Better medication management for Aboriginal people with mental health disorders: a survey of providers

OBJECTIVE: To explore the experiences and training needs of service providers in relation to medication management for Aboriginal people with mental health disorders. DESIGN: Survey. SETTING: Aboriginal and mainstream health and human service organisations in metropolitan, rural and remote South Australia. SUBJECTS: Aboriginal health workers, nurses, mental health workers, substance misuse workers, managers, liaison officers, social workers, police, pharmacists, general practitioners, community workers, counsellors, paramedics, educators, family support workers and others. RESULTS: The major health service issues for Aboriginal people with mental health disorders and their carers are related to access to, and availability and appropriateness of services. Quality use of medications by Aboriginal clients is influenced by drug and alcohol misuse, cost, compliance, feelings about the value of medicines, sharing of medications and unwanted side-effects. Many workers providing services to Aboriginal people with mental health disorders lack adequate training and/or resources on mental health and safe medication management; yet, are required to provide advice or assistance on these matters. CONCLUSIONS: The survey provides new, reliable evidence relevant to mental health services and medication management for South Australian Aboriginal people. It highlights the major issues impacting on quality of care and service provision, demonstrates the wide range of health and allied workers providing medication advice and assistance to Aboriginal people, and reveals workforce development needs.     

Challenges for psychosocial rehabilitation services in the Lisbon Metropolitan Area: A qualitative approach

In Portugal, a mental health reform process is in place aiming to redefine the model of service provision. In 2008, a National Mental Health Plan (NMHP) was approved to provide policy guidance over the transition period. The NMHP intended, among others, to develop community‐based services, with a specific focus on rehabilitation and deinstitutionalization. This study aims to explore the perspectives of service managers of psychosocial rehabilitation services regarding the main challenges to support the community living of persons with severe mental illnesses (PWSMI) in the Lisbon Metropolitan Area (LMA). The paper also contextualises the provision of psychosocial services within the country's mental health reform process and characterises the profile of service users in socio‐occupational units (SOUs) of the LMA. Semi‐structured interviews were performed with all SOUs’ managers of the LMA (n = 13). Information regarding service user characteristics was collected based on service records (n = 344). Interviews were analysed according to the framework methodology. The results of the interviews were triangulated using document analysis. Fieldwork took place between June and July 2016. The findings suggest that the development of the mental health reform ensured significant changes to service delivery. Community‐based mental health organisations are an important actor for service provision. However, important asymmetries were identified in the provision of psychosocial care within the LMA. At the same time, family carers are perceived as responsible for ensuring a large part of the social needs of the PWSMI but there is an increasing concern with their own ageing processes. As a conclusion, it is highlighted the current inequality between services and the need to contemplate a life‐course perspective that comprehends the ageing process of caregivers poses an emerging challenge for psychosocial rehabilitation. These findings are also important for other low‐ and middle‐income countries passing through similar reforms.     

Developing community mental health services: an evaluation of Glasgow's mental health resource centres

Greater Glasgow Health Board's strategy for the development of community mental health services includes the establishment, over a 7-year period, of multi-disciplinary community mental health resource centres throughout Glasgow. An evaluation of the first phase of the development was carried out in three resource centres. This focused on three key themes: the establishment of multi-disciplinary teams, targeting of those with the most severe illnesses and the participation of users in the care process. The evaluation exercise comprised five substantive elements: analysis of the clinical database; interviews with staff within each of those centres, interviews with representatives of key external agencies associated with each centre; a survey of general practitioners; and a survey of the views of clients, their carers, their key workers, and their general practitioners (GPs). Clients were generally very satisfied with the services and felt that the resource centres met all their mental health needs. Although the majority of current centre cases had severe mental illnesses and those with the more severe conditions had the highest contact rates there was evidence that in the absence of a clear framework for referral the centres were also providing services for those with less severe illnesses. Despite a wish by centre staff to move towards modes of working less dominated by health professionals and more inclusive of other resources and especially of clients themselves, these goals remained to be achieved: there was a lack of clarity in the definition of the appropriate target groups for the centres; access to crisis support was regarded as problematic; the concept of multi-disciplinary team working had yet to be fully realized with evidence suggesting that some psychiatrists working in the resource centres had not embraced many aspects of the new approach to service delivery including a focus on the severely ill; and progress towards the ideal of active client involvement had been slow.     

Canadian community mental health workers’ perceived priorities for supportive housing services in northern and rural contexts

A relationship between mental health and supportive housing has been established, yet there exist enduring challenges in meeting the supportive housing needs of people with severe mental health problems. Furthermore, not all stakeholder viewpoints of supportive housing services are well documented in the research literature, and research has tended to focus on supportive housing provision in large, urban centres. Potentially, distinct challenges and opportunities associated with the provision of supportive housing services in smaller urban and rural communities that define the greater geographical terrain of Canada and other jurisdictions are less developed. This study describes community mental health service workers’ priorities for supportive housing services. Using Q methodology, 39 statements about supportive housing services, developed from a mixed‐methods parent study, were sorted by 58 service providers working in four communities in northern Ontario, Canada. Data used in this study were collected in 2010. Q analysis was used to identify correlations between service workers who held similar and different viewpoints concerning service priorities. The results yielded four discrete viewpoints about priorities for delivery of supportive housing services including: a functional system, service efficiency, individualised services and promotion of social inclusion. Common across these viewpoints was the need for concrete deliverables inclusive of financial supports and timely access to adequate housing. These findings have the potential to inform the development of housing policy in regions of low population density which address both system and individual variables.     

Engaging communities to improve mental health in African and African Caribbean groups: a qualitative study evaluating the role of community well‐being champions

Over the last decade, Britain has undergone reforms to promote engagement in local structures of governance. These reforms have encouraged the promotion of active citizenship and have been central to the government's public service modernisation agenda. This article presents the findings from a study evaluating a pilot outreach intervention which adopted a community engagement model to address the mental health needs of African and African Caribbean groups, which entailed a partnership between faith‐based organisations, local public services and community organisations to co‐produce the pilot project. Lay people were trained to raise awareness about mental health among these communities in South London. Between 2012 and 2013, a qualitative participatory approach was used to evaluate the pilot project, which enabled a researcher to take part in the engagement phase of the pilot project, and the project co‐ordinators to be involved in the research process. Semi‐structured, one‐to‐one interviews were carried out with 13 community and well‐being champions (CWBCs) recruited from African and African Caribbean communities (seven male and six female). This study examines the impact of the relationship between the intervention and community through the participants’ engagement in the pilot outreach project and the action undertaken as champions. We found that although CWBCs used circles of influence to share ideas about mental health and well‐being and to encourage change, they encountered resistance on the part of the people they engaged with, which resulted from a lack of knowledge about mental health, taboos and ascribed stigma. We argue that CWBCs acted as healthy examples to communicate mental health knowledge to those approached, but that they needed to be equipped with bespoke communication skills to be able to talk about such sensitive issues as mental health.     

北京市社区精神障碍患者康复需求调查研究

[目的]了解目前北京市社区精神障碍患者的康复需求,以期为更好的提供精神卫生服务提供依据。[方法]采用自行设计的调查问卷,对北京市朝阳、西城、大兴、房山4个区在社区康复的精神障碍患者进行现场调查,回收的数据用Epidata 3. 1录入,并用SPSS 22. 0软件进行统计分析。[结果]①社区精神障碍患者以城市京籍中老年无业者居多,学历普遍较低,多为持有精神残疾类别的残疾证的严重精神障碍患者;②近一半的患者更愿意接受社区专业化康复医疗服务(344,48. 6%);③患者选择在社区接受精神卫生服务的原因主要是方便及时(570,80. 5%);④大部分患者认为应该通过提高服务的专业性来促进社区精神卫生服务的发展(299,42. 2%)。[结论]北京市社区精神障碍患者的需求集中体在优质专业的社区精神卫生服务、丰富多样的就业岗位、灵活有效的康复项目、美好和谐的家庭环境和社区氛围等方面,而要更好满足患者的需求需要政府完善相关政策、提高基层服务水平、加强宣传、促进多方合作。     

Advocacy for mental health: roles for consumer and family organizations and governments

The World Health Organization urges countries to become more active in advocacy efforts to put mental health on governments' agendas. Health policy makers, planners and managers, advocacy groups, consumer and family organizations, through their different roles and actions, can move the mental health agenda forward. This paper outlines the importance of the advocacy movement, describes some of the roles and functions of the different groups and identifies some specific actions that can be adopted by Ministries of Health. The mental health advocacy movement has developed over the last 30 years as a means of combating stigma and prejudice against people with mental disorders and improving services. Consumer and family organizations and related NGOs have been able to influence governments on mental health policies and laws and educating the public on social integration of people with mental disorders. Governments can promote the development of a strong mental health advocacy sector without compromising this sector's independence. For instance, they can publish and distribute a directory of mental health advocacy groups, include them in their mental health activities and help fledgling groups become more established. There are also some advocacy functions that government officials can, and indeed, should perform themselves. Officials in the ministry of health can persuade officials in other branches of government to make mental health more of a priority, support advocacy activities with both general health workers and mental health workers and carry out public information campaigns about mental disorders and how to maintain good mental health. In conclusion, the World Health Organization believes mental health advocacy is one of the pillars to improve mental health care and the human rights of people with mental disorders. It is hoped that the recommendations in this article will help government officials and activists to strengthen national advocacy movements.     

Involving communities in health service planning in primary care

Recent health service policy in the United Kingdom has emphasized the need to involve local people in health service planning. This paper will describe how local communities were involved in the development of Primary Care Resource Centres. These centres are designed to provide a base for the delivery of a range of health, social welfare and information services within a community setting. Four centres in the process of being developed in one region were selected for in-depth study. The main method of data collection consisted of semi-structured interviews with key “stakeholders”, namely purchasers and providers of primary health care, social care providers, hospital outreach staff and local community and voluntary group workers (Weiss 1983). This paper examines how the health service organizations developing the centres involved local communities in planning them and the obstacles and difficulties encountered. The paper suggests lessons that can be learned for future community involvement in the planning of local health services.     

精神分裂症社区服务现状与发展策略研究

目的旨在探讨推行具有中国特色社区精神卫生服务的可行性举措。方法回顾国内外面向精神分裂症的社区精神卫生服务不同模式及其发展现状,分析影响发展的因素。结果我国精神分裂症的社区精神卫生服务需要从建立健全精神卫生体系、加强社会宣传和促进多部门合作等方面入手进行研究、探索。结论顺应全球精神卫生服务模式转变,积极发展精神分裂症的社区精神卫生服务势在必行。     

精神分裂症社区精神卫生服务现状与发展策略初步研究

目的旨在探讨推行具有中国特色社区精神卫生服务的可行性举措。方法回顾国内外面向精神分裂症的社区精神卫生服务不同模式及其发展现状,分析我国社区精神卫生发展存在的问题。结果我国精神分裂症的社区精神卫生服务需要从建立健全精神卫生体系、加强社会宣传和促进多部门合作等方面入手进行研究、探索。结论顺应全球精神卫生服务模式转变,积极发展精神分裂症的社区精神卫生服务势在必行。     

Gerontological social work and cardiac rehabilitation

Cardiac rehabilitation is a setting in which integrating social work services can benefit older adults. Many cardiac rehabilitation patients endorse symptoms of stress and depression following a cardiac event, impeding their ability to participate fully in cardiac rehabilitation services or recover from a heart attack. Gerontologically trained social workers can improve the care of older adults with heart disease in a variety of ways and this paper discusses the potential roles social workers can play in enhancing care. Two examples demonstrating how community academic partnerships can lead to improved options for older adults following a heart attack are discussed. First, using a microsystems approach, social workers embedded within cardiac rehabilitation may improve patient quality of life, address social service needs, provide mental health treatment, and assist in the completion of standard cardiac rehabilitation assessments. Second, using a macrosystems approach, social workers can help communities by developing partnerships to establish infrastructure for new cardiac rehabilitation clinics that are integrated with mental health services in rural areas. Social workers can serve an important role in addressing the psychological or social service needs of cardiac rehabilitation patients while increasing access to care.     

The actions of health centres in realising the partial amendment of the law on mental health and welfare for people with mental disorders. A questionnaire survey of prefectural health centres

OBJECTIVE: In accordance with the partial amendment of the Law on Mental Health and Welfare for People with Mental Disorders, some mental health and welfare work is now under the jurisdiction of cities, towns and villages instead of prefecture. What is the role of prefectural health centres in realizing the change? To assess the smoothness of the transfer of the work from prefectures to the municipalities, we investigated the situation in the latter and the actual support provided by health centres. METHODS: A total of 103 health centres in the administrative divisions were recruited. A questionnaire survey was carried out to study the mental health and welfare work, the department in change and other data for cities, towns, and villages in the administrative division of each prefectural health centre. The actions of health centres were also investigated and analyzed. In addition, Japan was divided into 6 blocks of health centres, and comparisons among the 6 blocks were made based on the answers to survey questions. RESULTS: A total of 83 health centres responded to the questionnaire (the response rate was 80.6%), with 683 cities, towns and villages included in their territories about 60% of the municipalities had designated a person in charge of the transferred mental health and welfare services, the responsible department was decided in less than 40% of cases. There were differences among the 6 blocks in Japan in the rates of actions on mental health and welfare, and in the designation of the department in charge in municipalities. Over 95% of the health centres provided educational courses related this transfer of work for municipalities. About 80% of the health centres evaluated the merit of the partial amendment for promotion of mental health and welfare, and 60% were anxious about retrogressive policies for people with mental disorders. CONCLUSIONS: Educational courses supported the smooth transfer of services. The department in charge of the transfer of service in the cities, towns and villages was designated in less than 60% of municipalities.     

The mental health workforce in the community: a comparison of national Community Psychiatric Nursing and Approved Social Work survey results

In the past it has not been possible to compare the distribution and workload of two of the main professional groups providing mental health care in the community, community psychiatric nurses (CPNs) and approved social workers (ASWs) because no adequate national data were available. Two recent surveys permit a limited degree of comparison between the characteristics of the two national workforces and the present paper summarizes the comparison which can be made from the two different data sets, in terms of the numbers of staff and rates per head of population, number of clients seen, caseload variations and training. Training for, and provision of, out-of-hours services by ASWs are more uniform, but there is much less variation per head of population in the numbers of CPNs than ASWs across the UK. The CPNs are almost certainly working with more people with serious mental illness. There is some suggestion, which needs further research, that, in numerical terms, there might be an element of substitution of one discipline for another in different regions of the country.     

改良家庭干预技术对慢性严重精神障碍患者干预效果观察

目的：观察应用改良家庭干预技术对社区慢性严重精神障碍患者的康复效果,创新社区精神障碍管理服务模式,为社区的精神病防治与康复提供科学的理论依据。方法：随机抽取40例社区慢性严重精神障碍患者,随机分成两组：实验组应用改良家庭干预技术（每15 d1次）;对照组采用目前实施的国家基本公共卫生服务基础干预模式（每月1次）。每15d为一个评估时点,共7个时点,采用简明精神量表（BPRS）评价两组患者精神病症状,采用社会功能评估量表（SDSS）评价其社会功能,两个量表的指标值分别叠加作为康复效果评价。比较两组患者BPRS、SDSS评分及康复效果评价指标值。结果：实验组在1时点与2时点的BPRS评分与0时点的差异无统计学意义（P>0.05）,3～6时点的BPRS评分低于0时点,且低于同期的对照组（t值分别为4.333 0,4.615 3,5.261 4和5.771 1,P<0.05）。实验组3～6时点的康复效果评分均低于同期的对照组（t值分别为3.824 7,4.092 3,4.907 5和5.598 9,P<0.01）。结论：改良家庭干预技术能使社区慢性严重精神障碍患者的康复获益,...     

上海精神卫生服务的现状与前瞻

目的了解社区老年严重精神障碍患者的日常生活能力和社会支持现状,为社区照护与卫生服务提供依据。方法随机抽取400名社区在册老年严重精神障碍患者,采用日常生活能力量表(ADL)、社会支持评定量表(SSRS)进行现况调查和专题小组讨论。结果社区老年严重精神障碍患者ADL筛查发现,功能有明显障碍者为34.25%,性别间无显著差异(P＞0.05),年龄和受教育程度间有差异(P＜0.01)。共患多种慢性躯体疾病者ADL功能受损增多;社会支持评定总得分为(31.81±3.82)、客观支持得分为(7.10±2.09)、主观支持得分为(16.81±2.74)、支持的利用度得分为(7.84±2.07),低于社区一般老年人群(P＜0.01),不同居住状况者社会支持评定得分差异有统计学意义(P＜0.01);专题小组讨论印证了上述调查结果。结论社区老年精神障碍患者日常生活功能受损严重、社会支持评定结果低,应重视这些脆弱人群的日常生活功能的维护和康复,并提供相应的社会支持。     

加强精神卫生服务 保障社会安全和谐

近期几起残害儿童事件的直接肇祸者,或者是精神疾病患者,或者是有严重心理问题者,他们本属于社会弱势群体。悲剧提醒人们,精神卫生问题是公共卫生问题,是社会问题,正视和处理它们,是政府的职责,是全社会成员的义务。重性精神障碍患者,需要及时治疗,缓解症状,在社区得到持久的治疗康复和社会支持;对于存在严重心理问题者,要提供各种心理咨询、辅导和疏导,缓解其压力,帮助解决他们在社会生活中的困难;对于广大公众,要提供心理健康教育、心理问题预防和心理保健宣传,在他们遇到重大生活挫折时,能够得到政府和社会的关爱。总之,要让全社会成员都能够对生活充满希望。各级地方政府主要领导人只有认识到加强精神卫生工作的意义,做好本职工作,组织逐项落实各个指标,加强精神卫生服务尤其是社区精神卫生服务,带动政府部门真正履行职责,才能够预防悲剧发生,保障社会安全和谐。要把精神卫生服务提供到位,必须遵循"政府领导、部门合作、社会参与、依法办事"的原则。     

Exploration of joint working practices on anti‐social behaviour between criminal justice,mental health and social care agencies: A qualitative study

Although the police play an important role for people with mental health problems in the community, little is known about joint working practices between mental health, social care and police services. There is potential for tensions and negative outcomes for people with mental health problems, in particular when the focus is on behaviours that could be interpreted as anti‐social. This study explores perceptions about joint working between mental health, social care and police services with regard to anti‐social behaviour. We conducted a multi‐method sequential qualitative study in the UK collecting data between April 2014 and August 2016. Data were collected from two study sites: 60 narrative police logs of routinely gathered information, and semi‐structured interviews and focus groups with professionals from a range of statutory and third sector organisations (N = 55). Data sets were analysed individually, using thematic iterative coding before integrating the findings. We also looked at sequencing and turning points in the police logs. Findings mapped on a continuum of joint working practices, with examples more likely to be away from the policy ideal of partnership working as being central to mainstream activities. Joint working was driven by legal obligations and concerns about risk rather than a focus on the needs of a person with mental health problems. This was complicated by different perceptions of the police role in mental health. Adding anti‐social behaviour to this mix intensified challenges as conceptualisation of the nature of the problem and agreeing on best practice and care is open to interpretations and judgements. Of concern is an evident lack of awareness of these issues. There is a need to reflect on joint working practices, including processes and goals, keeping in mind the health and welfare needs of people with mental health problems.     

上海市社区医护人员精神卫生知识的现状及影响因素*

目的了解上海市社区医护人员的精神卫生知识现状及其影响因素,为今后针对性开展培训、提高社区心理卫生服务能力提供依据。方法依托上海市心理卫生服务体系建设三年行动计划项目,选取上海市3家试点社区卫生服务中心的医护人员进行调查,采用"非精神科临床医师心理卫生知识调查问卷"对医护人员进行调查。结果 (1)本次调查总体平均分50.0分,各维度得分均低于60.0%满分;(2)职业类别、参与精防工作和参加过培训是影响精神卫生及各维度知识得分的主要因素;(3)家庭医生的精神卫生知识得分较高57.4分,相比公共卫生人员高12.3分,家庭医生各维度的知识得分均较高,其次是中医/理疗/康复人员;(4)参加精防工作人员的精神卫生知识得分比没有参与的高14.6分,其各维度的知识得分均较高;(5)参加过培训在个别维度的得分较高。结论社区医护人员的精神卫生知识水平总体偏低,对抑郁、焦虑等心理疾病的认识有待提高;培训与实践相结合,是提高社区医护人员精神卫生知识水平的有效途径。