Mental Health of Elderly in Serbia-from Strategy to Reality

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Milicevic Kalasic
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Disorders ◽  
Primary Care Physicians ◽  
Action Plan ◽  
Mental Health Policy ◽  
Social Institutions ◽  
Special Focus ◽  
Elderly Persons ◽  
Care Facilities

National Mental Health Policy and Action Plan was adopted in January 2007 by Government of Republic Serbia. Elderly persons were brought in focus as growing population with growing number of elderly with mental disorders and services incapable to face this challenge. Last October, Institute of Gerontology promoted Geriatric Manual, published and distributed in Primary Care Facilities in Belgrade as it was supported by Municipal Secretariat of Health. Psychogeriatric issues took a part in Geriatric Manual with recognition of early detection of psychological disorders in elderly and importance of diagnose acute confusion state in everyday practice. It was just the beginning of education of primary care physicians in Belgrade. There were many meetings in Ministry of Health with aim of spreading this knowledge all around Serbia. Mental Health Department of Institute of Gerontology has ran education in psychogeriatric issues for primary care within Project supported by Municipal Secretariat of Health, Belgrade with main aim of developing network for caring of elderly mentally disturbed people. Very important part of network is within social institutions and in a private sector. On other hand in the same time round table within project was a part of antistigma campaign in primary care facilities and in community. A baseline report on health and social institutions accommodating with special focus on elderly with mental disorders were launched under WHO support.

scholarly journals Implementing mhGAP training to strengthen existing services for an internally displaced population in Pakistan

2017 ◽  
Vol 4 ◽  
Author(s):  
A. Humayun ◽  
I. Haq ◽  
F. R. Khan ◽  
N. Azad ◽  
M. M. Khan ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Disorders ◽  
Primary Care Physicians ◽  
Psychosocial Support ◽  
Common Mental Disorders ◽  
Care Staff ◽  
Humanitarian Crisis ◽  
Internally Displaced ◽  
Primary Care Staff

Background.In 2014, over a million people were internally displaced after the launch of a military operation in North Waziristan, a tribal region on Pakistan's side of the Durand Line. Despite security concerns and restrictions, a collaborative mental health and psychosocial support initiative was undertaken in the district of Bannu. Monthly mental health camps were conducted for a period of 6 months by a multidisciplinary mental health team. The initiative also helped to assess mental health needs and plan training for primary care staff to strengthen existing resources.Methods.As part of this initiative, Mental Health Gap Action Programme (mhGAP) training was conducted for physicians and psychosocial staff in the affected district. This marked the first instance of implementing these guidelines in Pakistan following a humanitarian crisis. This paper describes the training process including the adaptation of the mhGAP curriculum, training of trainers, training workshops for primary care staff and an analysis of results of pre- and post-testing of their knowledge about common mental disorders using a 25-item questionnaire.Results.The gaps in knowledge of primary care physicians in recognizing and managing common mental disorders were clearly identified. The mean pre- and post-test scores of the participants were 15.43, 62% (p value 0.000, s.d. 4.05) and 19.48, 78% (p value 0.000, s.d. 3.13) respectively, which showed significant improvement.Conclusions.Despite the challenges of a humanitarian crisis, mhGAP guidelines can be successfully implemented to train primary care physicians in in low- and middle-income countries such as Pakistan. However, the dearth of primary care resources can hinder the complete integration of mental health services into primary healthcare.

scholarly journals Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India

2016 ◽  
Vol 208 (s56) ◽  
pp. s13-s20 ◽  
Author(s):  
Rahul Shidhaye ◽  
Sanjay Shrivastava ◽  
Vaibhav Murhar ◽  
Sandesh Samudre ◽  
Shalini Ahuja ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Disorders ◽  
Action Plan ◽  
Mental Healthcare ◽  
Theory Of Change ◽  
World Health ◽  
Care Workers ◽  
Care Models ◽  
Health Organization

BackgroundThe large treatment gap for mental disorders in India underlines the need for integration of mental health in primary care.AimsTo operationalise the delivery of the World Health Organization Mental Health Gap Action Plan interventions for priority mental disorders and to design an integrated mental healthcare plan (MHCP) comprising packages of care for primary healthcare in one district.MethodMixed methods were used including theory of change workshops, qualitative research to develop the MHCP and piloting of specific packages of care in a single facility.ResultsThe MHCP comprises three enabling packages: programme management, capacity building and community mobilisation; and four service delivery packages: awareness for mental disorders, identification, treatment and recovery. Challenges were encountered in training primary care workers to improve identification and treatment.ConclusionsThere are a number of challenges to integrating mental health into primary care, which can be addressed through the injection of new resources and collaborative care models.

Outcomes of promotion, prevention, treatment and care

2016 ◽  
Vol 33 (S1) ◽  
pp. S3-S3
Author(s):  
M. Muijen
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Promotion ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Low Income ◽  
Action Plan ◽  
Vulnerable Groups ◽  
Populations At Risk

The WHO European Mental Health Action Plan encompasses promotion, prevention, treatment and recovery, within the context of a model of mental health that proposes a set of socio-economic and biological determinants that predispose to vulnerabilities and increase the risk of disorders. These determinants also negatively affect access to and quality of care. Such risk factors are shared with common non-communicable disorders, increasing the risk of morbidity and early mortality for people with mental disorders.Mental health promotion and prevention actions should therefore be addressing determinants such as alcohol and smoking. However, such determinants are not equally distributed in the population, but cluster among vulnerable groups, such as those with a low income, the unemployed and minority groups. These groups overlap with the populations services struggle to reach. In addition, both primary care and specialist mental health services struggle to identify and treat people with co-morbidities. This suggests that connections need to be established between public health, primary care and specialist mental health services.WHO is focussing on the strengthening of primary care and the interface with mental health services. In particular, there is an urgent need to screen people who present with symptoms of NCDs or mental disorders for common determinants and co-morbidities. Effective health promotion activities need to be offered to populations at risk, in addition to universal health promotion interventions such as taxation or advertising bans. Some examples will be presented.Disclosure of interestThe author has not supplied his declaration of competing interest.

PRIME-MD: Its Utility in Detecting Mental Disorders in American Indians

1997 ◽  
Vol 27 (2) ◽  
pp. 107-128 ◽  
Author(s):  
Tassy Parker ◽  
Philip A. May ◽  
Marcello A. Maviglia ◽  
Steven Petrakis ◽  
Scott Sunde ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Disorders ◽  
Health Professional ◽  
American Indians ◽  
Mental Health Professional ◽  
Primary Care Physicians ◽  
Primary Care Clinic ◽  
Assessment Procedure ◽  
Care Clinic

Objective: To examine the utility of using PRIME-MD (Primary Care Evaluation of Mental Disorders) for diagnosing mental disorders in American Indians. Method: One hundred randomly selected, adult, American-Indian patients who receive health care services at an urban Indian Health Service primary care clinic were evaluated for mental disorder by three primary care physicians using the PRIME-MD diagnostic assessment procedure. The main outcome measures were PRIME-MD diagnoses, diagnoses by an independent mental health professional, and treatment/referral decisions. Results: Eighteen percent of the patients had a threshold (met full DSM-IV criteria) PRIME-MD diagnosis, and an additional 17 percent had a subthreshold PRIME-MD diagnosis. The most frequently occurring PRIME-MD diagnoses were: probable alcohol abuse/dependence, major depressive disorder, and generalized anxiety disorder. Over 60 percent of the patients with a PRIME-MD diagnosis who were known “somewhat” or “fairly well” to their physician had not been recognized as having that psychiatric disorder prior to the PRIME-MD assessment. Therapy and/or referral was initiated for nineteen of the twenty-seven patients with a PRIME-MD diagnosis who were not previously receiving treatment. The primary care physicians were able to complete the PRIME-MD evaluations within an average of 7.8 minutes. There was a fair agreement between the PRIME-MD diagnoses and the diagnoses of the mental health professional (kappa = 0.56; overall accuracy rate = 79%). Conclusions: The present study represents the first formal examination of the use of PRIME-MD with American Indians. The results are encouraging. Further studies using PRIME-MD with other urban groups and reservation populations are recommended.

Effects of the mental health parity and addictions equality act on depression treatment choice in primary care facilities

2017 ◽  
Vol 52 (1) ◽  
pp. 34-47 ◽  
Author(s):  
Daniel M. Goldberg ◽  
Hsien-Chang Lin
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
The United States ◽  
Depression Treatment ◽  
Mental Health Parity ◽  
Care Providers ◽  
Multinomial Regression ◽  
Care Facilities

Objective The Mental Health Parity and Addictions Equality Act (MHPAEA) of 2010 in the United States sought to expand mental health insurance benefits on par with medical benefits. As primary care facilities are often the first step in identifying mental health concerns, it is essential to examine the association of this policy with primary care physicians’ choice on depression treatment. Method A retrospective cross-sectional study was conducted using data from the 2007–2012 National Ambulatory Medical Care Survey, including a weighted total of 162,699,930 depression patients. Using the Heckman two-step selection procedure, a logistic and a multinomial regression were conducted to examine the association of the MHPAEA with physicians’ two-step process of deciding whether and which type of treatment was prescribed. Sociological factors were controlled. Results Treatment was significantly more likely to be provided after the MHPAEA. Psychotherapy was used for treatment for 10.0% of the sample while medication was used for 75.0% of the sample. Patient race/ethnicity, practice setting, physician specialty, and primary source of payment were associated with diverging likelihood of being prescribed depression treatment. Non-Hispanic White patients were more likely to be provided treatment than non-Hispanic Black patients. Patients were less likely to be prescribed only medication than only psychotherapy after the MHPAEA enactment. Conclusions The MHPAEA was associated with primary care providers’ decision and choice on depression treatment. Educational and policy interventions aimed at improving physician’s understanding of their own treatment tendencies and decreasing barriers to depression treatment may impact the disparities in underserved, minority, and older populations.

scholarly journals Effectiveness of Mental Health Training Module Gap Action Programme (mhGAP) in Increasing Knowledge and Skills of Primary Care Physicians in Diagnosing Depression Disorders in the Gunungkidul District

2018 ◽  
Vol 1 (2) ◽  
pp. 69 ◽  
Author(s):  
Novi Fitri Yani ◽  
Carla R Marchira ◽  
Wahyudi Istiono
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Disorders ◽  
Primary Care Physicians ◽  
Community Health Centers ◽  
Care Physician ◽  
Female Group ◽  
Mental Health Training ◽  
Knowledge And Skills ◽  
District Hospitals

Background: Depression occurs in 3-8% of the population of the world and ranks fourth in the world's most prevalent diseases. Based on data from Riskesdas 2013, the rate of mental disorders (depression and anxiety) reached 6% for ages 15 and older. The mental disorder most prevalent in primary care is the depressive disorder (10%), but the diagnosis of depression by general practitioners in primary care is only 1%. Coverage of mental health in primary care is low, partly because primary care physicians who are in Community and Primary Health Care Centers (Puskesmas) are still experiencing difficulties in diagnosing mental disorders, especially depression.Objective: To determine the effectiveness of mhGAP training in improving the knowledge and skills of primary care physicians in diagnosing and treating depression in Gunungkidul.Research Methods: This study was a quasi-experimental research with pretest-posttest design with one group, in order to find a causal relationship involving one treatment group.Results: The knowledge of the primary care physician improved about diagnosis of depression before and after intervention training modules, p=0.000. Patients with depression mostly suffered in the female group ages 19-60 years old. An increase in the diagnosis of depression after training mhGAP with validation by a psychiatric specialist was at 49.41%.Conclusion: Training with modules mhGAP improved education for physicians in the diagnosis of depression and improved referral rates of depression cases from community health centers to district hospitals in Wonosari.

scholarly journals Chinese perspectives on primary care for common mental disorders: Barriers and policy implications

2018 ◽  
Vol 64 (5) ◽  
pp. 417-426 ◽  
Author(s):  
Kai Sing Sun ◽  
Tai Pong Lam ◽  
Dan Wu
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Disorders ◽  
Mental Health Care ◽  
Primary Care Physicians ◽  
Common Mental Disorders ◽  
Chinese Patient ◽  
Policy Implications ◽  
World Health

Background: The World Health Organization (WHO) has called for integration of mental health into primary care for a decade. In Western countries, around 15% to 25% of patients with common mental disorders including mood and anxiety disorders seek help from primary care physicians (PCPs). The rate is only about 5% in China. Aims: This article reviews the Chinese findings on the barriers to primary care for common mental disorders and how they compared with Western findings. Methods: A narrative literature review was conducted, focusing on literature published from mid-1990s in English or Chinese. Patient, PCP and health system factors were reviewed. Results: Although Chinese and Western findings show similar themes of barriers, the Chinese have stronger barriers in most aspects, including under-recognition of the need for treatment, stigma on mental illness, somatization, worries about taking psychiatric drugs, uncertainties in the role, competency and legitimacy of PCPs in mental health care and short consultation time. Conclusion: Current policies in China emphasize enhancement of mental health facilities and workforce in the community. Our review suggests that patients’ intention to seek help and PCPs’ competency in mental health care are other fundamental factors to be addressed.

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