Why should mental health have a place in the post-2015 global health agenda?

Background

The tenure of the Millennium Development Goals formally expires in 2015 and will be replaced with a new development agenda. The MDGs did not include goals or targets for mental health. Despite gathering momentum during the last 15 years, mental health has not enjoyed the same pace of progress as the sectors explicitly mentioned within the MDGs. This article outlines the evidence indicating that mental health should be firmly positioned in post-2015 health policy and discusses strategies to advance the global mental health agenda.

Discussion

The interactions between mental health and other development goals are numerous and complex. Consequently, investment in mental health pays dividends on a wider level than simply psychiatric clinical outcomes. Mental health’s reciprocal relationship with poverty is consistent with the strong focus on economic development, rather than health in isolation, detailed in the post-2015 UN statements to date. A focus on the quality of mental health care provided in low and middle-income countries deserves priority in the new health agenda. This should include consideration of the accessibility of mental health care and the use of evidence based diagnosis and management in these settings.

Summary

Lack of investment in the mental health of populations is a key driver of poverty and inequality in low and middle-income countries. Renewed focus on mental health post-2015 is an opportunity to address the global burden of mental disorders and make a positive impact on the wider development agenda.

     

Impact of shared mental health care in the general population on subjects’ perceptions of mental health care and on mental health status

Objective A community survey evaluated whether the development of a shared mental health care intervention had an impact on health care perceptions and mental health status of subjects with common mental health problems (MHP). Methods Adults <70 years old with common MHP (DSM-IV/CIDI-SF major depressive disorder, generalized anxiety or MHI-SF 36 psychic distress diagnoses), were randomly drawn from the general population in the intervention area (IA, n = 349) and in a control area (CA, n = 360), and evaluated twice at an interval of 18 months (percentage of follow-up: IA = 69.3%, CA = 71.9%, P = .44). CA and IA groups did not differ for the criteria of interest at baseline. Results At 18 months, compared to CA, IA reported significantly different help-seeking attitudes or behaviours (P = .02 for all subjects and .006 for subjects with current MHP) and greater general satisfaction with care (P = .03 for both). Remission rates and daily life functioning did not differ. Conclusions After 4 years of development of a mental health network based on a consultation-liaison model, Shared Mental Health Care was associated with greater satisfaction and access with care among subjects with common MHP. The association was not found with mental health status, but the study lacked power to adequately address the issues.     

Sexuality and mental health: Issues and what next?

Abstract

Human sexuality plays a major role in an individual's existence and functioning. In addition, rightly or wrongly sexuality often defines people and also affects social attitudes. These attitudes, if negative, can contribute to stigma and prevent people from help seeking if they are suffering from mental health problems. Recent changes in policy towards same-sex relationships have been positive in many countries including the UK and the USA, whereas in others such as Russia and Uganda attitudes have become more negative and punitive. Sexual activity is seen as having both pleasurable and procreational functions which contribute to society's attitudes to homosexual behaviour. Inevitably, individual responses to their own sexuality and sexual behaviour will be influenced by social attitudes. To ensure that those with various sexual variations can access psychiatric services without discrimination, various levels of interventions are needed. Here we discuss different levels of intervention and organizational change that may make it possible. Social organization and institutional organization of services need to be sensitive, especially as rates of many mental disorders are high in individuals who may be sexually variant. Those providing services need to understand their own negative attitudes as well as prejudices to ensure that services are emotionally accessible.     

Change in the mental health field?

An analysis of the current roles of the federally funded community mental health center and the public mental hospital suggests that despite the rhetoric about a community mental health revolution, the mental health field has yet to undergo significant change. Ideological, political, economic, and structural barriers-characteristics of the field itself-impede such change outside, inside, and across the centers and hospitals. Recent court decisions on patients' rights, however, have the potential for moving the field into a period where bold new action actually can occur.Preparation of this paper was supported, in part, by Research Grant No. 1 R01 MH23646 from the National Institute of Mental Health. The authors thank Al Imershein, Kent Miller, and Elane Nuehring for helpful comments on an earlier draft.     

Monitoring the impact of COVID-19 pandemic on mental health: a public health challenge? Reflection on Italian data

A recent Italian report on medicines use during COVID-19 epidemic outlined a non-significant increase in outpatient pharmaceutical antidepressant consumption in March and a significant increase in anxiolytic consumption. Along with this, an analysis of psychiatric hospitalizations in Lombardy revealed a reduction in voluntary admissions in the 40 days after the beginning of COVID-19 epidemic in Italy. Nevertheless, several studies reported a greater prevalence of depressive and anxiety symptoms in the Italian general population during the lockdown compared to before the pandemic. Furthermore, the request for psychological support by the Italian population appeared to be high during lockdown. Indeed, the Italian Ministry of Health declared that more than 50,000 calls to the telephone number for psychological support activated by the Ministry of Health and the Civil Protection because of the pandemic, with peaks during the lockdown. In addition, looking at Google Trends, the greatest searching activity for “psychological support” in recent years was detected the week of the 26th April 2020, followed by the week of the 22nd March 2020. We think that stronger indicators of mental health status and psychological well-being should be found to understand the long-term effects of the pandemic. The necessity of research for population-level and universal strategies is urgent, through repurposing, developing, and testing interventions to create evidence-based action plans for the entire population. Lastly, it is also essential to keep offering a psychological support suitable for all as done in past months to help individuals who have fewer opportunities to access care.

     

Combined oral contraceptives and mental health: Are adolescence and the gut-brain axis the missing links?

Combined oral contraceptives (containing synthetic forms of estradiol and progestins) are one of the most commonly used drugs among females. However, their effects on the gut-brain axis have not been investigated to a great extent despite clear evidence that suggest bi-directional interactions between the gut microbiome and endogenous sex hormones. Moreover, oral contraceptives are prescribed during adolescence, a critical period of development during which several brain structures and systems, such as hypothalamic-pituitary–gonadal axis, undergo maturation. Considering that oral contraceptives could impact the developing adolescent brain and that these effects may be mediated by the gut-brain axis, further research investigating the effects of oral contraceptives on the gut-brain axis is imperative. This article briefly reviews evidence from animal and human studies on the effects of combined oral contraceptives on the brain and the gut microbiota particularly during adolescence.     

Eco-crisis and mental health of children and young people: Do child mental health professionals have a role?

Child mental health professionals have an extremely important role to play in their distinct roles as clinicians, therapists, researchers, policy makers, advocates, preventative public health professionals and service developers pertaining to eco-crisis in the child and adolescent populations. This article provides examples of how this can be done.     

The surgeon general’s national action agenda on children’s mental health

The Surgeon General’s National Action Agenda highlighted key issues that challenge the public health system in appropriately meeting the mental health needs of children and their families. Among these issues included the need for screening and early identification, improving access to appropriate mental health care, strengthening the infrastructure, and expanding training for providers. Two key gate-keeping systems identified as critical in this reform of mental health care for children and their families are education and primary care. This paper focuses on these two systems to illustrate problems related to these issues. Central to the Surgeon General’s call for reform is also the pressing public health responsibility to improve and use the science base by strengthening the connection between what we know from the scientific evidence base and what we do in practice. The implications of this reform for specialty mental health are discussed.     

Migration and common mental disorder: An improvement in mental health over time?

Abstract

Global migration is reaching record high levels and UK migrant groups comprise an increasing proportion of the total population. The migratory process causes stress that can affect mental health. There is limited consistent empirical evidence of a longitudinal nature to explain the association between migration and mental health. This review aims to examine the evidence of a relationship between migration and common mental disorder (CMD) amongst migrants over time. A comprehensive search of medical and psychiatric databases for global quantitative empirical studies investigating incidence of CMD amongst adult migrants from 1975 to July 2012 was conducted. Declines in rates of CMD amongst migrants over time were reported by two thirds of the 18 studies reviewed, less than one third of which were statistically significant. On the contrary, three studies showed an increased rate of CMD, one statistically significant. Individual psychological resources, social support, the acculturation process, cultural variations and time since relocation are identified as statistically significant protective factors against the development of CMD amongst migrants. New enlightening points include the significant impact of varying patterns of psychological distress, of which negative is the most adverse for CMD. Migration is an extremely complex process. Further clarification is needed to gain deeper understanding of the relationship between migration and CMD to address contradictions in the literature and health inequalities amongst migrants.     

Do financial hardship and social support mediate the effect of unaffordable housing on mental health?

Social Psychiatry and Psychiatric Epidemiology - Unaffordable housing has a negative impact on mental health; however, little is known about the causal pathways through which it transmits this...