Child Mental Health Services in the New South Africa

Health departments in the new South Africa are undergoing major restructuring and, in some cases, severe financial cutbacks as new policies attempt to redress the inequities of the past. A district system is being phased in, with a shift in funding from academic hospitals to secondary and primary level care. The process is being undermined by the current recession, which also affects Welfare and Education facilities, and by widespread poverty, violence, and other adverse conditions. Child mental health services are discussed in the light of current human resources, epidemiological data, the effects of violence and cultural issues, together with some reflections on their future.     

Impact of Maternal Mental Health Status on Child Mental Health Treatment Outcome

This study examined the effect of maternal depression and anxiety on child treatment outcome. Psychiatric assessments were conducted on 180 mother–child pairs when the child entered treatment in a community mental health center and six months later. Children whose mothers were depressed or anxious were significantly more impaired than children of mentally healthy mothers at both time points. Both groups of children improved at approximately the same rate. The findings suggest that early mental health screening of children and their mothers may be important preventive practices. Addressing the mental health needs of mothers and children simultaneously may be an effective method of reducing their mental health problems.Carrie W. Rishel is affiliated with the Division of Social Work, West Virginia University.Catherine G. Greeno is affiliated with the School of Social Work/Department of Psychiatry, University of Pittsburgh.Steven C. Marcus is affiliated with the School of Social Policy and Practice, University of Pennsylvania.Esther Sales is affiliated with the School of Social Work, University of Pittsburgh.M. Katherine Shear is affiliated with the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical center.Holly A. Swartz is affiliated with the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical center.Carol Anderson is affiliated with the School of Social Work/Department of Psychiatry, University of Pittsburgh.     

Threats to Mental Health and Well-Being Associated with Climate Change

Climate change is a contributor to extreme weather events and natural disasters. The mental health effects of climate change are multifaceted, with post-traumatic stress disorder and depression predominant. This paper aims to describe the impact of climate change on mental health conditions, including risk and protective factors related to the expression of mental health conditions post-disaster, as well as a discussion of our local experience with a devastating wildfire to our region within Canada. The risk of the development of mental health conditions post-disaster is not equally distributed; research has consistently demonstrated that specific risk factors (e.g., gender, socioeconomic status and education, pre-existing mental health symptomatology), are associated with increased vulnerability to mental health conditions following natural disasters. There are multiple strategies that must be undertaken by communities to enhance adjustment and coping post-disaster, including improved access to care, inter-agency cooperation, enhanced community resiliency, and adequate preparation.     

Evaluating the Impact of the Winning New Jobs Programme on the Re-employment and Mental Health of a Mixed Profile of Unemployed People

This paper reports on the evaluation of the JOBS programme (Caplan et al, 1989), an evidence-based intervention designed to promote re-employment and improve the mental health of the unemployed. While previous evaluations have examined the programme's effects on the recently unemployed, this study examines the programme with a mixed profile of participants, including those long-term unemployed. The JOBS programme was adapted as the Winning New Jobs (WNJ) programme and implemented in the Republic and North of Ireland. It employs a quasi-experimental design, and programme outcomes included re-employment, general and mental health, and job search behaviour followed up over 12 months. The programme has produced positive long-term results, particularly with regard to re-employment. Specifically, 47.7% of the intervention group were employed compared with 16.8% of the comparison group (p<0.001) at the one-year follow-up. WNJ also had a positive effect on reducing economic hardship and enhancing inoculation against setbacks.     

Service Priority and Standard Performance of Community Mental Health Centers in South Korea: A Delphi Approach

Objective

The role of community mental health centers (CMHCs) in Korea is quite different than that of these centers in Western countries due to nation-specific health care system characteristics. For example, CMHCs of Korea are expected to provide services for serious mental illness in addition to other services in response to community needs, such as internet addiction of adolescents. Consequently, it is important to determine service priorities of CMHCs and to define standard service performances in order to maximize their effectiveness with limited resources. The present study aimed to generate expert consensus on service priorities and to identify standard service performances of CMHCs in South Korea.

Methods

Forty-five mental health professionals participated as experts in a Delphi survey. We made a survey questionnaire based on Korean and international data and guidelines of some countries such as the UK and Australia. Experts answered the first and second round questionnaires and their answers were analyzed using frequency analysis.

Results

For the question about future directions of CMHCs, twenty-two experts (49%) answered that the growth of services for serious mental illness should be preferred to other areas. The service for chronic mental illness was thought to be the most important service area (27.1%) and, early psychosis (10.5%) is included, the services for serious mental illness should be regarded as the most important service area of Korean CMHCs. It is followed by child and adolescent services (13.2%) and mental health promotion services (10.8%). The relative importance of service performances on each service domain were given by answers of experts.

Conclusion

CMHCs in Korea should focus their priority on the management of serious mental illness. Service standardization by the relative importance of service performances on each service domain is needed.     

Post-Disaster Mental Health Problems and the Utilization of Mental Health Services: A Four-year Longitudinal Comparative Study

This study examined mental health problems and mental health services (MHS) utilization after a fireworks disaster among adult survivors and a comparison group. The disaster took place on May 13, 2000, in the city of Enschede, The Netherlands. Victims (N=662) participated in a survey 2–3 weeks (T1), 18 months (T2) and 4 years (T3) post-disaster. The comparison group consisted of non-affected people from another city (N=526). They participated at T2 and T3. Victims used MHS more often than the comparison group in the 12-month period before T2 and T3 (OR 3.9 and 2.4). Victims with severe depression and anxiety symptoms at T2 used MHS more often than participants in the comparison group with these symptoms (OR 2.6 and 2.0). After 4 years, MHS utilization among participants in both groups with anxiety symptoms did not differ, suggesting attenuation of the observed effects. Results suggest that after a disaster survivors with mental health problems are less reluctant to use MHS than under normal circumstances.     

An In-Depth Examination of School-Based Mental Health Focus Groups with Young People: A Quality Enhancement Initiative

YouthNet/Réseau Ado (YN/RA) is a community-based, bilingual, mental health promotion and early intervention program for young people supported by a safety net of mental health professionals. The main objective of this study was to redesign an existing mental health promotion program better to engage and interest mainstream young people while enhancing the educational content. A youth-friendly methodology was used in which young people provided ideas for the redesign. The new two-session focus group format for mainstream young people met with success when pilot-tested in mainstream high schools. A majority of young people were either interested or very interested in session 1 (87.8%) as well as session 2 (94.7%) of the new model. Highlights of the new approach include an original mental health game and an open discussion geared specifically towards the needs of the young participants.     

Incorporating Community Mental Health into Local Bioterrorism Response Planning: Experiences from the DeKalb County Board of Health

Following a brief introduction to response planning for terrorism and other disasters, the authors present their experiences in developing a grassroots, interdisciplinary group charged with incorporating a mental health response component into the bioterrorism response plan for the metropolitan Atlanta area. This group was organized and supported by the Center for Public Health Preparedness at the DeKalb County Board of Health. Various viewpoints of key participating agencies are presented. Recommendations are provided for other localities and stakeholders who plan to incorporate a community mental health component into local disaster response plans.     

Development of Mental Health Indicators in Korea

Objective

Promoting mental health and preventing mental health problems are important tasks for international organizations and nations. Such goals entail the establishment of active information networks and effective systems and indicators to assess the mental health of populations. This being said, there is a need in Korea develop ways to measure the state of mental health in Korea.

Methods

This paper reviews the mental health indicator development policies and practices of seven organizations, countries, and regions: WHO, OECD, EU, United States, Australia, UK, and Scotland. Using Delphi method, we conducted two surveys of mental health indicators for experts in the field of mental health. The survey questionnaire included 5 domains: mental health status, mental health factor, mental health system, mental health service, and quality of mental health services. We considered 124 potential mental health indicators out of more than 600 from indicators of international organizations and foreign countries.

Results

We obtained the top 30 mental health indicators from the surveys. Among them, 10 indicators belong to the mental health system. The most important five mental health indicators are suicide rate, rate of increase in mental disorder treatment, burden caused by mental disorders, adequacy of identifying problems of mental health projects and deriving solutions, and annual prevalence of mental disorders.

Conclusion

Our study provides information about the process for indicator development and the use of survey results to measure the mental health status of the Korean population. The aim of mental health indicator development is to improve the mental health system by better grasping the current situation. We suggest these mental health indicators can monitor progress in efforts to implement reform policies, provide community services, and involve users, families and other stakeholders in mental health promotion, prevention, care and rehabilitation.     

The development of the Perth Charter for the Promotion of Mental Health and Wellbeing

The Perth Charter for the Promotion of Mental Health and Wellbeing is an initiative of the organizing committee of the 7th World Conference on the Promotion of Mental Health and Prevention of Mental and Behavioural Disorders. An iterative feedback process was used to develop and revise the charter principles in consultation with health professionals. A final online survey showed strong support for each of the eight principles, which were rated ‘essential’ (as distinct from ‘desirable’ or ‘not relevant’) by 73–96% of respondents. The principles were supported most strongly by practitioners, of whom 85–100% classified each as ‘essential’. It is hoped that mental health professionals find the Charter useful for advocating for greater resource allocation in their jurisdictions to mental health, in general and to mental health promotion in particular.     

Supervision Practices in Allied Mental Health: Relationships of Supervision Characteristics to Perceived Impact and Job Satisfaction

This study examined whether supervision characteristics impacted on mental health practice and morale, and developed a new Supervision Attitude Scale (SAS). Telephone surveys were conducted with a representative sample of 272 staff from public mental health services across Queensland. Although supervision was widely received and positively rated, it had low average intensity, and assessment and training of skills was rarely incorporated. Perceived impact on practice was associated with acquisition of skills and positive attitudes to supervisors, but extent of supervision was related to impact only if it was from within the profession. Intention to resign was unrelated to extent of supervision, but was associated with positive attitudes to supervisors, accessibility, high impact, and empathy or praise in supervision sessions. The SAS had high internal consistency, and its intercorrelations were consistent with it being a measure of relationship positivity. The study supported the role of supervision in retention and in improving practice. It also highlighted supervision characteristics that might be targeted in training, and provided preliminary data on a new measure.     

Traumatic Experiences and Mental Health of North Korean Refugees in South Korea

Objective

This study was conducted at Hanawon-a government sponsored educational facility for the settlement of North Korean refugees during their initial phase in South Korea-in 2004 to explore their mental health status and traumatic experiences in North Korea and during their escape period.

Methods

A survey was conducted in November 2004 with 62 North Korean refugees at Hanawon, and the Trauma Checklist was used to measure their traumatic experiences. To measure their psychological-mental health status, the Personality Assessment Inventory was administered.

Results

In comparison with the traumatic experiences of the North Korean refugees found in the study conducted in 2001 at Hanawon using the same methods, the current study showed a relatively lower frequency of traumatic experiences among the participants. The Personality Assessment Inventory results revealed that the study participants scored higher than average South Koreans in all clinical scales. Particularly, their mania (62.51) and schizophrenia (61.75) scores were above 60, a clinically meaningful score. In the gender comparison, the males exhibited meaningfully higher levels of alcohol problem, non-support, and warmth scale scores.

Conclusion

Compared to the 2001 study, the overall traumatic experiences among North Korean refugees participated in this study. But continous support is necessary for their successful adaptation to South Korean Society have declined. The North Korean refugees at Hanawon experienced difficulties maintaining their mental health and the men in particular requested more intensive care and support for this purpose.     

Promotion and Prevention in Child,Adolescent and Young People Mental Health: The Greek Experience of Participation in the Mental Health Network Programme of the European Commission

In 1997 the European Commission established the Mental Health Promotion Network to seek out, disseminate and promote best practice in mental health promotion and the prevention of mental disorders. The Network has commissioned a number of projects including two projects addressing the promotion of mental health and prevention of mental disorders in children and adolescents. Anticipated results included the establishment of criteria to identify good practice, development of a European database of good practice and widespread dissemination of good practice that could be implemented throughout the Community. The paper discusses the involvement and experiences of the staff employed in one organisation, from Greece, who have participated in the work Network, and highlights some of the difficulties faced and lessons learnt from participation in a multi-national project.     

The Relationship Between Maternal and Child Symptom Change in Community Mental Health

The mental health of mothers and children are closely linked. This study examined the relationship between child and maternal symptom change during a period in which children participated in community mental health treatment. Symptom change was measured using the Child Behavior Checklist for children and the Beck Depression Inventory for Mothers. Results indicate that mothers whose children improve in community mental health treatment are significantly more likely to report a reduction in maternal depressive symptoms than mothers whose children do not improve. Implications of these findings for mental health service settings are discussed.     

The Role of State Mental Health Authorities in Promoting Improved Client Outcomes through Evidence-Based Practice

The role of state mental health authorities (SMHA) is critical to implementing and sustaining evidence-based practices. This paper describes the seven major tasks of SMHA’s that comprise that role and provides examples from states which have been actively pursuing evidence-based practices.     

Challenges Relating to the Interface Between Crisis Mental Health Clinicians and Police When Engaging with People with a Mental Illness

Symptoms of mental illness can increase the risk of disturbed behaviour. Joint intervention between police and mental health services is therefore sometimes needed to manage crisis events safely, and to divert people with a mental illness from further criminal justice system contact. This study explored how crisis mental health clinicians and police officers experience the service interface to identify perceived challenges tocollaboration and possible solutions. This was explored through circulation of a developed questionnaire to staff of the Crisis Assessment Team of Alfred Psychiatry and police officers from three Melbourne police stations. In addition to identifying the high frequency of contact between interfacing services, a number of challenges to effective interface were identified. These included: inefficient communication before or following a joint event; difficulty accessing support from the interfacing service and delays in handing over care in hospital emergency departments; and staff occasionally not respecting the professional abilities of staff from interfacing services.     

Mental Health and Substance Abuse Services Preferences among American Indian People of the Northern Midwest

This study examines factors that influence preferences between traditional cultural and western mental health and substance use associated care among American Indians from the northern Midwest. Personal interviews were conducted with 865 parents/caretakers of tribally enrolled youth concerning their preferences for traditional/cultural and formal healthcare for mental health or substance abuse problems. Adults strongly preferred traditional informal services to formal medical services. In addition, formal services on reservation were preferred to off reservation services. To better serve the mental health and substance abuse treatment needs of American Indians, traditional informal services should be incorporated into the current medical model.Melissa L. Walls, Kurt D. Johnson, Les B. Whitbeck, Dan R. Hoyt are affiliated with the Department of Sociology, University of Nebraska-Lincoln, 711 Oldfather Hall, Lincoln, NE 68588-0324, USA; e-mail: mwalls@unlserve.unl.edu.This research was funded by the National Institute on Drug Abuse (DA13580) and the National Institute of Mental Health (MH67281), Les B. Whitbeck, Principal Investigator.     

Successful Application of a Canadian Mental Health Curriculum Resource by Usual Classroom Teachers in Significantly and Sustainably Improving Student Mental Health Literacy

Objective:

To investigate whether the significant and substantive findings from a previous study of youth mental health literacy (MHL) could be replicated using the same methods in another population.

Method:

We examined the impact of a curriculum resource, the Mental Health and High School Curriculum Guide (The Guide), taught by usual classroom teachers on students’ knowledge and attitudes related to mental health and mental illness in Canadian secondary schools. Survey data were collected before, immediately after, and 2 months after implementation of The Guide by teachers in usual classroom teaching. We conducted paired-sample t tests and calculated the Cohen d value to determine outcomes and impact of the curriculum resource application.

Results:

One hundred fourteen students were matched for analysis of knowledge data and 112 students were matched for analysis of attitude data at pre-intervention, post-intervention, and 2-month follow-up time periods. Following classroom exposure to the curriculum resource, students’ knowledge scores increased significantly and substantively, compared with baseline (P < 0.001, d = 1.11), and this was maintained at 2-month follow-up (P < 0.001, d = 0.91). Similar findings for attitude improvement were found (P < 0.001, d = 0.66), and this improvement was maintained at 2-month follow-up (P < 0.001, d = 0.52).

Conclusions:

These findings corroborate those from a previous study conducted in a different location. Taken together these results suggest a simple but effective approach to improving MHL in young people by embedding a classroom resource, delivered by usual classroom teachers in usual school settings.     

Jack Tizard Memorial Lecture: Educational Reform and the Mental Health of Vulnerable Children and Young People

Although research has demonstrated the differential influence of schools on children's psychosocial adjustment, the influence of radical legislative changes since 1979 is less clear. Evidence of a sharp rise in exclusions and in referral for special educational needs is contrasted with evidence that behaviour in most schools is good, and with data showing a steep reduction in the number of pupils leaving school with no qualifications. It is argued that these reforms have improved overall standards and may thereby have contributed positively to the mental health of many vulnerable children. However, the way they have been implemented has undermined teachers in some schools and, as a result, pupils there experience education as an additional source of stress rather than of stability and support.