Early psychosis initiative in Japan

Author(s):  
Masafumi Mizuno ◽  
Naomi Inoue ◽  
Takahiro Nemoto ◽  
Naohisa Tsujino ◽  
Naoyuki Katagiri ◽  
...  

Psychiatric services in Japan have been dominantly hospital-based, and the largest task for psychiatry in Japan today remains the deinstitutionalization of patients, rather than early intervention. Individuals with mental health problems and their families are often reluctant to seek help for various reasons, including a lack of knowledge regarding the features and treatability of mental disorders. These obstacles may explain the long duration of untreated psychosis (DUP) and the social stigma of mental disorders in Japan. The concept of an at-risk mental state (ARMS)/prodromal state might not yet be widely recognized among Japanese psychiatrists. Competency in treating and diagnosing mild and moderate disorders should be integrated into training for the primary care specialty, and building the community-based network for early detection is the key strategy in Japan.

Author(s):  
Rebecca McKnight ◽  
Jonathan Price ◽  
John Geddes

One in four individuals suffer from a psychiatric disorder at some point in their life, with 15– 20 per cent fitting cri­teria for a mental disorder at any given time. The latter corresponds to around 450 million people worldwide, placing mental disorders as one of the leading causes of global morbidity. Mental health problems represent five of the ten leading causes of disability worldwide. The World Health Organization (WHO) reported in mid 2016 that ‘the global cost of mental illness is £651 billion per year’, stating that the equivalent of 50 million working years was being lost annually due to mental disorders. The financial global impact is clearly vast, but on a smaller scale, the social and psychological impacts of having a mental dis­order on yourself or your family are greater still. It is often difficult for the general public and clin­icians outside psychiatry to think of mental health dis­orders as ‘diseases’ because it is harder to pinpoint a specific pathological cause for them. When confronted with this view, it is helpful to consider that most of medicine was actually founded on this basis. For ex­ample, although medicine has been a profession for the past 2500 years, it was only in the late 1980s that Helicobacter pylori was linked to gastric/ duodenal ul­cers and gastric carcinoma, or more recently still that the BRCA genes were found to be a cause of breast cancer. Still much of clinical medicine treats a patient’s symptoms rather than objective abnormalities. The WHO has given the following definition of mental health:… Mental health is defined as a state of well- being in which every individual realizes his or her own po­tential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.… This is a helpful definition, because it clearly defines a mental disorder as a condition that disrupts this state in any way, and sets clear goals of treatment for the clinician. It identifies the fact that a disruption of an individual’s mental health impacts negatively not only upon their enjoyment and ability to cope with life, but also upon that of the wider community.


1993 ◽  
Vol 17 (9) ◽  
pp. 524-525 ◽  
Author(s):  
Rosie Shepperd

The asylum movement was developed in the 19th century to provide care and cure for people with mental disorders. In the 20th century the old vision of asylum was abandoned, but no new alternative vision of community mental health care has taken its place. A divide between acute psychiatric services and provision for the social aspects of care has been described by Murphy (1991).


Author(s):  
Kaaren Mathias ◽  
Dale Corcoran ◽  
Pooja Pillai ◽  
Smita Deshpande ◽  
Miguel San Sebastian

Background: In low- and middle-income settings, many people with mental health problems cannot or do not access psychiatric services. Few studies of people with epilepsy and mental problems have evaluated the effectiveness of a predominantly psycho-social intervention, delivered by lay community workers. The aim of this study was to assess the effectiveness of a community-based complex mental health intervention within informal urban communities while simultaneously addressing social determinants of mental health among disadvantaged people with severe and common mental disorders (CMDs), and epilepsy. Methods: In this observational, prospective cohort study set in Uttarakhand, India, the lay-worker led intervention included psychoeducation, behavioural activation, facilitation of access to care, and facilitated psycho-social support groups. Participants were categorised as having a severe or CMD or epilepsy and assessed 5 times over 24 months using primary outcome measures, including the Patient Health Questionnaire (PHQ9) (severity of depression), the World Health Organization Disability Assessment Schedule (WHODAS 2.0), the Recovery Star, and scoring of a bespoke Engagement Index. Analysis included descriptive statistics as well as hierarchical linear regression models to report fixed effects as regression coefficients. Results: Among the 297 (baseline) participants only 96 people (31%) regularly used psychotropic medication (at least 4 weeks) and over 60% could not or did not consult a psychiatrist at all in the study period. Nonetheless, people with CMDs showed a significant reduction in their depression severity (PHQ9: B=-6.94, 95% CI -7.37 to -6.51), while people with severe mental disorders (SMDs) showed a significant reduction in their disability score (WHODAS 2.0: B=-4.86, 95% CI - 7.14 to- 2.57). People with epilepsy also reduced their disability score (WHODAS 2.0: B=-5.22, 95% CI -7.29 to -3.15). Conclusion: This study shows significant improvements in mental health, depression, recovery, disability and social engagement for people with common and SMDs, and epilepsy, through a community-based intervention that was nonpharmaceutical. It provides preliminary evidence of the value of predominantly psycho-social interventions implemented by lay health workers among people with limited or no access to psychiatric services.


2020 ◽  
pp. 1346-1354
Author(s):  
Rika Damayanti ◽  
Ishak Abdulhak ◽  
Ihat Hatimah ◽  
Jajat S. Ardiwinata

Schools have become the default mental health providers for children and adolescents, but they are often poorly equipped to meet the mental health needs of their students. The introduction tackles how to make students eligible for school-based services using the Individuals with Disabilities Education Act or Section 504 of the Rehabilitation Act. Using the new DSM-5 as an organizing principle, this book then addresses the 12 most common mental disorders of childhood and adolescence, ages 3–18. While there are many books that address child and adolescent psychopathology, this book focuses on how to help students with mental disorders in pre-K–12 schools. Each chapter addresses the prevalence of a disorder in school-age populations, appropriate diagnostic criteria, differential diagnosis, comorbid disorders, rapid assessment instruments available, school-based interventions using multitiered systems of support, and easy-to-follow suggestions for progress monitoring. Unique to this book, each chapter has detailed suggestions for how school-based clinicians can collaborate with teachers, parents, and community providers to address the needs of youth with mental health problems so that school, home, and community work together. Each chapter ends with a list of extensive web resources and a real-life case example drawn from the clinical practice of the authors. The final chapter addresses two newly proposed diagnoses for self-harm in the DSM-5 and brings a cautious and sensible approach to assessing and helping students who may be at risk for serious self-injury or suicide.


2021 ◽  
pp. 002076402110175
Author(s):  
Roberto Rusca ◽  
Ike-Foster Onwuchekwa ◽  
Catherine Kinane ◽  
Douglas MacInnes

Background: Relationships are vital to recovery however, there is uncertainty whether users have different types of social networks in different mental health settings and how these networks may impact on users’ wellbeing. Aims: To compare the social networks of people with long-term mental illness in the community with those of people in a general adult in-patient unit. Method: A sample of general adult in-patients with enduring mental health problems, aged between 18 and 65, was compared with a similar sample attending a general adult psychiatric clinic. A cross-sectional survey collected demographic data and information about participants’ social networks. Participants also completed the Short Warwick Edinburgh Mental Well-Being Scale to examine well-being and the Significant Others Scale to explore their social network support. Results: The study recruited 53 participants (25 living in the community and 28 current in-patients) with 339 named as important members of their social networks. Both groups recorded low numbers in their social networks though the community sample had a significantly greater number of social contacts (7.4 vs. 5.4), more monthly contacts with members of their network and significantly higher levels of social media use. The in-patient group reported greater levels of emotional and practical support from their network. Conclusions: People with serious and enduring mental health problems living in the community had a significantly greater number of people in their social network than those who were in-patients while the in-patient group reported greater levels of emotional and practical support from their network. Recommendations for future work have been made.


2021 ◽  
pp. 002076402110361
Author(s):  
Anwar Khatib ◽  
Fareeda Abo-Rass

Background: There has been a noticeable increase in the number of studies concerned with mental health literacy (MHL), specifically among students. Still, very few studies have examined MHL among students of non-Western minority groups. Aims: This study examined MHL among Arab students in Israel based on Jorm’s conceptual framework. Methods: Twenty-eight Arab students in Israel took part in semi-structured, in-depth interviews. Most were single and Muslim, in their second year of studies, and most reported low socioeconomic status. The data were analyzed thematically, guided by the Jorm’s six MHL dimensions. Results: Different levels of literacy were found in the various MHL dimensions. The participants identified severe mental disorders more easily than mood disorders; reported a variety of possible causes of mental disorders; were well aware of available professional help (apart for rehabilitative services); identified significant barriers to mental health help seeking, as Arabs; and reported the internet as a major source of information about mental health problems and their treatment Conclusions: The participants’ MHL appeared to be associated with their unique sociocultural characteristics. This study stresses the need to raise MHL among Arab students in Israel, and in particular to promote positive attitudes to seeking professional help. It also highlights the need to develop culturally adapted mental health interventions for the Arab population in Israel.


2021 ◽  
pp. 000486742110096
Author(s):  
David Lawrence ◽  
Sarah E Johnson ◽  
Francis Mitrou ◽  
Sharon Lawn ◽  
Michael Sawyer

Objectives: This study aimed to (1) examine the strength of the association between mental disorders/mental health problems, risk behaviours and tobacco smoking among Australian adolescents, (2) compare rates of tobacco smoking among Australian adolescents with major depressive disorder, attention-deficit/hyperactivity disorder and/or conduct disorder in 2013/14 vs 1998, and (3) identify the extent to which an association between tobacco smoking and mental health problems among adolescents can be attributed to non-mental health risk factors. Methods: The study utilised data from the first (1998) and second (2013/14) child and adolescent components of the National Surveys of Mental Health and Wellbeing. Both surveys identified nationally representative samples of Australian young people aged 4–17 years, living in private dwellings. Information was collected from parents and 13- to 17-year-olds about mental disorders, mental health problems, risk behaviours and tobacco smoking. Results: In the 2013/14 survey, the rate of current tobacco smoking among those with a mental disorder was 20% compared to 5% in those without a mental disorder. Rates were highest for young people with conduct disorder (50%), major depressive disorder (24%) and anxiety disorders (19%). In 2013/14, 38% of current tobacco smokers had a mental disorder and 32% reported self-harm and/or suicidal ideation vs 10% and 5%, respectively, among adolescents who had never smoked. Females with mental disorders or reporting self-harm or suicidal ideation had higher rates of current smoking than males. Other significant factors associated with current smoking included school-related problems, binge eating and having had more than one sexual partner. Conclusion: While smoking rates in 13- to 17-year-olds with mental disorders had declined since 1998, the strength of the association between mental disorders and smoking had increased, especially among females. Our findings highlight the need to address the tobacco smoking among adolescents with mental disorders, particularly females.


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