scholarly journals Divided we fall: clinicians and academic psychiatrists need to stand together

2017 ◽  
Vol 25 (5) ◽  
pp. 437-439
Author(s):  
Stephen Allison ◽  
Tarun Bastiampillai ◽  
Malcolm Battersby
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Health System ◽  
Mental Health System ◽  
State Mental Health ◽  
The State ◽  
Services Research ◽  
Academic Units ◽  
State Mental

Objective: Psychiatry faces urgent problems requiring united action. These problems affect academic psychiatrists in the universities, and clinicians in publicly funded mental health services. Academic units are isolated and endangered, finding it difficult to recruit. They could benefit from closer relationships with public mental health services, in terms of recruitment, shared teaching and clinical research. However, mental health services are preoccupied with their own problems, particularly in relation to acute clinical demand. How can we stand together to improve academic units and clinical psychiatry? Conclusions: Clinicians and academic psychiatrists can stand together on important matters, but it takes initiatives from local leaders to overcome the structural barriers between health services and the universities. An example is given of united action by clinicians and academic psychiatrists to address a crisis within a state mental health system. First, psychiatrists undertook independent health services research that compared the state system with those in other Australian and international jurisdictions. The comparative data was used to generate solutions, which were presented at every level from ministerial offices through to service managers. Finally, psychiatrists took up joint academic and clinical leadership roles in the university and the mental health system. This united research-led approach turned around the crisis in the state mental health system.

The balanced care model for global mental health

2012 ◽  
Vol 43 (4) ◽  
pp. 849-863 ◽  
Author(s):  
G. Thornicroft ◽  
M. Tansella
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health System ◽  
Mental Health System ◽  
Community Care ◽  
Care Model ◽  
Adult Mental Health ◽  
High Resource

BackgroundFor too long there have been heated debates between those who believe that mental health care should be largely or solely provided from hospitals and those who adhere to the view that community care should fully replace hospitals. The aim of this study was to propose a conceptual model relevant for mental health service development in low-, medium- and high-resource settings worldwide.MethodWe conducted a review of the relevant peer-reviewed evidence and a series of surveys including more than 170 individual experts with direct experience of mental health system change worldwide. We integrated data from these multiple sources to develop the balanced care model (BCM), framed in three sequential steps relevant to different resource settings.ResultsLow-resource settings need to focus on improving the recognition and treatment of people with mental illnesses in primary care. Medium-resource settings in addition can develop ‘general adult mental health services’, namely (i) out-patient clinics, (ii) community mental health teams (CMHTs), (iii) acute in-patient services, (iv) community residential care and (v) work/occupation. High-resource settings, in addition to primary care and general adult mental health services, can also provide specialized services in these same five categories.ConclusionsThe BCM refers both to a balance between hospital and community care and to a balance between all of the service components (e.g. clinical teams) that are present in any system, whether this is in low-, medium- or high-resource settings. The BCM therefore indicates that a comprehensive mental health system includes both community- and hospital-based components of care.

Mental health care in Madrid

2005 ◽  
Vol 20 (S2) ◽  
pp. s279-s284 ◽  
Author(s):  
F. Ferre Navarete ◽  
I. Palanca
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Care ◽  
Health System ◽  
Children And Adolescents ◽  
Health Plan ◽  
Mental Health System ◽  
Terrorist Attack

AbstractAimTo describe principles and characteristics of mental health care in Madrid.MethodBased on existing data, service provision, number of professionals working in services, funding arrangements, pathways intocare, user/carer involvement and specific issues are reported.ResultsIn Madrid, mental health services are organized into 11 zones/areas, divided into 36 districts, where there is a mental healthoutpatient service with a multi-disciplinary team. Home treatment and psychosocial rehabilitation services have been developed. Specialist programmes exist for vulnerable client groups, including Children and Adolescents, Addiction/Alcohol and Older People. The Madrid Mental Health Plan (2003–2008) is regarded as the key driver in implementing service improvement and increased mental health and well-being in Madrid. It has a meant global budget increase of more than 10% for mental health services. Results of the first 2 years are: an increase in mental health staff employed (17%), four new hospitalization units, 50% increase in places for children and adolescents Day Hospitals, 62 new beds in long care residential units, development of specific programmes for the homeless and gender-based violence, a significant investment in information systems (450 new computers) and development of best practice and operational guidelines. Mental health system was put to the test with Madrid's March 11th terrorist attack. A Special Mental Health Plan for Affected people was developed.DiscussionUnlike some European countries, public mental health service is the main heath care provider. There are no voluntary agenciescollaborating with mental health care. Continuity of care and coordination between all mental health resources is essential in service delivery. Increased demand of care for minor psychiatric disorders, children and adolescent mental health care, and implementation of rehabilitation and residential facilities for chronic patients are outstanding challenges similar to those in other European capitals. Overall, the mental health system had successfully coped with last year's increased care demand after March 11th terrorist attack in Madrid.

Patients of a Public State Mental Health System Who Commit Suicide

1980 ◽  
Vol 168 (7) ◽  
pp. 424-427 ◽  
Author(s):  
ELIZABETH A. NUTTALL ◽  
RICHARD C. EVENSON ◽  
DONG WON CHO
Keyword(s):  
Mental Health ◽  
Health System ◽  
Mental Health System ◽  
State Mental Health ◽  
State Mental ◽  
Commit Suicide

scholarly journals How shortcomings in the mental health system affect the use of involuntary community treatment orders

2017 ◽  
Vol 41 (3) ◽  
pp. 351 ◽  
Author(s):  
Edwina M. Light ◽  
Michael D. Robertson ◽  
Philip Boyce ◽  
Terry Carney ◽  
Alan Rosen ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Health System ◽  
Mental Health System ◽  
Mental Illnesses ◽  
Community Treatment ◽  
Involuntary Treatment ◽  
Community Settings ◽  
Community Treatment Orders

Objective The aim of the present study was to examine stakeholder perspectives on how the operation of the mental health system affects the use of involuntary community treatment orders (CTOs). Methods A qualitative study was performed, consisting of semi-structured interviews about CTO experiences with 38 purposively selected participants in New South Wales (NSW), Australia. Participants included mental health consumers (n = 5), carers (n = 6), clinicians (n = 15) and members of the Mental Health Review Tribunal of NSW (n = 12). Data were analysed using established qualitative methodologies. Results Analysis of participant accounts about CTOs and their role within the mental health system identified two key themes, namely that: (1) CTOs are used to increase access to services; and (2) CTOs cannot remedy non-existent or inadequate services. Conclusion The findings of the present study indicate that deficiencies in health service structures and resourcing are a significant factor in CTO use. This raises questions about policy accountability for mental health services (both voluntary and involuntary), as well as about the usefulness of CTOs, justifications for CTO use and the legal criteria regulating CTO implementation. What is known about this topic? Following the deinstitutionalisation of psychiatric services over recent decades, community settings are increasingly the focus for the delivery of mental health services to people living with severe and persistent mental illnesses. The rates of use of involuntary treatment in Australian community settings (under CTOs) vary between state and territory jurisdictions and are high by world standards; however, the reasons for variation in rates of CTO use are not well understood. What does this paper add? This paper provides an empirical basis for a link between the politics of mental health and the uptake and usefulness of CTOs. What are the implications for practitioners? This paper makes explicit the real-world demands on the mental health system and how service deficiencies are a significant determinant in the use of CTOs. Practitioners and policy makers need to be candid about system limitations and how they factor in clinical and legal justifications for using involuntary treatment. The results of the present study provide data to support advocacy to improve policy accountability and resourcing of community mental health services.

scholarly journals The Arab Spring movement: a catalyst for reform at the psychiatric hospital in Tripoli, Libya

2013 ◽  
Vol 10 (3) ◽  
pp. 56-58 ◽  
Author(s):  
Adel Abuazza
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Health System ◽  
Psychiatric Hospital ◽  
Psychotropic Medication ◽  
Mental Health System ◽  
Psychiatric Hospitals ◽  
The Arab Spring

Decades of neglect have left the mental health system in Libya in bad shape. Services for the entire population are scarce, highly centralised and provided only through two psychiatric hospitals in the two biggest cities of the country. There are virtually no other mental health services anywhere else in Libya. Even the most basic of services, such as the availability of psychotropic medication for people with severe mental illness, are scarce outside Tripoli and Benghazi. This paper reviews the state of the country's mental health services since the civil war of 2011 and highlights a new fourfold approach taken by the management of the psychiatric hospital in Tripoli.

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