The Netherlands Mental Health Survey and Incidence Study (NEMESIS): objectives and design

The article describes the objectives and design of a prospective study of the prevalence, incidence and course of psychiatric disorders in a representative sample of non-institutionalized Dutch adults. A total of 7146 men and women aged 18–64, contacted through a multistage sample of municipalities and households, were interviewed at home in 1996. The primary diagnostic instrument was the CIDI, which determines the lifetime occurrence of DSM-III-R disorders. The disorders included were: mood disorders, anxiety disorders, eating disorders, schizophrenia and other non-affective psychotic disorders, and dependence and abuse of psychoactive substances. Follow-up measurements in the same sample were scheduled at 12 and 36 months. The net response to the first measurement was 69.7%. Poststratification weightings were applied for gender, age, marital status and degree of urbanization. Limitations and advantages of the study design are discussed. Findings are reported elsewhere in this issue. Accepted: 18 May 1998     

Review Essay: Coercion in Mental Health Services: International Perspectives

Mental Health Services Research -     

The Healthy Immigrant Effect on Mental Health: Determinants and Implications for Mental Health Policy in Spain

Since the mid-1990s, Spain has started to receive a great number of migrant populations. The migration process can have a significantly negative impact on mental health of immigrant population and, consequently, generate implications for the delivery of mental health services. The aim of this article is to provide empirical evidence to demonstrate that the mental health of immigrants in Spain deteriorates the longer they are resident in the country. An empirical approach to this relationship is carried out with data from the National Survey of Health of Spain 2011–2012 and poisson and negative binomial models. Results show that immigrants who reside <10 years in Spain appear to be in a better state of mental health than that observed for the national population. Studying health disparities in the foreign population and its evolution are relevant to ensure the population’s access to health services and care. The need for further research is especially true in the case of the immigrant population’s mental health in Spain because there is scant evidence available on their situation.     

Age and Mental Health Services

This paper examines how age is related to theuse of formal and informal mental health services,adjustment to current life conditions, and expectationsfor improvement in future life conditions among a group of persons with serious mental illnesses.Interviews with 301 clients of 3 clinics at a publicpsychiatric facility serving West Brooklyn and StatenIsland provide the data from the study. Outcome measures include nine sorts of help receivedfrom informal members of the social network and frommental health professionals; desires to improve currentlife conditions; and expectations for futureimprovements in life conditions. Through hierarchicalregression procedures we examine the impact of age onthese outcomes, with controls for selfreported symptomsand functioning, sex, and the presence of social network members. The results indicate that youngerpeople receive more help from both informal socialnetworks and from mental health professionals. Inaddition, younger people are more likely to wantimprovements in their current life conditions and to beoptimistic about what the future holds for them. Thedecline in informal and formal support, optimism, anddesire to improve their current life situations among older clients may be cause for concern amongmental health professionals. Mental health serviceproviders should give greater recognition to the impactof age on mental health service needs among persons with serious mental illnesses.     

Obesity: The Role of Child Mental Health Services

Increasing levels of child obesity are placing pressure on all children's services, including CAMHS. The need for input by mental health professionals is justified by the increased risk of depression, low self-esteem, binge eating, and impaired quality of life seen in obese children and adolescents. Two routes for CAMHS involvement with obese youngsters are described. Balance It!, a service operating in the NE England, is an example of a long-term approach involving Tiers 1-3 of CAMHS. Research testifies to the psychological value of weight loss. However, a series of questions remain regarding best practice, perceived need, and funding of CAMHS in child obesity.     

The Mental Health Services Program for Youth

This paper traces the development of The Robert Wood Johnson Foundation's Mental Health Services Program for Youth, a private initiative designed to improve the organization, financing, and delivery of service to seriously mentally ill youth. The rationale and structure of this five-year initiative are discussed. In July 1989, 12 one-year development grants were awarded under the program's first phase. All of the grantees propose to utilize a number of strategies to restructure their mental health financing systems. Other common features include: the development of central intake units, early identification mechanisms, stronger utilization review protocols, and unified client tracking mechanisms.     

Beyond Criminalization: Toward a Criminologically Informed Framework for Mental Health Policy and Services Research

The problems posed by persons with mental illness involved with the criminal justice system are vexing ones that have received attention at the local, state and national levels. The conceptual model currently guiding research and social action around these problems is shaped by the “criminalization” perspective and the associated belief that reconnecting individuals with mental health services will by itself reduce risk for arrest. This paper argues that such efforts are necessary but possibly not sufficient to achieve that reduction. Arguing for the need to develop a services research framework that identifies a broader range of risk factors for arrest, we describe three potentially useful criminological frameworks—the “life course,” “local life circumstances” and “routine activities” perspectives. Their utility as platforms for research in a population of persons with mental illness is discussed and suggestions are provided with regard to how services research guided by these perspectives might inform the development of community-based services aimed at reducing risk of arrest.     

The Quality of VA Mental Health Services

This study examines whether male and female veterans differ on either subjective or objective measures of the quality of VA mental health care. The study sample were all discharged with a psychiatric diagnosis from a VA inpatient mental health program. Results indicate that women were less satisfied with inpatient care, but were mixed on their satisfaction with overall mental health care. Males and females did not differ on the quality of inpatient care, but women had significantly higher quality of outpatient care. These results not only highlight the need to stratify or adjust quality measures by gender, but also highlight the potential confounding effect of sub-group specific health behaviors on measures of quality.     

Mental Health Policy and Plans : Promoting an Optimal Mix of Services in Developing Countries

The World Health Report 2001 makes a compelling case for addressing the mental health needs of populations around the world. The key messages of the report are that mental disorders account for a significant burden of disease in all societies; effective interventions are available but are not accessible to the majority of the people who need them; and a comprehensive mental health policy is an important tool in increasing the accessibility of effective services. When properly formulated and implemented, a mental health policy can have a positive impact on the mental health of the population. Service organization forms one of the most important areas of a mental health policy and plan. In order to deliver a high standard of mental health treatment and care it is necessary to adopt an integrated system of service delivery that comprehensively addresses the full range of psychosocial needs of people with mental disorders. The World Health Organization Mental Health Policy and Service Development project commenced in 2000 and covers four main areas: the development of normative technical documents on mental health policy and service development; provision of training forums for policy makers and mental health professionals; direct country assistance; and the development of a faculty of consultants.     

The Right to Health,International Human Rights Legislation and Mental Health Policy and Care Practices for People with Psychiatric Disability

This article is based on research which examined the current and potential impact of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) on Australian and South Australian legislation and policy. A particular focus was on the ‘right to health’ for people with a psychiatric disability. Ten interviews were conducted with professionals from law, psychiatry, government and service user advocacy, working at state, national (Australian) and international levels. It addresses three key themes: the rights of people with psychiatric and other disabilities; perceptions of the rollout of the United Nations Convention on the Rights of Persons with Disabilities (CRPD); and the impact on current policy and practice of the ‘right to health’.     

Global Mental Health Needs,Services, Barriers,and Challenges

Mental health problems represent 5 of the 10 leading causes of disability in the world and affect as many as 500 million people. The direct and indirect burden of mental health problems is great. Limited resources are devoted to mental health care, and there are many barriers to receiving it. Stigma, human rights violations, war, and migration contribute to the problem. We need to do much more to address this critical issue.     

The Team Approach in Japanese Mental Health Services

This article describes the history and current state of health care professions in Japan and how team-based approaches have been promoted from medical institutions to the regional level and from a medical science model to a living model. This team-based approach is now recognized as being indispensable to practice and development in the field of mental health and welfare, but the independent participation of the client is regarded as fundamentally important, and a trusting and cooperative partnership must be cultivated through mutual communication between team members. From a national point of view, there are also situations in which the team-based approach does not function well due to a variety of factors such as health-care institutions' emphasis on business matters or discrimination and prejudice among local populations. Many problems remain unresolved, preventing effective support for the return of long-term hospitalized patients to the community and for the peaceful settlement of handicapped individuals in the community.     

San Antonio Mental Health Disaster Consortium: Hurricanes Katrina and Rita, a personal perspective

TOPIC: This is the personal perspective of the author's experience during Hurricanes Katrina and Rita. As a member of a professional mental health volunteer organization, this chronicles 3 months' experience in the local shelters. PURPOSE: Difficulties with organizational support and structure hampered the effectiveness and functioning of this volunteer organization in the shelters. To identify lessons learned from this experience. CONCLUSIONS: It is essential to identify where each mental health volunteer group fits into the organizational structure and what the role of each is. Volunteers need to be scheduled and relieved at regular intervals to rest so as to prevent stress reactions.     

Commentary: Hispanic Access to Health/Mental Health Services

Currently, the Hispanic population of the United States is growing very rapidly. Despite the significance of this growth and the fact that it is expected that Hispanics will be soon the largest ethnic minority group in this country, the access to health/mental health care for the Hispanic population is rather limited. Many factors are currently affecting the Hispanics' access to health/mental health care services. Among them, cultural and language barriers, insufficient numbers of Hispanic manpower in the health care professions, low educational and socioeconomic levels, the high number of uninsured Hispanics, and ethnic and racial prejudices and discrimination. In this commentary, I address the factors that interfere with the Hispanics' access to health/mental health care, and advance recommendations geared to alleviate and/or resolve this critical problem.     

Reorienting Mental Health Systems: The Dynamics of Policy and Planning

Mentoring plays a key role in whether a professional reaches the highest echelons of corporate rank and authority. Studies indicate that the most profitable companies today have the highest representation of women on their senior management teams. A review of the literature reveals that the transfer of corporate values, authority, and power is accomplished through mentoring and that few black women are offered opportunities to be mentored. Race continues to wield a profound influence on interpersonal relations and opportunities available in the workplace. Mental health executives, organizational psychologists, and policymakers have opportunities to play new roles, to ease and shape a transition in corporate consciousness to achieve greater parity for all women, particularly women of color.