Attitudes to people with mental disorders: a mental health literacy survey in a rural area of Maharashtra,India

Introduction  

People with mental disorders experience discrimination as a consequence of stigmatising attitudes that are largely socio-culturally constructed. Thus, there is a need to understand local contexts in order to develop effective programs to change such attitudes. We undertook a mental health literacy survey in rural Maharashtra, India, prior to developing a mental health training program for village health workers (VHWs) in a primary health care setting.     

Suicide attempt in a rural area of Vietnam: Incidence, methods used and access to mental health care

Objectives  

The study aims to determine the incidence of suicide attempt, describe the methods used, and assess use of health care services including mental health care after suicide attempt in a rural area of Vietnam.     

Direct health and residential care costs of people living with dementia in Australian residential aged care

Objectives

This analysis estimates the whole‐of‐system direct costs for people living with dementia in residential care by using a broad health and social care provision perspective and compares it to people without dementia living in residential care.

Methods

Data were collected from 541 individuals living permanently in 17 care facilities across Australia. The annual cost of health and residential care was determined by using individual resource use data and reported by the dementia status of the individuals.

Results

The average annual whole‐of‐system cost for people living with dementia in residential care was approximately AU$88 000 (US$ 67 100) per person in 2016. The cost of residential care constituted 93% of the total costs. The direct health care costs were comprised mainly of hospital admissions (48%), pharmaceuticals (31%) and out‐of‐hospital attendances (15%). While total costs were not significantly different between those with and without dementia, the cost of residential care was significantly higher and the cost of health care was significantly lower for people living with dementia.

Conclusion

This study provides the first estimate of the whole‐of‐system costs of providing health and residential care for people living with dementia in residential aged care in Australia using individual level health and social care data. This predominantly bottom‐up cost estimate indicates the high cost associated with caring for people with dementia living permanently in residential care, which is underestimated when limited cost perspectives or top‐down, population costing approaches are taken.     

Integrating mental health into primary health care in Zambia: a care provider's perspective

Background  

Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative in nature and based in tertiary health institutions. At primary health care level, there is either absence of, or fragmented health services.     

The mental health system in Lombardy,Italy: access to services and patterns of care

Purpose  

The psychiatric reform in Italy devolved to the regions the responsibility of implementing community psychiatric care. The aim of this paper is to evaluate the mental health system in Lombardy by assessing changes in accessibility and patterns of care occurred between 1999 and 2009.     

Developing and comparing methods for measuring the content of care in mental health services

Background  

Measurement of what happens in mental health services is needed to describe services, identify variation in care provision and understand service outcomes. However, there is no consensus about appropriate methods or measures for content of care. Previous research has primarily used a single information source and prioritised staff over patient perspectives on content of care. This study aims to enhance understanding of how to measure content of care by developing and evaluating four instruments, each using a different measurement method.     

Mapping mental health finances in Ghana, Uganda, Sri Lanka, India and Lao PDR

Background  

Limited evidence about mental health finances in low and middle-income countries is a key challenge to mental health care policy initiatives. This study aimed to map mental health finances in Ghana, Uganda, India (Kerala state), Sri Lanka and Lao PDR focusing on how much money is available for mental health, how it is spent, and how this impacts mental health services.     

Association of mental distress with health care utilization and costs: a 5-year observation in a general population

Objective  

Previous studies have associated mental distress and disorders with increased health care utilization and costs. However, most studies have selected subjects from treatment facilities or have applied retrospective designs.     

Stakeholder's perceptions of help-seeking behaviour among people with mental health problems in Uganda

Introduction  

Mental health facilities in Uganda remain underutilized, despite efforts to decentralize the services. One of the possible explanations for this is the help-seeking behaviours of people with mental health problems. Unfortunately little is known about the factors that influence the help-seeking behaviours. Delays in seeking proper treatment are known to compromise the outcome of the care.     

Collaboration between general hospitals and community health services in the care of suicide attempters in Norway: a longitudinal study

Background  

The aim of this paper was to study the collaboration between emergency departments (EDs) in general hospitals and community health services (CHS) in Norway when providing psychosocial care and aftercare to patients treated in EDs following a suicide attempt. We wanted to explore the extent to which quality indicators at the hospital level measured in 1999 and 2006 could predict the presence or absence of a chain of care structure in the CHS in 2006.     

Treatment prevalence and incidence of schizophrenia in Quebec using a population health services perspective: different algorithms,different estimates

Purpose  

Using a population health services perspective, this article defines and assesses an efficient criteria-based algorithm to identify treatment prevalent and incident cases of schizophrenia. We refer here “treatment” prevalence and incidence since its evaluation depends on a patient receiving a health care service with a diagnosis of schizophrenia.     

U.S. military mental health care utilization and attrition prior to the wars in Iraq and Afghanistan

Objective  

Health care utilization studies of mental disorders focus largely on the ICD-9 category 290–319, and do not generally include analysis of visits for mental health problems identified under V-code categories. Although active duty service members represent a large young adult employed population who use mental health services at similar rates as age-matched civilian populations, V-codes are used in a larger proportion of mental health visits in military mental health care settings than in civilian settings. However, the utilization of these diagnoses has not been systematically studied. The purpose of this study is to characterize outpatient behavioral health visits in military health care facilities prior to Operation Iraqi Freedom, including the use of diagnoses outside of the ICD-9 290–319 range, in order to evaluate the overall burden of mental health care. This study establishes baseline rates of mental health care utilization in military mental health clinics in 2000 and serves as a comparison for future studies of the mental health care burden of the current war.     

Shortage and underutilization of psychiatric beds in southern Brazil: independent data of Brazilian mental health reform

Background  

Mental health policies throughout the world are being subjected to several changes due to increased pressure from the public and from health administrators. Mental health policies in the developing world experienced changes following advice and consultation from the World Health Organization (WHO). This was the case with Brazil, which enacted several laws and policies affecting community care and the closure of beds in psychiatric hospitals (the deinstitutionalization movement). Rio Grande do Sul, the southeast state in Brazil, adopted this policy in 1992, but still suffers from a shortage of psychiatric beds in both general hospitals (GHs) and psychiatric hospitals (PHs), despite advances in the provision of community care. As a result, Rio Grande do Sul (RS) can be studied as an example of “what actually happens” in mental health care in the developing world.     

Knowledge, attitudes and practice pertaining to depression among primary health care workers in Tanzania

Background  

Examination of consultation data in a variety of primary care settings in Tanzania shows that, while psychoses are routinely diagnosed and treated at primary care level, depression is rarely recorded as a reason for consultation. Since, epidemiological studies elswhere show that depression is a much more common disorder than psychosis, a series of studies were undertaken to elucidate this apparent paradox in Tanzania and inform mental health policy; firstly, a household prevalence study to ascertain the prevalence of common mental disorders at community level in Tanzania; secondly, a study to ascertain the prevalence of common mental disorders in primary care attenders; and thirdly, a study to ascertain the current status of the knowledge, attitude and practice pertaining to depression among primary health care workers. This paper reports the findings of the latter study.     

Improving responses to depression and related disorders: evaluation of a innovative,general, mental health care workers training program

Background  

Australian General Practitioners have been beneficiaries of extensive training in mental health care delivery over the last few years but less so other workers who support those with mental illness. Training is needed as it is widely recognised that the most effective interventions to prevent and treat mental disorders are often not readily available. The Mental Health Aptitudes into Practice (MAP) training package is a broad, innovative, interdisciplinary, general mental health training aimed at improving responses to individuals with depression and related disorders. The modular structure of this training program meant that such training could be targeted at those with varied backgrounds. Two hundred and seventy one days of free MAP training was delivered across Victoria in 2004/2005. The evaluation reported here assessed whether changes occurred in the trainees' confidence, mental health literacy, attitudes towards effective treatments, mental health knowledge and skills and community mental health ideology following training.     

Cross-sectional and longitudinal associations between cardiometabolic measures and clinical stage in young people accessing early intervention mental health services

Aim

This retrospective cohort study aimed to identify the cardiometabolic characteristics, cross-sectionally and longitudinally, associated with clinical stage in youth accessing early intervention mental health services.

Methods

Cardiometabolic data we collected in 511 young people (aged 12–25 years at entry) receiving mental health care at the early intervention services in Sydney, Australia.

Results

The majority of young people (N = 448, 87.67%) were classified in stage 1a or 1b at entry. At entry to care, there was no cross-sectional relationship between clinical stage and age, gender, fasting insulin, fasting glucose, updated homeostatic model assessment for insulin resistance (HOMA2-IR) score, BMI or waist circumference. Of the 111 (21.7%) young people initially classified at stage 1a (‘non-specific symptoms’) and the 337 (65.9%) classified in stage 1b (‘attenuated syndromes’), 40 individuals transitioned to stage 2+ (7.8%) (“full-threshold disorders”) longitudinally. No cardiometabolic factors predicted clinical stage transitions. However, those with an increase in BMI over the course of care (n = 54) were 1.46 (OR; 95% CI: 1.02–2.17) times more likely to progress to stage 2+ at follow up.

Conclusions

Whilst no relationships were found between demographic or cardiometabolic variables and clinical stage at entry to care, an increased BMI over time was associated with clinical stage transition longitudinally. Further longitudinal research is needed to understand the demographic, clinical, illness progression or treatment factors associated with changes in cardiometabolic status.     

Innovations on a shoestring: a study of a collaborative community-based Aboriginal mental health service model in rural Canada

Background  

Collaborative, culturally safe services that integrate clinical approaches with traditional Aboriginal healing have been hailed as promising approaches to ameliorate the high rates of mental health problems in Aboriginal communities in Canada. Overcoming significant financial and human resources barriers, a mental health team in northern Ontario is beginning to realize this ideal. We studied the strategies, strengths and challenges related to collaborative Aboriginal mental health care.     

Experiences of acute mental health care in an ethnically diverse inner city: qualitative interview study

Purpose  

Ethnic inequalities in experiences of mental health care persist in the UK, although most evidence derives from in-patient settings. We aimed to explore service users’ and carers’ accounts of recent episodes of severe mental illness and of the care received in a multi-cultural inner city. We sought to examine factors impacting on these experiences, including whether and how users and carers felt that their experiences were mediated by ethnicity.     

Accessibility and factors associated with utilization of mental health services in youth health centers. A qualitative comparative analysis in northern Sweden

Background

Youth-friendly health care services can facilitate young people’s access to health care services and promote their health, including their mental health. In Sweden, a network of youth health centers exist since the 1970s, incorporated within the public health system. Even if such centers take a holistic approach to youth health, the focus has been in sexual and reproductive health care, and the extent of integrating mental health care services is less developed though it varies notably between different centers. This study aims to analyse the various conditions that are sufficient and/or necessary to make Swedish youth health centers accessible for mental and psychosocial health.

Methods

Multiple case study design, using qualitative comparative analysis to assess the various conditions that makes a youth health center accessible for mental and psychosocial issues and mental health. The cases included 18 youth health centers (from a total of 22) in the four northern counties of Sweden.

Results

In order to enhance accessibility for mental health services, youth health centers need to be trusted by young people. Trust was necessary but not sufficient, meaning that it had to be combined with other conditions: either having a team with a variety of professions represented in the youth health center, or being a youth health center that is both easy to contact and well-staffed with mental health professionals.

Conclusions

Differentiated, first-line services for youth can play an important role in promoting youth mental health if certain conditions are fulfilled. Trust is necessary, but has to be combined with either multidisciplinary teams, or expertise on mental health and easy accessibility.