scholarly journals Integrating mental health into primary care: the policy maker's perspective and experience in China

2010 ◽  
Vol 7 (1) ◽  
pp. 3-5 ◽  
Author(s):  
Yu Xin ◽  
Liu Jin ◽  
Ma Hong
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Rural Areas ◽  
Care Service ◽  
Psychiatric Service ◽  
Mental Healthcare ◽  
Health Resources ◽  
Psychiatric Hospitals ◽  
Administration And Supervision ◽  
Set Up

In China, ‘community’ was an alien word. Many people used to live in dormitories (Danwei), to which they were assigned by government according to their work units. ‘Dormitory form’ community was closely linked to where people worked, and thus administration and supervision were simple, as was the provision of health services. In each Danwei, a clinic provided basic healthcare not only for its employees but also for the other residents of the dormitory. The old primary care service was based on this. In fact, the ‘golden age’ of community mental healthcare was at that time, when psychiatric hospitals extended their service to communities via the Danwei's clinics in the cities and via ‘barefoot doctors’ in the rural areas. Home beds, occupational therapy stations and shelter factories were set up in some cities and mobile mental health teams played important roles in the villages. Although this did not really represent the ‘integration’ of mental health into primary care, it was a good example of maximising the utilisation of the very limited mental health resources by stretching the psychiatric service, using administrative power, and mobilising family members (Shen et al, 1990; Zhang & Yan, 1990; Zhang, 1999).

scholarly journals Mental Healthcare Delivery in Rural Greece: A 10-year Account of a Mobile Mental Health Unit

2017 ◽  
Vol 08 (04) ◽  
pp. 556-561 ◽  
Author(s):  
Vaios Peritogiannis ◽  
Thiresia Manthopoulou ◽  
Afroditi Gogou ◽  
Venetsanos Mavreas
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Community Mental Health ◽  
Rural Areas ◽  
Catchment Area ◽  
Mental Healthcare ◽  
Community Mental Health Service ◽  
Primary Care System ◽  
Mobile Mental Health ◽  
Care System

ABSTRACTIntroduction: Patients living in rural and remote areas may have limited access to mental healthcare due to lack of facilities and socioeconomic reasons, and this is the case of rural areas in Eastern Europe countries. In Greece, community mental health service delivery in rural areas has been implemented through the development of the Mobile Mental Health Units (MMHUs). Methods: We present a 10-year account of the operation of the MMHU of the prefectures of Ioannina and Thesprotia (MMHU I-T) and report on the impact of the service on mental health delivery in the catchment area. The MMHU I-T is a multidisciplinary community mental health team which delivers services in rural and mountainous areas of Northwest Greece. Results: The MMHU I-T has become an integral part of the local primary care system and is well known to the population of the catchment area. By the end of 2016, the majority of patients (60%) were self-referred or family-referred, compared to 24% in the first 2 years. Currently, the number of active patients is 293 (mean age 63 years, 49.5% are older adults), and the mean caseload for each member of the team is 36.6. A significant proportion of patients (28%) receive care with regular domiciliary visits, and the provision of home-based care was correlated with the age of the patients. Within the first 2 years of operation of the MMHU I-T hospitalizations of treatment, engaged patients were reduced significantly by 30.4%, whereas the treatment engagement rates of patients with psychotic disorders were 67.2% in 5 years. Conclusions: The MMHU I-T and other similar units in Greece are a successful paradigm of a low-cost service which promotes mental health in rural, remote, and deprived areas. This model of care may be informative for clinical practice and health policy given the ongoing recession and health budget cuts. It suggests that rural mental healthcare may be effectively delivered by integrating generic community mental health mobile teams into the primary care system.

scholarly journals The COVID-19 Pandemic Mental Health Crisis Ahead

2020 ◽  
Author(s):  
Areen Omary
Keyword(s):  
Mental Health ◽  
Rural Areas ◽  
Mental Healthcare ◽  
Health Resources ◽  
Mental Health Crisis ◽  
Urban Centers ◽  
Health Crisis ◽  
The Us ◽  
Health Related ◽  
The U.S

Acknowledging COVID-19 as being potentially fatal triggered mental health-related consequences. In the US, the pandemic has highlighted the inadequacies of the mental healthcare system, especially in rural areas, inadequacies that result from lack of awareness and the severe mental health ramifications of COVID-19. Rural areas in the U.S. are particularly susceptible because mental-health resources are scant to start with, telehealth counseling relies on spotty Internet coverage, and COVID-19 has been slower to emerge outside urban centers.

Living Arrangements of Individuals with Schizophrenia in Japan: Impact of Community-Based Mental Health Services

2006 ◽  
Vol 52 (1) ◽  
pp. 55-64 ◽  
Author(s):  
Iwao Oshima ◽  
Eri Kuno
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Living Arrangements ◽  
Psychiatric Service ◽  
Community Mental Health Services ◽  
Psychiatric Hospitals ◽  
Community Based ◽  
Age Cohorts ◽  
The Difference

Aims: In Japan psychiatric hospitals and family play the predominant roles in caring for people with serious mental illness. This study explored how the introduction of community-based care has changed this situation by examining living arrangements of individuals with schizophrenia who were treated in one of the most progressive systems in Japan (Kawasaki) compared with national norms. Methods: The proportion of clients with schizophrenia in the community versus hospital and living arrangements for those in the community were compared between the Kawasaki and national treated population, using data from the Kawasaki psychiatric service users survey in 1993 and two national surveys in 1993 and 1983. The variation in living arrangements was examined across five different age cohorts. Results: The estimated national population was 36.7, which was similar to 32.7 clients per 10,000 population in Kawasaki. Some 71% of the Kawasaki clients were treated in the community compared with 55% nationally. The difference between the Kawasaki and national populations was the largest among clients aged 40 to 59. The Kawasaki community clients had a higher proportion of clients living alone. Conclusions: The community mental health services available in Kawasaki appeared to reduce hospitalisation and help clients to live alone in the community.

Integration of mental health resources in a primary care setting leads to increased provider satisfaction and patient access

2013 ◽  
Vol 35 (5) ◽  
pp. 461-467 ◽  
Author(s):  
Kristin S. Vickers ◽  
Jennifer L. Ridgeway ◽  
Julie C. Hathaway ◽  
Jason S. Egginton ◽  
Angela B. Kaderlik ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Health Resources ◽  
Patient Access ◽  
Provider Satisfaction

scholarly journals Pathways to Mental Health–Related Treatment Among Caregiving Spouses

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 358-358
Author(s):  
Hyojin Choi ◽  
Kristin Litzelman ◽  
Molly Maher ◽  
Autumn Harnish
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Healthcare ◽  
Health Condition ◽  
Future Research ◽  
Provider Type ◽  
Hospital Emergency Room ◽  
Health Related ◽  
Nationally Representative

Abstract Spouses of cancer survivors are 33% less likely to receive guideline-concordant depression treatment than other married adults. However, depression is only one of many manifestations of psychological distress for caregivers. This exploratory study sought to assess the paths by which caregivers access mental health-related treatment. Using nationally representative data from the Medical Expenditures Panel Survey, we assessed the proportion of caregivers who received a mental health-related prescription or psychotherapy visit across care settings (office based versus outpatient hospital, emergency room, or inpatient visit), provider type (psychiatric, primary care, other specialty, or other), and visit purpose (regular checkup, diagnosis and treatment, follow-up, psychotherapy, other). In addition, we assessed the health condition(s) associated with the treatment. The findings indicate that a plurality of caregivers accessed mental health-related treatment through an office-based visit (90%) with a primary care provider (47%). A minority accessed this care through a psychologist or psychiatrist (11%) or a physician with another specialty (12%) or other provider types. Nearly a third accessed treatment as part of a regular check-up (32%). These patterns did not differ from the general population after controlling for sociodemographic characteristics. Interestingly, mental health-related treatments were associated with a mental health diagnosis in only a minority of caregivers. The findings confirm the importance of regular primary care as a door way to mental healthcare, and highlight the range of potential paths to care. Future research will examine the correlates of accessing care across path types.

scholarly journals Creating a ‘reverse’ integrated primary and mental healthcare clinic for those with serious mental illness

2015 ◽  
Vol 17 (05) ◽  
pp. 421-427 ◽  
Author(s):  
Alexandros Maragakis ◽  
Ragavan Siddharthan ◽  
Jill RachBeisel ◽  
Cassandra Snipes
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Quality Of Care ◽  
Serious Mental Illness ◽  
Mental Healthcare ◽  
Policy Reforms ◽  
Mental Health Settings ◽  
Primary Care Practitioners

Individuals with serious mental illness (SMI) are more likely to experience preventable medical health issues, such as diabetes, hyperlipidemia, obesity, and cardiovascular disease, than the general population. To further compound this issue, these individuals are less likely to seek preventative medical care. These factors result in higher usage of expensive emergency care, lower quality of care, and lower life expectancy. This manuscript presents literature that examines the health disparities this population experiences, and barriers to accessing primary care. Through the identification of these barriers, we recommend that the field of family medicine work in collaboration with the field of mental health to implement ‘reverse’ integrated care (RIC) systems, and provide primary care services in the mental health settings. By embedding primary care practitioners in mental health settings, where individuals with SMI are more likely to present for treatment, this population may receive treatment for somatic care by experts. This not only would improve the quality of care received by patients, but would also remove the burden of managing complex somatic care from providers trained in mental health. The rationale for this RIC system, as well as training and policy reforms, are discussed.

scholarly journals Providing a primary care service for psychiatric in-patients

2004 ◽  
Vol 28 (5) ◽  
pp. 167-170 ◽  
Author(s):  
Enone Welthagen ◽  
Sarah Talbot ◽  
Oliver Harrison ◽  
Michael Phelan
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Psychiatric Care ◽  
Care Service ◽  
Primary Care Service ◽  
Clinical Implications ◽  
Model Of Care ◽  
Wide Range ◽  
Set Up ◽  
Acute Psychiatric Care

Aims and MethodA prospective descriptive study was set up to evaluate the feasibility, acceptability and activity of an innovative weekly primary care service for patients admitted for acute psychiatric care.ResultsDuring 10 months, 36 clinics were held and 123 appointments were attended. Presenting complaints included a wide range of acute and chronic conditions, affecting all body systems. As well as treating specific complaints, the doctor providing this service undertook considerable health promotion work and gave advice about patient management to junior psychiatrists.Clinical ImplicationsIt appears that there is considerable need for primary care expertise within an acute psychiatric unit, and that a weekly clinic is a feasible model of care.

scholarly journals Patient engagement, autonomy, access to mental care services – the case for integrated care in Crete

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Petelos ◽  
M Papadakaki ◽  
C Lionis
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Rural Areas ◽  
Common Ground ◽  
Local Governance ◽  
Mental Health Disorders ◽  
Care Services ◽  
Interdisciplinary Approaches ◽  
Health And Social Care ◽  
Health Disorders

Abstract Access to comprehensive primary care (PC) services is imperative to address the complex biopsychosocial needs of patients with mental illness and their families, while it holds the potential to safeguard mental health and enhance resilience in communities. Integration of mental health and social care services in primary care has not yet been achieved, while access to such services for the mentally ill is still hindered by patient-, provider- and system-oriented barriers. Improving service integration, quality and access requires active engagement of patients and families in the design and planning of services. Interprofessional collaboration, interdisciplinary approaches and sound deliberative processes are only the start of initiating discussions to establish the needs of local communities. Mapping care paths, involving stakeholders and engaging in practice-based research are impeded by the organisation and design of care provision, including siloed processes and semantic ambiguity in establishing common ground. Academic centres ought to act as hubs for bringing together all actors, creating living labs and addressing the needs of people in urban and rural areas. The case study from Crete will focus on the following questions: What actions are needed to improve access of people with mental health disorders to PC services and how could PC mediate effective communication with mental health services?To what extent people with mental health disorders experience violence, abuse or discriminatory behaviour in PC?To what extent PC services recognize and facilitate autonomy, self-determination and inclusion of people with mental health disorders?To what extent stakeholders and PC services engage people with mental health disorders in decision making process and local governance?To what extent educational interventions for PC practitioners could result in the reduction of discriminatory behaviour and safeguard the dignity among people with mental health disorders?

scholarly journals 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

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.

"I'm Not That Innocent": Recruiting Sexual and Gender Minorities for Rural Mental Health Research

2007 ◽  
Vol 29 (2) ◽  
pp. 10-14
Author(s):  
Cathleen Willging
Keyword(s):  
Mental Health ◽  
Rural Areas ◽  
Mental Health Problems ◽  
Treatment Options ◽  
Health Resources ◽  
Mental Health Research ◽  
Sexual And Gender Minorities ◽  
Hidden Populations ◽  
Gender Minorities ◽  
And Gender

There is a dearth of research, anthropological and otherwise, focused on the mental health needs of sexual and gender minorities in rural areas. The risk for mental illness is greater for such groups due to their repeated exposure to psychosocial stressors associated with discrimination, stigmatization, and violence. The consequences of such exposure may be exacerbated in rural areas, where mental health resources are typically insufficient for the general population. Ethnographic research can provide important insights into how sexual and gender minorities cope with mental health problems within rural settings where treatment options are limited. The methodological challenges of undertaking such research are substantial, and include lack of identification among potential participants with externally imposed social categories, such as lesbian, gay, bisexual, and transgender (LGBT), and the problem of recruiting "hidden" populations to take part in studies on sensitive topics. When taking into account the geographical dispersion of LGBT people in rural areas, these challenges increase substantially.

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