scholarly journals Global mental health should engage with the ethics of involuntary admission

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Marisha N. Wickremsinhe
Keyword(s):  
Mental Health ◽  
Human Rights ◽  
Health Services ◽  
Clinical Ethics ◽  
Psychiatric Care ◽  
Global Mental Health ◽  
Mental Healthcare ◽  
Involuntary Admission ◽  
Persons With Disabilities ◽  
Psychosocial Disability

AbstractGlobal mental health, as a field, has focused on both increasing access to mental health services and promoting human rights. Amidst many successes in engaging with and addressing various human rights violations affecting individuals living with psychosocial disabilities, one human rights challenge remains under-discussed: involuntary inpatient admission for psychiatric care. Global mental health ought to engage proactively with the debate on the ethics of involuntary admission and work to develop a clear position, for three reasons. Firstly, the field promotes models of mental healthcare that are likely to include involuntary admission. Secondly, the field aligns much of its human rights framework with the UN Convention on the Rights of Persons with Disabilities, which opposes the discriminatory use of involuntary admission on the basis of psychosocial disability or impairment. Finally, global mental health, as a field, is uniquely positioned to offer novel contributions to this long-standing debate in clinical ethics by collecting data and conducting analyses across settings. Global mental health should take up involuntary admission as a priority area of engagement, applying its own orientation toward research and advocacy in order to explore the dimensions of when, if ever, involuntary admission may be permissible. Such work stands to offer meaningful contributions to the challenge of involuntary admission.

Human rights in community psychiatry

2016 ◽  
Author(s):  
Genevra Richardson
Keyword(s):  
Mental Health ◽  
Human Rights ◽  
Community Mental Health ◽  
Mental Health Professionals ◽  
Global Mental Health ◽  
Mental Health Policy ◽  
European Convention ◽  
Health It ◽  
Persons With Disabilities ◽  
United Nations Convention

This chapter examines the increased concern for human rights within the global mental health policy agenda and considers what value human rights might add in relation to the use of coercion in community mental health. It describes the position underlying the European Convention on Human Rights (ECHR) and compares it with the more radical approach of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). While the CRPD might be more challenging to mental health professionals, it contains within its principles that the wishes and preferences of the person be centre stage and as such deserve to be taken seriously in the provision of community mental health care.

scholarly journals The Deinstitutionalization of Lithuanian Mental Health Services in Light of the Evidence-based Practice and Principles of Global Mental Health

2017 ◽  
Vol 15 (15) ◽  
pp. 7
Author(s):  
Ugnė Grigaitė
Keyword(s):  
Mental Health ◽  
Human Rights ◽  
Mental Health Services ◽  
Health Services ◽  
Health Outcomes ◽  
Mental Health Problems ◽  
Global Mental Health ◽  
Mental Health Outcomes ◽  
Major Step ◽  
Current Form

During this time, in which Lithuania is going through the deinstitutionalization of its mental health services, the principles of Global Mental Health are especially relevant. This global field for study, research and practice places a priority on improving mental health outcomes as well as reducing respective inequities for all people worldwide. Scaling-up support services for persons who have mental health problems based on both scientific evidence and human rights has become one of the main focuses for action globally, and the key principles of Global Mental Health apply to the situation in Lithuania as much as they do in a number of other countries. This article explores the critical need to effectively reform the existing mental health care system in the country, which in its current form often results in human rights violations. It points to the idea, based on the global evidence base, that different Lithuanian authorities and other key stakeholders could start working together in an intersectoral way in order to reorganize mental health services from institutional to community-based models of care. It is suggested by this article that a sensible, local application of the broad key principles of Global Mental Health could be a mature and rational step taken by Lithuania. This has the potential to be a major step toward the improvement of human rights and mental health outcomes in the country.

scholarly journals Global mental health in high-income countries

2016 ◽  
Vol 209 (1) ◽  
pp. 3-5 ◽  
Author(s):  
S. P. Sashidharan ◽  
Ross White ◽  
Roberto Mezzina ◽  
Stefan Jansen ◽  
Darius Gishoma
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Global Mental Health ◽  
Scale Up ◽  
Mental Healthcare ◽  
Cost Effective ◽  
High Income ◽  
Middle Income ◽  
Poor Countries

SummaryOver the past decade there have been significant efforts to scale-up mental health services in resource-poor countries. A number of cost-effective innovations have emerged as a result. At the same time, there is increasing concern in resource-rich countries about efficacy, efficiency and acceptability of mental health services. We consider two specific innovations used widely in low- and middle-income countries, task-sharing and a development model of mental healthcare, that we believe have the potential to address some of the current challenges facing mental health services in high-income countries.

scholarly journals Human rights-based approaches to mental health legislation and global mental health

2018 ◽  
Vol 16 (02) ◽  
pp. 37-40 ◽  
Author(s):  
Julian Eaton
Keyword(s):  
Mental Health ◽  
Human Rights ◽  
Global Mental Health ◽  
Best Interest ◽  
Persons With Disabilities ◽  
Medical Authority ◽  
Mental Health Legislation ◽  
United Nations Convention ◽  
Alternative Practices ◽  
Health Legislation

Globally, established practice in mental health services has tended to be codified into law in ways that are paternalistic, seeking to make decisions for patients that presume ‘best interest’ and which ultimately place power in the hands of medical authority. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) – which has been widely ratified globally – challenges these assumptions, instead placing the expressed will and preference of patients as the most important factor in decision-making, including treatment and consent to admission. The contradictions between these approaches cause profound challenges in legislation reform, but a human rights framework offers the potential for a paradigm shift in the way that people are treated in services, and in exploration of alternative practices that promise a more humane and dignified future for mental health care.

The EPA Guidance Project: Guidance for Mental Healthcare in Europe

2015 ◽  
Vol 12 (01) ◽  
pp. 5-11
Author(s):  
I. Großimlinghaus ◽  
J. Zielasek ◽  
W. Gaebel
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Graduate Training ◽  
Action Plan ◽  
Stakeholder Involvement ◽  
Mental Healthcare ◽  
World Health ◽  
Post Graduate Training ◽  
Health Organization

Summary Background: The development of guidelines is an important and common method to assure and improve quality in mental healthcare in European countries. While guidelines have to fulfill predefined criteria such as methodological accuracy of evidence retrieval and assessment, and stakeholder involvement, the development of guidance was not standardized yet. Aim: In 2008, the European Psychiatric Association (EPA) initiated the EPA Guidance project in order to provide guidance in the field of European psychiatry and related fields for topics that are not dealt with by guideline developers – for instance due to lack of evidence or lack of funding. The first three series of EPA Guidance deal with diverse topics that are relevant to European mental healthcare, such as quality assurance for mental health services, post-graduate training in mental healthcare, trust in mental health services and mental health promotion. Results: EPA Guidance recommendations address current and future challenges for European psychiatry. They are developed in accordance with the World Health Organization (WHO) European Mental Health Action Plan.

Inclusion of people with psychosocial disability in low and middle income contexts: a practice review

2017 ◽  
Vol 4 (3) ◽  
pp. 72-81 ◽  
Author(s):  
Helen Lea Fernandes ◽  
Stephanie Cantrill ◽  
Raj Kamal ◽  
Ram Lal Shrestha
Keyword(s):  
Mental Health ◽  
Local Community ◽  
Global Mental Health ◽  
Economic Life ◽  
Health Programs ◽  
Middle Income ◽  
Psychosocial Disability ◽  
Practice Review ◽  
Mental Health Programs ◽  
Low And Middle Income

Much of the literature about mental illness in low and middle income countries (LMICs) focuses on prevalence rates, the treatment gap, and scaling up access to medical expertise and treatment. As a cause and consequence of this, global mental health programs have focused heavily on service delivery without due exploration of how programs fit into a broader picture of culture and community. There is a need for research which highlights approaches to broader inclusion, considering historical, cultural, social, and economic life contexts and recognises the community as a determinant of mental health — in prevention, recovery, resilience, and support of holistic wellness. The purpose of this practice review is to explore the experiences of three local organisations working with people with psychosocial disability living in LMICs: Afghanistan, India, and Nepal. All three organisations have a wealth of experience in implementing mental health programs, and the review brings together evidence of this experience from interviews, reports, and evaluations. Learnings from these organisations highlight both successful approaches to strengthening inclusion and the challenges faced by people with psychosocial disability, their families, and communities.  The findings can largely be summarised in two categories, although both are very much intertwined: first, a broad advocacy, public health, and policy approach to inclusion; and second, more local, community-based initiatives. The evidence draws attention to the need to acknowledge the complexities surrounding mental health and inclusion, such as additional stigmatisation due to multidimensional poverty, gender inequality, security issues, natural disasters, and additional stressors associated with access. Organisational experiences also highlight the need to work with communities’ strengths to increase capacity around inclusion and to apply community development approaches where space is created for communities to generate holistic solutions. Most significantly, approaches at all levels require efforts to ensure that people with psychosocial disability are given a voice and are included in shaping programs, policies, and appropriate responses.

scholarly journals Remote care for mental health: qualitative study with service users, carers and staff during the COVID-19 pandemic

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e049210
Author(s):  
Elisa Liberati ◽  
Natalie Richards ◽  
Jennie Parker ◽  
Janet Willars ◽  
David Scott ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Mental Healthcare ◽  
Well Being ◽  
Comparison Method ◽  
Service Users ◽  
Qualitative Interview Study ◽  
Remote Care

ObjectivesTo explore the experiences of service users, carers and staff seeking or providing secondary mental health services during the COVID-19 pandemic.DesignQualitative interview study, codesigned with mental health service users and carers.MethodsWe conducted semistructured, telephone or online interviews with a purposively constructed sample; a lived experience researcher conducted and analysed interviews with service users. Analysis was based on the constant comparison method.SettingNational Health Service (NHS) secondary mental health services in England between June and August 2020.ParticipantsOf 65 participants, 20 had either accessed or needed to access English secondary mental healthcare during the pandemic; 10 were carers of people with mental health difficulties; 35 were members of staff working in NHS secondary mental health services during the pandemic.ResultsExperiences of remote care were mixed. Some service users valued the convenience of remote methods in the context of maintaining contact with familiar clinicians. Most participants commented that a lack of non-verbal cues and the loss of a therapeutic ‘safe space’ challenged therapeutic relationship building, assessments and identification of deteriorating mental well-being. Some carers felt excluded from remote meetings and concerned that assessments were incomplete without their input. Like service users, remote methods posed challenges for clinicians who reported uncertainty about technical options and a lack of training. All groups expressed concern about intersectionality exacerbating inequalities and the exclusion of some service user groups if alternatives to remote care are lost.ConclusionsThough remote mental healthcare is likely to become increasingly widespread in secondary mental health services, our findings highlight the continued importance of a tailored, personal approach to decision making in this area. Further research should focus on which types of consultations best suit face-to-face interaction, and for whom and why, and which can be provided remotely and by which medium.

scholarly journals Understanding barriers to accessing mental health services for newcomers to Canada using Peterborough, Ontario, as an illustrative example

2021 ◽  
Author(s):  
Nurun Layla Chowdhury
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Help Seeking ◽  
Mental Healthcare ◽  
Healthcare Services ◽  
Mental Illnesses ◽  
Cultural Barriers ◽  
Accurate Information

The quality of an individual’s mental health has a significant impact on their quality of life, as well as on the cost to society. Regular access to mental health services can help mitigate the risk factors of developing mental illnesses. This paper examines barriers to accessing mental health services, using the community of Peterborough, Ontario, as an example. Social, economic, and cultural barriers impact help-seeking amongst immigrants, putting them at a higher risk of developing mental disorders. The social determinants of mental health can be useful when developing policies aimed at improving utilization of mental healthcare services. Policy makers need to first focus on collecting accurate information on the population, and then developing targeted solutions to eliminate barriers such as language and employment that prevent help-seeking in immigrants.

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