Systems development of child mental health services in developing countries

This article reviews recent findings in the epidemiology of childhood psychiatric disorders in the developing world and the relationship of epidemiology to system development. Examples of systems developed in the Third World are discussed. The experience with attention-deficit/hyperactivity disorder and the development of a comprehensive system of care around it in Lebanon are described. Cultural factors that affect special populations in childhood mental health are examined. The article concludes with recommendations for systems development in Third World countries.     

Developing mental health services in Nigeria

This grass-roots level mental health awareness programme considerably increased use of community-based mental health services in a part of Nigeria where knowledge about treatability of mental illness was limited. The benefits of the programme were sustained for a significant period after the initial awareness programme. In order for attitude changes to be reinforced, similar awareness programmes must be repeated at regular intervals.     

Emergency child mental health services in Poland

This paper describes emergency child mental health services in Poland. The paper defines common emergencies for children and adolescents, describes who responds and how services are organized. The evaluation process, interventions and treatment follow-up are outlined. The lack of consistency across Poland is highlighted. Recommendations for further training of professionals, as well as improvements in the mental health and legal systems are made.     

Engaging families in child mental health services

To increase the involvement of urban youth and families who need mental health services, child mental health agencies and providers might consider the following: (1) examining intake procedures and developing interventions to target specific barriers to service use; (2) providing training and supervision to providers to increase a focus on engagement in the first face-to-face meetings with youth and families; (3) providing service delivery options with input from consumers regarding types of services offered. Involvement of youth and their families is a primary goal that must receive as much attention as any other part of the service delivery process. One might argue that without youth and family participation, effective services never will be provided to youth and families in need.     

Emergency child mental health services in Estonia

This paper describes emergency child mental health services in Estonia. The paper defines what is an emergency in Estonia, who provides services to children and adolescents, the process of evaluation, follow-up care and societal emergencies. Centers for care in Tartu and Tallin are described. The need for ongoing training and the expansion of services into the countryside is noted.     

Emergency child mental health services in Latvia

This paper describes emergency child mental health services in Latvia. The paper defines child mental health emergency and outlines which professionals are involved in evaluation and where evaluations occur. The described follow-up services are only now developing, with the majority of children still receiving minimal mental health services in shelters or detention centers. Recommendations for more training of professionals, specific protocols and an integrated system of care are made.     

Developing needs led child and adolescent mental health services: issues and prospects

For many years mental health services for children have been developed incrementally with little attention to the needs of the local population. However, over the past decade there have been attempts to develop more rational ways of planning child mental health services. This paper describes the information required to develop a needs-led child mental health service and, within that context, discusses how priorities should be set. It will be suggested that although the assessment of needs for child and adolescent mental health services is still very haphazard, there is now a clear trend for the evaluation of clinical practice to become more systematic. At an individual level we know quite a lot about the efficacy of treatment and the measurement of outcomes. At the service level, several models of good practice are being specified and evaluated. Accepted: 16 September 1998     

Three-generation households and child mental health in European countries

Social Psychiatry and Psychiatric Epidemiology - To evaluate the associations between the presence of a grand parent at home that is three-generation household, with children mental health in...     

Developing mental health services in the global south

Abstract

This paper outlines the diversity of medical and healing systems indigenous to many regions of the world and their under-development and suppression during colonialism; describes briefly social and cultural changes that have taken place in the Global South after de-colonisation, resulting in varying degrees of a plurality (in terms of cultural style) of mental health systems currently available; summarizes important general principles of post-colonial development in the Global South; and, finally, points to ways of mental health and wellbeing development in the Global South by drawing on the example of Sri Lanka where the author was involved in a four-year research and capacity building project between 2007 and 2012. The paper takes a historical post-colonial approach to development on the principals of sustainability and cultural relevance and argues for a pragmatic approach in the short term while building up a body of knowledge about the countries concerned, their ground realities and their indigenous psychologies.     

Evidence-based practice in child and adolescent mental health services

The authors review the status, strength, and quality of evidence-based practice in child and adolescent mental health services. The definitional criteria that have been applied to the evidence base differ considerably across treatments, and these definitions circumscribe the range, depth, and extensionality of the evidence. The authors describe major dimensions that differentiate evidence-based practices for children from those for adults and summarize the status of the scientific literature on a range of service practices. The readiness of the child and adolescent evidence base for large-scale dissemination should be viewed with healthy skepticism until studies of the fit between empirically based treatments and the context of service delivery have been undertaken. Acceleration of the pace at which evidence-based practices can be more readily disseminated will require new models of development of clinical services that consider the practice setting in which the service is ultimately to be delivered.     

User satisfaction with child and adolescent mental health services

BACKGROUND: Child and adolescent mental health service units (CAMHS) play an important role in the supply of services to children and adolescents with mental illness. The purpose of this study was to examine the service unit effect on parent satisfaction with outpatient treatment. METHOD: The study was undertaken in 49 of 72 Norwegian outpatient CAMHS in 2004. A total of 2253 of the parents who were asked to participate (87%) responded. Parent satisfaction was measured using two summated scales: clinician interaction/information and treatment outcome. Multilevel analyses were used to assess the contribution of the service units to satisfaction and to investigate patient level predictors of parent satisfaction. RESULTS: About 96-98% of the parent satisfaction variance could be attributed to factors within CAMHS, leaving only 2-4% of the variance attributable to the CAMHS level. Parents of patients aged 0-6 years were more satisfied than older patients' parents. Longer treatment episodes were positively associated with satisfaction. Parents whose children had been referred with externalizing symptoms were less satisfied with treatment outcome than those referred for internalizing symptoms. Waiting time was negatively associated with treatment outcome satisfaction. Adjustments for patient characteristics did not substantially change the relative effect of CAMHS on satisfaction ratings. CONCLUSION: The results indicate that information from user satisfaction surveys has clear limitations as an indicator of CAMHS quality. From a quality improvement perspective, the factors affecting the variance within CAMHS are of dominating importance compared to factors affecting between CAMHS variance.     

Three models of community mental health services In low-income countries

Objective  

To compare and contrast three models of community mental health services in low-income settings.     

Developing outpatient mental health services for managed care.

One of the characteristics of the best outpatient treaters is their capacity to manage their own anxieties so as not to interfere with their patients' progress. This does not mean "sitting on," shutting out, or otherwise ignoring those signals to prevent their intruding into the therapeutic space. On the contrary, this requires that a clinician be acutely aware of his or her internal dialogue and be able to listen to use it to facilitate the treatment. This has meant simultaneously listening to oneself while paying complete attention to one's patient. This paradox is part of the nature of this work and remains one of its important features. Today, those who choose to treat psychiatric patients in this setting are presented with many more such paradoxes, including the necessity of being aware of (1) populations needing to be served while providing the best care for individual patients; (2) limited resources; and (3) balancing ethical, fiscal, legal, and clinical concerns. This article demonstrates that the successful development of outpatient services in a managed care environment requires attention to these same tensions on a larger scale. It also shows that understanding the evolution of managed care and the myriad competing interests involved are necessary to be able to care successfully for psychiatric patients.     

Developing local service standards for managed mental health services

Managed care schemes for community mental health services are becoming common. Capitated funding models designed to control costs may create incentives to withhold care. The authors describe a method for creating local standards for minimally appropriate levels of service. The use of such standards can lead to a dialogue with funders and managed care administrators over what constitutes a suitable service package.The authors are grateful to the clinical staff of the mental health centers whose commitment and hard work made the project possible. The study was supported by the King County Mental Health Division, the Board of Community Psychiatry Clinic, and the School of Social Work, University of Washington.     

Differences in dropout between diagnoses in child and adolescent mental health services

Dropout from treatment is a significant problem in child and adolescent mental health services, and findings regarding the role of possible contributing factors are inconsistent. It is argued that this inconsistency may be the result of the confounding effects of different definitions of dropout, and different dropout rates for different diagnoses. A file review of 520 new cases over a 12-month period in a large Child and Adolescent Mental Health Service in Melbourne, Australia was performed. Information was collected about the intake, parents, family, child, diagnoses and treatment. A significant relationship was found between diagnosis and dropout rate, with clients experiencing family problems or conduct disorder and ADHD being more likely to dropout, and those experiencing negative life events, anxiety disorders or those not having a diagnosis being less likely to dropout. These findings offer potential directions for services to consider specific strategies for retaining their clients. Possible reasons for these findings, methodological issues and future research directions are discussed.     

Connecting science and practice in child and adolescent mental health services research

Collaboration between researchers and stakeholder groups is a potentially powerful mechanism for strengthening the quality of mental health research and for amplifying its public health impact. For stakeholders, collaboration offers opportunities to help shape research questions; participate in data collection and interpretation; and improve local capacity to access and use research findings. For researchers, collaboration can build understanding of what stakeholders want and need from research; enhance capacity to frame research questions and findings in language and metrics of value to stakeholders; and provide opportunities to contribute science-backed knowledge to decision-making processes in real world settings. Key stakeholder groups can include the recipients and providers of care, public and private care systems, health plans, schools, family service and faith-based organizations, correctional systems, and employers providing mental health benefits. This commentary reflects on the path that NIMH has taken in fostering researcher-stakeholder collaboration, particularly regarding child and adolescent mental health research. It describes the goals that NIMH set out to achieve, steps taken to realize those goals, lessons learned from those efforts, and possible next steps.     

Examining the research base for child mental health services and policy

This article reviews the existing research base for child mental health services and policy. It emphasizes the importance of research that looks at the overall community-based system of care as the unit of analysis, and stresses the need to maintain a systems perspective, even when research is focused on components of the overall system. The review concludes that there is a need for a considerable increase in child mental health services research but also indicates that there has been a recent increase in research that has the potential of building a base to change policy. In particular, a need is identified for well-controlled studies that assess both clinical and cost outcomes and for studies that examine the mega issues of the organization and financing of systems of care.     

Designing a benefit plan for child and adolescent mental health services

The rising costs of mental health services for children and adolescents are a growing concern for insurers and employers alike. Several studies have indicated that the costs for children's treatment continue to grow, while others have reported that only a small number of the children diagnosed with mental disorders receive treatment. The authors propose an innovative model benefit plan and briefly provide the rationale for coverage and payment features.