Does the mental health system provide effective coverage to people with schizophrenic disorder? A self-controlled case series study in Italy

Abstract Purpose To measure indicators of timeliness and continuity of treatments on patients with schizophrenic disorder in ‘real-life’ practice, and to validate them through their relationship with relapse occurrences. Methods The target population was from four Italian regions overall covering 22 million beneficiaries of the NHS (37% of the entire Italian population). The cohort included 12,054 patients newly taken into care for schizophrenic disorder between January 2015 and June 2016. The self-controlled case series (SCCS) design was used to estimate the incidence rate ratio of relapse occurrences according to mental healthcare coverage. Results Poor timeliness (82% and 33% of cohort members had not yet started treatment with psychosocial interventions and antipsychotic drug therapy within the first year after they were taken into care) and continuity (27% and 23% of patients were persistent with psychosocial interventions, and antipsychotic drug therapy within the first 2 years after starting the specific treatment) were observed. According to SCCS design, 4794 relapses occurred during 9430 PY (with incidence rate of 50.8 every 100 PY). Compared with periods not covered by mental healthcare, those covered by psychosocial intervention alone, antipsychotic drugs alone and by psychosocial intervention and antipsychotic drugs together were, respectively, associated with relapse rate reductions of 28% (95% CI 4–46%), 24% (17–30%) and 44% (32–53%). Conclusion Healthcare administrative data may contribute to monitor and to assess the effectiveness of a mental health system. Persistent use of both psychosocial intervention and antipsychotic drugs reduces risk of severe relapse.

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Mental health law in Ghana

BJPsych International ◽

10.1192/s2056474000001768 ◽

2017 ◽

Vol 14 (2) ◽

pp. 38-39 ◽

Cited By ~ 7

Author(s):

George Hudson Walker ◽

Akwasi Osei

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Health System ◽

Mental Health System ◽

Mental Healthcare ◽

Health Law ◽

Community Based ◽

Mental Health Law ◽

Mental Health Act ◽

New System

In 2012 Ghana passed a new Mental Health Act, which aimed to create a new system of mental healthcare in Ghana. The Act includes provisions for the creation of a modern, community-based mental health system and for the protection of the rights of persons with mental disorders. This article discusses the implications of the Act and the progress which has been made towards its implementation.

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Mental health system costs, resources and constraints in South Africa: a national survey

Health Policy and Planning ◽

10.1093/heapol/czz085 ◽

2019 ◽

Vol 34 (9) ◽

pp. 706-719 ◽

Cited By ~ 14

Author(s):

Sumaiyah Docrat ◽

Donela Besada ◽

Susan Cleary ◽

Emmanuelle Daviaud ◽

Crick Lund

Keyword(s):

Public Health ◽

Mental Health ◽

South Africa ◽

Health System ◽

National Survey ◽

Mental Health System ◽

Scale Up ◽

Health Spending ◽

Mental Healthcare ◽

Mental Health Expenditure

Abstract The inclusion of mental health in the Sustainable Development Goals represents a global commitment to include mental health among the highest health and development priorities for investment. Low- and middle-income countries (LMICs), such as South Africa, contemplating mental health system scale-up embedded into wider universal health coverage-related health system transformations, require detailed and locally derived estimates on existing mental health system resources and constraints. The absence of these data has limited scale-up efforts to address the burden of mental disorders in most LMICs. We conducted a national survey to quantify public expenditure on mental health and evaluate the constraints of the South African mental health system. The study found that South Africa’s public mental health expenditure in the 2016/17 financial year was USD615.3 million, representing 5.0% of the total public health budget (provincial range: 2.1–7.7% of provincial health budgets) and USD13.3 per capita uninsured. Inpatient care represented 86% of mental healthcare expenditure, with nearly half of total mental health spending occurring at the psychiatric hospital-level. Almost one-quarter of mental health inpatients are readmitted to hospital within 3 months of a previous discharge, costing the public health system an estimated USD112 million. Crude estimates indicate that only 0.89% and 7.35% of the uninsured population requiring care received some form of public inpatient and outpatient mental healthcare, during the study period. Further, mental health human resource availability, infrastructure and medication supply are significant constraints to the realization of the country’s progressive mental health legislation. For the first time, this study offers a nationally representative reflection of the state of mental health spending and elucidates inefficiencies and constraints emanating from existing mental health investments in South Africa. With this information at hand, the government now has a baseline for which a rational process to planning for system reforms can be initiated.

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Towards a Culturally Appropriate Mental Health System: Sudanese-Australians' Experiences with Trauma

Journal of Pacific Rim Psychology ◽

10.1375/prp.4.1.53 ◽

2010 ◽

Vol 4 (1) ◽

pp. 53-60 ◽

Cited By ~ 17

Author(s):

Alicia Copping ◽

Jane Shakespeare-Finch ◽

Douglas Paton

Keyword(s):

Mental Health ◽

Grounded Theory ◽

Health System ◽

Mental Health System ◽

Mental Healthcare ◽

Previous Literature ◽

Refugee Camps ◽

Culturally Appropriate ◽

Cultural Contexts ◽

Grounded Theory Methodology

AbstractAustralia is fortunate to welcome approximately 13,000 humanitarian entrants per year, most of whom have experienced protracted violence, hardship and life in refugee camps. The majority of humanitarian migrants were raised in cultural contexts very different to that of Australia, contributing to the increasing diversity of this region. With this diversity comes a responsibility to ensure every Australian receives culturally appropriate mental healthcare. Those who are forced into migration have experienced trauma and the stress of acculturation often compounds this trauma. This study investigated the experience of trauma from the perspectives of Sudanese-Australians. Grounded theory methodology was employed to extract themes from interviews with 15 Sudanese-Australians aged between 19 and 49 years. Results demonstrated four overarching themes: support, religion, strength and new possibilities. The data within these themes are compared and contrasted with previous literature that has examined notions of trauma, distress and growth in western populations. Conclusions drawn from these results highlight the need to build inclusive practices that support diversity into existing trauma services in Australia.

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‘Gentlemen, we have no money therefore we must think’ – mental health services in hard times

The Psychiatrist ◽

10.1192/pb.bp.110.030627 ◽

2011 ◽

Vol 35 (3) ◽

pp. 81-83 ◽

Cited By ~ 4

Author(s):

Frank Holloway

Keyword(s):

Mental Health ◽

Health Services ◽

Health System ◽

Mental Health System ◽

Mental Healthcare ◽

Evidence Base ◽

Evidence Based ◽

Demographic Trends ◽

Hard Times ◽

Uncertain Future

SummaryIn common with all elements of public services, mental healthcare in England faces a troubling and uncertain future. Two things, however, are certain: demographic trends ensure that demand will rise and harsh economic realities dictate that resources will in real terms shrink. In order to cope with these challenges, commissioners and providers will have to review very critically all aspects of the mental health system, including those that are currently fashionable. There is a need to identify and promote activities that are evidence-based and effective and to jettison practices and services that lack an evidence base.

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The balanced care model: the case for both hospital- and community-based mental healthcare

The British Journal of Psychiatry ◽

10.1192/bjp.bp.112.111377 ◽

2013 ◽

Vol 202 (4) ◽

pp. 246-248 ◽

Cited By ~ 50

Author(s):

Graham Thornicroft ◽

Michele Tansella

Keyword(s):

Mental Health ◽

Health System ◽

Mental Health System ◽

Scientific Evidence ◽

Mental Healthcare ◽

System Change ◽

Care Model ◽

Community Based ◽

Health System Change

SummaryThe balanced care model proposes that a comprehensive mental health system needs to include both community-and hospital-based care. The model is based on a structured review of scientific evidence, and is also informed by the experience of experts active in mental health system change in many countries worldwide.

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The Trieste model

Basaglia's International Legacy: From Asylum to Community ◽

10.1093/med/9780198841012.003.0019 ◽

2020 ◽

pp. 317-332

Author(s):

Robert Okin

Keyword(s):

Mental Health ◽

Health System ◽

San Francisco ◽

Affordable Housing ◽

Mentally Ill ◽

Mental Health System ◽

Medical Model ◽

Mental Healthcare ◽

Fee For Service ◽

Resource Base

This chapter describes a collaboration between academics from Berkeley and leaders of the Trieste mental health system and of San Francisco General Hospital, to determine the feasibility of replicating the Trieste model of mental healthcare in San Francisco. The participants ultimately concluded that Basaglia has had no influence on the mental health system in the United States, and determined that the obstacles to replication of the Trieste model were, in whole or in part, insuperable at this time. Among these obstacles are the demographics of the population in San Francisco (e.g. large numbers of poor, disabled people competing for the same small resource base), the pervasiveness of substance abuse among the mentally ill population, the extent of homelessness and criminalization of the mentally ill, the dearth of affordable housing, the predominant use of the medical model, and the fee-for-service financing system which supports this model.

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