The role of states in mental health policy in Brazil

This article examines the role of States in mental health policy in Brazil from 1990 to 2009. The methods included the use of an electronic questionnaire on State coordination of mental health in 24 Brazilian States, document review, and analysis based on official data. The results showed that the States use various strategies and tools to conduct mental health policy, especially in monitoring and services delivery. However, the study showed that States have not developed systematic approaches to planning, coordination with other levels of government, or coordination of care. Funding poses a major challenge for management of mental health at the State level. The study suggests that overcoming the challenges in mental health policy depends on the relationship between the Federal government, States, and Municipalities in drafting policies to address each region's specific needs, the promotion of participatory planning, and investment in the sector.     

From financial analysis to policy development in mental health care: the need for broader conceptual models and partnerships

International mental health economics is emerging as a significant field in the increasingly intricate and interactive world in which we live. In line with this, the conceptualisation and gathering of pertinent data for international studies such as WHO's Atlas Project pose considerable methodological challenges. This paper outlines the need for broader conceptual models and partnerships and discusses some promising endeavours.     

Cultural competence in mental health care: a review of model evaluations

Background  

Cultural competency is now a core requirement for mental health professionals working with culturally diverse patient groups. Cultural competency training may improve the quality of mental health care for ethnic groups.     

Occupational mental health: a brief history

This paper describes the development of occupational mental health in the United Kingdom. It looks at the increasing involvement of occupational health staff in this aspect of the workplace and the role played by organizational psychologists in exploring the relationship between work and mental well-being. It provides a background for the reviews of current knowledge described in the other papers in this issue of Occupational Medicine.     

The development of health care for workers through history

The definition of occupational health has changed significantly over time to cover broader aspects of health care and to promote worker's health. Over the centuries, the relationship between workplace hazards and occupational health care has been influenced by the character of work, social evolution and changes in manufacture, economy and demographics of the working populations. Numerous old civilizations showed deep prejudice towards human work. Very often manual work was done by slaves, and their health and safety were neglected. A spectrum of occupational diseases (acute, chronic, malignant and damage of reproduction) cover all organic body system, each of which can be affected by exposure to specific agents at workplace. Work and working conditions may deteriorate and worsen an existing illness which is not necessarily work-related. Living habits may also interfere with occupational factors leading to the development of a disease. Today, occupational medicine is the only medical field encompassing occupation and environment and health. This article also describes the historic development of occupational medicine in Croatia and some of the current regulations on occupational health in the country.     

The dynamic binding of resources for health in Brazil: 1995 to 2004

The aim of this study is to discuss the Brazilian Federal participation in the financing health sector from 1995 to 2004, having the basis the resources of the institutional initiatives related to the indexation of expenses, considering the macroeconomic adjustment practiced in that period and the institutions role to protect the cash flow. Examining the performances of the institutional mechanism actually adopted with the purpose of guarantee the flow regularity and extension of the values, by the analisys of the Temporary Contribution on the Financial Movement (TCFM) and the Constitutional Amendment Number 29 (CA 29) whose initiatives has their efficiency questioned. It demonstrates the impact of the destination of such measures from the statistics analysis of the use of the resources of the TCFM regarding its levies and the indexation of Union resources effects measures from the CA 29 before and after the application of its determinations.     

Community psychiatric care: from libertarianism to coercion. Moral panic and mental health policy in Britain.

This article discusses recent developments in mental health policy in Britain, focusing on the move towards compulsory supervision of mentally ill people in the community. It is argued that the desire for compulsion reflects moral panic rather than rational appraisal of the undoubted problems with community mental health care. Alternative strategies involving education of the patient and cares, the deployment of psychological treatments of psychosis and an emphasis on the negotiation of treatment plans, are advocated.     

The evaluation of a model of primary mental health care in rural Tasmania

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a primary care mental health service. DESIGN: The study used a naturalistic longitudinal design to follow groups of participants who received intervention from a rural mental health worker, or 'usual' mental health service, or no treatment, over a period of 12 months. SETTING: The service was evaluated in a rural primary care setting. PARTICIPANTS: One hundred and forty-five primary care patients. OUTCOME MEASURES: Changes in symptomatology were assessed using the SCL-90R summary scales, and changes in quality of life were assessed using the EuroQOL. RESULTS: Those participants treated by the primary mental health worker showed significant improvements in symptoms and quality of life compared to both the usual and no-treatment groups. CONCLUSION: There are few studies evaluating mental health services in rural settings. This study demonstrated that a particular model of primary mental health care was more effective than usual mental health care and no treatment at resolving symptoms and improving quality of life.     

The tidal model: the lived-experience in person-centred mental health nursing care

Abstract Nursing theories and nursing models have a low profile within psychiatric and mental health nursing within the United Kingdom. This paper considers some of the historical, policy and rhetorical issues that may have framed nursing's relative dependency on the medical paradigm, and briefly considers some of the ethical challenges, which proposed 'extensions' of the nurse's role might have for a 'caring' discipline.
The paper describes the philosophical background of the Tidal Model, which emerged from a series of studies of the 'need for psychiatric nursing'. The Tidal Model extends and develops some of the traditional assumptions concerning the centrality of interpersonal relations within nursing practice, emphasizing in particular the importance of perceived meanings within the lived-experience of the person-in-care and the role of the narrative in the development of person-centred care plans. The model also integrates discrete processes for re-empowering the person who is in mental distress, and provides a practical template for the exploration of the spiritual dimensions of the person's lived-experience, if appropriate.     

HEE-GER: a systematic review of German economic evaluations of health care published 1990–2004

Background  

Studies published in non-English languages are systematically missing in systematic reviews of growth and quality of economic evaluations of health care. The aims of this study were: to characterize German evaluations, published in English or German-language, in terms of various key parameters; to investigate methods to derive quality-of-life weights in cost-utility studies; and to examine changes in study characteristics over the years.     

Day care, maternal mental health and child development: evidence from a longitudinal study

Data from a long-term follow-up study of 632 born in Calgary in 1980 are reported, with particular reference to the experience of day care and its association with parental factors and the children's adjustment when they were, on average 6#lb7 years old. The sample was specially selected to include a high proportion of children with serious disabilities, and data for these children have been considered separately. Children with several years of day care behind them did not display attachment problems when they entered elementary schooling. They were however more active and aggressive than children without day care experience. This activity pattern is associated with Type A behaviour, which represents busy, active, competitive children. These traits probably reflect parental ambitions and activity patterns. Mothers who stayed home to look after several children were much more likely to be seriously depressed than mothers who returned to the external labour force in their child's preschool years. Maternal depression was associated with neurosis and depression in the child. This study gives support to the idea that high quality, affordable and universally available day care would be supportive of parental child care roles. Several sub-types of adaptation and day care experience have been identified, and hypotheses for exploration in a longer term study are suggested.     

From policy to practice: physicians' views on OBRA and mental health resources in long-term care

OBJECTIVES: The purpose of this national survey was to seek to clarify physician beliefs about nursing home mental health needs, understand the perceived effectiveness of OBRA legislation, determine physician exposure to OBRA PASARR Level II assessments, and understand the current role of community mental health interventions in the nursing home. DESIGN: A self-administered questionnaire. SETTING: Surveyed physicians were nursing home medical directors and/or attending physicians. PARTICIPANTS: The overall response rate for the 1000 physicians surveyed nationally, was 62% (n = 620). Fifty-nine percent (n = 361) of all responders were family physicians, and 41% (n = 250) were general internists. MEASUREMENTS/RESULTS: Only 48% (n = 291) of all respondents ever saw the recommendations from their patient's OBRA PASARR Level II assessment screening. Approximately one-third of all respondents viewed each discipline's recommendations as "very" or "somewhat" helpful. Thirty-seven percent (n = 228) of respondents viewed OBRA's psychotropic guidelines as only somewhat helpful. More than two-thirds (n = 412) believed OBRA regulations had not improved access to mental health care for their nursing home patients. CONCLUSIONS: This survey demonstrated that OBRA PASARR Level II assessments are not being viewed or valued by many physicians. In nursing homes, limited access to community mental health staff and psychiatric input may leave primary care physicians treating difficult behavioral problems themselves. Collaborating on helpful mental health interventions for nursing home patients is an ongoing critical issue in long-term care.