Mental Health in Australia and the Challenge of Community Mental Health Reform

Australia was one of the first countries to develop and implement a national mental health plan, 30 years ago. This national approach belied the countrys federal structure, in which the federal government takes responsibility for primary care while state and territory governments manage acute and hospital mental health care. This arrangement has led to significant variations across jurisdictions. It has also left secondary care, often provided in the community, outside of this governance arrangement. This article explores this dilemma and its implications for community mental health, and suggests key steps towards more effective reform of this vital element of mental health care.

Emerging mental health challenges, strategies, and opportunities in the context of the COVID-19 pandemic: Perspectives from South American decision-makers

Objective. To identify emerging mental health problems, strategies to address them, and opportunities to reform mental health systems during the COVID-19 pandemic in South America. Methods. An online questionnaire was sent to mental health decision-makers of ministries of health in 10 South American countries in mid-April 2020. The semi-structured questionnaire had 12 questions clustered into three main sections: emerging challenges in mental health, current and potential strategies to face the pandemic, and key elements for mental health reform. We identified keywords and themes for each section through summative content analysis. Results. Increasing mental health burden and needs were reported as direct and indirect consequences of the COVID-19 pandemic. National lockdowns challenge the delivery and access to mental health treatment and care. Strategies to meet mental health needs rely heavily on timely and adequate responses by strengthened mental health governance and systems, availability of services, virtual platforms, and appropriate capacity-building for service providers. Short- and medium-term strategies focused on bolstering community-based mental health networks and telemedicine for high-risk populations. Opportunities for long-term mental health reform entail strengthening legal frameworks, redistribution of financial resources, and collaboration with local and international partners. Conclusions. Mental health and psychosocial support have been identified as a priority area by South American countries in the COVID-19 response. The pandemic has generated specific needs that require appropriate actions, including implementing virtual interventions, orienting capacity-building toward protecting users and health providers, strengthening evidence-driven decision-making, and integrating mental health and psychosocial support in high-level mechanisms guiding the response to COVID-19.

Emerging Mental Health Challenges, Strategies and Opportunities in the context of the COVID-19 Pandemic: Perspectives from South American Decision-makers.

Background Mental health awareness has increased during the COVID-19 pandemic. Although international guidelines address the mental health and psychosocial support (MHPSS) response to emergencies, regional recommendations on COVID-19 are still insufficient. We identified emerging mental health problems, strategies to address them, and opportunities to reform mental health systems during the COVID-19 pandemic in South America. Methods An anonymous online questionnaire was sent to mental health decision-makers of Ministries of Health in 10 South American countries in mid-April 2020. The semi-structured questionnaire had 12 questions clustered into 3 main sections: emerging challenges in mental health, current and potential strategies to face the pandemic, and, key elements for mental health reform. We identified keywords and themes for each section through summative content analysis. Findings An increasing mental health burden and emerging needs are arising as direct and indirect consequences of the pandemic among health care providers and the general population. National lockdowns challenge the delivery and access to mental health treatment and care. Strategies to meet these health needs rely heavily on timely and adequate responses by strengthened mental health governance and systems, availability of services, virtual platforms, and appropriate capacity building for service providers. Short- and medium-term strategies focused on bolstering community-based mental health networks and telemedicine for high-risk populations. Opportunities for long-term mental health reform entail strengthening legal frameworks, redistribution of financial resources and collaboration with local and international partners. Interpretation Mental health and psychosocial support have been identified as a priority area by South American countries in the COVID-19 response. The pandemic has generated specific needs that require appropriate actions including: implementing virtual based interventions, orienting capacity building towards protection of users and health providers, strengthening evidence-driven decision making and integrating MHPSS in high-level mechanisms guiding the response to COVID-19. Funding None.

Basaglia’s international influence

This chapter tries to answer the question of whether the thinking and the work of Franco Basaglia are widespread and influential outside Italy. In the 1970s, Basaglia had a remarkable impact both on the new Spanish psychiatry and also in Brazil where, through a series of lectures, he inspired the early stages of the Brazilian Psychiatric Reform. Since Basaglia’s premature death in 1980, his vision and thinking have continued to influence psychiatric practice and mental health reform. However, distortion of Basaglia’s thinking may be present in some psychiatric literature. The most common distortions about Basaglia can be summarized as follows: (1) Basaglia belonged to the movement of anti-psychiatry; (2) Basaglia’s approach was driven by ideology; and (3) Basaglia’s work was essentially inspired by a philanthropic impetus. All three statements are inaccurate and essentially wrong: they will be challenged by the authors of this chapter.

From the asylum to community mental health services

This chapter intends to give insight into the tensions generated in Argentinian mental healthcare by alternations in policies and practices, while analysing Basaglia’s influence on policy making, on the development of mental health services, and on professional cultures. Basaglia’s thoughts and Italian reform have had a major impact in Argentina, thanks to his successors in the Trieste Department of Mental Health and the work they have carried out in the last 30 years. The core of his activity and reflections has become a guiding light in the protection of social and civil rights and the fight against traditional psychiatric power. Italian mental health reform is considered to be a central reference for Argentina’s National Mental Health Law 26657, passed in 2010; but even legislation which is human rights oriented still has to fully guarantee a system of mental healthcare respectful of people’s dignity and freedom.