From the asylum to community mental health services

2020 ◽  
pp. 129-146
Author(s):  
Diana Mauri ◽  
Alejandra Barcala
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Civil Rights ◽  
Health Services ◽  
Mental Healthcare ◽  
Community Mental Health Services ◽  
Mental Health Reform ◽  
National Mental Health ◽  
Psychiatric Power ◽  
Insight Into

This chapter intends to give insight into the tensions generated in Argentinian mental healthcare by alternations in policies and practices, while analysing Basaglia’s influence on policy making, on the development of mental health services, and on professional cultures. Basaglia’s thoughts and Italian reform have had a major impact in Argentina, thanks to his successors in the Trieste Department of Mental Health and the work they have carried out in the last 30 years. The core of his activity and reflections has become a guiding light in the protection of social and civil rights and the fight against traditional psychiatric power. Italian mental health reform is considered to be a central reference for Argentina’s National Mental Health Law 26657, passed in 2010; but even legislation which is human rights oriented still has to fully guarantee a system of mental healthcare respectful of people’s dignity and freedom.

scholarly journals Mental health services in Cambodia: an overview

2019 ◽  
Vol 17 (2) ◽  
pp. 29-31
Author(s):  
Sarah J. Parry ◽  
Ewan Wilkinson
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Rapid Growth ◽  
Urban Areas ◽  
Mental Healthcare ◽  
Mental Health Training ◽  
Health Strategy ◽  
Professional Mental Health ◽  
National Mental Health

Mental health services in Cambodia required rebuilding in their entirety after their destruction during conflict in the 1970s. During the late 1990s there was rapid growth and development of professional mental health training and education. Currently, basic mental healthcare is available primarily in urban areas and is provided by a mixture of government, non-government and private services. Despite the initial rapid growth of services and the development of a national mental health strategy in 2010, significant challenges remain in achieving an acceptable, standardised level of mental healthcare nationally.

Maximising resilience resources for mental healthcare staff

2018 ◽  
Vol 23 (1) ◽  
pp. 37-53
Author(s):  
Nicole S. Gevaux ◽  
Stephanie Petty
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Healthcare ◽  
Working Environment ◽  
Card Sorting ◽  
Content Type ◽  
Mental Health Settings ◽  
Practical Implications ◽  
Insight Into

Purpose The purpose of this paper is to investigate optimal resources to promote resilience in staff working in inpatient mental health services. The study also provides an example of card sorting methodology used as an efficient way to identify the most helpful resources for resilience. Design/methodology/approach In total, 25 clinical staff participated in the study. A preliminary focus group and brief literature search identified resources used in two tasks. Two card sorting tasks identified resources participants found helpful vs unhelpful and abundant vs scarce, and resources they would find valuable to use more often. Findings The results indicate that most resources helpful to resilience and available to staff were personal resources (relating to positive outlooks or ways of working), whereas resources valuable to resilience but scarce in the working environment were organisational resources (relating to management or social workplace culture). Resources found to not be valuable to resilience were largely personal tangible resources (e.g. smoking, massages). Practical implications The findings and method may be generalisable to other mental health services, giving insight into promoting resilience within individuals and organisations. This information could serve as guidelines to streamline the allocation of organisational resources to best promote resilience across various mental health settings. Originality/value Staff resilience to working in mental health services contributes to high-quality, sustainable patient care. This study provides further insight into how personal and organisational resources are both vital to resilience in staff working in highly challenging environments.

scholarly journals A qualitative study of experiences of NHS mental healthcare workers during the Covid-19 pandemic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elisa Liberati ◽  
Natalie Richards ◽  
Janet Willars ◽  
David Scott ◽  
Nicola Boydell ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Healthcare Workers ◽  
Clinical Decision Making ◽  
Health Workers ◽  
Comparative Method ◽  
Mental Healthcare ◽  
Community Mental Health Services ◽  
Clinical Decision

Abstract Background The Covid-19 pandemic has imposed extraordinary strains on healthcare workers. But, in contrast with acute settings, relatively little attention has been given to those who work in mental health settings. We aimed to characterise the experiences of those working in English NHS secondary mental health services during the first wave of the pandemic. Methods The design was a qualitative interview-based study. We conducted semi-structured, remote (telephone or online) interviews with 35 members of staff from NHS secondary (inpatient and community) mental health services in England. Analysis was based on the constant comparative method. Results Participants reported wide-ranging changes in the organisation of secondary mental health care and the nature of work in response to the pandemic, including pausing of all services deemed to be “non-essential”, deployment of staff across services to new and unfamiliar roles, and moves to remote working. The quality of participants’ working life was impaired by increasing levels of daily challenge associated with trying to provide care in trying and constrained circumstances, the problems of forging new ways of working remotely, and constraints on ability to access informal support. Participants were confronted with difficult dilemmas relating to clinical decision-making, prioritisation of care, and compromises in ability to perform the therapeutic function of their roles. Other dilemmas centred on trying to balance the risks of controlling infection with the need for human contact. Many reported features of moral injury linked to their perceived failures in providing the quality or level of care that they felt service users needed. They sometimes sought to compensate for deficits in care through increased advocacy, taking on additional tasks, or making exceptions, but this led to further personal strain. Many experienced feelings of grief, helplessness, isolation, distress, and burnout. These problems were compounded by sometimes poor communication about service changes and by staff feeling that they could not take time off because of the potential impact on others. Some reported feeling poorly supported by organisations. Conclusions Mental health workers faced multiple adversities during the pandemic that were highly consequential for their wellbeing. These findings can help in identifying targets for support.

scholarly journals Experiences of NHS Mental Healthcare Workers During the Covid-19 Pandemic: Qualitative Study

2021 ◽  
Author(s):  
Elisa Liberati ◽  
Natalie Richards ◽  
Janet Willars ◽  
David Scott ◽  
Nicola Boydell ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Health Services ◽  
Health Services ◽  
Healthcare Workers ◽  
Clinical Decision Making ◽  
Health Workers ◽  
Comparative Method ◽  
Mental Healthcare ◽  
Community Mental Health Services

Abstract Background: The Covid-19 pandemic has imposed extraordinary strains on healthcare workers, but, in contrast with acute settings, relatively little attention has been given to those who work in mental health settings. We aimed to characterise the experiences of those working in English NHS secondary mental health services during the first wave of the pandemic.Methods: The design was a qualitative interview-based study. We conducted semi-structured, remote (telephone or online) interviews with 35 members of staff from NHS secondary (inpatient and community) mental health services in England. Analysis was based on the constant comparative method. Results: Participants reported wide-ranging changes in the organisation of secondary mental health care and the nature of work in response to the pandemic, including pausing of all services deemed to be “non-essential”, deployment of staff across services to new and unfamiliar roles, and moves to remote working. The quality of participants’ working life was impaired by increasing levels of daily challenge associated with trying to provide care in trying and constrained circumstances, the problems of forging new ways of working remotely, and constraints on ability to access informal support for decision-making. Participants were confronted with difficult dilemmas relating to clinical decision-making, prioritisation of care, and compromises in ability to perform the therapeutic function of their roles. Other dilemmas centred on trying to balance the risks of controlling infection with the need for human contact. Many reported features of moral injury linked to their perceived failures in providing the quality or level of care that they felt service users needed. They sometimes sought to compensate for deficits in care through increased advocacy, taking on additional tasks, or making exceptions, but this led to further personal strain. Many experienced feelings of grief, helplessness, isolation, distress, and burnout. These problems were compounded by sometimes poor communication about service changes and by staff feeling that they could not take time off because of the potential impact on others. Some reported feeling poorly supported by organisations. Conclusions: Mental health workers faced multiple adversities during the pandemic that were highly consequential for their wellbeing. These findings help in identifying targets for support.

Recovery-oriented intersectoral care between mental health hospitals and community mental health services: An integrative review

2020 ◽  
pp. 002076402096663 ◽  
Author(s):  
Kim Jørgensen ◽  
Tonie Rasmussen ◽  
Morten Hansen ◽  
Kate Andreasson
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Mental Healthcare ◽  
Community Mental Health Services ◽  
Routine Care ◽  
Integrative Review ◽  
Patient Journey ◽  
Mental Health Hospitals

Background: Recovery-oriented intersectoral care is described as an aim in mental healthcare to create a holistic framework for planning that provides integration of treatment and rehabilitation. Existing studies show that nurses and other professionals do not take responsibility for the collaborative element of intersectoral care between mental health hospitals and community mental health services. The users of mental healthcare do not experience their patient journey as a cohesive process when they are discharged from a mental health hospital to community mental health services. Aim: The integrative review aims to examine the professionals’ experience with recovery-oriented intersectoral care between mental health hospitals and community mental health services. Design: Since the aim was to review user experience, we chose an integrative review as an obvious choice for design. Ethical approval: Not applicable. Findings: Seven studies met the inclusion criteria. The interactive inductive and deductive analysis generated four themes, which clarify the experience of professionals with recovery-oriented intersectoral care between the mental health hospitals and community mental health services, namely ‘structurally routine care’, ‘unequal balance of power between the sectors’, ‘bureaucracy as a barrier to recovery-oriented intersectoral care’ and ‘flexible mental healthcare approaches’. Conclusion: This review achieves specific knowledge of recovery-oriented intersectoral care. The studies included show that recovery-oriented intersectoral care is not clearly defined. It is challenging to transfer intersectoral care to an organisation with different structural and linguistic barriers.

scholarly journals Primary care mental health services in Qatar

2020 ◽  
pp. 1-3
Author(s):  
Ovais Wadoo ◽  
Mohamed Ali Siddig Ahmed ◽  
Shuja Reagu ◽  
Samya Ahmad Al Abdulla ◽  
Majid Ali Y. A. Al Abdulla
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Healthcare ◽  
Primary Care Mental Health ◽  
Health Strategy ◽  
New Strategy ◽  
World Class ◽  
National Mental Health

With rapid growth and development in recent decades, the State of Qatar has been redefining strategies and policies towards building a world-class healthcare system. Mental health has emerged as a priority area for development. As a result, mental health services in the region are being redefined and expanded, and this was realised with the launching of the ambitious National Mental Health Strategy in 2013. Traditionally, mental healthcare in Qatar had been considered to be the remit of psychiatrists within secondary care. The new strategy supported the transition towards community-based care. It outlined a plan to design and build a comprehensive and integrated mental health system, offering treatment in a range of settings. In this article, we provide an overview of the advent of primary care mental health services in Qatar. We discuss the historical aspects of psychiatric care and development of primary care mental health services in Qatar.

scholarly journals Development of a Perceived Access Inventory for Community Care Mental Healthcare Services for Veterans

2019 ◽  
Vol 184 (7-8) ◽  
pp. e301-e308 ◽  
Author(s):  
Jeffrey M Pyne ◽  
P Adam Kelly ◽  
Ellen P Fischer ◽  
Christopher J Miller ◽  
Patricia Wright ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Community Care ◽  
Mental Healthcare ◽  
Community Mental Health Services ◽  
Mental Health Providers ◽  
Health Providers ◽  
Perceived Access

Abstract Introduction Access to high-quality healthcare, including mental healthcare, is a high priority for the Department of Veterans Affairs (VA). Meaningful monitoring of progress will require patient-centered measures of access. To that end, we developed the Perceived Access Inventory focused on access to VA mental health services (PAI-VA). However, VA is purchasing increasing amounts of mental health services from community mental health providers. In this paper, we describe the development of a PAI for users of VA-funded community mental healthcare that incorporates access barriers unique to community care service use and compares the barriers most frequently reported by veterans using community mental health services to those most frequently reported by veterans using VA mental health services. Materials and Methods We conducted mixed qualitative and quantitative interviews with 25 veterans who had experience using community mental health services through the Veterans Choice Program (VCP). We used opt-out invitation letters to recruit veterans from three geographic regions. Data were collected on sociodemographics, rurality, symptom severity, and service satisfaction. Participants also completed two measures of perceived barriers to mental healthcare: the PAI-VA adapted to focus on access to mental healthcare in the community and Hoge’s 13-item measure. This study was reviewed and approved by the VA Central Institutional Review Board. Results Analysis of qualitative interview data identified four topics that were not addressed in the PAI-VA: veterans being billed directly by a VCP mental health provider, lack of care coordination and communication between VCP and VA mental health providers, veterans needing to travel to a VA facility to have VCP provider prescriptions filled, and delays in VCP re-authorization. To develop a PAI for community-care users, we created items corresponding to each of the four community-care-specific topics and added them to the 43-item PAI-VA. When we compared the 10 most frequently endorsed barriers to mental healthcare in this study sample to the ten most frequently endorsed by a separate sample of current VA mental healthcare users, six items were common to both groups. The four items unique to community-care were: long waits for the first mental health appointment, lack of awareness of available mental health services, short appointments, and providers’ lack of knowledge of military culture. Conclusions Four new barriers specific to veteran access to community mental healthcare were identified. These barriers, which were largely administrative rather than arising from the clinical encounter itself, were included in the PAI for community care. Study strengths include capturing access barriers from the veteran experience across three geographic regions. Weaknesses include the relatively small number of participants and data collection from an early stage of Veteran Choice Program implementation. As VA expands its coverage of community-based mental healthcare, being able to assess the success of the initiative from the perspective of program users becomes increasingly important. The 47-item PAI for community care offers a useful tool to identify barriers experienced by veterans in accessing mental healthcare in the community, overall and in specific settings, as well as to track the impact of interventions to improve access to mental healthcare.

scholarly journals “I wouldn’t know where to start”: Perspectives from clinicians, agency leaders, and autistic adults on improving community mental health services for autistic adults

Autism ◽  
2019 ◽  
Vol 24 (4) ◽  
pp. 919-930 ◽  
Author(s):  
Brenna B Maddox ◽  
Samantha Crabbe ◽  
Rinad S Beidas ◽  
Lauren Brookman-Frazee ◽  
Carolyn C Cannuscio ◽  
...  
Keyword(s):  
Mental Health ◽  
Developmental Disabilities ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Mental Health Problems ◽  
Mental Healthcare ◽  
Community Mental Health Services ◽  
The United States ◽  
Autistic Adults

Most autistic adults struggle with mental health problems, and traditional mental health services generally do not meet their needs. This study used qualitative methods to identify ways to improve community mental health services for autistic adults for treatment of their co-occurring psychiatric conditions. We conducted semistructured, open-ended interviews with 22 autistic adults with mental healthcare experience, 44 community mental health clinicians, and 11 community mental health agency leaders in the United States. The participants identified clinician-, client-, and systems-level barriers and facilitators to providing quality mental healthcare to autistic adults. Across all three stakeholder groups, most of the reported barriers involved clinicians’ limited knowledge, lack of experience, poor competence, and low confidence working with autistic adults. All three groups also discussed the disconnect between the community mental health and developmental disabilities systems, which can result in autistic adults being turned away from services when they contact the mental health division and disclose their autism diagnosis during the intake process. Further efforts are needed to train clinicians to work more effectively with autistic adults and to increase coordination between the mental health and developmental disabilities systems. Lay Abstract Most autistic adults struggle with mental health problems, such as anxiety and depression. However, they often have trouble finding effective mental health treatment in their community. The goal of this study was to identify ways to improve community mental health services for autistic adults. We interviewed 22 autistic adults with mental healthcare experience, 44 community mental health clinicians (outpatient therapists, case managers, and intake coordinators), and 11 community mental health agency leaders in the United States. Our participants identified a variety of barriers to providing quality mental healthcare to autistic adults. Across all three groups, most of the reported barriers involved clinicians’ limited knowledge, lack of experience, poor competence, and low confidence working with autistic adults. All three groups also discussed the disconnect between the community mental health and developmental disabilities systems and the need to improve communication between these two systems. Further efforts are needed to train clinicians and provide follow-up consultation to work more effectively with autistic adults. A common suggestion from all three groups was to include autistic adults in creating and delivering the clinician training. The autistic participants provided concrete recommendations for clinicians, such as consider sensory issues, slow the pace, incorporate special interests, use direct language, and set clear expectations. Our findings also highlight a need for community education about co-occurring psychiatric conditions with autism and available treatments, in order to increase awareness about treatment options.

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