, contributing to service options that favour self‐management for mild mental illness and clinical (but not social) services for people with severe mental illness. There is also limited scope for mental health promotion with prevention activities focused upon populations identified by the government as being at‐risk. This occurs to the detriment of other at‐risk populations.

Residential Transience Among Adults: Prevalence, Characteristics, and Association with Mental Illness and Mental Health Service Use.

This study examined the association between frequent residential mobility (i.e., residential transience) and mental illness, mental health service use, and unmet need for services. Data are from the 2010 to 2014 National Surveys on Drug Use and Health (n = ~ 229,600). Logistic regression models examined the relationship between proximal (past year) and distal (past 2-5years) residential transience and past year any mental illness (AMI), serious mental illness (SMI), mental health service use among adults with mental illness, and unmet need for services. Adults with transience had greater odds of AMI and SMI than those without transience. Proximal and distal transience were unrelated to past year mental health service use among adults with mental illness, but the odds of unmet need for services were greater among adults with transience compared with those without, suggesting a level of unmet service need among those with transience.

Knowledge and Awareness Regarding Mental Health and Barriers to Seeking Psychiatric Consultation in Saudi Arabia

The Middle Eastern region, in general and Saudi Arabia, in specific, suffers from a large burden of mental illness. People’s positive attitudes and correct perceptions towards mental illness and their willingness to seek help when needed can help in reducing such burden. To determine the knowledge, attitudes and perceptions of the Saudi population toward mental illness and health services and to understand the barriers that affect the people’s willingness to seek psychiatric help when needed. A convenient sample of Saudi population of either sex was included in the study. A structured questionnaire was used to assess knowledge, attitudes and perceptions on mental health and the willingness to seek psychiatric help through multi-approach methods. Logistic regression was used to determine factors that were associated with not willing to seek psychiatric help, adjusting for other factors in the model. A total of 5644 participants (49.5% males) participated. About 87% were unaware about psychiatric services available in the kingdom, 85% reported that social factors were responsible for mental illnesses, about a quarter of them reported that they wouldn’t seek psychiatric help when needed and about half felt ashamed about it. Male gender, >20 years age group, not knowing whether a relative is suffering from mental illness and not knowing about the services provided by psychiatric health services in the kingdom were significantly associated with not willing to seek psychiatrist consultation when needed. A number of gaps were identified in the people’s knowledge about mental illness. Anti-stigma campaigns and evidence-based mental health educational programs should be implemented to enable people to reduce stigma and seek early mental health care.

Knowledge, attitude, and practice towards mental illness service provision and associated factors among health extension professionals in Addis Ababa, Ethiopia

BackgroundMental, neurological and substance use disorders are highly prevalent in Ethiopia which are known to result in substantial disability. Improving the knowledge, attitude and practice of the primary health care workers is important to reduce this problem. Hence, this study aimed at assessing knowledge, attitude, and practice towards mental illness service provision and associated factors among urban health extension professionals (UHEPs) of Addis Ababa City Administration.MethodsA cross sectional study design was used. Data was collected from 455 study participants using structured and pre-tested self-administered questionnaire and analyzed using SPSS version 20 software respectively. Multivariate logistic regression analysis was performed to identify variables which have significant association with the outcome variables. The level of significant association was determined by adjusted odds ratio (AOR) with 95% confidence interval.ResultsThis study showed that 44.0% of urban health extension professionals (UHEPs) had adequate knowledge, 93.4% did not have positive attitude and 75.2% had good practice towards mental illness. Age 30 years and above [adjusted odds ratio (AOR): 95% CI 0.55 (0.34, 0.90)], having diploma educational status [AOR 95% CI 0.49 (0.32, 0.78)], and personal history of mental illness [AOR 95% CI 0.10 (0.01, 0.89)] were found to have a negative association with knowledge. Presence of job aid (AOR 95% CI 4.30 (2.59, 7.15)) and having good knowledge (AOR 95% CI 0.52 (0.32, 0.85) were increased the practice of service provision of UHEPs.ConclusionLess than half of UHEPs had adequate knowledge, most had unfavorable attitude and about three-fourth of them had good practice. Presence of job aid and having good knowledge were increased the UHEPs practice of mental health service provision. Hence, providing refresher training to UHEPs and fully implementing the national mental health strategy as well as proper clinical supervision and support to improve behavioral change is vital.

Prevalence and predictors of airflow obstruction in an HIV tertiary care clinic in Montreal, Canada: a cross-sectional study.

ObjectivesThe reported prevalence of chronic obstructive pulmonary disease (COPD) in people living with HIV (PLWHIV) varies widely. Our objective was to estimate the prevalence of airflow obstruction and COPD in unselected PLWHIV and identify characteristics that increase the risk of nonreversible airflow obstruction in order to guide case finding strategies for COPD.MethodsAll adults attending the Chronic Viral Illness Service were invited to participate in the study, regardless of smoking status or history of known COPD/asthma. Individuals underwent spirometric testing both before and after use of a salbutamol bronchodilator. Airflow obstruction was defined as forced expiratory volume in 1 s (FEV 1)/forced vital capacity (FVC) < 0.7 post‐bronchodilation, whereas COPD was defined as FEV 1/FVC < 0.7 post‐bronchodilation and Medical Research Council (MRC) score > 2. Multivariate logistic regression was used to evaluate risk factors associated with airflow obstruction, reported as adjusted odds ratios (aORs).ResultsFive hundred and three participants successfully completed spirometry testing. The median (Q1; Q3) age was 52 (44; 58) years. The median (Q1; Q3) CD4 count was 598 (438; 784) cells/μL and the median (Q1; Q3) nadir CD4 count was 224 (121; 351) cells/μL. There were 119 (24%) current smokers and 145 (29%) former smokers. Among those screened, 54 (11%) had airflow obstruction whereas three (1%) of the participants had COPD. Factors that were associated with airflow obstruction included a history of smoking [aOR 2.2; 95% confidence interval (CI) 1.1; 4.7], older age (aOR 1.6; 95% CI 1.2; 2.2), and lower CD4 count (aOR 0.8; 95% CI 0.7; 1.0).ConclusionsAirflow obstruction was relatively uncommon. Our findings suggest that PLWHIV who are ≥50 years old, smokers and those with nadir CD4 counts ≤ 200 cells/μL could be targeted to undergo spirometry to diagnose chronic airflow obstruction.

Distribution and Correlates of Assertive Community Treatment (ACT) and ACT-Like Programs: Results From the 2015 N-MHSS.

The study examined the availability and characteristics of assertive community treatment (ACT) programs across mental health treatment facilities in the United States. Prevalence and correlates of facilities that reported offering ACT, broadly defined as intensive community services for serious mental illness provided by multidisciplinary teams in the clients' natural settings and including both ACT and "ACT-like" programs, were examined by using data from the National Mental Health Services Survey. Availability of services essential to the ACT model in these facilities was also examined. Of the 12,826 surveyed facilities, 13.4% reported offering ACT, with significant variability among states. Of the facilities with ACT, 19.2% reported offering all core ACT services. Few facilities offered peer support, employment, and housing services. Compared with programs at facilities that did not offer all core ACT services, facilities with ACT programs that offered these services had higher odds of being publicly owned (odds ratio [OR]=2.12, 95% confidence interval [CI]=1.64-2.74) and of receiving federal (OR=3.60, CI=2.17-5.98) or grant funding (OR=1.87, CI=1.45-2.41). Facilities with ACT that offered all core services also had higher odds of offering other services important to individuals with serious mental disorders. Substantial differences existed in availability of ACT and ACT-like programs among states, with evidence of a large unmet need overall, even when a very broad and inclusive definition of ACT was used. Few ACT programs offered all core services. Legislative, administrative, and funding differences may explain some of the variability.

Mental health treatment – Still a Stigma and Concern in the 21st Century Stigma to appear normal, Stigma to keep the family drama invisibleStigma to protect the family honor, Stigma to coerce yourself out of the need for help

People with mental disorders who live in low- and middle-income countries have low access to quality mental health care and are consequently vulnerable susceptible to suffering and incapacitation, human rights abuses, stigma and discrimination, impoverishment, and premature mortality. The more a mentally ill person feels stigmatized; the lower is their self-esteem, convivial adjustment, and quality of life. The aim of the review is to explore the stigma of mental illness and mental heath services in low and middle-income countries. A PubMed and open-access database literature search (English only) was performed using search strings: stigma of mental illness, Ghana's mental health system, community psychiatry in India, mental health awareness in Nigeria, psychiatric stigma and discrimination in South Africa, and stigma and community intervention. Mental health workforce in India is a shortfall of specialist and psychiatric social worker for mental illness; treatment is unavailable or inaccessible even for those who actively seek health care. In Ethiopia, mental health services coverage and financial auspice for people with mental disorders are constrained. In low- and middle-income countries, the causative agent for mental illness in the current decade is still supernatural power or agents and serves as a major barrier to the treatment. The interventions have the potential to reduce stigma in society at large with the appropriate planning and evaluation. Mental health is still a taboo, and no one acknowledges it. The review demonstrates an adaptation to utilize and participate in mental health care facilities remains a policy aspiration, which generally has not been translated into clinical practice.

Hepatitis C Prevalence and Management Among Patients Receiving Opioid Substitution Treatment in General Practice in Ireland: Baseline Data from a Feasibility Study.

BackgroundHepatitis C virus (HCV) infection is a major cause of chronic liver disease and death. Injection drug use is now one of the main routes of transmission of HCV in Ireland and globally with an estimated 80% new infections occurring among people who inject drugs (PWID).ObjectiveWe aimed to examine whether patients receiving opioid substitution therapy in primary care practices in Ireland were receiving guideline-adherent care regarding HCV screening. Ireland has developed a model of care for delivering opioid substitution treatment in the primary care setting. We conducted this study given the shift of providing care for PWID from secondary to primary care settings, in light of current guidelines aimed at scaling up interventions to reduce chronic HCV infection and associated mortality.MethodsWe included baseline data from the Dublin site of the Heplink study, a feasibility study focusing on developing complex interventions to enhance community-based HCV treatment and improve the HCV care pathway between primary and secondary care. We recruited 14 opioid substitution treatment-prescribing general practices that employed the administration of opioid substitution therapy from the professional networks and databases of members of the research consortium. A standardized nonprobability sampling framework was used to identify 10 patients from each practice to participate in the study. Patients were eligible if aged ≥18 years, on opioid substitution treatment, and attending the practice for any reason during the recruitment period. The baseline data were collected from the clinical records of participating patients. We collected and analyzed data on demographic characteristics, care processes and outcomes regarding HCV and other blood-borne viruses, urinalysis test results, alcohol use disorders, chronic illness, and health service utilization. We examined whether patients received care concordant with guidelines related to HCV screening and care.ResultsThe baseline data were collected from clinical records of 134 patients; 72.2% (96/134) were males; (mean age 43, SD 7.6; range 27-71 years); 94.8% (127/134) of patients had been tested for anti-HCV antibody in their lifetime; of those, 77.9% (99/127) tested positive. Then, 83.6% (112/134) of patients had received an HIV antibody test in their lifetime; of those, 6.3% (7/112) tested HIV positive. Moreover, 66.4% (89/134) of patients had been tested for hepatitis B virus in their lifetime and 8% (7/89) of those were positive. In the 12 months before the study, 30.6% (41/134) of patients were asked about their alcohol use by their general practitioner, 6.0% (8/134) received a brief intervention, and 2.2% (3/134) were referred to a specialist addiction or alcohol treatment service.ConclusionsWith general practice and primary care playing an increased role in HCV care, this study highlights the importance of prioritizing the development and evaluation of real-world clinical solutions that support patients from diagnosis to treatment completion.

Seeking Help for Mental Health Problems in Hong Kong: The Role of Family.

Family members, rather than mental health professionals, are often the first responders for emotional or mental problems, particularly in Chinese societies where family is regarded as the primary care unit. Using data from the third wave of a representative sample of Chinese adults in the Hong Kong Panel Study of Social Dynamics, we investigate how family, and particularly family functioning, is associated with individual mental health help seeking and perceived barriers to professional service use, and how the associations vary across different generations of immigrants and between individuals with high versus low psychological distress. Our results demonstrate that family is still the primary source of help sought for mental health problems. Stronger family functioning is particularly significant for second-generation immigrants when they consider seeking help from immediate family members. Seeking professional help is uncommon, and stronger family functioning is associated with a lower probability of seeking help from general health professionals and alternative services. A well-functioning family is related to certain structural and cultural barriers to seeking professional help, yet trust in professional mental health services does not diminish along with stronger family functioning, even among the high psychological distress subgroup. The findings indicate that family can facilitate mental illness prevention and service integration. It is recommended that appropriate family support and services be incorporated into mental health treatment according to clients' differential family circumstances.

Person-Centricity: Promoting Self-Determination and Responsibility in Health and Health Care.

The transition from a system focused on the delivery of sickness and illness services to one with a heavy focus of helping people become and remain healthier requires a major shift in how we view the patient and person. The health care system attempts to magically transform us from persons to patients in a context of sickness and disease, in need of medical procedures and interventions. Those few hours we spend a year in formal medical and health care contexts do not define us in the broader life space. We contend that "person-centricity" is more reflective of the life space and as such better supports that shift than do models of consumer or patient empowerment, centeredness, engagement, or activation. "Person-centricity" represents the complexity of how individuals make decisions including health and health care decisions, within the broader context of their lives, and accurately addresses the needs and aspirations of people throughout their life journey. This is not simply a shift in semantics, but an entirely new paradigm that frees the individual from assuming and succumbing to the passive and subservient patient role and dramatically changes the way in which we view ourselves and interact with the health care system.The changes required to create a healthier America and affect costs associated with lifestyle-related diseases need to happen on a personal level, coupled with a supportive infrastructure and public policies to promote and sustain them. This shift is critical to our transition from health care to a healthier way of living and of controlling avoidable costs.

“Healthcare as a refuge”: building a culture of care in Montreal for refugees and asylum-seekers living with HIV

PurposeBetween 2012 and 2016, the Government of Canada modified health insurance for refugees and asylum seekers. In Quebec, this resulted in refusals of care and uncertainties about publicly reimbursed services, despite guaranteed coverage for people with this status under the provincial plan. The Chronic Viral Illness Service (CVIS) at the McGill University Health Centre in Montreal continued to provide care to refugees and asylum seekers living with HIV. The purpose of this paper is to explain how and why challenges brought by this policy change could be overcome.Design/methodology/approachA qualitative case study was conducted using interviews with patients and staff members, observation sessions and a review of media, documents and articles. A discussion group validated the interpretation of preliminary results.FindingsThe CVIS provides patient-centered care through a multidisciplinary team. It collectively responds to medical, social and legal issues specific to refugees. Its organizational culture and expertise explain the sustained provision of care. The team’s empathetic view of patients, anchored in the service’s history, care for men who have sex with men and commitment to human rights, is key. A culture of care developed over time thanks to the commitment of exemplary figures. Because they countered the team’s values, changes in refugee healthcare coverage strengthened the service’s culture of care. However, the healthcare system reform launched in 2014 in Quebec is perceived as jeopardizing the culture of care, as it makes, refugee and asylum-seeker patients a non-lucrative venture for providers.Originality/valueThis research analyzes the origin of sustained provision of care to refugees and asylum seekers living with HIV through the lens of culture of care. It considers the historical and political contexts in which this culture developed.

Briefing: Politics, planning and health – an inconvenient truth

The prevailing public discourse about health – at least in the United Kingdom – is much more about illness and how to cope with it than health. It is about the crisis of the National Health (or illness) service and the related issue of social care. However, much research demonstrates that wellness is tied up with income, equality, lifestyle choices (diet and exercise) and environment. And there is powerful evidence that we are literally building unhealthy conditions into the environment. This paper does not provide all the evidence in a systematic way – that has been done very fully in other sources – but takes the theme of the urban environment and relates it back to political philosophy and forward to health and well-being, telling the stories of three contrasting cities.

Household ownership and utilization of insecticide-treated nets under the Regional Artemisinin Resistance Initiative in Myanmar

BackgroundMalaria is a major public health problem in Myanmar with reported artemisinin resistance. Myanmar promotes the use of insecticide-treated nets (ITNs) through the free delivery of long-lasting insecticide nets (LLINs) with target coverage of at least 80% in moderate and high-risk areas by 2014. Migrant people are at greater risk of malaria. They have significant barriers to health care services for febrile illness and malaria. Thus, a community-based survey was conducted among the migrant population to assess the ownership and utilization of bed nets (ITN/LLINs) for malaria.MethodsThe study analyzed secondary data from a community-based malaria survey conducted in 2014 among migrant population in 30 randomly selected townships out of 52 Regional Artemisinin Resistance Initiative (RAI) townships. In each township, five migrant sites were randomly selected (total of 150 migrant sites). A total of 3933 households (approximately 125 households from each township) were selected.ResultsOf 3923 households assessed, 97% had access to at least one bed net (any type), but only half had access to ITN/LLINs. Only 24% of households had adequate ITN/LLIN access (at least one ITN/LLIN per two persons). In terms of household utilization, 94.3% slept under a bed net (any type) the previous night. Only 43.4% slept under an ITN/LLIN. ITN/LLIN utilization in children under 5 years and pregnant women (high-malaria risk groups) was 45.3 and 46.6%, respectively. Of all nets, 31.3% had holes or had already undergone repairs. In terms of insecticide treatment status, 52.9% of bed nets were untreated and 35.9% of ITNs had not been treated with insecticide for more than a year.ConclusionThis study highlights poor access and high utilization of ITN/LLINs among migrant population, particularly among children and pregnant women. It highlights the need for improving bed net coverage and access to ITN/LLINs through bed net distributions and/or social marketing with the focus on migrant population and targeting of households with children and pregnant women.

Perceptions of mental health and mental health services among college students in Vietnam and the United States

The global burden of mental health disorders is a significant public health issue. One population that has a risk for mental health issues is college students. Little is known about perceptions of mental illness and mental health services among college students in Vietnam. The purpose of this study is to describe perceptions of mental illness and mental health services among college students in Vietnam, and to compare them with those in the United States (US). The cross-sectional data were collected using a self-administered survey from January to March in 2018 at a national university in Vietnam, and a state university in the US. The study revealed differences in perceptions of causes of mental health between Vietnamese and US participants. Vietnamese participants tended to believe that individuals with mental illness were dangerous and need to be kept out from the community, while US participants perceived that mental illnesses are the same as other illnesses. An important indicator of Vietnamese perceptions of mental health was the low likelihood of seeking formal help because of preference for seeking help from family or friends for mental illness. Interventions, such as mental health awareness campaigns or training courses should be provided for college students in Vietnam. Some strategies to improve mental health among college students used in the US may help to reduce stigma toward mental illness in Vietnam.

Psychosocial problems, chronic illness and welfare service utilization among elderly population in urban areas of Vijayapur, Karnataka

Background: Aging is a universal process. In India, the elderly account for 7.7% of the total population and the United Nations defines a country as “ageing” where the proportion of people over 60 years reaches 7.7%. Morbidity among elderly has an important influence on their physical functioning and psychological well-being. The objectives of the study were to assess the psychosocial problems associated with the elderly and to describe the chronic illness and utilization of welfare services among elderly.Methods: A cross sectional study was conducted in the urban field practice area of Shri B M Patil Medical College, Vijayapur. House to house survey was conducted for a period of 3 months from September to November 2014.Results: Total of 372 elders were interviewed, 54.5% were males, 45.4% were females. Majority were Hindus 78.8%. 46% were illiterate. Majority 79% were financially dependent. 53% were working. Around 32% were feeling lonely Most common chronic illness is joint pain (66.66%), visual problem (50%), dental and chewing problem (48%).Conclusions: Financial dependence was high among the participants and majorities were suffering from one or the other chronic illness which needs attention and knowledge about geriatric welfare services should be given.

A conceptual review of family involvement in acute mental health treatment: Methodology and personal reflections

This paper describes a process developed in order to work collaboratively on a conceptual review of some of the family involvement models that are used in acute mental health treatment. The members of the review team consisted of clinicians, academics and people with lived experience of mental illness and mental health services. This combination of backgrounds had the potential to present many challenges to the dynamics of the group. There were varying levels of research knowledge and experience within the group, as well as a lack of literature describing how to actualize their potential to best effect. Financial resources were minimal, which meant that the number of meetings had to be limited. Most importantly, however, there was the strong potential for a power imbalance within the group during the review process. Senior academics and clinicians were being expected to help to create a research environment in which the patient voice carried as much weight as theirs. In this paper, we discuss how we overcame these challenges and ended up with a process that was coherent, equable and enjoyable.

Association between Socio-demographic Characteristics of Community Health Workers with Compliance to Quality Delivery of Integrated Community Case Management of Febrile Illness services in Nigeria

Association between Socio-demographic Characteristics of Community Health Workers with Compliance to Quality Delivery of Integrated Community Case Management of Febrile Illness services in Nigeria