Child Mental Health Services in the New South Africa

Health departments in the new South Africa are undergoing major restructuring and, in some cases, severe financial cutbacks as new policies attempt to redress the inequities of the past. A district system is being phased in, with a shift in funding from academic hospitals to secondary and primary level care. The process is being undermined by the current recession, which also affects Welfare and Education facilities, and by widespread poverty, violence, and other adverse conditions. Child mental health services are discussed in the light of current human resources, epidemiological data, the effects of violence and cultural issues, together with some reflections on their future.     

The Limits for Deinstitutionalization of Psychiatry in Russia: Perspectives of Professionals Working in Outpatient Mental Health Services

The purpose of this study was to explore the views of mental health professionals on deinstitutionalization reforms in Russia. Qualitative interviews were conducted with 33 specialists from outpatient mental health clinics. The data were analyzed using thematic analysis. The results revealed that the professionals appeared very restrained in supporting the reforms. They argued for the preservation of the existing mental health care system rather than its transformation. Their lines of argumentation were organized around four key themes as follows: 1) critiques of state policies and a suspicion of reforms, 2) tradition instead of innovation: reclaiming the image of Soviet psychiatry, 3) hospitals as a means of social control, and 4) reform as a threat to the protection of people with mental health problems. The findings suggest that practitioner resistance to deinstitutionalization is a complex phenomenon, demonstrating how various political, economic, social, and cultural factors are intertwined in the construction of professional discourse on the reforms.     

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.     

HIV and Mental Health Services in the US South: A Meso Analysis

The US South is disproportionately impacted by HIV. Social, cultural, economic, and political characteristics of the South shape access to mental health services leaving adverse impacts on health and wellness outcomes among People Living with HIV. The aim of this paper was to: (a) identify meso factors (at individual, organizational and community-level manifestations) which impact mental health services among People living with HIV in the South of those factors and (b) pose community-articulated recommendation and strategies. Through qualitative interviews with People Living with HIV and service providers, this study found that the meso factors of restricted funding and compounding stigma shaped mental health services in the South. Given the disproportionate rate of HIV, lack of mental health care, and landscape of socio-political factors unique to the region, attention to intervenable meso factors and community-based strategies are needed to enhance mental health services and respond to the HIV epidemic in the US South.

     

Mental Health Services in South Africa: Scaling up and future directions

"No health without mental health" has become a rallying call for the World Health Organization and numerous service providers, training institutions, health researchers, and advocacy groups around the world. It is timely to consider the implications of this call for South Africa. We review key evidence regarding the burden and risk factors for mental disorders in South Africa and crucial challenges for local mental health services and research. We emphasize that mental disorders are more impairing but less treated than physical disorders, and that existing services need to be scaled up and adapted to the local context. New research is needed to determine what interventions work best in the South African context.     

Evaluation of a Suicide Prevention Training Program for Mental Health Services Staff

Training for health services staff often focuses on improving individual practitioner’s knowledge and skills, with less emphasis given to the broader organizational context, in particular those elements that support successful implementation of changes post-training. This paper compares the effectiveness of a standard training model for suicide prevention to an enhanced training model. The training involved the public mental health workforce throughout the State of Queensland, Australia and was developed in collaboration with the State health department and as such took place within a policy and practice context. The standard training involved participation in a one-day training workshop, which provided information on evidence-based suicide prevention strategies. The enhanced model took an organizational development approach and incorporated a focus on creating and strengthening networks to enhance the capacity of mental health service staff to undertake preventive strategies. Findings suggest that multi-component organizational approaches for suicide prevention produces benefits that should now be trialled through experimental approaches.     

The Need for School-Based Mental Health Services and Recommendations for Implementation

Mental illness is a major public health concern with significant social cost. Symptoms of mental health problems generally emerge during the school-age years. Although effective interventions are available to decelerate or eliminate incipient concerns, they are rarely accessible to youth. Evidence suggests that school-based mental health services (SBMHS) have the highest likelihood of reaching youth in need. In this paper, the authors and the Council for Children with Behavior Disorders present a foundation for future policy recommendations relative to the need for SBMHS and recommendations for implementation.     

Provision of Mental Health Services in South African Substance Abuse Treatment Facilities

To date, South African research has not examined mental health service provision in substance abuse treatment facilities, even though these services improve client retention and treatment outcomes. To describe the extent to which substance abuse treatment facilities in Gauteng and KwaZulu-Natal provinces provide clients with mental health services during the course of treatment and to compare mental health service provision in these settings by type of facility and staff composition. Cross-sectional audits of substance abuse treatment facilities were conducted in Gauteng and KwaZulu-Natal provinces. Data were collected using the Treatment Services Audit Questionnaire. A response rate of 84% was obtained. Few treatment facilities provide clients with access to mental health services. Inpatient facilities are more likely than outpatient facilities to provide clients with access to mental health services. Facilities with for-profit ownership status are more likely than facilities with non-profit status to provide access to mental health care. Based on the above findings, a number of recommendations are made to increase the provision of mental health services during the course of substance abuse treatment.     

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.     

The Process of Transforming Mental Health Services in Australia

Australia commenced a nationally coordinated transformation of its public and private mental health services in 1993. This paper presents an overview of the changes in mental health service delivery using data from the 2004 Australian National Mental Health Report. In the 10 years from 1993 to 2002, government spending on mental health increased 65 percent in real terms, with a 145 percent growth in expenditure for community-based services. Government subsidies to the private psychiatrist sector have declined. Consumer and carer participation in service planning and delivery increased, measures to improve quality introduced and patient level outcome measures are being adopted widely. However, some consumers with specific needs have been neglected and the transformation has not been implemented uniformly across the country.     

The Use of Bilingual, Bicultural Paraprofessionals in Mental Health Services: Issues for Hiring, Training, and Supervision

Language and cultural barriers mitigate between refugee and immigrant populations and the mental health services they need to adjust to life in the United States. To bridge the gap between mental health professional and client, and to educate communities regarding services, agencies are recruiting paraprofessionals who are bilingual and bicultural to perform outreach functions and provide interpretation services. This article presents the recent circumstances that have created this situation, discusses the roles of paraprofessionals in mental health, and addresses the issues and problems that can arise around the hiring, training, and supervision of bilingual, bicultural paraprofessionals.     

The Professor of Public Psychiatry Model in Ohio: The Impact on Training,Program Innovation,and the Quality of Mental Health Care

The Ohio Department of Mental Health and five of Ohio's University-based Departments of Psychiatry have developed strong working partnerships that have improved the quality of psychiatric residency education and Ohio's mental health services. Strategies integral to Ohio's Public Psychiatry Model include identifying a strong champion, integrating expert consultation, and developing consensus expectations using a small amount of catalytic funding. Successful outcomes include the establishment of public psychiatry leadership roles in Ohio's community and academic settings; positive community-focused residency training experiences; revised curricula; and spin-off opportunities, such as "Coordinating Centers of Excellence" to accelerate adoption of evidence-based practices in community settings.     

The Most Dangerous and Difficult Question in Mental Health Services Research

Mental Health Services Research -     

The Impact of Racism on the Delivery of Health Care and Mental Health Services

This article presents research findings useful in formulating a Best Practices Model for the delivery of mental health services to underserved minority populations. Aspects of the role of racism in health care delivery and public health planning are explored. An argument is made for inclusion of the legacy of the slavery experience and the history of racism in America in understanding the current health care crisis in the African-American population. The development of an outline in APA DSM IV for the use of cultural formulations in psychiatric diagnosis is discussed.     

Variation in Criminogenic Risks by Mental Health Symptom Severity: Implications for Mental Health Services and Research

Psychiatric Quarterly - Although a growing body of literature has demonstrated that justice-involved people with mental illnesses have criminogenic risk factors at similar or elevated rates as...     

The Need for Substance Abuse Training Among Mental Health Professionals

This study examines substance abuse as encountered by practitioners in six major mental health professions, from private practice to organizational settings. Respective national professional associations surveyed representative samples of their members, including psychiatrists, psychologists, professional counselors, social workers, marriage and family therapists, and substance abuse counselors. About one in five clients seen in private practice of mental health professionals had substance abuse disorders, with somewhat higher rates in organized mental health treatment settings. For a large majority of clients, substance abuse was secondary to a mental disorder. A significant minority of these practitioners reported having little or no training to address substance abuse, either from formal graduate education, internships, or continuing education.