Mental health services in Asia: International perspective and challenge for the coming years

In contrast to European countries and the United States of America, there has been a steady increase in the psychiatric inpatient population in Japan between 1960 and 1993. Japan has the biggest number of psychiatric beds in the world, both in absolute and relative numbers per population. However, Japan now focuses on community based services and the human rights of patients. In other Asian countries, the number of psychiatric beds is relatively small; however, the numbers are increasing each year in China, the Republic of Korea, Philippines, Indonesia and in many other countries in Asia. These countries are still facing the challenge of increasing psychiatric services and to improve the quality of care with scarce mental health resources. Should Asian countries take the similar path to European countries and develop mental health services? This review provides an overview of Asian mental health services and discussing the following issues: how many psychiatric beds do we need in Asia?; public vs private psychiatric services?; financing scheme to promote community based care in Asia; mental health services in primary health care; family education and user involvement in Asia; and the challenge for psychiatrists in Asia.     

Mental health practice in Arab countries

PURPOSE OF REVIEW: This review deals with the current situation of mental health practice in Arab countries. Despite the complexity and importance of the topic, the Arab world still shows a lack of awareness regarding mental health problems and a dearth of mental health services and professionals. The main purpose of this paper is to examine changes in the area of mental health, and what still needs to be developed or investigated. RECENT FINDINGS: Mental health patients in Arab countries tend to express their psychological problems in terms of physical symptoms, thereby avoiding the stigma attached to mental illness. They also tend to underutilize mental health services and to hold negative attitudes toward formal mental health services. Reliance upon a deity and religious leaders as a means of coping with mental health issues is another prevalent theme in the Arab world. Another issue is that of mental health practices in politically volatile and violent regions, where higher rates of mental health problems and psychiatric diagnoses have been found. In addition, women in Arab/Muslim countries are at paramount risk from mental health problems. SUMMARY: The findings have implications for professional service delivery. Further research, intervention and activism are needed in the field of mental health systems in Arab countries to improve awareness of mental health problems. Further research is also needed regarding issues such as cultural competence and the suitability of mental health treatment and services for the non-Western communities in many Arab/Muslim countries.     

BIOMED‐MEROPE* project: service provision for adults with intellectual disability: a European comparison

The aim of the present paper is to describe and compare services for adults with intellectual disability (ID) and mental health needs in five European countries: Austria, England, Greece, Ireland and Spain. A framework and structure for collecting information about service provision was designed. This information was collected through a mixture of interviews with service providers, questionnaires and a review of the research literature within each country. Information was collected on historical context, policy, legislation, assessment, treatment and the structure of services for people with ID and mental health problems. Overall, the needs of those with additional mental health needs have not been specifically addressed at a national level with perhaps the exception of England and Ireland, although there are still gaps in services in these nations. Normalization has been adopted in each of the five countries, and there are moves toward deinstitutionalization, integration and inclusion. Families and self‐advocacy groups have grown. The pace of this change varies between and even within countries. The main findings of the study include: unclear policy, trends for legislative changes, increased prevalence of mental health problems, inadequate generic service provision, a need for specialist mental health services, a need for improved interconnections of services, and a need for training developments. Policy and legislation in the five European countries under consideration tend to separate the disability aspects of people with ID from their mental health needs. Consequently, the service needs of this group remain largely invisible. This might be a direct reflection of policy clarity and legislation, or could be the result of a failure to implement existing guidelines. This has a detrimental effect on the lives of people with ID, and their families and carers.     

Promoting mental health in Asia‐Pacific: Systematic review focusing on Thailand and China

Mental health is essential for functioning, general health, and quality of life in low and middle‐income countries (LAMICs), as for high‐income countries. This study aimed first to search in the English language peer‐reviewed literature for reviews of mental health promotion interventions in the Asia‐Pacific region. A global rapid review by Barry and colleagues indicated a paucity of publications on this topic in the peer‐reviewed literature. The second aim of the study followed from this observation. Two systematic reviews of English language literature were conducted as case studies in two countries with known interest in mental health promotion, Thailand and China. The reviews covered publications in peer‐reviewed journals and the “grey” literature. In Thailand, the review demonstrated: strong evidence for an empowerment program for human immunodeficiency virus (HIV)‐infected mothers; a reduction in HIV‐related stigma in a community‐based program; and a coping program for adolescents. The second review concerned suicide prevention interventions in China. It found one relevant study, a WHO multi‐site study of suicide prevention. We found surprisingly little evidence in either country of interventions focused on health equity or modifying the social determinants of mental health. We agree with Barry and colleagues that there is an urgent need to invest in the policy, practice, and research capacity for mental health promotion in LAMICs so that mental health promotion can be incorporated into the wider health promotion and global health development agenda. This includes the Global Action for Health Equity Network. Evidence‐based interventions in parenting, schools, workplaces, and among older people can be initiated or adapted and evaluated in LAMIC settings.     

Mental health care in Fiji

Fiji is one of the largest island nations in the South Pacific. It is multicultural and has an economy based on tourism and sugar production. Like many developing countries Fiji faces the double burden of communicable and non‐communicable diseases as well as a third emerging burden of accidents and injuries. Fiji lacks data on the national prevalence and burden of disease of mental disorders. Using World Health Organization estimates there is over a 90% treatment gap for mental disorders. Contributing to this treatment gap are the misconceptions and stigma surrounding mental illness leading people to seek alternative treatments. Fiji's mental health services were established in 1884, comprising a single ward to care for mentally ill expatriates. Services have since expanded to include a 136‐bed inpatient facility (St. Giles Hospital), which provides outpatient, psychosocial rehabilitative and community psychiatric services. Mental health services remain centralized at St. Giles, with follow‐up in the community supported by a well‐established public health hierarchy and by medical personnel at the divisional hospitals. St. Giles is also responsible for conducting mental health awareness and training for health workers and the public and provides input at a national level for mental health policy, plans and legislation. Psychiatric training is available at the undergraduate nursing and medical levels. The Fiji School of Medicine is in the process of developing a postgraduate psychiatric program. With its limited resources Fiji needs to integrate mental health services into the general and public health systems to achieve a comprehensive and integrated mental health system.     

Developing a culturally appropriate mental health care service for Samoa

Mental Health Care Services are part of the National Health Services for Samoa. Their function is to provide mental health care services to the population of Samoa, which numbers 180,000 people. However, like many other countries in the Pacific region, mental health is considered a low priority. The mental health budget allocation barely covers the operation of mental health care services. More broadly, there is a lack of political awareness about mental health care services and mental health rarely becomes an issue of deliberation in the political arena. This article outlines the recent development of mental health care services in Samoa, including the Mental Health Policy 2006 and Mental Health Act 2007. It tells the story of the successful integration of aiga (family) as an active partner in the provision of care, and the development of the Aiga model utilizing Samoan cultural values to promote culturally appropriate family‐focused community mental health care for Samoa. Mental Health Care Services today encompass both clinical and family‐focused community mental health care services. The work is largely nurse‐led. Much has been achieved over the past 25 years. Increased recognition by government and increased resourcing are necessary to meet the future health care needs of the Samoan people.     

Qualitative analysis of key informant interviews about adolescent stigma surrounding use of school mental health services

Given the increased access to mental health services that schools provide, there has been a growing consensus among mental health professionals for the delivery of services for youth in schools. Building the capacity of schools to provide evidence-based socio-emotional supports across a continuum of care has been prioritized in recent decades. However, despite policy changes to implement more mental health services in schools, these services still remain widely underutilized by adolescents experiencing mental health problems. Understanding the factors impacting students’ decisions to seek help or use resources provided in a school setting is crucial for actually increasing utilization of care. Yet, little is known about the role of stigma in students’ underutilization of school mental health services. The current study examined stigma about mental health and services in schools through a qualitative analysis of 15 school personnel and student interviews at three high schools in South Carolina. Thematic analysis of interviews indicated that students have a negative outlook of mental health services because of fear of being stereotyped or embarrassed as a result of receiving school counseling. Data from this exploratory study directly contribute to the field of education by providing a model for professionals to implement strategies to eliminate the stigma that causes underutilization of school mental health services.     

Do we still need beds for psychiatric patients?

While the utilization of outpatient psychiatric care increased steeply in the last few decades, the number of beds in psychiatric hospitals declined continuously in most countries. The future need for psychiatric hospital beds is influenced by changes in psychiatric morbidity, the range of services offered by mental hospitals and the availability of alternative forms of care for the chronically ill. A prospective cohort study conducted in Mannheim showed that currently, at a favourable standard of complementary service provision, one quarter of the schizophrenic patients requiring institutional care for more than one year - schizophrenics are the largest group of mental patients in need of long-term residential care - still need to be treated in mental hospitals. Beyond this threshold value the costs of alternative care exceed those of a continuous inpatient treatment, and, concurrently with them, the burden upon the people involved grows. Estimates of the future need can be made on the basis of field surveys, utilization data of a population and an analysis of long-term trends by using case register data. Provided a well-functioning system of alternative and outpatient mental health services is available, psychiatric bed ratios covering the actual needs in developed countries seem to range from 0.5 to 0.8 per 1000 population over 15 for the short-stay group and from 0.3 to 0.6 per 1000 for long-stay patients. The uncertainty inherent in the estimates requires a sufficient degree of flexibility in service planning and a continuous monitoring to make adjustments to changed conditions possible.     

The Organization of Mental Health Care in the USSR: Past and Present

Since the 1960s, French public mental health services have been organized in sectors, with each sector team providing mental health care for a mean population of 54,000 inhabitants. This organization is aimed at providing continuity of care for patients from an identified area. The reduction in the number of hospital beds has been more progressive in France than in the United States and other European countries. In 2000, there were 9.4 beds for 10,000 inhabitants over 20 years old. The sectorization system has shown its efficacy in terms of access to care and continuity of care for severe mental illness. It is now challenged by a growing demand expressed by society in a context of restricted funding and by the difficulties generated by a programmed decrease in the number of psychiatrists. The last mental health program published by the Ministry of Health in 2005 identified the areas in which improvement must be made and gave precise figures for resources to be provided to achieve those aims.     

Mental health care in Egypt: Review of current state,policy, and needs

This study aims to analyze the new Egyptian mental health law from a rights perspective in order to measure its compatibility with established human rights principles and the international standards that guide the practice of the mental health care. At the same time, the study considers the status of psychiatric care and basic mental health services for people with mental disorders in Egypt after several recent national upheavals along with the national prevalence of psychiatric disorders in the country. It will address the needs and the challenges facing current practice, with a discussion of some suggestions for improvements. Relevant data bases were searched (Medline, PubMed, and Cochrane library of systemic reviews and clinical trials) with the following Mesh terms: “mental disorders,” “substance-related disorders,” “Egyptian Mental Health systems,” and “Egyptian Mental health laws.” Articles published since 2000 were prioritized. In the latest years, a considerable gap between mental healthcare needs and available services in Egypt has been documented. There is comprehensive mental health legislation to enforce the rights of persons with mental disorders; but there is a lack of firm policy for implementation of interventions. The transformation of hospital-based to community-based mental health and the building of accessible services are necessary. Egypt urgently needs a national assessment of the deficiencies of its mental health system. The assessment would provide evidence and reliable information on existing needs and the barriers to accessing mental health care. The outputs of such an assessment will be helpful in finding locally and culturally sensitive solutions to reduce the mental health gap and can then be used in lobbying public opinion to rectify these conditions.     

The current state of adult mental health care in France

Since the 1960s, French public mental health services are organised in “sectors”, each sector catering for a mean population of 54,000 inhabitants. Although this organisation was aimed at insuring equal access to care whatever the place of residence, there are still huge disparities in number of staff and bed resources from one sector to another. The reduction in the number of hospital beds started later in France than in most other European countries, and was really effective in the 1990s. In 2000, there were 9.4 beds for 10,000 inhabitants aged over 20 years. Hospital-based care has still an overwhelming importance, and is associated with a marked under-development of community services and lack of sheltered housing for the most disabled patients. With more than 13,000 registered psychiatrists in France, the density of psychiatrists is one of the highest in the world. However, French psychiatry has currently to face a structural crisis due to the reduction in public health budgets, as well as to the reduction of 30% in the number of French psychiatrists over the next two decades. The numerous national programmes aimed at renovating French mental health services, published over the last decade, have not yet kept their promises.     

Geriatric Mental Health and COVID-19: An Eye-Opener to the Situation of the Arab Countries in the Middle East and North Africa Region

While the detrimental ramifications of the COVID-19 outbreak on the mental wellbeing of the general public continue to unravel, older adults seem to be at high risk. As the geriatric population continues to grow in the Middle East and North Africa (MENA) region, it is essential to explore the influence of this outbreak on geriatric mental health, a topic often neglected. In this review, we depict the status of geriatric psychiatry in the Arab countries of the MENA region, exploring the variations from one nation to another. While some have a null exposure to the field, resources and expertise in other countries range from very limited to extensive. Furthermore, we highlight the measures implemented in the Arab region to address mental health during the COVID-19 outbreak; these tend to be insufficient when targeting the geriatric population. Finally, we provide short- and long-term recommendations to stakeholders that aim at enhancing the mental healthcare of older adults in the Arab countries of the MENA region, particularly during this pandemic.     

A Survey of Mental Health Services at Post-Secondary Institutions in Alberta

Objectives:

The relatively high prevalence of mental health problems among students at post-secondary institutions in Canada is well documented; in contrast, less is known about the adequacy of mental health services available to Canadian post-secondary students on campuses. Our study sought to examine the current state of campus mental health initiatives and services in Alberta as well as the extent to which resources identified in mental health literature as being key in mental health problem prevention and promotion appear to be available.

Methods:

A 60-question, online survey was sent to staff (primarily front-line workers; n = 45) at Alberta’s 26 publicly funded post-secondary institutions. Responses were organized according to small (less than 2000 students), medium (2000 to 10 000 students), and large (10 000 or more students) institutions.

Results:

All of Alberta’s post-secondary institutions were represented in the responses. Mental health initiatives and services are available, to varying extent, at all of Alberta’s post-secondary institutions. However, many institutions do not have initiatives and (or) services aimed at identifying students with mental health problems or policies for monitoring their mental health services. Additionally, smaller institutions are less likely to offer certain services (for example, gatekeeper training and campus medical services), compared with larger ones. Finally, a systematic review or an evaluation of services appears to be infrequently conducted.

Conclusions:

These findings highlight the need for post-secondary institutions in Alberta, and by extension in Canada, to develop and institute a comprehensive strategy to evaluate and optimize the delivery of mental health initiatives and services.     

Treatment of mental disorders and pathways to care in Arab countries

Abstract

Introduction. The available studies on the treatment of mental disorders in the Arab world are uncommon. Methods. A literature review was conducted aiming at identifying studies related to the rate and type of treatment of mental disorders in Arab countries from the Middle Eastern Mediterranean region. Results. A total of 23 articles were included in this review. These articles focused mainly on type of services used and/ or the rate of treatment. Findings from several articles showed a paucity of treatment of mental disorders, and when present, individuals were more likely to receive it from the general medical than from the mental health sector. Only two studies have assessed patterns of treatment of mental disorders on a national level from the Arab Middle Eastern countries (Lebanon and Iraq). Conclusion. The need for national studies on mental disorders in this part of the world and the improvement of public awareness in this field were highlighted.     

Establishing mental health policy and services in Vanuatu

With a population of 245,000 spread mostly over six groups of islands and a total land area of 12,189 km², Vanuatu is one of the larger Pacific Island countries. Compared to other Pacific Island countries of similar or larger size, mental health has received little attention from government until very recently. While systematic studies are lacking, the limited available data suggest that mental disorders and suicide are increasing. The first ever National Mental Health Policy and Strategic Plan were launched in October 2009. Key areas include formalization of the National Mental Health Committee established in 2007, financing, mental health legislation, service organization, human resources, essential medicines, information systems, quality, advocacy, and monitoring and evaluation. In 2010, mental health was inserted for the first time into the new Ministry of Health organizational structure. The Ministry of Health mandate is to work with partners to achieve sustainable progress in reducing all key risk factors to improve the wellbeing of everybody with mental illness. The country has commenced a program of mental health training for workers at primary and secondary health facilities and community awareness, with support from the World Health Organization Pacific Island Mental Health Network (PIMHnet) and others. A foundation for modern mental health services has been laid.     

Editorial: Child and Adolescent Mental Health: a global challenge

Welcome to the first issue of Child and Adolescent Mental Health of 2015. A pleasure of being an editor of this journal is the sheer breadth and diversity of papers that we receive. The best papers not only share the achievements and successes of new research and innovation but also shed light on the complex struggles and challenges involved in helping children and young people overcome the emotional, behavioural and other mental health difficulties they endure. Child and Adolescent Mental Health aims to publish high quality health services research that informs, influences and transforms the quality and effectiveness of the mental health care available to children, young people, their parents and families. When placed in the global context outlined by Patel and Rahman (2015) in this issue, the scale of this task is daunting. Nearly half of the world's population are under the age of 18 and only a small fraction of the global mental health resources currently available are invested in child and adolescent mental health care across low, medium and high income countries. Patel and Rahman (2015) argue that the step change needed to transform global child mental health requires a bold agenda that mobilises community assets, such as lay health workers, harnesses the use of mobile and electronic health technologies alongside more conventional improvement in access and effectiveness of both universal and specialist services from early life onwards. This agenda resonates for children and young people in high income countries as much as it does for those living in low and middle income countries. Child and Adolescent Mental Health needs to reflect the global challenge of children and young people's mental health. This issue contains papers from authors based in Australia, Brazil, India, Italy, Ireland, Turkey, the UK and the USA, each of which uses scientific methods to make an informed contribution to clinical practice.     

Mental health resources for older persons in the Western Pacific Region of the World Health Organization

Background: The Western Pacific Region of the World Health Organization (WHO) contains 27% of the world population and 29% of the world population of elderly people: it is the oldest among the six WHO regions. The demographic transition (from high child mortality and low life expectancy to a low child mortality and high life expectancy) is happening at high speed and this proportion of the world's elderly population is expected to increase significantly in the coming years. Consequently, there is a high risk that the number of older persons with mental disorders will significantly increase. To better understand the organization of care for older persons, data is being collected to reduce the imbalance between ‘disease information’ and ‘resource information’—information that addresses older persons' needs in terms of mental health care. This article presents some results for this region. Method: Data were essentially collected from the World Health Report 2005. The data concerning NGOs was obtained at the websites of the World Psychiatric Association, the World Federation of Neurology, the International Association of Gerontology and Geriatrics and Alzheimer's Disease International (ADI). Results: Because the mental health problems of older adults is still not a public health priority, the careful examination of individual countries nevertheless reveals certain specificities, such as divergent life expectancy or different values regarding aging. The authors present some recommendations for the development of care for elderly persons with mental disorders in the region based on the general recommendations made by WHO in the World Health Report 2001 (WHR 2001) and by WHO and the World Psychiatric Association (WPA) in some consensus statements on Psychiatry of the Elderly. Conclusion: The Western Pacific WHO region has a high proportion of older persons in its population (11.2% of total population), with important differences between the countries in life expectancy at birth. Strong cultural forces and migration may affect the growing and aging processes. Local poverty, with all the consequences it may have for health, may also be an important factor negatively influencing quality of life and life expectancy at birth. Mental health for all ages should become a priority issue in the public agenda in the region. National governments should make efforts to promote mental health and provide care for elderly persons with mental disorders, depending on local resources and cultures. As mental disorders in old age can represent a severe limitation on quality of life for older persons and their families good care should be extended to all concerned. The challenge of finding solutions for better living conditions for older people with mental health problems lies in the hands of researchers, policy makers and the population. Funding and creativity are two factors necessary to find such solutions.     

Mental health services in the Solomon Islands

The Solomon Islands comprise an archipelago of nearly 1,000 islands and coral atolls and have an estimated population of 549,574 people. Formal mental health services date back to 1950 when an asylum was established. Since then the process of mental health service development has been largely one of incremental change, with a major boost to community services in the last two decades. During the 1990s a mental health outpatient clinic was established in Honiara, together with attempts to recruit nursing staff as psychiatric coordinators in the provinces. In 1996, the Ministry commenced sending registered nurses for psychiatric training in Papua New Guinea. By 2010, there were 13 psychiatric nurses and one psychiatrist, with a second psychiatrist in training. A National Mental Health Policy was drafted in 2009 but is yet to be endorsed by Cabinet. A significant portion of the population still turns to traditional healers or church leaders for purposes of healing, seeking help from Western medicine only after all other alternatives in the community have been exhausted. There is still a long way to go before mental health services are available, affordable and accessible to the whole population, including people living in geographically remote areas. Realization of this vision requires increased resourcing for mental health services; improved communication and collaboration between the centrally‐based, national mental health services and the provincial health services; and closer, ongoing relationships between all stakeholders and partners, both locally and internationally.     

Community Mental Health in the People’s Republic of China: A Critical Analysis

Community mental health has long been the crucial modality in service delivery of mental health services. This paper is an attempt to evaluate community mental health services in the People’s Republic of China. The writer critically argues that community mental health services in the People’s Republic of China still have faced a lot of difficulties such as huge demand but scarce resources, withdrawal of governmental funding in related services, inaccessibility of services to deprived and remote rural areas, political control, high mental health illiteracy and problems in formation of multidisciplinary team. An articulation of community mental health in the China context is also discussed.