scholarly journals Pathways to mental health care in Nepal: a 14-center nationwide study

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Anoop Krishna Gupta ◽  
Sulochana Joshi ◽  
Bikram Kafle ◽  
Ranjan Thapa ◽  
Manisha Chapagai ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Professionals ◽  
Clinical Presentation ◽  
Service Providers ◽  
Mental Illnesses ◽  
World Health ◽  
Pathways To Care ◽  
Duration Of Untreated Illness

Abstract Background Pathways to care studies are feasible and tested means of finding the actual routes taken by patients before reaching proper care. In view of the predominance of nonprofessional service providers and the lack of previous large studies on pathways in Nepal, this multicenter study is needed. The aim of the study was to trace the various pathways and carers involved in mental health care; assess clinical variables such as the duration of untreated illness, clinical presentation and treatment; and compare geographically and culturally diverse landscapes. Methods This was a cross-sectional, convenience sampling study performed at 14 centers where new cases were being taken. The World Health Organization Study of the Pathways-to-Care Schedule was applied. The Nepali version of the encounter form was used. The data were collected between 17 September and 16 October 2020 and were analyzed using the Statistical Package for the Social Sciences (SPSS). Additionally, perspectives from local investigators were collected and discussed. Results Most of the first carers were native/religious faith healers (28.2%), followed by psychiatrists (26%). The median duration for the first psychiatric consultation was 3 weeks. The duration of untreated illness was 30.72 ± 80.34 (median: 4) weeks, and the time taken for this journey was 94.99 ± 274.58 (median: 30) min. The longest delay from the onset of illness to psychiatric care was for epilepsy {90.0 ± 199.0 (median: 25.5)} weeks, followed by neurotic illness {22.89 ± 73.45 (median: 2)} and psychotic illness {10.54 ± 18.28 (median: 2)} weeks. Overall, most patients with severe mental illnesses (SMIs) had their first contact with faithhealers (49%), then met with medical doctors (13%) or psychiatrists (28%). Marked differences in clinical presentation surfaced when hilly centers were compared with the Terai belt. Conclusions Faith healers, general practitioners and hospital doctors are major carers, and the means of educating them for proper referral can be considered. The investigators see several hindrances and opportunities in the studied pathways. The employment of more mental health professionals and better mental health advocacy, public awareness programs and school education are suggested strategies to improve proper mental health care.

The next step: a strategic focus on physical activity and sedentary behaviour in Irish mental health care

2018 ◽  
pp. 1-3 ◽  
Author(s):  
E. Matthews ◽  
M. Cowman ◽  
S. Denieffe
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Health Care ◽  
Mental Health Care ◽  
Sedentary Behaviour ◽  
Mental Health Professionals ◽  
Mental Illnesses ◽  
Multidisciplinary Teams ◽  
Mental Health Nurses ◽  
Health Strategy

People with severe mental illnesses have dramatically reduced life expectancy compared with the general population, which is largely attributed to physical comorbidity. Physical activity and sedentary behaviour interventions offer a safe and viable therapeutic resource for multi-disciplinary mental health care teams. The accumulating evidence supporting the role of these interventions has changed the focus of mental health strategy in some countries, with new developing roles for certain mental health professionals in this field. However, in Ireland the absence of specialised exercise practitioners places a leadership role for mental health nurses in this regard. National mental health strategy in Ireland should prioritise physical activity and sedentary behaviour interventions, make recommendations for the integration of specialised exercise practitioners in all mental health multidisciplinary teams, and recommend the provision of training and awareness for mental health nurses and other multidisciplinary professionals who are already well placed to address this issue.

scholarly journals Common Mental Disorders

2012 ◽  
Vol 9 (3) ◽  
pp. 213-217
Author(s):  
A Risal
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Disorders ◽  
Mental Health Care ◽  
Mental Health Professionals ◽  
Common Mental Disorders ◽  
Economic Status ◽  
Pathways To Care ◽  
Middle Income

Common mental disorders are a group of distress states manifesting with anxiety, depressive and unexplained somatic symptoms typically encountered in community and primary care settings. Risk factors for these disorders are mainly lower socio-economic status, psychological illnesses, poor reproductive health, gender disadvantage and physical ill-health. WHO has recommended that treatment of all these disorders should be based in primary care to be more effective and accessible to all the community people. The structure of mental health care in primary care is generally understood in terms of the “pathways to care” model and it plays a major role in countries like ours where community-based mental health services do not exist. Both the psychological and pharmacological therapies are found to be equally effective for treating these disorders. Integration of mental health into primary care can be considered as the stepping stone in the way forward to tackle the barriers and problems in effective management of common mental disorders in the community. The acute shortage of mental health professionals and the relatively low levels of awareness about mental disorders make it mandatory that primary health care should remain the single largest sector for mental health care in low and middle income countries like ours.DOI: http://dx.doi.org/10.3126/kumj.v9i3.6308 Kathmandu Univ Med J 2011;9(3):213-7  

scholarly journals Pathways to mental health care in KwaZulu - Natal

Curationis ◽  
2004 ◽  
Vol 27 (3) ◽  
Author(s):  
L.P. Mkize ◽  
L.R. Uys
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Mental Health Care ◽  
Service Providers ◽  
Mental Illnesses ◽  
Structured Interviews ◽  
Violent Behaviour ◽  
Health Institution ◽  
Mental Health Institution

The understanding of popular beliefs about mental health care and the pathways clients take prior to admission to a mental health institution is vital in planning to reduce delays in seeking treatment. The objectives of this exploratory survey were to determine pathways of care the clients with mental illness take, which ultimately lead to the mental health institution, the effects of socio-cultural and economic factor on the pathways to mental health care and the satisfaction with different service providers consulted. Data was gathered through semi-structured interviews. The results indicate that African clients interpret mental illness as bewitchment. Delays in seeking appropriate mental health care are experienced because traditional and faith healers are the first port of call. The short pathways are used when the first signs of psychotic features are severe, including like aggressive or violent behaviour. Financial constraints seem to be the problem for most of the clients in accessing mental health care. Furthermore, defaulting treatment was also observed due to the fact that mental illnesses are stigmatised in African communities.

scholarly journals A Systematic Review of Culturally Responsive Approaches to Child and Adolescent Mental Health Care in Ethiopia

2021 ◽  
Vol 5 ◽  
Author(s):  
Hana Shewamoltot Meshesha ◽  
Veronica Johnson
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Culturally Responsive ◽  
Child And Adolescent ◽  
World Health ◽  
Pyramid Model

In 2012/2013, the prevalence of child mental illness was estimated to be between 12 and 25% in Ethiopia. The Federal Ministry of Health is currently considering the implementation of the second national mental health strategy guided by the World Health Organization’s pyramid model for an optimal mix of services. This model states self-care as the fundamental concept and practice that can be facilitated by the formal and informal sectors surrounding an individual. Despite this remarkable move toward endorsing contemporary approaches to mental health services, Ethiopia struggles with a limited number of knowledgeable and skilled mental health professionals. This systematic review aims at identifying the main challenges Ethiopia might face while implementing the pyramid model. We will suggest ways to bridge the gap between the need for child/adolescent trained mental health professionals and training mental health professionals informed with the value of integrating the concepts of the pyramid model into the system of mental health care for Ethiopians. The paper also discusses the importance of integrating the Wellness based mental health approach into mental health professionals’ training as a means of developing a culturally responsive approach to child and adolescent services. This review provides implications for further studies and mental health policy, systems and services in Ethiopia.

Pathways to Mental Health Services and Perceptions about the Effectiveness of Treatment

2018 ◽  
Vol 9 (3) ◽  
pp. 388-407 ◽  
Author(s):  
Sirry M. Alang ◽  
Donna D. McAlpine
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Severity Of Illness ◽  
Mental Illnesses ◽  
Social Characteristics ◽  
Treatment Gap ◽  
Quality Outcomes ◽  
Effectiveness Of Care

The gap between need and effective treatment for mental health problems continues to be a challenge for researchers and policymakers. Much of the attention has been on differences in treatment rates, with insufficient attention to variation in pathways that people take into treatment. Individuals may choose to seek help but may also be substantially influenced by others or coerced into care. The chances of each type of pathway are influenced by social characteristics and may shape perceptions of effectiveness of care. This paper investigates variation in pathways into care and perceived effectiveness of care. We also examine whether choice or coercion into care are associated with whether individuals perceive care as effective and if severity of illness moderates this relationship. We use data from the 2010–2014 National Survey on Drug Use and Health (N = 10,020). Persons who independently sought mental health care were more likely to rate treatment as effective compared to persons ordered into care. Among people with severe mental illnesses, the probability of rating treatment as effective is lowest among those who were ordered into care. Entry into mental health care is not sufficient for closing the treatment gap if coerced care leads to poorer quality outcomes.

scholarly journals Training school teachers in Malawi about substance misuse and trauma: the need for a sustainable strategy

2021 ◽  
Vol 16 (6) ◽  
pp. 480-488
Author(s):  
Nicola Evans ◽  
Rhiannon Lane ◽  
Gemma Stacey-Emile ◽  
Anthony Sefasi
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Substance Misuse ◽  
World Health Organisation ◽  
World Health ◽  
Content Type ◽  
Sustainable Improvement ◽  
Post Measure ◽  
Health Need

Purpose The World Health Organisation found depression to be the fourth leading cause of disability in Malawi (Bowie, 2006) with the prevalence of mental health need in children and young people in Malawi estimated between 10 and 30% (Kutcher et al., 2019). One option to address this was to provide schoolteachers with skills and knowledge related to mental health so they can better support children. There is generally a lack of evidence of the utility or feasibility of school-based mental health literacy programmes in low to medium income countries (LMIC). This paper aims to report on a project to train schoolteachers in Malawi on aspects of mental health. Design/methodology/approach The aim of this project was to determine the acceptability and feasibility of delivering a training initiative in Malawi to teachers to better enable them to recognise and cope with school children who had been exposed to trauma and substance misuse. Findings Feedback was generated through the use of a specifically designed pre and post measure, focus groups, interviews and observations of the teaching delivery. Practical implications Teachers found the training built on their existing knowledge and they requested further opportunities for training and consultation about how to manage difficult presentations. It was evident that teachers did not know how to access mental health care or support for children whose needs could not be met by schoolteachers alone. Originality/value For a sustainable improvement for children’s mental health care in this context, further training becomes valuable when located as part of a network of joined up health and educational services.

Transitioning Concussion Care to Mental Health Care: A Case Study of an Elite Athlete

2021 ◽  
Vol 5 (1) ◽  
pp. 135-144
Author(s):  
Natalie S. Sherry ◽  
Abigail Feder ◽  
Raymond Pan ◽  
Shawn R. Eagle ◽  
Anthony P. Kontos
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Biopsychosocial Model ◽  
Elite Athlete ◽  
Clinical Presentation ◽  
Health Changes ◽  
Memory Problems ◽  
Treatment Focus

Athletes with recent concussion experience a constellation of physical (e.g., headache, nausea), cognitive (e.g., memory problems, difficulty concentrating), sleep, and emotional (e.g., anxiety, depressed mood) symptoms after injury. Mental health changes may also be a product of typical maturation in adolescents/young adults, making mood disruption difficult to disentangle from concussion sequelae. In this case study, we present the case of a high-achieving 18-year-old female rower whose concussion clinical trajectory exhibits this type of difficulty. Specifically, we provide a detailed chronological summary of the athlete’s visits with a multidisciplinary concussion team. We highlight in this case study (a) an individualized, biopsychosocial model of concussion care and (b) subtle aspects of her clinical presentation that led the clinical team to transition her treatment focus from concussion specific to formal mental health care.

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