Health policy and mental health

Health policy can be described as policy directed at the determinantsof health, i.e. biological and environmental factors, lifestyleand the health care system. This type of policy now has become a policy objective in anincreasing number of countries. In this article mental health is placed in the broad contextof this policy. The central question is: can the mental healthfield grasp the opportunity of a growing interest in preventionand health promotion in general, as major objectives of healthpolicy? Or will it stay more or less isolated from the mainstreamof current developments? Answering this question means looking at the conditions of healthpolicy. For health policy it is required that a definition begiven of health problems and "causing" conditions. There shouldfurther be available intervention possibilities of a preventiveand intersecloral character and also preventive strategies. It is stated that there is enough standardized information onmental health problems and experience with community-based researchto let mental health participate in drawing up a community diagnosis.It also appears possible to construct an ecological health statusmodel for mental health. Research on the factors in this modelshows a shift in focus from risk populations to risk situations,e.g. unemployment, industrial disability, divorce and isolation.Further it is recognized that the search for causal factorsis substituted by that for precipitating factors. Social-demographicfactors, taken alone, are not precipitating factors. What mattersis the combination of an underdeveloped coping mechanism, littlesocial support, and prolonged stressful conditions or suddenstressful events. Our knowledge on the determinants of mentaldisturbances is growing, but for the sake of credibility weneed more detailed data. The practice of mental health preventionshows an emphasis on mental health education which in most casesconsists of a mild form of group therapy. To become a partnerin the topical health policy debate mental health should also(again) stress the socio-economic factors, as for example isdone in the "Healthy Cities" project. Voluntary organizationscan play an important role in this respect. The conclusion is that mental health prevention has enough knowledgeand skills to take part in the health policy development. Itis hoped that the mental health field takes more initiativeto become a partner in that development.     

Health services research and health policy

Health services research (HSR) has the potential to influence the decision-making process in a health services system that is acutely aware of its resource limitations. Nonetheless, health services researchers feel, with some truth, that their research has had only a limited effect on health policy. Some reasons for this are described, including the primacy of political, rather than technical, considerations in policy making, the lack of a comprehensive health policy, and the poor quality and irrelevance of much HSR. The role of funding for HSR by the Federal government is described; it is shown that the Federal effort is fragmented, despite the consolidation efforts made in 1968. Increased support for specific targeted, problem-solving health services research is proposed, and some possible methods to achieve this are described.Dr. Banta is a Professional Staff Member with the Office of Technology Assessment, Congress of the United States, Washington, D.C. 20510, and Associate Clinical Professor, Mount Sinai School of Medicine of the City University of New York. Ms. Bauman is a Professional Staff Member, Committee on Labor and Public Welfare, Senate of the United States, Washington, D.C. 20510. The authors would like to thank Carl Taylor of the Office of Technology Assessment, Arthur Viseltear of Yale University, and Richard Seggel of the Institute of Medicine for their helpful comments. Dr. Banta is grateful to the Robert Wood Johnson Foundation for its support of the Robert Wood Johnson Health Policy Fellowship and to the Institute of Medicine, which developed the Fellowship. A version of this paper was presented at the Medical Care Section, American Public Health Association meetings, Chicago, Illinois, November 19, 1975.     

Defining 'mental illness' in mental health policy

Mental health policy is shaped fundamentally by the definition of mental illness associated with the policy. Changing policies reflect changing definitions. At various times, the definition may be narrow or broad with respect to the scope of conditions covered by a specific policy. The priority accorded to impairment severity is the most crucial and enduring policy issue related to the definition of mental illness and the scope of that definition. This paper explores the role of definitions in framing mental health policy, using examples from the history of policy making over the past half-century.     

Economic barriers to better mental health practice and policy

Mental health systems in many countries are seriously under-developed, yet mental health problems not only have huge consequences for quality of life, but--particularly in low- and middle-income countries--contribute to continued economic burden and reinforce poverty. This paper discusses economic barriers to improving the availability, accessibility, efficiency and equity of mental health care in low- and middle-income countries. Six sets of barriers are identified: an information barrier, resource insufficiency, resource distribution, resource inappropriateness, resource inflexibility and resource timing. Overcoming these barriers will be a major task, although there is no shortage of suggestions for action. The paper discusses broadening the evidence base, improving mental health literacy, tackling stigma, improving financing mechanisms, prioritizing and protecting mental health care budgets, emphasizing mental health promotion through the development of resilience, exploring routes to improved equity, experimenting with new arrangements for purchasing and delivering services, improving coordination between agencies and professionals at both macro- and micro-levels, building alliances between public and private sectors, and training and mobilizing primary care services to improve identification and treatment of mental health problems.     

Revisiting health and mental health linkages: a policy whose time has come ... again.

This review and policy analysis examines the connection between physical and mental health. The review includes an analysis of individual diagnoses of physical and mental illness and training issues for both health and mental health professionals. A summary of earlier efforts to link health and mental health services includes a brief history of federal involvement and evaluation of linkage efforts. Linkage examples from a rural context are described briefly. Barriers to successful linkages are discussed with some suggestions for overcoming these obstacles. Policy recommendations for encouraging and establishing health and mental health linkages are presented.