Filters on the pathway to mental health care I. Incident mental disorders

1995 ◽  
Vol 25 (6) ◽  
pp. 1135-1148 ◽  
Author(s):  
S. Marino ◽  
J. J. Gallo ◽  
D. Ford ◽  
J. C. Anthony
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
The United States ◽  
Psychiatric Disturbances ◽  
Medical Sector ◽  
Initial Survey

SynopsisThis study investigates health and mental health services use by adults with and without newly incident mental disorders and uses prospectively gathered data from the Epidemiologic Catchment Area Program, a multi-site interview survey of adult household residents in the United States. Study subjects were 13400 participants who completed interviews in the initial survey and also in a follow-up 1 year later, and who reported no contact with mental health services in either the specialized mental health sector or in the general medical sector in the 6 months prior to the initial survey. Case ascertainment was by means of a standardized interview method, the Diagnostic Interview Schedule. Separately, and before the mental health assessments were made, respondents were asked about their use of health and mental health services. ‘Hierarchical’ and ‘filter’ models of mental health services provide frameworks useful in understanding the possible effects of specific categories of psychiatric disturbances on use of health services. Only a minority of individuals with newly incident psychiatric disorder report discussion of mental health issues in a health care setting. Persons who developed a mental disorder during the follow-up interval were just as likely to consult a non-psychiatrist physician for their mental health problems as to consult a specialist in mental health, even accounting for other factors known to be associated with differential use of health care services. This large community study of incident psychiatric disorders strengthens prior evidence on the importance of the general medical sector in the care of individuals with psychiatric disturbances.

scholarly journals Mental health services in Nicaragua: Ten years of revolution

1990 ◽  
Vol 14 (6) ◽  
pp. 346-350 ◽  
Author(s):  
Alison Harris ◽  
Tammy Shefer
Keyword(s):  
Mental Health ◽  
United States ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
The United States ◽  
Democratic Society ◽  
A Priority

Nicaragua is celebrating ten years of revolution since the overthrow of the 45 year long Somoza dictatorship∗. In this time, the Sandinista government has attempted to construct a more democratic society with considerable achievements in the area of health, welfare and education. Indeed, health care has been a priority in spite of severe economic difficulties caused by the United States economic blockade and by the need for defence against the war waged by the counter-revolutionaries (the Contra).

Expanding the Role of Primary Health Care in the Provision of Mental Health Services to the Population of the Kyrgyz Republic

2017 ◽  
Vol 41 (S1) ◽  
pp. S606-S606
Author(s):  
T. Galako
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Mental Health Care ◽  
Kyrgyz Republic ◽  
Family Doctors ◽  
Primary Health

Providing comprehensive, integrated services in the field of mental health in primary health care (PHC) is a component of the state mental health program for the population of the Kyrgyz republic (KR) in the 2017–2030 biennium. In order to develop an action plan in this area a situational analysis of resources of psychiatric care at PHC level was carried out. There was revealed a significant deficit of specialists, such as family doctors, mental health care professionals. In spite of the need for 3,300 family doctors, only 1706 work, and 80% of them are of retirement age.The results of a research showed a low level of knowledge and skills of family physicians for the early detection of mental disorders and provision of appropriate medical care. There are also a limited number of psychiatrists, especially in rural regions (77% of the required quantity).During recent years, there have been implemented significant changes in the system of mental health services, aimed at improving its quality, the approach to the place of residence of the patient and the prevalence of psychosocial services.Since 2016 in 8 southern regions in the Kyrgyz Republic has been introduced a new model for the provision of comprehensive health care services. Piloting this model involves psychosocial rehabilitation of patients with mental disorders, the help of mobile teams at the place of patient residence, as well as psychoeducation, training, and support to family doctors. These and other measures will help to optimise mental health care at PHC level.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Filters on the pathway to mental health care, II. Sociodemographic factors

1995 ◽  
Vol 25 (6) ◽  
pp. 1149-1160 ◽  
Author(s):  
J. J. Gallo ◽  
S. Marino ◽  
D. Ford ◽  
J. C. Anthony
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Psychiatric Disorder ◽  
The United States ◽  
Sociodemographic Characteristics ◽  
Health Services Use ◽  
Relative Odds ◽  
Services Use

SynopsisThis study uses the prospectively gathered data of the Epidemiologic Catchment Area Program, a multi-site interview survey of mental disturbances among adult household residents in the United States, to compare health services use by individuals with different sociodemographic characteristics, accounting for the first-time occurrence of psychiatric disorder, over the course of a 1-year follow-up interval. Case ascertainment was by means of a standardized interview method, the Diagnostic Interview Schedule. In the present investigation, 13400 continuing participants in the household sample who reported no contact with mental health services in the 6 months prior to the initial interview were studied with regard to health services use and sociodemographic characteristics. Separately, and before the mental health assessments were made, respondents were asked about their use of health and mental health services. African-Americans were significantly less likely than whites to have consulted with a specialist in mental health (estimated relative odds, 0·22, 95% confidence interval 0·10 to 0·52), even accounting for coincident psychiatric disorder, gender, and other covariates known to be associated with differential use of health care services. Hispanics and other minorities were also less likely to have consulted a specialist in mental health (estimated relative odds, 0·37 and 0·26, respectively). This large community study extends previous work on mental health services and ethnicity.

scholarly journals Adherence to clinical guidelines in integration of mental health services into primary health care in Mbarara, southwestern Uganda: a medical records review

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Edith K. Wakida ◽  
Moses Ocan ◽  
Godfrey Z. Rukundo ◽  
Samuel Maling ◽  
Peter Ssebutinde ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Clinical Guidelines ◽  
Common Mental Disorders ◽  
Primary Health ◽  
Southwestern Uganda

Abstract Background The Ugandan Ministry of Health decentralized mental healthcare to the district level; developed the Uganda Clinical Guidelines (UCG); and trained primary health care (PHC) providers in identification, management, and referral of individuals with common mental disorders. This was intended to promote integration of mental health services into PHC in the country. ‘Common mental disorders’ here refers to mental, neurological and substance use conditions as indicated in the UCG. However, the extent of integration of mental health into general healthcare remains unknown. This study aimed to establish the level of adherence of PHC providers to the UCG in the identification and management of mental disorders. Methods This was a prospective medical record review of patient information collected in November and December 2018, and March and April 2019 at two health centers (III and IV) in southwestern Uganda. Data (health facility level; sex and age of the patient; and mental disorder diagnosis, management) was collected using a checklist. Continuous data was analyzed using means and standard deviation while categorical data was analyzed using Chi-square. Multivariable logistic regression analysis was performed to establish predictors of PHC provider adherence to the clinical guidelines on integration of mental health services into PHC. The analysis was conducted at a 95% level of significance. Results Of the 6093 records of patients at the study health facilities during the study period, 146 (2.4%) had a mental or neurological disorder diagnosis. The commonly diagnosed disorders were epilepsy 91 (1.5%) and bipolar 25 (0.4%). The most prescribed medications were carbamazepine 65 (44.5%), and phenobarbital 26 (17.8%). The medicines inappropriately prescribed at health center III for a mental diagnosis included chlorpromazine for epilepsy 3 (2.1%) and haloperidol for epilepsy 1 (0.7%). Female gender (aOR: 0.52, 95% CI 0.39–0.69) and age 61+ years (aOR: 3.02, 95% CI 1.40–6.49) were predictors of a mental disorder entry into the HMIS register. Conclusion There was a noticeable change of practice by PHC providers in integrating mental health services in routine care as reflected by the rise in the number of mental disorders diagnosed and treated and entered into the modified paper based HMIS registers.

Prevalence of common mental disorders among Dutch medical students and related use and need of mental health care: a cross-sectional study

2012 ◽  
Vol 24 (2) ◽  
Author(s):  
Roxanne Gaspersz ◽  
Monique H.W. Frings-Dresen ◽  
Judith K. Sluiter
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Medical Students ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Mental Health Care ◽  
Common Mental Disorders ◽  
Post Traumatic Stress ◽  
Cross Sectional

Abstract Objective: The purpose of the study was to assess common mental disorders and the related use and need for mental health care among clinically not yet active and clinically active medical students. Methods: All medical students (n=2266) at one Dutch medical university were approached. Students from study years 1–4 were defined as clinically not yet active and students from study years 5 and 6 as clinically active. An electronic survey was used to detect common mental disorders depression (BSI-DEP), anxiety (BSI-ANG), stress (4DSQ) and post-traumatic stress disorder (IES). The use of mental health services in the past 3 months and the need for mental health services were asked for. The prevalence of common mental disorders, the use and need for mental health services and differences between groups were calculated. Results: The response rate was 52%: 814 clinically not yet active and 316 clinically active students. The prevalence of common mental disorders among clinically not yet active and clinically active students was 54% and 48%, respectively. The use of mental health services was 14% in clinically not yet active and 12% in clinically active students with common mental disorders (n.s.). The need for mental health services by clinically not yet active and clinically active students was 52% and 46%, respectively (n.s.). Conclusions: The prevalence of probable common mental disorders are higher among clinically not yet active than among clinically active students. The need of mental health services exceeds use, but is the same in the two groups of students.

scholarly journals Insurance Status, Use of Mental Health Services, and Unmet Need for Mental Health Care in the United States

2015 ◽  
Vol 66 (6) ◽  
pp. 578-584 ◽  
Author(s):  
Elizabeth Reisinger Walker ◽  
Janet R. Cummings ◽  
Jason M. Hockenberry ◽  
Benjamin G. Druss
Keyword(s):  
Mental Health ◽  
United States ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Care ◽  
Unmet Need ◽  
The United States ◽  
Insurance Status

scholarly journals Changes in community mental health services availability and suicide mortality in the US: A retrospective study

2020 ◽  
Author(s):  
Peiyin Hung ◽  
Susan Busch ◽  
Yi-Wen Shih ◽  
Alecia McGregor ◽  
Shi-Yi Wang
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Mental Health Care ◽  
Mental Health Professionals ◽  
The United States ◽  
Suicide Mortality ◽  
Per Capita

Abstract Background: Despite the fact that the overwhelming majority of mental health services are delivered in outpatient settings, the effect of changes in non-hospital-based mental health care on increased suicide rates is largely unknown. This study examines the association between changes in community mental health center (CMHC) supply and suicide mortality in the United States. Methods: Retrospective analysis was performed using data from National Mental Health Services Survey (N-MHSS) and the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) (2014-2017). Population-weighted multiple linear regressions were used to examine within-state associations between CMHCs per capita and suicide mortality. Models controlled for state-level characteristics (i.e., number of hospital psychiatric units per capita, number of mental health professionals per capita, age, race, and percent low-income), year and state. Results: From 2014 to 2017, the number of CMHCs decreased by 14% nationally (from 3,406 to 2,920). Suicide increased by 9.7% (from 15.4 to 16.9 per 100,000) in the same time period. We find a small but negative association between the number of CMHCs and suicide deaths (-0.52, 95% CI -1.08 to 0.03; p=0.066). Declines in the number of CMHCs from 2014 to 2017 may be associated with approximately 6% of the national increase in suicide, representing 263 additional suicide deaths. Conclusions: State governments should avoid the declining number of CMHCs and the services these facilities provide, which may be an important component of suicide prevention efforts. Keywords: Suicide, Deinstitutionalization, Access to mental health care, Community mental health

scholarly journals Adherence to Clinical Guidelines in Integration of Mental Health Services Into Primary Health Care in Mbarara, Southwestern Uganda: a Medical Record Review

2021 ◽  
Author(s):  
Edith K Wakida ◽  
Moses Ocan ◽  
Godfrey Zari Rukundo ◽  
Peter Sebutinde ◽  
Samuel Maling ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Clinical Guidelines ◽  
Primary Health ◽  
Record Review ◽  
Southwestern Uganda

Abstract Background: The Ugandan Ministry of Health decentralized mental health care delivery to the district level; developed the Uganda Clinical Guidelines (UCG); and trained primary health care (PHC) providers in identification, management, and referral of individuals with common mental disorders. This was intended to promote the integration of mental health services into PHC in the country. However, the extent of integration of mental health into general health care service delivery remains unknown. This study aimed to establish the level of adherence of PHC providers to the UCG in the identification and management of mental disorders. Methods: This was a prospective medical record review study of patient information collected in November and December 2018, and March and April 2019 at two health centers (III and IV) in southwestern Uganda. Data (health facility level; sex and age of the patient; and mental disorder diagnosis, management) was collected using a checklist. Continuous data was analyzed using means and standard deviation while categorical data was analyzed using Chi-square. Multivariable logistic regression analysis was performed to establish predictors of PHC provider adherence to the clinical guidelines on integration of mental health services into PHC. The analysis was conducted at a 95% level of significance.Results: Of the 6093 records of patients at the study health facilities during the study period, 146 (2.4%) had a mental or neurological disorder diagnosis. The commonly diagnosed disorders were epilepsy 91 (1.5%) and bipolar 25 (0.4%). The most prescribed medications were carbamazepine 65 (44.5%), and phenobarbital 26 (17.8%). The medicines inappropriately prescribed at health center III for a mental diagnosis included chlorpromazine for epilepsy 3 (2.1%) and haloperidol for epilepsy 1 (0.7%). Female gender (aOR: 0.52, 95%CI: 0.39 -0.69) and age 61+ years (aOR: 3.02, 95%CI: 1.40 – 6.49) were predictors of a mental disorder entry into the HMIS register.Conclusion: There was a noticeable change of practice by PHC providers in integrating mental health services in routine care as reflected by the rise in the number of mental disorders diagnosed and treated and entered into the modified paper based HMIS registers.

scholarly journals Pattern of Presentation and Utilization of Services for Mental and Neurological Disorders in Northeastern Nigeria: A Ten-Year Study

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Jidda Mohammed Said ◽  
Abdulmalik Jibril ◽  
Rabbebe Isah ◽  
Omeiza Beida
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Low Income ◽  
Neurological Disorders ◽  
Health Care Services ◽  
Significant Proportion ◽  
Care Services

Mental and neurological disorders are common in the primary health care settings. The organization of mental health services focuses on a vertical approach. The northeast as other low income regions has weak mental health services with potentially huge mental health burden. The manner of presentations and utilization of these services by the population may assist in determining treatment gap. We investigated the pattern and geographical distribution of presentations with mental disorders and explored the linkages with primary care in northeastern Nigeria over the last decade. A retrospective review of hospital-based records of all the available mental health service units in the region was conducted over a decade spanning between January 2001 and December 2011. A total of 47, 664 patients attended available mental health facilities within the past decade in the northeast. Overwhelming majority (83%,n=39,800) attended the region’s tertiary mental health facility. A substantial proportion (30%,n=14,440) had primary physical illness, while 18%,n=8606, had primary neurologic disorders. The commonest physical comorbidity was hypertension (4%) and diabetes (2%). A significant proportion of the populace with mental disorders appeared not to be accessing mental health care services, even when it is available. Meaningful efforts to improve access to mental health services in the northeast region of Nigeria will require successful integration of mental health into primary and general medical services.

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