Opportunities for community mental health training within the residential college campus context

The utilization of college campuses as a setting for providing training in community mental health offers an exciting prospect. If the possibilities available are to be realized, however, training programs within the mental health professions will need to be geared to provide course work which both precedes and accompanies student practicum experiences in the campus settings. In addition, postgraduate training opportunities in community mental health for all of the mental health professions will need to be greatly increased. This becomes vital in order that mental health professionals who work in college settings enlarge their own professional identifications to include community mental health concepts.presented this paper at the American Psychological Association's annual convention at Los Angeles in September, 1964.     

Changing mental health services in Madrid: international issues

With the backing of a socialist government that came to power in 1982, mental health services in Spain are shifting away from institutional and custodial care toward community-based services. Provincial governments now control most mental health programs as a result of a law passed in 1983. In Madrid, mental health service priorities include preventing psychiatric hospitalization, developing a range of residential facilities, reducing the population of chronic patients in hospitals, and improving the quality of hospital care. A network of 20 health promotion centers is being developed to serve newly identified patients, while long-stay hospital patients who can be discharged will become the responsibility of social services. From an international perspective, the most interesting aspect of the Spanish transformation is how the country will deal with the problems other nations have encountered in implementing systems reforms.     

Youth suicide in an international context

Mortality statistics are examined for 10- to 19-year-old males and females to examine whether the widely-claimed high rates and upward trends in suicide among young men in England and Wales during recent years are applicable to this group. Various definitions of suicide are considered. A consistent increase in rates between 1980 and 1994 was found in England and Wales for 15- to 19-year-old males (and for younger males although not for females) but this was less dramatic than has been reported for a slightly wider age band. Comparisons between these profiles of young deaths and those for Finland, Germany, Hungary, Ireland and Norway indicated that, regardless of definition, rates of suicide for those under 20 years are lower in England and Wales than any of the other countries studied. Trends, nonetheless, showed varying patterns. While the upward trend among 15- to 19-year-old males in England and Wales was of similar order to that found in Finland or Norway, it represented a far less marked rise than in Ireland and was in contrast to the declining rates found in Germany and Hungary. Methods used in deaths recorded as suicide differed by country but there were few consistent trends. Accepted: 17 November, 1998     

Global mental health: from science to action

This article charts the historical development of the discipline of global mental health, whose goal is to improve access to mental health care and reduce inequalities in mental health outcomes between and within nations. The article begins with an overview of the contribution of four scientific foundations toward the discipline's core agenda: to scale up services for people with mental disorders and to promote their human rights. Next, the article highlights four recent, key events that are indicative of the actions shaping the discipline: the Mental Health Gap Action Programme to synthesize evidence on what treatments are effective for a range of mental disorders; the evidence on task shifting to nonspecialist health workers to deliver these treatments; the Movement for Global Mental Health's efforts to build a common platform for professionals and civil society to advocate for their shared goal; and the Grand Challenges in Global Mental Health, which has identified the research priorities that, within the next decade, can lead to substantial improvements in the lives of people living with mental disorders. The article ends by examining the major challenges for the field, and the opportunities for addressing them in the future.     

Economic context analysis in mental health care. Usability of health financing and cost of illness studies for international comparisons

This paper discusses an integrated approach to mental health studies on Financing of Illness (FoI) and health accounting, Cost of Illness (CoI) and Burden of Disease (BoD). In order to expand the mental health policies, the following are suggested: (a) an international consensus on the standard scope, methods to collect and to analyse mental health data, as well as to report comparative information; (b) mathematical models are also to be validated and tested in an integrated approach, (c) a better knowledge transfer between clinicians and knowledge engineers, and between researchers and policy makers to translate economic analysis into practice and health planning.     

Global mental health: the role of psychiatry

Despite the huge personal and social impact of mental illnesses, mental health globally is widely neglected and marginalised. A conceptual change in thinking, from the biomedical to a public health model, is essential for integrating mental health services into health systems across the globe. This article discusses the burden of mental health globally, resources available to tackle the massive burden, WHO’s mental health Gap Action Programme (mhGAP) on scaling up services with a special focus on low- and middle-income countries, and the paradigm shift required in psychiatry as the way forward.

     

Capacity building in global mental health: professional training

We suggest that the optimal approach to building capacity in global mental health care will require partnerships between professional resources in high-income countries and promising health-related institutions in low- and middle-income countries. The result of these partnerships will be sustainable academic relationships that can educate a new generation of in-country primary care physicians and, eventually, specialized health professionals. Research capabilities will be an essential educational component to inform policy and practice, and to ensure careful outcome measurements of training and of intervention, prevention, and promotion strategies. The goal of these academic centers of excellence will be to develop quality, in-country clinical and research professionals, and to build a productive environment for these professionals to advance their careers locally. In sum, this article discusses human capacity building in global mental health, provides recommendations for training, and offers examples of recent initiatives.     

Public health context of women's mental health research.

As more attention is directed to the mental health care of women, sex and gender differences in research design and in regulatory policies have interfaced with clinical care and public policy. An emphasis on women's mental health issues in the provision of treatment and care as well as the design of large-scale screening strategies to identify and treat women with mental disorders promises to be effective public health approaches to reducing the burden of mental illness in women. The past decade has seen increased emphasis on women's mental health and sex/gender differences in the federal sector and in the research community. Federal regulations (summarized in the NIH Outreach Notebook) call for the inclusion of women and minorities in NIH-funded clinical research. The regulations also place emphasis on gender analysis of the results of clinical trials, in particular phase III trials, the findings of which are likely to influence practice. There has been substantial progress toward the goal of including women in research, but more remains to be done. A 2000 GAO report titled "Women's Health: NIH Has Increased Its Efforts to Include Women in Research" commended NIH for tracking the number of women in clinical research but the report also noted that relatively few NIH-funded studies, including major clinical trials, had reported findings by gender of study participants. This was seen as an impediment to progress in developing gender-based effective treatments. In the past decade, the women's health field has moved beyond an exclusive emphasis on women's reproductive function to one that defines health as a scientific enterprise to identify clinically important sex and gender differences in prevalence, etiology, course, and treatment of illnesses affecting men and women in the population as well as conditions specific to women. Nonetheless, for mental disorders, women's reproductive function and its impact on mental health conditions is still understudied. Based on the epidemiology of mental disorders, the course of mental disorders in women in relation to reproductive transitions remains an important issue for the mental health field because the burden of mental disorders, such as depression and anxiety, fall disproportionately on women of childbearing and childrearing age. The public health emphasis on women's mental health does not lessen the basic scientific opportunities to be had by a focus on gender and sex differences. A 2001 report of the Institute of Medicine titled "Exploring the Biological Contributions to Health: Does Sex Matter?" underscores the benefit to health care of looking for sex differences at the biological level. Basic and clinical neuroscience research is rapidly accruing a knowledge base that will provide information at the level of genes and cells of the influences of biological sex on mental health outcomes in both women and men. A focus on women's mental health and gender/sex differences research promises to yield improvement in treatments and services and thereby to improve the public health as well as to increase fundamental knowledge about the etiology and neurophysiology of mental disorders.     

HIV/AIDS mental health training for health care providers: an evaluation of three models

Three models of continuing education--full-day, half-day, and brief workshop--for health providers treating patients with HIV/AIDS were compared on measures of effectiveness with regard to knowledge, attitude, and practice outcomes. Analyses of pre- and postintervention data from two years of training events suggest consistent, modest, program effects in the full-day and half-day approaches, specifically in the area of knowledge enhancement.     

Global mental health and development: a thematic series

Background

A political movement towards building alternatives to long-term hospitalization of psychiatric patients in Korea has gained momentum. We aimed to provide sturdy foundation needed to formulate the most rational policy by review of caregiver’s opinion to the political alternatives under discussion for facilitating discharge of long-term stayed psychiatric patients in Korea.

Discussion

Caregivers in Korea, whose family members had been hospitalized longer than 6 months and all of whom applied to the Mental Health Review Board (MHRB) for an examination required for extended stay, have shown reluctance to take their patients back home. Especially, a half of them answered that if MHRB would order compulsory discharge, they would take their patients to another hospital instead of living together. Despite of those pessimistic attitudes, one of the promising solutions might be residential care as an alternative to the long-term hospital care, which is most preferred by caregivers.

Conclusion

After all, the issue of who should take an accountability of the psychiatric patients is essential in establishing mental health policy. Korean government should analyze and reform mental health delivery systems such as residential service system, community-based case management programs and hospital treatment systems including payment program which can facilitate reasonable decision by professionals as well as caregivers for the appropriate admission rather than longer term hospitalizations.     

Career development and training in geriatric mental health: report of an NIMH workshop.

At a National Institute of Mental Health (NIMH)-sponsored meeting, the participants discussed means of increasing the pool of late-life mental-illness researchers. Approaches identified included encouraging retention of junior scientists through greater mentoring and support; creation of research postdoctoral programs by investigators and institutions that lack late-life emphasis; earlier commitment to late-life research with predoctoral training mechanisms; recruitment of ethnic and racial minority scholars into late-life research; and recruitment of newly established researchers through postdoctoral training mechanisms. Federal, public, and private mechanisms need to be better leveraged to grow late-life mental-illness research infrastructure and meet increasing demand and scientific opportunities.