Psychiatry in Transition: Outcomes of Mental Health Policy Shift in Italy

Objective: To assess the outcomes of changes in mental health policy introduced in Italy in 1978. Methods: Data on psychiatric services, before and after the policy change, are presented. Effects of change are evaluated through indicators related to four issues: transfer of care, criminalisation of the mentally ill, suicides, and homelessness. Results: Admissions of new patients to mental hospitals have been stopped and the size of the mental hospital population is now very low (26 per 100 000 population). Psychiatric care has been shifted to community services including general hospital psychiatric units. There has been an overall reduction of psychiatric hospitalisation. However, the provision of residential facilities is inadequate and community services are unevenly distributed across the country. Few negative effects of changing patterns of care have been reported, although the low quality of data limits the validity of such a conclusion. Outcome of care in areas where the full range of community services is available has been rated as satisfactory. Conclusions: Although care of the mentally ill has been shifted to community services, we lack hard data on the social and clinical outcome of communty care at the nation-wide level. Long-term monitoring and evaluation of community services is a high priority in Italy.

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All of us? An exploration of the concept of mental health literacy based on young people’s responses to fictional mental health vignettes

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2014.82 ◽

2015 ◽

Vol 32 (1) ◽

pp. 129-136 ◽

Cited By ~ 7

Author(s):

D. Chambers ◽

F. Murphy ◽

H. S. Keeley

Keyword(s):

Mental Health ◽

Health Policy ◽

Health Literacy ◽

Young People ◽

Mental Disorders ◽

Mental Health Literacy ◽

Full Range ◽

Mental Health Policy ◽

Current Definition ◽

Definition Of

ObjectivesMental health literacy is increasingly referenced as a goal of mental health policy. However, the current definition of this concept has a relatively narrow focus on mental disorders. The objectives of this study were to explore mental health literacy through the use of vignettes and to begin to articulate a broader definition.MethodsSix groups of young people (n=42) aged between 16 and 25 years old responded to open-ended questions about vignettes depicting fictional characters with diagnosable mental health problems. The responses were analysed using Foucault’s governmentality theory.ResultsThe responses to the vignettes highlighted a range of determinants of our mental health. The young people suggested informal mental health-promoting techniques and highlighted the importance of talking. Ambiguity was reported in relation to the types of knowledge that are important in responding to mental health need. Finally, the responses were reflective of young people who are empathetic and view mental health from the perspective of our shared humanity, rather than as a marginal issue.ConclusionsAs mental health literacy is increasingly becoming a goal of mental health policy, it is timely that a shared understanding of this important concept is articulated. The current definition of mental health literacy is narrow in its focus on the recognition of mental disorders. A more broad-based definition of mental health literacy should be adopted by policy makers, reflecting the full range of determinants of mental health and recognising the importance of mental wellbeing.

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When health means illness: analysing mental health discourses and practices in Ireland

Reframing Health and Health Policy in Ireland ◽

10.7228/manchester/9780719095870.003.0006 ◽

2017 ◽

Author(s):

Derek Chambers

Keyword(s):

Mental Health ◽

Health Promotion ◽

Health Policy ◽

Mentally Ill ◽

Mental Health Policy ◽

Policy Documents ◽

Health Strategy ◽

Provision Of Services ◽

Mental Health Service User ◽

Promotion Campaigns

This chapter focuses on the area of mental health policy as an arena in which expert systems, in the form of biomedical discourses and psychiatry, have played a central role in constituting mental health ‘subjects’. The analysis focuses on the discourses emerging from recent mental health policy documents, including Ireland’s main mental health strategy, A Vision for Change. Drawing on Dean’s ideas about fields of visibility and valued knowledge, this chapter suggests that despite a broadening of understanding of mental health beyond medicalised discourses, seen most recently in health promotion campaigns and suicide prevention strategies, in practice, the focus remains on the mental health service user, and the provision of services for those who are mentally ‘ill’. Attempts to reconfigure mental health as something which affects ‘all of us’, and moves beyond mental ‘illness’ – which, it is argued, may have the potential to open up less stigmatising modes of understanding about mental health – are hampered by the continuing dominance of the biomedical frameworks of understanding.

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Intersectoral policy for severe and persistent mental illness: review of approaches in a sample of high-income countries

Global Mental Health ◽

10.1017/gmh.2015.16 ◽

2015 ◽

Vol 2 ◽

Cited By ~ 2

Author(s):

S. Diminic ◽

G. Carstensen ◽

M. G. Harris ◽

N. Reavley ◽

J. Pirkis ◽

...

Keyword(s):

Mental Health ◽

Mental Illness ◽

Health Policy ◽

Web Search ◽

Mental Health Policy ◽

Monitoring And Evaluation ◽

Aged Care ◽

Service Planning ◽

Intersectoral Collaboration ◽

Persistent Mental Illness

BackgroundIt is increasingly recognised that intersectoral linkages between mental health and other health and support sectors are essential for providing effective care for individuals with severe and persistent mental illness. The extent to which intersectoral collaboration and approaches to achieve it are detailed in mental health policy has not yet been systematically examined.MethodsThirty-eight mental health policy documents from 22 jurisdictions in Australia, New Zealand, the United Kingdom, Ireland and Canada were identified via a web search. Information was extracted and synthesised on: the extent to which intersectoral collaboration was an objective or guiding principle of policy; the sectors acknowledged as targets for collaboration; and the characteristics of detailed intersectoral collaboration efforts.ResultsRecurring themes in objectives/guiding principles included a whole of government approach, coordination and integration of services, and increased social and economic participation. All jurisdictions acknowledged the importance of intersectoral collaboration, particularly with employment, education, housing, community, criminal justice, drug and alcohol, physical health, Indigenous, disability, emergency and aged care services. However, the level of detail provided varied widely. Where detailed strategies were described, the most common linkage mechanisms were joint service planning through intersectoral coordinating committees or liaison workers, interagency agreements, staff training and joint service provision.ConclusionsSectors and mechanisms identified for collaboration were largely consistent across jurisdictions. Little information was provided about strategies for accountability, resourcing, monitoring and evaluation of intersectoral collaboration initiatives, highlighting an area for further improvement. Examples of collaboration detailed in the policies provide a useful resource for other countries.

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Correcting Misconceptions in Mental Health Policy: Strategies for Improved Care of the Seriously Mentally Ill

Milbank Quarterly ◽

10.2307/3350020 ◽

1987 ◽

Vol 65 (2) ◽

pp. 203 ◽

Cited By ~ 31

Author(s):

David Mechanic

Keyword(s):

Mental Health ◽

Health Policy ◽

Mentally Ill ◽

Mental Health Policy ◽

Seriously Mentally Ill ◽

Policy Strategies

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Psychosocial Healthcare Centres (CAPS) in Brazilian Mental Health Policy, 2008-2017

10.21203/rs.3.rs-72301/v1 ◽

2020 ◽

Author(s):

Rafael da Silva Barbosa ◽

Maria Lucia Teixeira Garcia ◽

Gary C Spolander ◽

Edineia Figueira dos Anjos Oliveira

Keyword(s):

Mental Health ◽

Health Care ◽

Health Policy ◽

Mental Health Care ◽

Mental Health Policy ◽

Secondary Data ◽

Community Services ◽

Health Coverage ◽

Ministry Of Health ◽

Using Data

Abstract Psychosocial Healthcare Centres have been promoted by Brazilian mental health policy along with a guaranteed financing from the Ministry of Health. This paper used Strata 2014 data to analyse the extent of Psychosocial Healthcare Centres care capacity available for user as the central driver of mental health care in Brazil. Retrospective, descriptive study with secondary data analysis of services was undertaken using data from Brazilian federal government databases. Brazil does not have 100% mental health care coverage and our analysis, using the Brazilian Health Ministry criteria, identified only 36% (842) municipalities have been adequately resourced. Our analysis identified that while the number of CAPS units increased around 100%, due to increased extra-hospital and community services in the period, effective cover reduced due to budget cuts and increases as a result of rights to access. The Ministry of Health identified coverage in the ratio of 1 CAPS / 100 thousand inhabitants, although CAPS availability is not the only parameter for assessing mental health coverage. Within municipalities, the mental health network is not synonymous with CAPS nor its quality. We believe that the priority given to investing in CAPS, without guaranteeing resources for other mental health intervention, may negate the efforts of building of a network of new de-institutionalising services which replaced traditional models.

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Assessing dangerousness: protecting the interests of patients

The British Journal of Psychiatry ◽

10.1192/s0007125000298693 ◽

1997 ◽

Vol 170 (S32) ◽

pp. 28-29 ◽

Cited By ~ 7

Author(s):

William Bingley

Keyword(s):

Mental Health ◽

Health Policy ◽

Mentally Ill ◽

Mental Health Policy ◽

Mentally Disordered Offenders ◽

Mentally Disordered ◽

Seriously Mentally Ill ◽

Care And Treatment ◽

Competent Assessment

Peter Scott's (1975) characterisation of the concept of dangerousness as potentially dangerous in itself could not be more relevant than today. The principal focus of mental health policy over the last six years has been the care and treatment of seriously mentally ill people and mentally disordered offenders, and central to the successful care of the former and many of the latter is the competent assessment of the risk they pose: mostly to themselves, but occasionally to others.

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