‘Fair Horizons’: a person-centred, non-discriminatory model of mental healthcare delivery

Aims and methodService access is currently determined primarily by age and intellectual function and, unwittingly, is discriminatory. Our aim is to develop a novel, person-centred, non-discriminatory model of mental healthcare delivery. We sought the views of people who use services, carers, commissioners and local politicians.ResultsThe model represents a major change programme that commenced in September 2011.Clinical implicationsBy integrating specialist mental health services, with a single access point, and mapping of care to the person's needs, rather than their circumstances we hope to have developed a greatly improved and fairer service. A similar model could be adopted in other locations nationally.

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Efforts and Challenges to Ensure Continuity of Mental Healthcare Service Delivery in a Low Resource Settings During COVID-19 Pandemic—A Case of a Kenyan Referral Hospital

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.588216 ◽

2021 ◽

Vol 11 ◽

Author(s):

Edith Kwobah ◽

Florence Jaguga ◽

Kiptoo Robert ◽

Elias Ndolo ◽

Jane Kariuki

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Service Delivery ◽

Mental Health Care ◽

Healthcare Service ◽

Healthcare Delivery ◽

Mental Healthcare ◽

Referral Hospital ◽

Number Of Patients

The rising number of patients with Covid-19 as well as the infection control measures have affected healthcare service delivery, including mental healthcare. Mental healthcare delivery in low and middle income countries where resources were already limited are likely to be affected more during this pandemic. This paper describes the efforts of ensuring mental healthcare delivery is continued in a referral hospital in Kenya, Moi Teaching and Referral hospital, as well as the challenges faced. These efforts are guided by the interim guidelines developed by the Kenyan ministry of health. Some of the adjustments described includes reducing number of patients admitted, shortening the stay in the inpatient setting, using outdoors for therapy to promote physical distancing, utilization of electronic platforms for family therapy sessions, strengthening outpatient services, and supporting primary care workers to deliver mental health care services. Some of the challenges include limited ability to move about, declining ability for patients to pay out of pocket due to the economic challenges brought about by measures to control Covid-19, limited drug supplies in primary care facilities, inability to fully implement telehealth due to connectivity issues and stigma for mental health which results in poor social support for the mentally ill patients. It is clear that current pandemic has jeopardized the continuity of usual mental healthcare in many settings. This has brought to sharp focus the need to decentralize mental health care and promote community based services. Meanwhile, there is need to explore feasible alternatives to ensure continuity of care.

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Mitigating COVID-19 impact on the Portuguese population mental health: the opportunity that lies in Digital Mental Health (Preprint)

10.2196/preprints.19435 ◽

2020 ◽

Author(s):

Cristina Mendes-Santos ◽

Gerhard Andersson ◽

Elisabete Weiderpass ◽

Rui Santana

Keyword(s):

Mental Health ◽

Healthcare Delivery ◽

Mental Healthcare ◽

Intervention Strategies ◽

Mitigation Measures ◽

Equitable Access ◽

Portuguese Population ◽

Research Education ◽

Health Strategy ◽

Population Mental Health

UNSTRUCTURED COVID-19 mitigation measures present unprecedent challenges in mental healthcare delivery, posing high risk to the mental health of populations. Ensuring safe and equitable access to mental healthcare requires resorting to innovative psychosocial intervention strategies such as, Digital Mental Health. In this perspective piece, we discuss how timely implementation of a comprehensive Digital Mental Health strategy, coupling research, education, implementation and quality assessment initiatives, might strengthen the Portuguese mental healthcare system and, therefore, buffer COVID-19´s impact on the Portuguese society.

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UK health policy in relation to mentally disordered offenders in the community

10.1093/med/9780198738664.003.0002 ◽

2017 ◽

Author(s):

Jane Senior ◽

Adrian Hayes ◽

Jenny Shaw

Keyword(s):

Mental Health ◽

Criminal Justice ◽

Criminal Justice System ◽

Mental Health Treatment ◽

Justice System ◽

Healthcare Delivery ◽

Mental Healthcare ◽

Mentally Disordered Offenders ◽

Mentally Disordered ◽

Point Of Entry

The majority of mentally disordered offenders are never treated within forensic mental health services. Instead, they remain within the criminal justice system, where care and treatment for complex and co-morbid mental health, substance-misuse, and personality disorder issues remain secondary to justice and punishment. In this chapter, we explore the policy, practice, and legislative drivers influencing healthcare delivery throughout the criminal justice pathway. Firstly, we consider the current liaison and diversion programme in England, which aims to identify people with mental health issues at the point of entry into the criminal justice system. Secondly, we review the state of mental healthcare in prisons, a quarter of a century after the clinical improvement partnership between the National Health Service and HM Prison Service. Thirdly, we discuss issues around court mandated mental health treatment in the community. Finally, we consider initiatives designed to meet the discrete needs of offenders with personality disorders.

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Building the digital mental health ecosystem: opportunities and challenges for innovators (Preprint)

10.2196/preprints.27507 ◽

2021 ◽

Author(s):

Benedetta Spadaro ◽

Nayra Anna Martin-Key ◽

Sabine Bahn

Keyword(s):

Mental Health ◽

Clinical Practice ◽

Care Pathway ◽

Digital Health ◽

Healthcare Delivery ◽

Mental Healthcare ◽

Digital Tools ◽

Middle Income ◽

Digital Ecosystem ◽

Regulatory Flexibility

UNSTRUCTURED Digital mental health holds promise in tackling the growing demand for psychotherapeutic services. However, existing digital approaches are rarely integrated in clinical practice and rely on patients’ ability to self-diagnose and seek support. Digital health innovators are presented with opportunities and challenges to create an integrated digital ecosystem for mental healthcare. The uptake of digital tools depends on efficacy and engagement of end-users. To this aim, behavior theories offer the opportunity to identify behavioral drivers and address barriers to uptake. The agenda for innovators also includes building strong evidence-based cases for digital mental health, moving away from a one-size-fits-all wellbeing approach, to embrace the development of comprehensive digital diagnostics and validated digital tools. Innovators have the opportunity to make their clinical evaluation more insightful by assessing effectiveness and feasibility in the intended context of use with hybrid pragmatic trials. The COVID-19 pandemic has prompted regulatory flexibility and increased implementation of digital mental health, however equitable access remains a challenge, particularly in low- and middle-income countries, and the mental health gap is still present and increasing. A joint effort by digital health developers and providers is required to enable individuals to access care through digital technologies in communities where mental health services may be otherwise scarce. Shifting from the practice of designing for to designing with users will enhance traditional healthcare delivery and connect more patients to the appropriate care pathway. By laying these foundations, digital services can become integrated in clinical practice and set the scene for deeper technology-enabled changes.

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A Qualitative Exploration of the Views of Policymakers and Policy Advisors on the Impact of Mental Health Stigma on the Development and Implementation of Mental Health Policy in Singapore

Administration and Policy in Mental Health and Mental Health Services Research ◽

10.1007/s10488-021-01171-1 ◽

2021 ◽

Author(s):

Mythily Subramaniam ◽

Shazana Shahwan ◽

Chong Min Janrius Goh ◽

Gregory Tee Hng Tan ◽

Wei Jie Ong ◽

...

Keyword(s):

Mental Health ◽

Health Policy ◽

Mental Health Treatment ◽

Mental Health Policy ◽

Healthcare Delivery ◽

Mental Healthcare ◽

Mental Health Stigma ◽

Structured Interviews ◽

The Impact ◽

Health Programmes

AbstractFew studies have examined the views of policy makers regarding the impact of mental health stigma on the development and implementation of mental health policies. This study aimed to address this knowledge gap by exploring policymakers’ and policy advisors’ perspectives regarding the impact of mental health stigma on the development and implementation of mental health programmes, strategies, and services in Singapore. In all 13 participants were recruited for the study comprising practicing policymakers, senior staff of organisations involved in implementing the various mental health programmes, and policy advisors. Data was collected through semi-structured interviews, which were transcribed verbatim and analysed using reflexive thematic analysis. Data analysis revealed three superordinate themes related to challenges experienced by the policymakers/advisors when dealing with mental health policy and implementation of programmes. These themes included stigma as a barrier to mental health treatment, community-level barriers to mental health recovery, and mental health being a neglected need. Policymakers/advisors demonstrated an in-depth and nuanced understanding of the barriers (consequent to stigma) to mental healthcare delivery and access. Policymakers/advisors were able to associate the themes related to the stigma towards mental illness with help-seeking barriers based on personal experiences, knowledge, and insight gained through the implementation of mental health programmes and initiatives.

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Secondary mental healthcare in prisons in England and Wales: results of a postal questionnaire

The Psychiatrist ◽

10.1192/pb.bp.110.033274 ◽

2011 ◽

Vol 35 (12) ◽

pp. 445-448 ◽

Cited By ~ 2

Author(s):

Nick Kosky ◽

Clifford Hoyle

Keyword(s):

Mental Health ◽

National Health Service ◽

Health Service ◽

National Health ◽

Mental Healthcare ◽

Postal Questionnaire ◽

Service Development ◽

Clinical Implications ◽

England And Wales ◽

Prison Capacity

Aims and methodPrison mental health inreach teams (PMHITs) were introduced in response to policy from 2003. This provision comes under the responsibility of the National Health Service. Service development and structure was not defined in policy. A total of 97 prisons of an estimated 100 known to have a PMHIT were targeted by postal questionnaire and responses covered 62 prisons. Team structures were captured in the data with specific regard to the number of available professional sessions.ResultsFindings determine there is generally no correlation between input and prison capacity, although there was some evidence of correlation in the high secure (category A) estate and that the female estate was generally better served.Clinical implicationsIt is evident from this study that PMHITs have evolved piecemeal, with no clear standards or equity across the estate. This is of concern.

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

International Journal of Social Psychiatry ◽

10.1177/0020764021992807 ◽

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.

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Refugees, the asylum system and mental healthcare in Ireland

BJPsych International ◽

10.1192/s2056474000001082 ◽

2016 ◽

Vol 13 (2) ◽

pp. 35-37 ◽

Cited By ~ 1

Author(s):

Molly O'Connell ◽

Richard Duffy ◽

Niall Crumlish

Keyword(s):

Mental Health ◽

Mental Illness ◽

Asylum Seekers ◽

Healthcare Delivery ◽

Mental Healthcare ◽

Refugee Status ◽

Current Health ◽

Refugee Mental Health ◽

Service Policy ◽

Refugees And Asylum Seekers

The number of people seeking refugee status in Ireland is increasing year on year and the burden of mental illness experienced by refugees and asylum seekers is high. The College of Psychiatrists of Ireland has recommended the establishment of a number of specialist refugee mental health teams. In this paper we discuss the Irish asylum system, the Irish evidence regarding mental illness in this population, and current health service policy regarding refugee mental health. We propose a model of specialist refugee mental healthcare delivery.

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Specialist mental healthcare for children with epilepsy: child and adolescent mental health service liaison with neuroscience

Psychiatric Bulletin ◽

10.1192/pb.bp.108.021139 ◽

2009 ◽

Vol 33 (10) ◽

pp. 384-386

Author(s):

Ross J. Johnstone ◽

Michael J. S. Morton

Keyword(s):

Mental Health ◽

Educational Psychology ◽

Mental Healthcare ◽

Family Treatment ◽

Clinical Psychologist ◽

Clinical Implications ◽

Liaison Psychiatry ◽

Work Involvement ◽

Adolescent Mental Health Service ◽

Patients With Epilepsy

Aims and MethodTo describe services used by children with epilepsy seen by a liaison psychiatry team in Scotland and to examine existing guidance. Case notes of all patients with epilepsy were systematically reviewed to determine service involvement.ResultsThe majority of patients attended joint psychiatry and neurology clinics. Scottish Intercollegiate Guidelines Network (SIGN) recommendations for the psychosocial management of children with epilepsy were met. Most patients were assessed by a clinical psychologist and received educational psychology input, individual and family treatment approaches. Half had social work involvement.Clinical ImplicationsA liaison model is presented for the management of children with more complex epilepsy and psychiatric disorders.

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Escalating complexity and fragmentation of mental health service systems: the role of recovery as a form of moral communication

Kybernetes ◽

10.1108/k-11-2020-0782 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Nicholas Weaver

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Health Service ◽

Meaning Making ◽

Healthcare Delivery ◽

Mental Healthcare ◽

Magic Bullet ◽

Care Pathways ◽

Content Type ◽

Moral Communication

PurposeTheoretical generalisation provides the basis for tackling problems of service complexity, fragmentation and disrupted care pathways.Design/methodology/approachRecent mental health service transformation in Wales, United Kingdom, has been stimulated by a policy programme underpinned by person-centred recovery values. This paper offers analysis informed by the perspectives of Niklas Luhmann and other noted theorists to examine escalating service system complexity related to this transformation. Analysis builds upon the findings of a qualitative study employing thematic discourse analysis of talk of people with mental illness and associated workers.FindingsIn total, three themes were constructed in participants' talk: “Competing versions of recovery”, “Misaligned service expectations” and “Disrupted care pathways.” Recovery may be understood as a form of moral communication and autopoietic meaning-making activity, according to Luhmann's radical constructionist epistemology. This has the potential to generate competing versions of recovery, a key contributor to escalating complexity.Research limitations/implicationsFindings could be developed further by continued investigation of the relationship between recovery implementation and service fragmentation.Social implicationsA more judicious, balanced policy-implementation may cultivate optimal conditions for recovery pluralism by avoiding polarisation towards either top-down, policy-based recovery implementation or a proliferation of approaches at the grassroots level. Findings have implications for healthcare settings beyond the scope of mental healthcare, given the prevalence of person-centred care internationally.Originality/valueA simplistic view of recovery implementation should be challenged. Recovery should not be considered a “magic bullet” for mental healthcare delivery. Haphazard recovery-implementation may have detrimental effects of escalating complexity, service fragmentation and disrupted care pathways.

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