scholarly journals Mental healthcare in Brazil: modest advances and major challenges

2014 ◽  
Vol 20 (2) ◽  
pp. 113-115 ◽  
Author(s):  
Jair de Jesus Mari
Keyword(s):  
Mental Health ◽  
Healthcare System ◽  
Psychiatric Care ◽  
Mental Healthcare ◽  
Health Indicators ◽  
The Future

SummaryThis brief article describes the main health indicators of Brazil and gives an overview of psychiatric care. It points out the primary pitfalls of the mental healthcare system and presents some suggestions for the future of mental health in the country.

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.

Providing Care for Migrants and Refugees

2017 ◽  
Vol 41 (S1) ◽  
pp. S35-S35
Author(s):  
M. Schouler-Ocak
Keyword(s):  
Mental Health ◽  
Healthcare System ◽  
Mental Health Professionals ◽  
Asylum Seekers ◽  
Mental Health Problems ◽  
Service Providers ◽  
Mental Healthcare ◽  
Healthcare Services ◽  
Common Mental Health Problems ◽  
Refugees And Asylum Seekers

With growing globalisation and an increasing number of people on the move across boundaries, it has become vital that service providers, policy makers and mental health professionals are aware of the different needs of the patients they are responsible. One of the most fundamental barriers for migrants, refugees and asylum seekers in accessing health services are inadequate legal entitlement and, mechanisms for ensuring that they are well known and respected in practice. Access to the healthcare system is impeded by language and cultural communication problems. Qualified language and cultural mediators are not widely available, and moreover, are not regularly asked to attend. This can lead to misunderstandings, misdiagnosis and incorrect treatment, with serious consequences for the afflicted. The language barrier represents one of the main barriers to access to the healthcare system for people who do not speak the local language; indeed, language is the main working tool of psychiatry and psychotherapy, without which successful communication is impossible. Additionally, the lack of health literacy among the staff of institutions, which provide care for refugees and asylum seekers means that there is a lack of knowledge about the main symptoms of common mental health problems among these groups. The healthcare services, which are currently available, are not well prepared for these increasing specific groups. In dealing with ethnic minorities, including asylum seekers and refugees, mental healthcare professionals need to be culturally competent.In this talk, main models for providing mental health care for migrants and refugees will be presented and discussed.Disclosure of interestThe author has not supplied his declaration of competing interest.

scholarly journals The architecture of the primary mental healthcare system for older people in India: what public policies tell us

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Tom Kafczyk ◽  
Kerstin Hämel
Keyword(s):  
Mental Health ◽  
Older People ◽  
Old Age ◽  
Healthcare System ◽  
General Health ◽  
Older Persons ◽  
Mental Healthcare ◽  
Community Based ◽  
The Family ◽  
Policy Fields

Abstract Background Old age mental healthcare is an issue that cuts across old age, general health, and mental healthcare policies. While strengthening the primary mental healthcare system in India is a common strategy across policy fields to improve the mental health of older persons, very little is known about the system’s planned architecture. This study explores public policy strategies for and approaches to the mental health of older persons, focusing on the primary healthcare (PHC) level and the role of the family. Methods A document analysis of 39 key public national policy documents (2007 – 2019) from three thematically grouped policy fields (mental health, old age, and general health) was conducted. Results Comprehensive community-based primary mental healthcare – focusing on vulnerable population groups including older persons – has been strengthened significantly since 2007. The promulgated approaches and strategies build on traditional community-based approaches to mental healthcare in India. They focus on (a) integrating community health workers into primary mental healthcare, (b) empowering the community to participate in healthcare planning, implementation, and monitoring, (c) supporting the family through a family-led approach to mental healthcare, and (d) integrating traditional Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy (AYUSH) services into primary mental healthcare. Conclusions While all policy fields address mental PHC, they do so in different ways, and approaches and strategies that promote an integrated perspective across policy fields are lacking. To realize the policies vision, strengthening PHC will be essential. Further research should evaluate strategies and approaches in light of social developments, such as eroding family norms and the poor state of the public health system in India, in order to assess their opportunities, challenges, and overall feasibility, with the benefits older people would experience taking centre stage in these inquiries.

Sociodemographic profile and mental health needs of referrals to an Irish psychiatric service: a transcultural perspective

2011 ◽  
Vol 28 (3) ◽  
pp. 141-144 ◽  
Author(s):  
Mohamed Ahmed ◽  
Brendan Dineen ◽  
Sinead O'Brien ◽  
Philip A Carney
Keyword(s):  
Mental Health ◽  
Service Utilization ◽  
Psychiatric Care ◽  
Psychiatric Service ◽  
Mental Healthcare ◽  
Alcohol Problems ◽  
Health Needs ◽  
Service Utilisation ◽  
Service Users ◽  
Mental Health Needs

AbstractObjectives: This study describes the social, demographic and clinical characteristics of all the new referrals in a mental health catchment area. This study aims to compare Irish and non-Irish service users in terms of their mental health needs and service utilization.Method: Case notes were reviewed retrospectively to investigate demographic, clinical and service utilization parameters among new referrals to the psychiatric services in Galway, Ireland over a six-month period.Results: One hundred and fifty-four new referrals, of whom 41 were non-Irish, presented over a six-month period. Results showed no difference between Irish and non-Irish service users in terms of socio-demographic variables. Alcohol problems and subsequent need for detoxification and counselling were significantly higher among service users from the new EU accession states with a significant impact on the duration of their hospital stay and the need for intensive psychiatric care.Conclusions: There is an urgent need for enhanced resources for the delivery of mental healthcare to immigrants. Service utilisation and mental health needs are not explained merely by illness-related aspects in immigrant service users. Social and cultural factors have to be recognised in order to prevent disadvantages in psychiatric care.

scholarly journals Estranged relations: coercion and care in narratives of supported decision-making in mental healthcare

2019 ◽  
Vol 46 (1) ◽  
pp. 62-72 ◽  
Author(s):  
Meredith Stone ◽  
Renata Kokanovic ◽  
Felicity Callard ◽  
Alex F Broom
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Healthcare System ◽  
Medical Humanities ◽  
Final Section ◽  
Mental Healthcare ◽  
Psychiatric Services ◽  
Formal Care ◽  
Family Carers ◽  
Dynamic Relations

Supported decision-making has become popular among policymakers and mental health advocates as a means of reducing coercion in mental healthcare. Nevertheless, users of psychiatric services often seem equivocal about the value of supported decision-making initiatives. In this paper we explore why such initiatives might be rejected or ignored by the would-be beneficiaries, and we reflect on broader implications for care and coercion. We take a critical medical humanities approach, particularly through the lens of entanglement. We analyse the narratives of 29 people diagnosed with mental illness, and 29 self-identified carers speaking of their experiences of an Australian mental healthcare system and of their views of supported decision-making. As a scaffolding for our critique we consider two supported decision-making instruments in the 2014 Victorian Mental Health Act: the advance statement and the nominated person. These instruments presuppose that patients and carers endorse a particular set of relationships between the agentic self and illness, as well as between patient, carer and the healthcare system. Our participant narratives instead conveyed ‘entangled’ relations, which we explore in three sections. In the first we show how ideas about fault and illness often coexisted, which corresponded with shifting views on the need for more versus less agency for patients. In the second section, we illustrate how family carers struggled to embody the supported decision-making ideal of the independent yet altruistic nominated person, and in the final section we suggest that both care and coercion were narrated as existing across informal/formal care divisions. We conclude by reflecting on how these dynamic relations complicate supported decision-making projects, and prompt a rethink of how care and coercion unfold in contemporary mental healthcare.

scholarly journals The Architecture of the Primary Mental Healthcare System for Older People in India – What Public Policies Tell Us

2021 ◽  
Author(s):  
Tom Manuel Kafczyk ◽  
Kerstin Haemel
Keyword(s):  
Mental Health ◽  
Older People ◽  
Old Age ◽  
Healthcare System ◽  
General Health ◽  
Older Persons ◽  
Mental Healthcare ◽  
Community Based ◽  
The Family ◽  
Policy Fields

Abstract Background: Old age mental healthcare is an issue that cuts across old age, general health, and mental healthcare policies. While strengthening the primary mental healthcare system in India is a common strategy across policy fields to improve the mental health of older persons, very little is known about the system’s planned architecture. This study explores public policy strategies for and approaches to the mental health of older persons, focusing on the primary healthcare (PHC) level and the role of the family.Methods: A document analysis of 39 key public national policy documents (2007-2019) from three thematically grouped policy fields (mental health, old age, and general health) was conducted.Results: Comprehensive community-based primary mental healthcare – focusing on vulnerable population groups including older persons – has been strengthened significantly since 2007. The promulgated approaches and strategies build on traditional community-based approaches to mental healthcare in India. They focus on (a) integrating community health workers into primary mental healthcare, (b) empowering the community to participate in healthcare planning, implementation, and monitoring, (c) supporting the family through a family-led approach to mental healthcare, and (d) integrating traditional Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy (AYUSH) services into primary mental healthcare.Conclusions: While all policy fields address mental PHC, they do so in different ways, and approaches and strategies that promote an integrated perspective across policy fields are lacking. Further research should evaluate strategies and approaches in light of social developments such as eroding family norms and the poor state of the public health system in India in order to assess their opportunities, challenges, and overall feasibility, with the benefits older people would experience taking center stage in these inquiries.

scholarly journals Spaces of psychiatric care between past and present. Learning to reflect on the caring stories they tell

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maria Benedetta Gambacorti-Passerini ◽  
Katia Daniele ◽  
Lucia Zannini
Keyword(s):  
Mental Health ◽  
Healthcare System ◽  
Psychiatric Care ◽  
Psychiatric Services ◽  
The Past ◽  
Education And Care ◽  
Implicit And Explicit ◽  
System Today

In our perspective, a reflection on education and caring in the psychiatric services cannot ignore their past, where spaces and times of care were completely different from those that characterize the healthcare system today. Many signs, traces, implicit and explicit fragments of that past can be found in current services. According to an “archeological” approach, we believe that those spaces have not been completely overcome and somehow, they are still part of our way of caring in psychiatric services. Hence, what traces of the past are left in those services? How and where can we find them? What should we preserve from the past and what should we overcome? In our work, we will try to find some of the traces and stories that could have contributed to shaping education and care in present day Italian psychiatric services. These developed as isolated spaces and places of confinement and oppression and are transforming into open places and healing spaces, aimed at promoting mental health.

Mental health-related stigma and attitudes toward patient care among providers of mental health services in a rural Chinese county

2021 ◽  
pp. 002076402199280
Author(s):  
Yuer Deng ◽  
An-Li Wang ◽  
Rosemary Frasso ◽  
Mao-Sheng Ran ◽  
Tian-Ming Zhang ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Healthcare System ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Mental Healthcare ◽  
Educational Background ◽  
Mental Health Recovery ◽  
Public Health Issue ◽  
People With Mental Illness

Background and aims: The increasing prevalence of mental illness and low treatment rate presents a pressing public health issue in China. Pervasive stigma is a significant barrier to mental health recovery and community inclusion. In particular, stigmatizing or supportive attitudes held by healthcare providers could either perpetuate or mitigate self-stigma of people with mental illness. Moreover, mental health resources are unevenly distributed in China, with most of them concentrated in urban centers and provincial capitals. This study explores healthcare providers’ attitudes toward mental illness and the challenges they faced at work in a rural Chinese county. Method: Four focus groups were conducted with 36 healthcare providers from a three-tier mental healthcare system in a rural county in southwestern China. Focus group discussions were recorded and transcribed verbatim. The team employed a conventional content analysis approach for data analysis. All transcripts were double-coded by three bilingual team members who are native Chinese speakers. Coding discrepancies were resolved by consensus. Results: Healthcare providers recruited from the county, township, and village levels varied in educational background, professional qualification, and experience of working with people with mental illness. Five thematic categories identified across four groups include (1) barriers to mental healthcare delivery, (2) keys to mental health recovery, (3) providers’ attitudes toward providing care, (4) providers’ perception toward patients and family members, and (5) providers’ perception of training needs. Conclusions: This is a unique study that included healthcare providers from a three-tier healthcare system. Findings signal the importance of understanding healthcare practitioners’ experiences and views to inform the design of training initiatives in rural or low-resource communities.

scholarly journals SUNDAR: mental health for all by all

2015 ◽  
Vol 12 (01) ◽  
pp. 21-23 ◽  
Author(s):  
Vikram Patel
Keyword(s):  
Mental Health ◽  
Healthcare System ◽  
Randomised Controlled Trials ◽  
Mental Healthcare ◽  
Psychosocial Interventions ◽  
Health Conditions ◽  
Controlled Trials ◽  
The Core ◽  
Training And Supervision ◽  
Randomised Controlled

This article describes the rationale and principles for the SUNDAR approach adopted by Sangath, an Indian non-governmental organisation: to use lay people, with appropriate training and supervision, to deliver psychosocial interventions for a range of mental health conditions. This approach has been evaluated in a number of randomised controlled trials and is now being scaled up. At the core of this innovation is revisiting the questions of what constitutes mental healthcare, who provides mental healthcare and where mental healthcare is provided. In doing so, SUNDAR offers a vision for a mental healthcare system which is empowering, inclusive, equitable and effective.

The role of regional planning and management strategies in the transformation of the healthcare system

2003 ◽  
Vol 16 (1) ◽  
pp. 56-69 ◽  
Author(s):  
Marie-Josée Fleury ◽  
Jean-Louis Denis ◽  
Claude Sicotte
Keyword(s):  
Mental Health ◽  
Healthcare System ◽  
Regional Planning ◽  
Local Level ◽  
Management Strategies ◽  
Health Sector ◽  
Mental Healthcare ◽  
Public Healthcare ◽  
Planning And Management

Drawing on a case study, this article questions the role of planning and management strategies in the process of transforming a regional public healthcare system that involves a number of organizations and is characterized by fluidity in its functions and division of power. It examines the efficacy of the Regional Plan for the Organization of Health Services (PROS) in reforming the mental health sector in a health and social service district in Quebec, in terms of integrated regional management of mental healthcare and activities at the local level. The regional planning procedure involves a major transformation in management of the mental health system, organizational roles and clinical and professional practices. Our assessment of PROS highlights the importance of taking into account the context of implementation and the instrumental value of planning, before judging its efficacy. To transform a complex healthcare system at the regional and local level, the study suggests a revised conception of the main roles played by planning and of the process shaping its implementation. Our study concludes in favour of developing management strategies at the operational, clinical and professional levels, and integrating them as a planning aid that allows a more corporate and matrix-based system to be set up.

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