A partial solution: a local mental health authority for the UK

BACKGROUND: the structural problems of the mental health system in the UK have been analyzed by a number of authors over the past several years as the "reforms" of the health and social service systems have continued (Kavanagh and Knapp, 1995; Mechanic, 1995). In a recent article, Hadley and Goldman (1995) suggest that one possible solution to some of these issues may be the creation of a local mental health authority. Such an authority would consolidate the funding, authority and responsibility in a single entity. We believe this model, which is typical of many local public mental health systems in the US, is at least part of the solution to the current problem of financial and service fragmentation of the current system in the UK. The numerous "reforms" of the health and social service systems (which include the Community Care Act, the development of the Internal Market, GP fundholding and the purchaser-provider split) were not designed for the care of the mentally ill (Han, 1996). These policy changes in the design of health and social services have created a complicated and difficult context in which services must be delivered. Too many agencies play a significant role in the delivery and management of mental health services. Health authorities, social service agencies and GP fundholders are direct and indirect funders of the system while community care trusts, social service agencies and GPs are service providers (Hadley, 1996a). RESULTS AND A PROPOSAL: We believe that the development of local mental health authorities may be part of the solution to the structural and economic problems of the current system in the UK. It is not the answer to limited resources or limited skills, but can create a new structure, which will permit and encourage the cooperation and innovation that is now possible only with unusual effort. Local mental health authorities have a number of crucial characteristics, but, most importantly, they refocus the system on the provision of care to the seriously mentally ill. This is the expressed priority of government, advocates and providers, alike.These new entities could be created at either the purchaser or provider level or, as exists in a number of jurisdictions in the US, at both levels, where a single purchaser may be responsible for multiple consolidated providers. This combination is now the emerging model for innovative services in the US. In the UK, the development of a local mental health authority at the purchaser and/or provider level might be relatively simple. Although the creation of a statutory authority would require primary legislation and is therefore probably not a short-term solution, there appears to be a variety of administrative options that would have the same effect. IMPLICATIONS FOR HEALTH POLICY FORMULATION: The creation of a local mental health authority may be a necessary first step towards the development of a coordinated and comprehensive system of care. It seems likely that there is currently more "political" support for the development of a purchaser model but the development of a sophisticated purchsaer is also likely to take considerable time and effort. Although all the structural and policy problems of the mental health system in the UK will not all be solved by local mental health authorities, they may be beneficial if responsibility for mental illness care is to be centralized and fragmentation is to be reduced. Without making structural changes, the best efforts by clinicians, policymakers and managers are most likely to be in vain. Without a clear point of ultimate purchasing and service responsibility, the fragmentation and inefficiency of the current system will remain (Hadley et al., 1996).     

社会支持与职业应激的关系

目的探讨社会支持与职业应激的关系。方法采用横断面研究方法对654名来自不同行业的职业人群进行调查,使用职业紧张测量工具测试社会支持、职业应激因素、个性特征及职业应激反应。结果不同职业人群获得的社会支持程度不同;调查人群的社会支持评分与工作中的多种职业应激因素有关。获得社会支持越多者,工作人际关系、对人的责任、对事的责任、提升机会、参与机会、任务一致性、培训的充分性、工作挑战性、工作自主性、工作满意感、心理卫生、情绪平衡、正性情绪、自尊感及应付策略评分越高,与对照组比较,差异有统计学意义(P<0.05或P<0.01);而角色冲突、角色模糊、工作前景未知性、负性情绪、抑郁症状、每日紧张感及工作心理控制源评分则随社会支持程度的增加而减少,与对照组的差异亦有统计学意义(P<0.05或P<0.01)。逐步回归分析结果显示,社会支持对抑郁症状有较大的影响(R2>0.05)。结论社会支持对职业应激有较大影响,对职业人群的心理健康发挥着重要的维护作用;不同职业人群获得的社会支持程度不同。     

The role of family carers in the use of personal budgets by people with mental health problems

Personal budgets aim to increase choice and independence for people with social care needs but they remain underused by people with mental health problems compared to other disability groups. The use of personal budgets may impact on families in a variety of ways, both positive and negative. This paper draws on interviews, undertaken in 2012–2013 with 18 family carers and 12 mental health service users, that explored experiences of family involvement in accessing and managing personal budgets for a person with mental health‐related social care needs. The sample was drawn from three sites across England, with additional carers being recruited via voluntary sector networks. Our findings show that for many people with severe mental health needs who lack motivation and confidence to negotiate access to personal budgets, carers may provide the necessary support to enable them to benefit from this form of social care support. We illustrate the role carers may play in initiating, pursuing and maximising the level of support available through personal budgets. However, some carers interviewed considered that personal budget funding was reduced because of practitioners’ assumptions about carers’ willingness and ability to provide support. We also report perceived tensions between family carers and practitioners around appropriate involvement in decision‐making. The study findings have implications for local authorities, practitioners and family carers in supporting the involvement of family carers in support for people with severe mental health problems.     

The prevalence of mental disorders among income support recipients: an important issue for welfare reform

OBJECTIVE: To estimate the prevalence of mental disorders and psychological distress among Australian income support recipients. METHODS: Data from the 1997 National Survey of Mental Health and Wellbeing were used to examine measures of mental health, disability and use of mental health services, comparing working-age people in receipt of government payments to those with other main sources of income. RESULTS: One-quarter of all income support recipients had experienced substantial levels of psychological distress during the previous four weeks and almost one in three had experienced a diagnosable mental disorder during the previous 12 months. Around 45% of unpartnered women with children in receipt of income support payments were identified with a mental disorder. In contrast, around 10% of people not receiving welfare reported substantial psychological distress and 19% had a diagnosable mental disorder. The prevalence of physical and mental disability was also greater among income support recipients. There was no difference in service use between recipients and non-recipients. CONCLUSIONS: Mental illness is a significant issue among income support recipients. The presence of a mental disorder is a substantial barrier to work and other forms of social participation. Mental health is an issue with relevance beyond the health portfolio, with implications for many domains of social policy and service delivery. Understanding and better assisting income support recipients with mental health problems will be important in welfare reform and in the introduction of a more active welfare system.     

The health and wellbeing of mental health professionals

We examine dimensions of job satisfaction, occupational burnout and general health of a sample of 123 mental health care professionals (psychiatric nurses and nursing assistants, and smaller professional groups such as social workers, occupational and recreational therapists and psychologists) employed at a large Canadian psychiatric hospital. Psychiatric nursing assistants exhibit more of the consequences of job-related stress (less job satisfaction, greater occupational burnout, greater incidence of negative physical and psychological symptoms of stress) relative to the other professional groups in the sample. This may be linked with their position within the hospital organization (having less authority and professional autonomy relative to the other groups), affecting their ability to cope with job-related problems and stresses experienced by all direct care workers. We examine attitudes of mental health professionals towards organized support groups at the hospital, which could provide one forum for the open discussion (and potential resolution) of job-related stresses and problems experienced in hospital settings.     

两类职业人群自感紧张度的调查及健康对策

[目的 ]　了解机关公务员及商业人员自感紧张度的状况。 [方法 ]　采用自评紧张值量表 ,对两种职业的 332 4名对象作问卷式调查 ,通过量表中各项得分的总和来综合评判个体的紧张程度。 [结果 ]　两类职业人群中女性自感紧张度高于男性 ,公务员高于商业人群 ,且在公务员中青年人的自感紧张度高于老年人。随着健康和生活满意度的增加 ,其自感紧张度明显下降。个人因素对自感紧张度有显著的影响。 [结论 ]　在作业场所开展心理健康教育及健康促进非常迫切和必要 ,尤其是针对职业妇女     

Attitudes to the use of videoconferencing in general and specialist psychiatric services

Mental health professionals and support staff were invited to complete a questionnaire about their experience of using videoconferencing. Our hypotheses were that mental health professionals in the UK do not have access to videoconferencing and do not believe that videoconferencing is appropriate for their work. Of the 134 people who completed and returned a questionnaire, 78 worked in deaf mental health services and 56 worked in general mental health services. The majority were nurses (n = 33) or psychologists (n = 30). A total of 109 respondents (81%) knew what videoconferencing was, but only 16 respondents (12%) had ever used it. The majority of the 32 respondents who knew the location of their nearest videoconferencing facility said that it could be accessed in less than 30 min. The 16 people who had previously used videoconferencing identified four different benefits of videoconferencing and eight different drawbacks. We conclude that mental health staff did not have adequate knowledge of, or access to, videoconferencing.     

Bridging the gap between professionals and the community in mental health services: findings and policy implications of two demonstration projects

This paper describes two projects which targeted citizens as key players in the well-being and mental health of local communities and have tapped the mutual aid resources of informal helping networks. One of these projects was implemented with people who had mental health problems, many of whom were homeless and dependant drug users, in Quebec's inner city. Two professional workers, who were experienced in neighbourhood interventions (a psychologist and an educator) and a researcher were employed for a period of 28 months (from September 1989 to December 1991). The other project was implemented within the context of primary care for a wide range of health and social problems in a rural LCCS (Local Centre for Community Services). A social worker, who specialized in rural network intervention, was employed for 2 years. The same research team worked on both of the projects. The main objective of both projects was the development and testing of a method of intervention which aimed to encourage citizen involvement, both in promoting the physical and mental health of those suffering from transitory problems, and in the rehabilitation process of those suffering from severe social or mental health problems. In order to accomplish that objective, the professional workers made themselves visible and accessible in the community. The projects generated two very different models of intervention. The inner city model of intervention was tied closely to pivotal citizens and placed a great emphasis on the helper-therapy principle. The rural model was founded on network intervention, mutual aid being more relevant for marginal people. Even though these models of intervention embody provincial and federal government policies, professionals are far from ready and able to change their practice accordingly.     

headspace: National Youth Mental Health Foundation: making headway with rural young people and their mental health

Mental health is the number one health issue affecting young people in Australia today, yet only one in four of these young people receive professional help. Approximately 14% of 12- to 17-year-olds and 27% of 18- to 25-year-olds experience mental health problems each year. However, many do not have ready access to treatment or are reluctant to seek that help. These issues might be exacerbated in the rural and remote regions of Australia where sociocultural barriers such as stigma, lack of anonymity and logistic difficulties including cost and availability of transport can hinder young people accessing mental health services. headspace: the National Youth Mental Health Foundation has been funded to address these issues. headspace will provide funding for the establishment of communities of youth services across Australia, provide national and local community awareness campaigns and plans, establish a centre of excellence that will identify and disseminate evidence-based practice in addressing youth mental health issues, and translate findings into education and training programs that are targeted at service providers to work with youth mental health. The communities of youth services will build the capacity of local communities to identify early, and provide effective responses to, young people aged 12-25 years with mental health and related substance use disorders. Specific approaches in rural, regional and remote areas will be developed as well as specific programs to involve young Indigenous people.     

无锡市HIV/AIDS患者生活质量及其影响因素调查

目的：调查无锡市艾滋病病毒感染者和艾滋病患者的生活质量,分析其影响因素,为更好地进行关怀干预提供依据。方法：采用健康状况调查问卷（SF-36）加上艾滋病相关条目作为调查问卷,对208例HIV/AIDS患者进行调查。结果：HIV/AIDS患者SF-36的生理健康和心理健康平均得分为53.2±5.9和50.0±11.8;文化程度、工作状况、CD4＋T细胞计数、机会性感染、抗病毒治疗、社会支持等因素,对HIV/AIDS患者的生活质量有影响。结论：艾滋病问题严重影响HIV/AIDS患者的生活质量,应针对其主要的影响因素,加强关怀与干预工作。     

Mental health referral role of rural financial counsellors

OBJECTIVE: To quantify the proportion of rural financial counsellors' (RFC) clients requiring social, emotional and stress-related (SESR) assistance and the referral of these clients to other services. DESIGN: Survey of all Australian RFCs. SETTING: Rural and remote agricultural locations in Australia. PARTICIPANTS: Australian RFCs employed over the months of November and December 2004. MAIN OUTCOME MEASURES: The proportion of counsellors' clients who required assistance with SESR problems and the proportion of these who were referred. Counsellors' usual referral networks, rating of referral difficulty and ranking of strategies to improve referrals. RESULTS: Counsellors reported that on average 20% of their clients required SESR assistance and half of the counsellors referred more than 75% of these clients. Referrals were mainly to GPs, mental health teams, personal counselling and health and welfare organisations. Almost half (49%) reported that referrals were difficult because of rural clients' reluctance to acknowledge such problems and use mental health services, as well as the lack of these services. Counsellors were placed in a practical role dilemma when clients raised personal issues that were beyond the counsellors' role but were linked to the financial reason for presentation. Strategies identified to improve referrals were to network with mental health and personal counsellors in the region, training and a referral guide. CONCLUSIONS: Because RFCs are a first contact for rural people in crisis, they could be brought into a local counselling network. This network could improve the process of referrals and build local mental health system capacity.     

Neighbourhood environment and positive mental health in older people: the Hertfordshire Cohort Study

Little is known about the potential effects of neighbourhood environment on positive mental health in older people. We examined cross-sectional associations between the index of multiple deprivation score of the census area of residence, perceptions of neighbourhood cohesion and neighbourhood problems and mental wellbeing, as measured by the Warwick-Edinburgh Mental Wellbeing Scale, in 1157 men and women aged 69-78 years from Hertfordshire, UK. We found no association between area-level deprivation and mental wellbeing. People who felt a stronger sense of cohesion within their neighbourhood and reported fewer neighbourhood problems had higher levels of mental wellbeing, independently of social class, income, presence of limiting illness or disability, mobility problems, and perceived social support. Adjustment for emotional stability attenuated the associations between mental wellbeing and both of these measures of perceived neighbourhood environment, particularly in the case of neighbourhood problems. How older people feel about their neighbourhood may be important for positive mental health in later life.     

Developing healthy local communities at local government level: lessons from the past decade

Abstract: There have been many approaches by the health sector to developing healthy communities based on local government areas in Australia in the past decade. Each has struggled with the need to establish realistic goals and to find ways of working more effectively with local government. This paper outlines four of these approaches–Healthy Cities, the Healthy Localities project, municipal health plans, and programs to address specific health problems or issues. Although the picture is one of huge diversity in the ways in which the issue is defined and action taken, a number of dimensions to a healthy community are emerging. However, if we are to be able to monitor change within and between the health of communities over time, indicators need to be developed and goals set. This will require a shift away from defining goals and targets in terms of populations (people), towards goals based on changes in organisations and systems. Engaging local government in this process will be vital and will require the health sector to develop a better understanding of the ways in which local government defines its role in creating healthy communities. It will also involve learning from local government the strategies that they have found most effective in dealing with complex problems that require action at many levels.     

The place of primary health care in a comprehensive health system

In considering the place of Primary Health Care in a comprehensive health system, we must first consider what is meant by the term 'comprehensive'. Comprehensive systems take into account all phases of life from infancy to old age, and integrate all aspects of being, including physical, psychological, mental, social, environmental, political and so on. It is the task of those who deliver the primary health care system to evaluate and prioritize health needs in specific populations, and to implement programs which honor the community's unique priorities, taking into account all phases and aspects of life. Drawing upon data collected from a comprehensive field survey of community health activities in Hiketa, in Kagawa Prefecture in Shikoku, and other similar surveys carried out in Japan, as well as references such as the Report of the International Conference on Primary Health Care (Alma Ata), and the World Health Organization Global Strategy for Health for All by the Year 2000, this background paper will outline the critical aspects to be considered in implementation of primary health care in comprehensive health systems, as a context for further discussion. Aspects to be considered are as follows: Community representation and participation Evaluation of health needs Prioritization of health needs Implementation: consultation with specialists Implementation: utilization of local resources Implementation: health education Implementation: support of local government Implementation: co-ordination of laymen, specialists, officials and others Evaluation Follow through. Illustrative examples will be used to highlight problems and solutions as each aspects is considered.     

NIMBY syndrome and public consultation policy: the implications of a discourse analysis of local responses to the establishment of a community mental health facility

The relocation of mental health services from an institutional to community base in different parts of the UK has witnessed incidents of public opposition in relation to the establishment of community mental health projects. It has been argued that this not-in-my-backyard (NIMBY) syndrome is partly a result of the attitudes held by the public towards people with mental health problems. The present paper reports some findings from a study of community attitudes towards individuals with mental health problems in a Scottish community, and discusses their implications for the development of public consultation guidelines with respect to the establishment of community mental health facilities. Discourse analysis was used to explore people's views about individuals with mental health problems. The study examined the ways in which their views were expressed in letters to the local press, and in subsequent discussions and interviews, when arguing for or against a supported accommodation project in their neighbourhood. Participants formulated their arguments around a number of issues which they claimed were of public concern. One of these related to the way in which the project was set up. In particular, participants argued that it had been established without any prior consultation with local people and in circumstances of secrecy. The findings demonstrate that, while consultation is relatively unproblematically defined in terms of its function, the specific nature of consultation is more problematic. The implications of these findings for mental health policy and practice are considered in the light of current official guidelines on public consultation relating to the establishment of community mental health facilities. It is argued that existing guidelines fail to take account of the concerns of local people, and therefore, that any intervention based on such guidelines is likely to be ineffective. It is suggested that the findings of this study will be of interest to policy makers and practitioners seeking to devise future public consultation strategies.     

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.     

照料孙辈对我国农村中老年人心理健康的影响

本文使用中国健康与养老追踪调查的面板数据，分析了照料孙辈对农村中老年人抑郁和生活满意度的影响，并进一步探讨了不同居住安排下的照料行为对其心理健康影响的差异。研究发现：（1）照料孙辈对农村中老年人抑郁症状频率有正向影响，对农村流动中老年人的生活满意度有负向影响，但对农村非流动中老年人的生活满意度有正向影响；（2）不和子女、孙辈居住且照料孙辈的农村中老年人生活满意度为好的概率最高，隔代居住且照料孙辈的农村流动中老年人生活满意度为好的概率最低，三代同堂居住且照料孙辈的农村非流动中老年人生活满意度为好的概率最低；（3）代际情感支持比代际经济支持更有利于农村中老年人的心理健康。基于上述结论，本文认为政府应支持兴办农村婴幼儿托管服务机构，为农村流动中老年人提供社会支持服务，支持子女与父母保持"一碗汤的距离"居住，倡导子女增强对父母的精神慰藉。     

Role of the social support network which influences age of death and physical function of elderly people: study of trends in and outside of Japan and future problems

Concerning associations between the social support network and physical health of the elderly, longitudinal studies have been conducted using various measurement indexes. The studies indicated that the support network influences on physical function and life expectancy. In this study we compared research papers from Japan and elsewhere that appeared after 1980, from the viewpoint of 1) social support effects, and 2) social network effects, to examine potential problems in the future. The main knowledge obtained was that the receipt of emotional support, wide network size, and participation in social activities reduced the risk of early death and decrease in physical function of elderly people. Sex differences were indicated, and in many cases, the effects were more remarkable in men than women. In addition the positive influence of receiving help from a support network, a major subject of conventional research, the effects of offering help to others and negative findings were also examined. It has been indicated that participation in volunteer groups and offer of support to other people can prevent decrease in physical function or early death. As negative effects, improper instrumental support rather disturbs the mental and physical independence of elderly people. As future issues, it is necessary to focus on both positive/negative and receipt/offer effects of support network, and to clarify how to provide example which best match the life of elderly people by comparing sexes and regions. It is also important to actually apply the knowledge gained from observational studies to prevent the elderly from becoming a condition requiring care, and to develop intervention studies which can increase the social contacts of elderly people at the same time as conducting health education and medical treatment.     

Public attitudes towards mental health facilities in the community

Taking account of community attitudes towards mental health problems may be crucial to the success of community care. Exceeding the limits of the community's tolerance could lead to the policy ‘backfiring’ - jeopardizing the future of community care and increasing rather than decreasing the stigma attached to mental health problems (Hall et al. 1991, p. 302). There is evidence that local opposition to community facilities has escalated over the past 3 years and frequently threatens the siting of community mental health facilities. This paper reviews research into attitudes towards community facilities for people with mental health problems, and explores the nature of public protest in order to make recommendations for the consensual siting of mental health facilities in the community. Although a substantial body of research exists concerning attitudes towards people with mental health problems, far less work has focused on attitudes towards facilities for people with mental health problems. An understanding of this literature is sought in the nature of community opposition more generally: the siting of locally unwanted land uses (for example power stations and waste disposal sites) and the phenomenon of the ‘not in my back yard’ (NIMBY) attitude are discussed critically and rival theoretical explanations are explored. Taken as a whole, this literature gives rise to strategies that might reduce opposition and achieve positive working relationships. Nevertheless, in view of the scarce, inconclusive and somewhat contradictory research in this area, there is a need for specific investigation into the concerns of local communities, and an assessment of factors that exacerbate and ameliorate these concerns.