Impact of shared mental health care in the general population on subjects’ perceptions of mental health care and on mental health status

Objective A community survey evaluated whether the development of a shared mental health care intervention had an impact on health care perceptions and mental health status of subjects with common mental health problems (MHP). Methods Adults <70 years old with common MHP (DSM-IV/CIDI-SF major depressive disorder, generalized anxiety or MHI-SF 36 psychic distress diagnoses), were randomly drawn from the general population in the intervention area (IA, n = 349) and in a control area (CA, n = 360), and evaluated twice at an interval of 18 months (percentage of follow-up: IA = 69.3%, CA = 71.9%, P = .44). CA and IA groups did not differ for the criteria of interest at baseline. Results At 18 months, compared to CA, IA reported significantly different help-seeking attitudes or behaviours (P = .02 for all subjects and .006 for subjects with current MHP) and greater general satisfaction with care (P = .03 for both). Remission rates and daily life functioning did not differ. Conclusions After 4 years of development of a mental health network based on a consultation-liaison model, Shared Mental Health Care was associated with greater satisfaction and access with care among subjects with common MHP. The association was not found with mental health status, but the study lacked power to adequately address the issues.     

Mass violence and mental health – Training implications

Mass violence carries with it an enormous impact on health; the psychological impact is well recognized but poorly understood. There is a need for health professionals around the world to learn basic issues about the psychological impact of violence and to have available more specialized training to equip them with skills necessary to work directly with victims of mass violence. Organizing mental health services in conflict and in post-conflict situations requires many skills and complex work across sectors. Understanding mass violence from a public mental health perspective provides a framework for a curriculum that covers treatment for individuals and interventions for populations as well as exploring the mental states and social relationships which promote peace. Training implications are broad and should take account of individual and population needs, but also of a deeper human need to understand and contain that violent side of our nature that threatens us with extinction.     

Sexuality and mental health: Issues and what next?

Abstract

Human sexuality plays a major role in an individual's existence and functioning. In addition, rightly or wrongly sexuality often defines people and also affects social attitudes. These attitudes, if negative, can contribute to stigma and prevent people from help seeking if they are suffering from mental health problems. Recent changes in policy towards same-sex relationships have been positive in many countries including the UK and the USA, whereas in others such as Russia and Uganda attitudes have become more negative and punitive. Sexual activity is seen as having both pleasurable and procreational functions which contribute to society's attitudes to homosexual behaviour. Inevitably, individual responses to their own sexuality and sexual behaviour will be influenced by social attitudes. To ensure that those with various sexual variations can access psychiatric services without discrimination, various levels of interventions are needed. Here we discuss different levels of intervention and organizational change that may make it possible. Social organization and institutional organization of services need to be sensitive, especially as rates of many mental disorders are high in individuals who may be sexually variant. Those providing services need to understand their own negative attitudes as well as prejudices to ensure that services are emotionally accessible.     

Interface of women’s mental and reproductive health

The interface of women’s reproductive and mental health is an evolving area of psychiatric practice, necessitating familiarity with psychobiological factors unique to women. The role of estrogen in particular has profound implications for the etiology and treatment of women’s psychiatric illness, and has been reviewed along with the role of other hormones. Additionally, the stress of specific life events such as miscarriage, abortion, and menopause affects female mental health from a biological and psychosocial standpoint with the potential for secondary mood and anxiety disorders. Psychiatric issues during pregnancy and the postpartum period present special diagnostic and treatment challenges to the clinician. Biological and psychosocial treatments of these conditions have been reviewed. Management of psychiatric conditions during pregnancy and the postpartum period should include the obstetrician, pediatrician, and involved family members. Treatment decisions should involve careful assessment of the risks and benefits of any intervention including the risk of no treatment.     

Admitted and detained — community members and mental health review boards

This article presents the findings from research in 1997–98 which examined administrative review forums in Australia, including the operations of the Victorian Mental Health Review Board ("MHRB"). As part of a larger research project 25 hearings of the MHRB were observed. The MHRB is charged with responsibility for critical decisions regarding detention and the conditions associated with release of a person from inpatient to community care. Although hearings are essentially informal, participants are nevertheless entitled to the guarantees of procedural fairness. This raises dilemmas for the Board, for applicants, their families and advisers, as applicants may through their illness be unable to participate effectively in a process designed for their protection. The article examines how the MHRB actually conducts Its hearings, and the practice and fairness dilemmas associated with proceedings before the Board as presently constituted. It presents an analysis of member's perceptions about the value of the contribution made by their community member colleagues.     

International military operations and mental health – A review

Background: Volunteering in international military missions has been scrutinized for its effects on mental health. Different kinds of exposures to traumatic events are associated with a variety of mental disorders, mainly heightened rates of post-traumatic stress disorder (PTSD) and alcohol abuse. Aims: Based on the literature we discuss risk and protective factors concerning the psychological well-being of soldiers attending to international military operations. Methods: A systematic literature search was carried out using relevant search terms to identify the articles for this review. Results and conclusions: The ability to recognize and treat acute stress reactions during deployments is important. Post-deployment psychosocial support and services have a role in lowering barriers to care, diminishing stigma and also in recognizing individuals who suffer from psychological distress or psychiatric symptoms, to connect them with appropriate care. Further investigation of gender differences and the role of stigmatization is warranted. Most of those participating in international military operations are repatriated without problems, but repeated exposure to combat situations and other stressors may affect mental health in various ways. Stigmatization is still a barrier to care.     

Migration and common mental disorder: An improvement in mental health over time?

Abstract

Global migration is reaching record high levels and UK migrant groups comprise an increasing proportion of the total population. The migratory process causes stress that can affect mental health. There is limited consistent empirical evidence of a longitudinal nature to explain the association between migration and mental health. This review aims to examine the evidence of a relationship between migration and common mental disorder (CMD) amongst migrants over time. A comprehensive search of medical and psychiatric databases for global quantitative empirical studies investigating incidence of CMD amongst adult migrants from 1975 to July 2012 was conducted. Declines in rates of CMD amongst migrants over time were reported by two thirds of the 18 studies reviewed, less than one third of which were statistically significant. On the contrary, three studies showed an increased rate of CMD, one statistically significant. Individual psychological resources, social support, the acculturation process, cultural variations and time since relocation are identified as statistically significant protective factors against the development of CMD amongst migrants. New enlightening points include the significant impact of varying patterns of psychological distress, of which negative is the most adverse for CMD. Migration is an extremely complex process. Further clarification is needed to gain deeper understanding of the relationship between migration and CMD to address contradictions in the literature and health inequalities amongst migrants.     

The influence of state mental health perceptions and spending on an individual’s use of mental health services

Purpose

To explore the possible contextual effects of state-level mental health perceptions and public spending for mental health treatment on an individual’s use of mental health services, independent of the individual’s own perceptions.

Methods

Cross-sectional data from the 2007 Behavioral Risk Factor Surveillance System were used. A total of 216,514 participants from 35 states and the District of Columbia were included in the study. Logistic regression and multilevel modeling were used to estimate the effects of individual-level characteristics and three state-level factors—per capita spending on community mental health services, aggregated perceptions of the effectiveness of mental health treatment and the stigma of mental illness—on the individual’s current use of mental health services.

Results

Adjusting for the individual’s perceptions and characteristics, state-level perception of treatment effectiveness was positively associated with the use of mental health services [odds ratio (OR) for 5 % increase in the percentage perceiving effectiveness = 1.08; 95 % confidence interval (CI): 1.01, 1.16]. This association was strongest for individuals who experienced 1–4 days of mental distress in the past 30 days (OR = 1.17; 95 % CI 1.06, 1.29). State-level public spending on community mental health services was also positively associated with an individual’s use of mental health services (OR for a $40 increase in spending = 1.09; 95 % CI 1.01, 1.17); however, state-level perceptions of mental-illness stigma was not.

Conclusions

Our findings suggest there may be contextual effects of state-level perceptions of treatment effectiveness and state spending on community mental health services on the use of mental health services.     

Parents’ mental health and children’s cognitive and social development

Background  

The development of children of parents who are experiencing mental health difficulties is a continuing cause of concern for professionals working in health, social care and education as well as policy makers. In light of this interest our study investigates the interplay between the mental health of mothers and fathers and family socioeconomic resources, and the impact for children’s cognitive and social development.     

Data and decisions: can mental health management be knowledge-based?

Three major factors suggest a healthy future for data-based decision making within mental health authorities: (1) the improved knowledge base related to the treatment and management of serious mental illness, (2) advances in data-processing technology and (3) conceptual advances in management information system design, most notably the National Institute of Mental Health (NIMH) Mental Health Statistics Improvement Package. This paper briefly outlines these three factors and goes on to examine information needed by state mental health authorities (SMHAs) to enhance decision making. The client-level data necessary for data-based policy decisions, while still scarce, are increasingly available and are increasingly finding homes within SMHA management information systems. As SMHAs improve their information systems to accommodate such data, they face substantial implementation challenges and substantial payoffs in terms of increased knowledge for decision making.     

What do mental health professionals really think of family members of mental health patients?

Mental health professionals working at three rural public community mental health agencies were asked for their views on the families of mental health patients. Findings revealed themes that included families as supportive caregivers, as unsupportive agitators, as in pain, as uninformed, and as unequal partners. Implications for clinical intervention, education, and research are discussed.     

Children’s mental health strategies and practices in Addis Ababa Ethiopia

In recent years, children’s well-being has become a hot research topic that has been increasingly gaining attention in the field of psychiatry, social work, psychology, and public health research. The present study was meant to explore the existing children’s mental health service strategies and practices in Addis Ababa, Ethiopia. The data have been carefully collected through open-ended interviews and focus group discussions, by capturing the participants’ experiences. This study counted with the participation of managers of child-serving organizations, mental health workers (psychologists, psychiatric nurses, social workers, and psychiatrists), orphans, and vulnerable children, including their guardians. The findings indicated limited access to specialized treatment, inadequate skilled human resources, lack of mental health education, and depicted that the local community preferred traditional medicine and religious healing practices in order to cure mental illnesses. Children’s mental health services are at a disadvantage and the most neglected health program, needing urgent involvement of the local government, non-governmental organizations, researchers, and policymakers, amongst several other stakeholders.