scholarly journals Whose responsibility? Part 2 of 2: views of patients, families, and clinicians about responsibilities for addressing the needs of persons with mental health problems in Chennai, India and Montreal, Canada

Author(s):  
Srividya N. Iyer ◽  
Ashok Malla ◽  
Megan Pope ◽  
Sally Mustafa ◽  
Greeshma Mohan ◽  
...  

Abstract Background Individuals with mental health problems have many insufficiently met support needs. Across sociocultural contexts, various parties (e.g., governments, families, persons with mental health problems) assume responsibility for meeting these needs. However, key stakeholders' opinions of the relative responsibilities of these parties for meeting support needs remain largely unexplored. This is a critical knowledge gap, as these perceptions may influence policy and caregiving decisions. Methods Patients with first-episode psychosis (n = 250), their family members (n = 228), and clinicians (n = 50) at two early intervention services in Chennai, India and Montreal, Canada were asked how much responsibility they thought the government versus persons with mental health problems; the government versus families; and families versus persons with mental health problems should bear for meeting seven support needs of persons with mental health problems (e.g., housing; help covering costs of substance use treatment; etc.). Two-way analyses of variance were conducted to examine differences in ratings of responsibility between sites (Chennai, Montreal); raters (patients, families, clinicians); and support needs. Results Across sites and raters, governments were held most responsible for meeting each support need and all needs together. Montreal raters assigned more responsibility to the government than did Chennai raters. Compared to those in Montreal, Chennai raters assigned more responsibility to families versus persons with mental health problems, except for the costs of substance use treatment. Family raters across sites assigned more responsibility to governments than did patient raters, and more responsibility to families versus persons with mental health problems than did patient and clinician raters. At both sites, governments were assigned less responsibility for addressing housing- and school/work reintegration-related needs compared to other needs. In Chennai, the government was seen as most responsible for stigma reduction and least for covering substance use services. Conclusions All stakeholders thought that governments should have substantial responsibility for meeting the needs of individuals with mental health problems, reinforcing calls for greater government investment in mental healthcare across contexts. The greater perceived responsibility of the government in Montreal and of families in Chennai may both reflect and influence differences in cultural norms and healthcare systems in India and Canada.

2021 ◽  
Author(s):  
Srividya Iyer ◽  
Megan Pope ◽  
Aarati Taksal ◽  
Greeshma Mohan ◽  
Thara Rangaswamy ◽  
...  

Abstract Background Individuals with mental health problems have multiple, often inadequately met needs. Responsibility for meeting these needs frequently falls to patients, their families/caregivers, and governments. Little is known about stakeholders' views of who should be responsible for these needs and there are no measures to assess this construct. This study’s objectives were to present the newly designed Whose Responsibility Scale (WRS), which assesses how stakeholders apportion responsibility to persons with mental health problems, their families, and the government for addressing various needs of persons with mental health problems, and to report its psychometric properties. Methods The 22-item WRS asks respondents to assign relative responsibility to the government vis-à-vis persons with mental health problems, government vis-à-vis families, and families vis-à-vis persons with mental health problems for seven support needs. The items were modelled on a World Values Survey item comparing the government’s and people’s responsibility for ensuring that everyone is provided for. We administered English, Tamil, and French versions to 57 patients, 60 family members, and 27 clinicians at two early psychosis programs in Chennai, India, and Montreal, Canada, evaluating test-retest reliability, internal consistency, and ease of use. Results Test-retest reliability (intra-class correlation coefficients) ranged from excellent to good across stakeholders (patients, families, and clinicians); settings (Montreal and Chennai), and languages (English, French, and Tamil). Internal consistency estimates (Cronbach’s alphas) ranged from acceptable to excellent. The WRS scored average on ease of comprehension and completion. Scores were spread across the 1–10 range, suggesting that the scale captured variations in views on how responsibility for meeting needs should be distributed. On select items, scores at one end of the scale were never endorsed, but these reflected expected views about specific needs (e.g., Chennai patients never endorsed patients as being substantially more responsible for housing needs than families). Conclusions The WRS is a promising measure for use across geo-cultural contexts to inform mental health policies, and to foster dialogue and accountability among stakeholders about roles and responsibilities. It can help researchers study stakeholders’ views about responsibilities, and how these are shaped by and shape sociocultural contexts and mental healthcare systems.


2018 ◽  
Vol 64 (3) ◽  
pp. 293-302 ◽  
Author(s):  
Megan A Pope ◽  
Ashok K Malla ◽  
Srividya N Iyer

Background: Individuals with mental health problems have many support needs that are often inadequately met; however, perceptions of who should be responsible for meeting these needs have been largely unexplored. Varying perceptions may influence whether, how, and to what extent relevant stakeholders support individuals with mental health problems. Aims: To critically evaluate the literature to determine who different stakeholders believe should be responsible for supporting individuals with mental health problems, what factors shape these perceptions, and how they relate to one another. Method: A critical literature review was undertaken. Following an extensive literature search, the conceptual contributions of relevant works were critically evaluated. A concept map was created to build a conceptual framework of the topic. Results: Views of individual versus societal responsibility for need provision and health; the morality of caring; and attributions of responsibility for mental illness offered valuable understandings of the review questions. Creating a concept map revealed that various interrelated factors may influence perceptions of responsibility. Conclusions: Varying perceptions of who should be responsible for supporting individuals with mental health problems may contribute to unmet support needs among this group. Our critical review helps build a much-needed conceptual framework of factors influencing perceptions of responsibility. Such a framework is essential as these views iteratively shape and reflect the complex divisions of mental healthcare roles and responsibilities. Understanding these perceptions can help define relevant stakeholders’ roles more clearly, which can improve mental health services and strengthen stakeholder accountability.


2018 ◽  
Vol 94 ◽  
pp. 113-121 ◽  
Author(s):  
David H. Morris ◽  
Alan K. Davis ◽  
Kirstin J. Lauritsen ◽  
C. Martin Rieth ◽  
Mark M. Silvestri ◽  
...  

Author(s):  
Srividya N. Iyer ◽  
Megan Pope ◽  
Aarati Taksal ◽  
Greeshma Mohan ◽  
Thara Rangaswamy ◽  
...  

Abstract Background Individuals with mental health problems have multiple, often inadequately met needs. Responsibility for meeting these needs frequently falls to patients, their families/caregivers, and governments. Little is known about stakeholders' views of who should be responsible for these needs and there are no measures to assess this construct. This study’s objectives were to present the newly designed Whose Responsibility Scale (WRS), which assesses how stakeholders apportion responsibility to persons with mental health problems, their families, and the government for addressing various needs of persons with mental health problems, and to report its psychometric properties. Methods The 22-item WRS asks respondents to assign relative responsibility to the government versus persons with mental health problems, government versus families, and families versus persons with mental health problems for seven support needs. The items were modelled on a World Values Survey item comparing the government’s and people’s responsibility for ensuring that everyone is provided for. We administered English, Tamil, and French versions to 57 patients, 60 family members, and 27 clinicians at two early psychosis programs in Chennai, India, and Montreal, Canada, evaluating test–retest reliability, internal consistency, and ease of use. Internal consistency estimates were also calculated for confirmatory purposes with the larger samples from the main comparative study. Results Test–retest reliability (intra-class correlation coefficients) generally ranged from excellent to fair across stakeholders (patients, families, and clinicians), settings (Montreal and Chennai), and languages (English, French, and Tamil). In the standardization and larger confirmatory samples, internal consistency estimates (Cronbach’s alphas) ranged from acceptable to excellent. The WRS scored average on ease of comprehension and completion. Scores were spread across the 1–10 range, suggesting that the scale captured variations in views on how responsibility for meeting needs should be distributed. On select items, scores at one end of the scale were never endorsed, but these reflected expected views about specific needs (e.g., Chennai patients never endorsed patients as being substantially more responsible for housing needs than families). Conclusions The WRS is a promising measure for use across geo-cultural contexts to inform mental health policies, and to foster dialogue and accountability among stakeholders about roles and responsibilities. It can help researchers study stakeholders’ views about responsibilities, and how these shape and are shaped by sociocultural contexts and mental healthcare systems.


2020 ◽  
Author(s):  
Matthias Schützwohl

Background: People with an intellectual disability (ID) show a great number and complex constellation of support needs. With respect to the planning of services, it is important to assess needs at the population level. ID services need to know to what extent support needs of clients with mental health problems differ from support needs of clients without any mental health problem.Aims: The aim of this study was to compare the prevalence rates of needs in relevant study groups. Methods: Data was generated from the MEMENTA-Study (“Mental health care for adults with intellectual disability and a mental disorder”). The Camberwell Assessment of Need for Adults with Intellectual Disabilities (CANDID) was used to assess met und unmet support needs. Data was available for n=248 adults with mild to moderate ID.Results: Mean total number of needs and unmet needs was associated with mental health status. However, in most particular areas under study, individuals without significant psychiatric symptoms or any behaviour problem needed as much as often help as individuals with such mental health problems. A higher rate of need for care among study participants with significant psychiatric symptoms or any behaviour problem was mainly found with regard to these specific areas (“minor mental health problems”, “major mental health problems”, “inappropriate behaviour”) or with regard to closely related areas (“safety of others”).Conclusions: Differences in prevalence rates mainly occurred in such areas of need that rather fall under the responsibility of mental health services than under the responsibility of ID services. This has implications for service planning.


2019 ◽  
Vol 23 (4) ◽  
pp. 835-846
Author(s):  
Julie H. Levison ◽  
Margarita Alegría ◽  
Ye Wang ◽  
Sheri L. Markle ◽  
Larmiar Fuentes ◽  
...  

2021 ◽  
Vol 28 (1) ◽  
pp. 3
Author(s):  
Daniel Rogoža ◽  
Robertas Strumila ◽  
Eglė Klivickaitė ◽  
Edgaras Diržius ◽  
Neringa Čėnaitė

Background: Previous research suggests that healthcare professionals (HCPs) experience high levels of work-related psychological distress, including depressive symptoms. Due to the stigma of mental health problems and other barriers, HCPs are likely to be hesitant to seek appropriate mental healthcare. We aimed to explore these phenomena among HCPs in Lithuania.Methods: A web survey inquiring about depressive symptoms, help-seeking, and barriers to mental healthcare was conducted. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). 601 complete questionnaires were included in the analyses. The barriers to help-seeking were identified using the inductive content analysis approach. Descriptive, non-parametric, and robust statistical analysis was performed using SPSS software.Results: Most of the respondents have reported depression-like symptoms over the lifetime, although only about a third of them sought professional help. Of those, roughly half preferred a private specialist. The stigma and neglect of mental health problems were the most common barriers to help-seeking. Around half of the HCPs believed that seeking mental healthcare can imperil their occupational license. About a quarter of the HCPs screened positive for clinically relevant depressive symptoms. Statistically significant differences in the PHQ-9 score were found between categories of healthcare specialty, marital status, religious beliefs, workplace, and years of work as a HCP. Fewer years of work and younger age were associated with the higher PHQ-9 score.Conclusions: Our findings suggest that HCPs in Lithuania may be inclined not to seek appropriate mental healthcare and experience poor mental health, although stronger evidence is needed to verify these findings. 


Author(s):  
Hae Ran Kim ◽  
Eun Jung Kim

The purpose of this study was to investigate mental health problems among international students in South Korean universities during the COVID-19 pandemic, as well as to identify the factors that affect their mental health. A total of 488 international students living in South Korea participated in a web-based survey. The questionnaire was created using the Google Forms platform, and a link to the questionnaire was shared through social media. Multiple logistic regression analysis was conducted to analyze the data. The prevalence rates of sleep problems, anxiety, and depression among international students were 47.1%, 39.6%, and 49%, respectively. The prevalence of mental health problems was higher among participants who were male, living with someone, residents of a rural area, and earning a higher income. The following variables were found to contribute to the prevalence of mental health problems: undergraduate student status, good understanding of the Korean language, longer hours of media usage, and experiences related to COVID-19 infection. A collaborative effort between the government and universities to manage the mental health of international students could promote the mental health of these students.


Author(s):  
Gopal K Singh ◽  
Hyunjung Lee ◽  
Romuladus E. Azuine

Background: The COVID-19 pandemic has had a substantial adverse impact on workers’ employment and physical and mental health. However, job losses, job-related household income shocks, and their related physical and mental health problems have not been well-documented. Using temporal, nationally representative data, this study examines inequalities in job-related income losses and their resultant health impact among US workers aged 18-64 years in different job sectors during the pandemic. Methods: Using April, August, and December 2020 rounds of the US Census Bureau’s Household Pulse Survey (N=56,156, 82,173, and 51,500), job-related income losses among workers in various job sectors and associated impacts on self-assessed health, depression, anxiety, worry, and lack of interest were analyzed by multivariable logistic regression. Results: In December 2020, 64.0% of self-employed and 66.3% of unemployed adults reported that they or someone in their household experienced a loss of employment income since the start of the pandemic in March 2020. This percentage was the lowest for the public sector (35.2%) and non-profit-sector (45.0%) workers. Job/income losses increased by 26% between April and December for workers in the private and non-profit sectors. Prevalence of fair/poor overall health, serious depression, serious anxiety, serious worry, and serious lack of interest increased substantially during the pandemic for workers in all sectors, with the self-employed, those in the family business, and the unemployed experiencing the highest risk and those in the government/public and non-profit sectors experiencing the lowest risk of poor physical and mental health. Workers in all sectors reporting job-related income losses experienced approximately 2-to-4-fold higher odds of poor overall health, serious depression, serious anxiety, serious worry, and serious lack of interest, compared to public-sector workers with no job/income losses, controlling for covariates. Conclusion and Implications for Translation: Job-related income losses and prevalence of poor overall health and mental health among workers in all sectors increased markedly during the pandemic, with the self-employed, family business, and unemployed workers being especially vulnerable to poor health, depression, anxiety, and stress.   Copyright © 2021 Singh, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.


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