World Health Organization Assessment Instrument Research Articles

Child and adolescent mental health services in Khartoum State, Sudan: a desktop situational analysis.

Sudan is a Northeast African country, with 61.7% of its population under 24 years. With a large youth population and significant cultural and linguistic diversity, Sudan, like most low-income countries, has contributed minimal data to global child and adolescent mental health (CAMH) research. This study aimed to perform the first ever situational analysis of CAMH services and systems in Khartoum State, Sudan. The study focused on Khartoum state and covered the calendar years 2019 and 2020. Using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) version 2.2 adapted for CAMH, the study focused on the publically available data sources. Findings were described and presented in tables and figures using the WHO-AIMS template. The situational analysis found no CAMH-specific policies, no separate budget for CAMH, and no supervising body for CAMH services in Khartoum. Three tertiary mental health hospitals provided CAMH services, all combined with adult mental health services. Essential medicines were available in all facilities, except methylphenidate available only in 3 central pharmacies. There was no free access to essential psychotropic drugs for children and adolescents except in emergency settings. Data about training to primary healthcare providers and the process of referral to specialized services were limited. A school mental health programme existed which provided early identification and management of CAMH problems in schools. The workforce was small and variable across all levels of care. No formal public health awareness campaigns and little evidence of formal intersectoral collaboration on CAMH were identified. A health information system existed, but no CAMH-specific items were reported. Among a handful of publications on CAMH, no national studies on CAMH were identified. This situational analysis represented the first systematic collation of data and information about CAMH in Sudan. Findings highlighted some areas of strength, but also many gaps in CAMH services and systems. We acknowledge the need to complement the desktop analysis with in-depth data collection with stakeholders across multiple levels, but hope that this will serve as a first step towards strengthening CAMH services in Sudan and other low-income countries.

A situational analysis of the mental health system of the West Region of Cameroon using the World Health Organization\u2019s assessment instrument for mental health systems (WHO-AIMS)

BackgroundThe publication of the World Health Report of 2001 by the World Health Organization (WHO) raised awareness of mental health worldwide. It reported a higher burden of mental illnesses in developing countries, with fewer resources to address the conditions. Since then, many initiatives have been taken in Cameroon to improve the mental health of the population, but these efforts lack local scientific evidence to support them. This study aims to describe the mental health services available in the West Region of Cameroon and to provide evidence-based support to this process.MethodWe used the World Health Organization Assessment Instrument for Mental Health systems (WHO-AIMS) version 2.2 to collect, analyze, and report the data on mental health services offered in 2020 in the West Region of Cameroon. We extracted our data from the registers of 10 mental health facilities of the region, and we interviewed the staff in these facilities and at the Ministry of Public Health.ResultsThe region is divided into 20 health districts, of which six offered mental health services. As a whole, Cameroon had a mental health policy, mental health plan, but no mental health legislation or emergency plan. There was no specific budget for mental health in the country. In the West Region there were not any psychiatrists. Mental health services were provided by nurses, psychologists, general practitioners, and neurologists. There were 1.87 human resources in mental health facilities per 100,000 population, of which 1.4 were nurses. 1 in 1.4 of these nurses worked in the main city. There was no formal link of mental health services with other sectors and no publication in the previous five years about mental health in the region referenced on PubMed.ConclusionIn 2020, the access to mental health services in the West Region of Cameroon was inequitable. The approach to mental health system development was not inclusive and not supported by enough scientific evidence.

A situational analysis of child and adolescent mental health services and systems in the Western Cape Province of South Africa

BackgroundEven though child and adolescent mental health is a global health priority, services are very limited, particularly in low- and middle-income countries (LMIC), and therefore need comprehensive strengthening. This requires knowledge of the hardware elements of the system (human resources, financing, medicines, technology, organisational structure, service infrastructure, and information systems). This study sought to examine these elements of child and adolescent mental health (CAMH) services and systems in the Western Cape Province of South Africa.MethodsThe World Health Organization Assessment Instrument of Mental Health Systems (WHO-AIMS) version 2.2 of 2005 was adapted to identify key variables of interest in CAMH. Data were collected for the calendar year 2016 and focused on the public health sector. We outlined findings based on best available data across the six domains of the WHO-AIMS.ResultsIn domain 1, we found no provincial CAMH policy or implementation plans to support the national CAMH policy and were unable to identify a CAMH-specific budget. In domain 2, there was no dedicated provincial leadership structure for CAMH, and no dedicated or ‘child- and adolescent-friendly’ mental health services at primary or secondary care levels. At tertiary level, there were only three specialist CAMH teams. The majority of CAMH resources were based in the City of Cape Town, with limited resources in the rural districts. Essential medicines were available in all facilities, and the majority of children and adolescents had access to free services. In domain 3, data were limited about the extent of training offered to primary healthcare staff, and little or no psychosocial interventions were available in primary care. Domain 4 identified a small and variable CAMH workforce across all levels of care. In domain 5, few public health campaigns focused on CAMH, and little evidence of formal intersectoral collaboration on CAMH was identified. Domain 6 identified significant limitations in health information systems for CAMH, including lack of child- and adolescent-specific and disaggregated data to establish baselines for policy development, monitoring, evaluation and CAMH research.ConclusionsThis study identified significant structural weaknesses in CAMH and presents a clear call for action to strengthen services and systems in the province and in South Africa. it would be important to expand research also to include provider and user perspectives for service strengthening.

A review of the world health organization assessment instrument for mental health system: WHO-AIMS

A review of the world health organization assessment instrument for mental health system: WHO-AIMS

Integrated mapping of local mental health systems in Central Chile.

ABSTRACTObjectiveTo describe the availability of local mental health (MH) services in small MH catchment areas in Central Chile, using a bottom-up approach.MethodsMH services of 19 small MH catchment areas in five health districts of Central Chile that provide health care to more than 4 million inhabitants were assessed using DESDE-LTC (Description and Evaluation of Services and Directories in Europe for Long-Term Care), a tool for standardized description and classification of LTC health services, in a study conducted in 2012 (“DESDE-Chile”) designed to complement other studies conducted in 2004 and 2012 at the national and regional level using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS). Key informants from national, regional, and local health authorities were contacted to compile a comprehensive list of MH services or facilities (health, social services, education, employment, and housing). The analysis of local care provision covered three criteria—service availability, placement capacity, and workforce capacity.ResultsThe study detected disparities in all three criteria (availability and placement and workforce capacity) across the five health districts, between urban and rural areas, and between neighboring urban areas. Analysis of service availability revealed differences in the weight of residential services versus day and outpatient care. The Talcahuano area could be considered a benchmark of MH care in Central Chile, based on its service provision patterns, and the criteria of the community care model. The list of MH services identified in this study differed from the one generated in the 2012 WHO-AIMS study.ConclusionsThis survey of local MH service provision in small catchment areas using the DESDE-LTC tool provided MH service provision data that complemented information collected in other studies conducted at the national/regional level using the WHO-AIMS tool. The bottom-up approach applied in this study would also be useful for the assessment of equity and accessibility and local planning.

Opportunities and obstacles in child and adolescent mental health services in low- and middle-income countries: a review of the literature.

Lower-income, less developed countries have few child and adolescent mental health professionals and a low availability of paediatric community mental health care. Child mental health professionals in low- and middle-income countries (LMICs) must therefore balance comprehensive tertiary care for the minority and provision of child and adolescent mental health services (CAMHS) within primary health care to serve the majority. This review aimed to identify the obstacles to, and opportunities for, providing CAMHS in LMICs. Articles from PsychInfo and PubMed, published up to November 2011, were retrieved using the search terms "child and adolescent", "mental health services", "child psychiatry", "low- and middle-income countries", "low-income countries" and "developing countries". Articles were then retrieved from PubMed alone, using these search terms plus the individual country names of 154 LMICs. Fifty-four articles were retrieved from PsychInfo and 632 from PubMed. Searching PubMed with 154 LMIC names retrieved seven related articles. Inclusion criteria were (i) articles relating to CAMHS or child psychiatric services; (ii) subjects included in the articles were inhabitants of LMICs or developing countries; (iii) articles reported in English. After removal of duplicates, 22 articles remained. The contents of these articles were categorized and analysed by use of the six domains of the World Health Organization assessment instrument for mental health systems (WHO-AIMS), a tool developed to collect information on available resources within mental health systems. The provision of CAMHS in LMICs clearly needs a specific strategy to maximize the potential of limited resources. Mental health-policy and awareness campaigns are powerful measures to drive CAMHS. Training in CAMH for primary health-care professionals, and integration of CAMHS into existing primary health-care services, is essential in resource-constrained settings. A wide gap in research into CAMHS still needs to be filled. To overcome these challenges, the child mental health professional's role in LMICs must encompass both clinical and public-health-related activities.

Information for global mental health.

Information is needed for development of mental health (MH) services; and particularly in low- and middle-income countries (LAMICs), where the MH systems are relatively weak. World Health Organization (WHO) has worked intensively during the last 15 years for developing a strategy in the field of MH information. The paper analyzes WHO instruments developed in this area [MH Atlas series and WHO Assessment Instrument for Mental Health Systems (WHO-AIMS)]. Data from Atlas series and WHO-AIMS demonstrated that the role of information is often neglected at all the steps: from data collection and processing to analysis, dissemination and utilization, particularly in LAMIC. By implementing several sets of feasible MH indicators WHO has technically supported the improvement of the MH information systems in LAMICs. In the last few years the importance of information in MH has increased and has been successfully highlighted; but a lot of work still needs to be done for achieving a minimum set of MH indicators and reliable data that can be used by both high-income countries and LAMIC.

Mental health services: the African gap

Purpose – Neuropsychiatric disorders account for a substantial proportion of disease burden and disability in Africa. Despite this, mental health systems are under-resourced in Africa, as in most parts of the world, creating a “treatment gap” and denying the African population the right to mental health achieved through access to mental health services. The paper aims to discuss these issues. Design/methodology/approach – The mental health systems of African countries were compared with figures for all low- and middle-income countries (LAMICS) using data from the World Health Organization Assessment Instrument for Mental Health Systems. Comparable global figures were also available for some indicators from the WHO's World Mental Health Atlas 2011. Findings – Selected indicators of mental health systems are presented for 14 African countries and shows that they are lower as compared to figures for all other LAMICS and also global figures. The treatment gap for mental disorders is much higher in Africa than comparable global figures. For example, the treatment gap for mood disorders has been estimated from 95 to 100 per cent for some African countries. Originality/value – There is an imbalance between need and service provision in the area of mental health across the world but particularly in Africa. Despite this, there are a greater number of outpatient than inpatient services in Africa which provides an opportunity for development of community-based services. There are also many encouraging examples of effective approaches to reducing the burden of neuropsychiatic disease in Africa.

124. Mental Health Gap in School-Based Services in Two Massachusetts Towns: Service Assessment Using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS)

124. Mental Health Gap in School-Based Services in Two Massachusetts Towns: Service Assessment Using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS)

Mental health system in Saudi Arabia: an overview

BackgroundThere is evidence that mapping mental health systems (MHSs) helps in planning and developing mental health care services for users, families, and other caregivers. The General Administration of Mental Health and Social Services of the Ministry of Health over the past 4 years has sought to streamline the delivery of mental health care services to health consumers in Saudi Arabia.ObjectiveWe overview here the outcome of a survey that assessed the Saudi MHS and suggest strategic steps for its further improvement.MethodThe World Health Organization Assessment Instrument for Mental Health Systems was used systematically to collect information on the Saudi MHS in 2009–2010, 4 years after a baseline assessment.ResultsSeveral mental health care milestones, especially provision of inpatient mental health services supported by a ratified Mental Health Act, were achieved during this period. However, community mental health care services are needed to match international trends evident in developed countries. Similarly, a larger well-trained mental health workforce is needed at all levels to meet the ever-increasing demand of Saudi society.ConclusionThis updated MHS information, discussed in light of international data, will help guide further development of the MHS in Saudi Arabia in the future, and other countries in the Eastern Mediterranean region may also benefit from Saudi experience.

Comparison of tolerability between quetiapine and haloperidol in schizophrenia

Schizophrenia is a serious, disabling, often lifetime condition, which can produce severe functional impairment in patients. The life time morbidity risk for schizophrenia is estimated to be 1% and account for 2.8% of the total global YLDs. The World Health Organization Assessment Instrument for Mental Health Systems report of 2006 done in Nepal states in Nepal states that 12% of the patients are diagnosed as schizophrenia in out-patient mental facilities, 14% in community based psychiatry inpatient units and 34% in mental hospital. Atypical antipsychotics are the first line agents recommended for the treatment of schizophrenia considering better efficacy at least in the negative symptoms and better side-effect profile compared with typical antipsychotic. Haloperidol has been used as a standard comparator in numerous trials and new drugs have been compared to it to establish their efficacy, and safety profile. As the authors could not find out any such study which had compared the safety profile of quetipine against conventional antipsychotic, hence this present study is purposed to carry as an attempt to address this issue among Nepalese population.DOI: http://dx.doi.org/10.3126/jonmc.v1i1.7289 Journal of Nobel Medical College Vol.1(1) 2011 59-64

A comparative study of mental health services in two African countries: South Africa and Nigeria

Mental health services in South Africa and Nigeria were compared using the reports of World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) of both countries. WHO-AIMS assessment reveals the extent of implementation and provision of mental health care services. South Africa has made considerable progress with restructuring its mental health care system that provides mental health care at the community level. Nigeria, in spite of adopting mental health care as part of its primary health care services and having a strong academic history in psychiatry, does not provide services in rural communities. It is important for Nigeria that mental health care nurses become advocates for mental health policy reforms to improve access, and that countries with similar challenges learn from each other about providing care for people who cannot care for themselves, namely, the mentally challenged. Keywords: Advocacy, integrated care, mental health policy, mental health services, primary health care.

The role of health systems factors in facilitating access to psychotropic medicines: a cross-sectional analysis of the WHO-AIMS in 63 low- and middle-income countries.

Neuropsychiatric conditions comprise 14% of the global burden of disease and 30% of all noncommunicable disease. Despite the existence of cost-effective interventions, including administration of psychotropic medicines, the number of persons who remain untreated is as high as 85% in low- and middle-income countries (LAMICs). While access to psychotropic medicines varies substantially across countries, no studies to date have empirically investigated potential health systems factors underlying this issue. This study uses a cross-sectional sample of 63 LAMICs and country regions to identify key health systems components associated with access to psychotropic medicines. Data from countries that completed the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) were included in multiple regression analyses to investigate the role of five major mental health systems domains in shaping medicine availability and affordability. These domains are: mental health legislation, human rights implementations, mental health care financing, human resources, and the role of advocacy groups. Availability of psychotropic medicines was associated with features of all five mental health systems domains. Most notably, within the domain of mental health legislation, a comprehensive national mental health plan was associated with 15% greater availability; and in terms of advocacy groups, the participation of family-based organizations in the development of mental health legislation was associated with 17% greater availability. Only three measures were related with affordability of medicines to consumers: level of human resources, percentage of countries' health budget dedicated to mental health, and availability of mental health care in prisons. Controlling for country development, as measured by the Human Development Index, health systems features were associated with medicine availability but not affordability. Results suggest that strengthening particular facets of mental health systems might improve availability of psychotropic medicines and that overall country development is associated with affordability.

Service availability and utilization and treatment gap for schizophrenic disorders: a survey in 50 low- and middle-income countries

To outline mental health service accessibility, estimate the treatment gap and describe service utilization for people with schizophrenic disorders in 50 low- and middle-income countries. The World Health Organization Assessment Instrument for Mental Health Systems was used to assess the accessibility of mental health services for schizophrenic disorders and their utilization. The treatment gap measurement was based on the number of cases treated per 100,000 persons with schizophrenic disorders, and it was compared with subregional estimates based on the Global burden of disease 2004 update report. Multivariate analysis using backward step-wise regression was performed to assess predictors of accessibility, treatment gap and service utilization. The median annual rate of treatment for schizophrenic disorders in mental health services was 128 cases per 100,000 population. The median treatment gap was 69% and was higher in participating low-income countries (89%) than in lower-middle-income and upper-middle-income countries (69% and 63%, respectively). Of the people with schizophrenic disorders, 80% were treated in outpatient facilities. The availability of psychiatrists and nurses in mental health facilities was found to be a significant predictor of service accessibility and treatment gap. The treatment gap for schizophrenic disorders in the 50 low- and middle-income countries in this study is disconcertingly large and outpatient facilities bear the major burden of care. The significant predictors found suggest an avenue for improving care in these countries.

Treated prevalence of and mental health services received by children and adolescents in 42 low-and-middle-income countries

Little is known about the treated prevalence and services received by children and adolescents in low- and middle-income countries (LAMICs). The purpose of this study is to describe the characteristics and capacity of mental health services for children and adolescents in 42 LAMICs. The World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS), a 155-indicator instrument developed to assess key components of mental health service systems, was used to describe mental health services in 13 low, 24 lower-middle, and 5 upper-middle-income countries. Child and adolescent service indicators used in the analysis were drawn from Domains 2 (mental health services), 4 (human resources), and 5 (links with other sectors) of the WHO-AIMS instrument. The median one-year treated prevalence for children and adolescents is 159 per 100,000 population compared to a treated prevalence of 664 per 100,000 for the adult population. Children and adolescents make up 12% of the patient population in mental health outpatient facilities and less than 6% in all other types of mental health facilities. Less than 1% of beds in inpatient facilities are reserved for children and adolescents. Training provided for mental health professionals on child and adolescent mental health is minimal, with less than 1% receiving refresher training. Most countries (76%) organize educational campaigns on child and adolescent mental health. Mental health services for children and adolescents in low- and middle-income countries are extremely scarce and greatly limit access to appropriate care. Scaling up of services resources will be necessary in order to meet the objectives of the WHO Mental Health Gap Action (mhGAP) program which identifies increased services for the treatment of child mental disorders as a priority.

Focus on Global Mental Health: Mental Health Services in 42 Low- and Middle-Income Countries: A WHO-AIMS Cross-National Analysis

The authors describe characteristics and capacities of mental health systems in low- and middle-income countries. The World Health Organization Assessment Instrument for Mental Health Systems was used to assess services in 42 countries (13 low-, 24 lower-middle, and five upper-middle income). Of 36 countries with a mental health plan, 90% include the goal of developing community services. However, inpatient facilities are the main service providers, with less than one community contact (.70) for each inpatient day. Mental hospitals consume 80% of mental health budgets, and outpatient care is limited. Mental health services in participating countries are limited and often hospital based.

‘Mental health is everybody's business’: Roles for an intersectoral approach in South Africa

Intersectoral action is increasingly recognized as necessary to address the social determinants of mental health. This study aims to assess South Africa's progress in intersectoral collaboration for mental health, and provide recommendations for intersectoral collaboration, to generate lessons for other low- and middle-income countries. We conducted a survey of the existing mental health system in South Africa using the World Health Organization Assessment Instrument for Mental Health Systems. We also conducted 96 semi-structured interviews and 12 focus group discussions with a range of stakeholders at national, provincial and district level. Data were analysed thematically to understand the roles and responsibilities of different sectors in realizing the right to mental health. A range of key sectors were identified as having roles in mental health promotion, illness prevention and service delivery. In discussing South Africa's progress, respondents gave several suggestions about how to formulate an intersectoral response in this context, including increasing high level political commitment, and using leadership from the health sector. We outline roles and responsibilities for various sectors and lessons that can be learnt from this context. These include the importance of developing programmes alongside legislation, employing targeted awareness-raising to engage sectors, and developing a structured approach to intersectoral action.

The mental health system in Brazil: Policies and future challenges

BackgroundThe aim of this paper is to assess the mental health system in Brazil in relation to the human resources and the services available to the population.MethodsThe World Health Organization Assessment Instrument for Mental Health Systems (WHO AIMS) was recently applied in Brazil. This paper will analyse data on the following sections of the WHO-AIMS: a) mental health services; and b) human resources. In addition, two more national datasets will be used to complete the information provided by the WHO questionnaire: a) the Executive Bureau of the Department of Health (Datasus); and b) the National Register of Health Institutions (CNS).ResultsThere are 6003 psychiatrists, 18,763 psychologists, 1985 social workers, 3119 nurses and 3589 occupational therapists working for the Unified Health System (SUS). At primary care level, there are 104,789 doctors, 184, 437 nurses and nurse technicians and 210,887 health agents.The number of psychiatrists is roughly 5 per 100,000 inhabitants in the Southeast region, and the Northeast region has less than 1 psychiatrist per 100,000 inhabitants. The number of psychiatric nurses is insufficient in all geographical areas, and psychologists outnumber other mental health professionals in all regions of the country. The rate of beds in psychiatric hospitals in the country is 27.17 beds per 100,000 inhabitants. The rate of patients in psychiatric hospitals is 119 per 100,000 inhabitants. The average length of stay in mental hospitals is 65.29 days. In June 2006, there were 848 Community Psychosocial Centers (CAPS) registered in Brazil, a ratio of 0.9 CAPS per 200,000 inhabitants, unequally distributed in the different geographical areas: the Northeast and the North regions having lower figures than the South and Southeast regions.ConclusionThe country has opted for innovative services and programs, such as the expansion of Psychosocial Community Centers and the Return Home program to deinstitutionalize long-stay patients. However, services are unequally distributed across the regions of the country, and the growth of the elderly population, combined with an existing treatment gap is increasing the burden on mental health care. This gap may get even wider if funding does not increase and mental health services are not expanded in the country. There is not yet a good degree of integration between primary care and the mental health teams working at CAPS level, and it is necessary to train professionals to act as mental health planners and as managers. Research on service organization, policy and mental health systems evaluation are strongly recommended in the country. There are no firm data to show the impact of such policies in terms of community service cost-effectiveness and no tangible indicators to assess the results of these policies.

WHO's Assessment Instrument for Mental Health Systems: Collecting Essential Information for Policy and Service Delivery

Information about mental health systems is essential for mental health planning to reduce the burden of neuropsychiatric disorders. Unfortunately, many low- and middle-income countries lack systematic information on their mental health systems. The objectives, scope, structure, and contents of mental health assessment and monitoring instruments commonly used in high-income countries may not be appropriate for use in middle- and low-income countries. The World Health Organization (WHO) has recently developed the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), a comprehensive assessment tool for mental health systems designed for middle- and low-income countries. WHO-AIMS was developed through an iterative process that included input from in-country and international experts on the clarity, content, validity, and feasibility of the instrument, as well as a pilot trial. The resulting instrument, WHO-AIMS 2.2, consists of six domains: policy and legislative framework, mental health services, mental health in primary care, human resources, public information and links with other sectors, and monitoring and research. These domains address the ten recommendations of the World Health Report 2001 through 28 facets and 155 items. All six domains need to be assessed to form a basic, yet broad, picture of a mental health system, with a focus on health sector activities. WHO-AIMS provides essential information for mental health policy and service delivery. Countries will be able to develop information-based mental health policy and plans with clear baseline information and targets. Moreover, they will be able to monitor progress in implementing reform policies, providing community services, and involving consumers, families, and other stakeholders in mental health promotion, prevention, care and rehabilitation. This article provides an overview of the rationale, development process, and potential uses and benefits of WHO-AIMS.

Mental health system and services in Albania

To describe the mental health system in Albania. Data were gathered in 2003 and in 2004 using a new WHO instrument, World Health Organization Assessment Instrument for Mental health Systems (WHO-AIMS), designed for collecting essential information on the mental health system of low and middle income countries. It consists of 6 domains, 28 facets and 156 items. The information collected through WHO AIMS covered the key aspects of mental health system in Albania: the mental health policy and the legislative framework, the network of mental health services and the characteristics of the users, the role of the primary health care, the human resources, the public education and the links with other governmental sectors, monitoring and research. The data collection through WHO AIMS represented a needed step for a better in-depth knowledge of the system and for implementing actions to strengthen the system. Examples of planned actions were the improvement of the mental health component in primary care, a clear shift of resources from mental hospitals to community facilities, an increase of the outpatient care and an expansion of the mental health information system.