Measuring mental health needs

The 11th Australian Rural and Remote Mental Health Symposium Communiqué.

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

More andmore, I am hearing that people with mental health issues aspire to work in the professional sector, possibly as a manager, an executive, or a technician. Many are not interested in more mundane work, such as data entry. Yet, for various reasons, finding work as a professional is difficult for people with mental health problems, especially if they have recently been discharged from a psychiatric hospitalization.

Abstract: People with psychiatric disabilities face barriers to employment both in the larger community and within the mental health system itself. Strategies used to affirmatively employ people with psychiatric disabilities as research personnel in an evaluation of community mental health services are described in this article. Our goal was to address two critical issues in the provision and evaluation of mental health services: the importance of meaningful work and productivity in the lives of people with psychiatric disabilities, and obtaining valid and reliable data regarding the effectiveness of community mental health services. A three-phase methodology for developing affirmative employment opportunities is presented, consisting of three components: affirmative planning, affirmative support, and affirmative rigour and method. The methodology is intended as a guide to assist evaluators and researchers in fulfilling the vision of the Canadian Human Rights Act and the Employment Equity Act.

This study describes the development of the Consumer Participation Questionnaire to measure consumer involvement in the planning, management and evaluation of mental health services, and the attitudes of mental health workers towards consumer participation. Results indicate that while most professionals view the concept positively, progress may be occurring faster at the level of individual treatment than at the organisational level. Professionals with a more biological (as opposed to psychosocial) orientation were less likely to predict that services would improve if consumers were involved in the planning of services or were employed therein. Recommendations to facilitate more effective consumer participation are made, including the need for the value of a collaborative approach to be emphasised in professional training programmes.

In every sector, the COVID-19 pandemic has highlighted the importance of mental health resources for wellbeing. Although scholars have long recognized the interdependent relationship between academic success and positive mental health, research that can be used to guide mental health service design and delivery in post-secondary institutions is relatively unexplored. Further, the experiences of practitioners, in their day-to-day operations toward understanding and responding to student mental health problems, are an under-recognized source of data that can contribute to more effective planning and implementation. The objective of this project is to use practitioner action research principles to design, implement, and evaluate a mental health and addiction services plan at Brock University in Ontario, Canada. This paper details what occurred in the plan-act-observe-reflect cycles as practitioners gathered qualitative data using interviews and the World Café methodology. Results show improvement in student satisfaction ratings with on-campus mental health services. Our experience reveals that practitioner action research is a useful framework for practitioners seeking a systematic process to contribute to both fields of knowledge and fields of practice.

WPA Project on Partnerships for Best Practices in Working with Service Users and Carers.

Against the backdrop of a large treatment gap for mental disorders in low- to middle-income countries (LMICs), the 2007 Lancet series on global mental health calls for a scaling up of mental health services. Community participation is largely harnessed as one strategy to facilitate this call. Using a participatory implementation framework for the development of mental health services for common mental disorders (CMDs) in a rural subdistrict in South Africa as a case study, this study sought to understand the benefits and challenges of community participation beyond that of scaling up. Qualitative process evaluation involving interviews with service providers and users was employed. The results suggest that in addition to promoting mobilization of resources and actions for scaling up mental health services, community participation can potentially contribute to more culturally competent services and personal empowerment of recipients of care. In addition, community participation holds promise for engendering community-led public health actions to ameliorate some of the social determinants of mental ill health. Challenges include that community members involved in these activities are mainly marginalized women, who have limited power to achieve structural change, including cultural practices that may be harmful to the mental health of women and children. We conclude that in addition to contributing to scaling up mental health services, community participation can potentially promote the development of culturally competent mental health services and greater community control of mental health.

Service user involvement in the planning and provision of mental health services has been growing over the last two decades, especially in countries and areas where institutional service provision has been changed to a community-orientated model of care. However, the material involvement of service users in mental health research is still in its infancy. The aim of this paper is to attempt to place these developments in a conceptual context, to summarise the ethics-based and evidence-based reasons why it has to be considered as necessary, and to illustrate some of the emerging evidence which shows the advantages to be gained from it. In particular the results of recent studies are briefly reported, showing that outcomes data rated by service users in some cases are more important than those rated by staff. The reduction in patient-rated unmet needs in the social domain was the strongest predictor of an increase in subjective quality of life. The importance of including service user preferences within the content of the research questions is exemplified by the results of a recent study that showed that joint crisis plans can significantly reduce the use of compulsory admission during crises and by a review that demonstrated that the use of an explicit service user perspective produced distinctive insights into the long-term effects of Electro-Convulsive Therapy (ECT).

In Australia, mental health services are delivered by a complex web of public- and private-sector providers. There is a growing recognition that linkages between these groups are not optimal, and a concern that this may lead to poor outcomes. This paper illustrates a conceptual framework for developing, implementing and evaluating programmes concerned with linkages. Drawing on theoretical and practical literature, this paper identifies different levels of integration, issues in evaluating programmes to address poor linkages, and features of useful evaluations. Within this context, it describes the method by which the Public and Private Partnerships in Mental Health Project (Partnership Project) is being evaluated. Conducted by St Vincent's Mental Health Service and The Melbourne Clinic, this is one of several Demonstration Projects in Integrated Mental Health Care funded under the National Mental Health Strategy. Collaboration is hard to conceptualize and collaborative programmes usually have many players and components, and tend to operate within already-complex systems. This creates difficulties for evaluation, in terms of what to measure, how to measure it, and how to interpret findings. In spite of these difficulties, the illustrative example demonstrates a model for evaluating collaborative programmes that is currently working well because it is strongly conceptualized, descriptive, comparative, constructively sceptical, positioned from the bottom up, and collaborative. This model, or aspects of it, could be extended to the evaluation of other mental health programmes and services that have collaborative elements.

The participation of people who use mental health services in service planning and evaluation has become increasingly important in recent years. Health planners and people who use services are seeking information about how to enable participation that is meaningful and impacts positively on service delivery. This qualitative study explored the perspectives of people who use mental health services on participation in mental health service planning and evaluation. Sixty-three people from diverse backgrounds participated in either a focus group or interview. Themes were extracted from the data and resulted in a conceptual framework that can be used to guide the development and evaluation of participation.

The mental health system in Viet Nam (population >85 million) has services provided at the central, provincial, district and community levels. There are 31 central and provincial mental hospitals, 27 psychiatric departments in general hospitals, 60 outpatient mental health facilities and 17 social care centres. Its workforce comprises about 950 mental health doctors, 2700 nurses and 800 other staff. Each of Viet Nam's 10,750 communes has a primary health centre (PHC), and there are over 47,000 primary health staff. Delivering mental health care via the primary care system is endorsed as a suitable option for many developing countries 1,2,3. A national community mental health care (CMHC) program was launched in Viet Nam in 2001 to build up community mental health service by integrating mental health care into PHCs. The components provided were illness identification, basic treatment, relapse prevention, and reduction of risk and disability. Activities included training of PHC staff, screening at the community level, monthly review and medication provision, rehabilitation in activities of daily living, community education and regular interactions between the PHCs and the provincial and central hospitals. In 2009, the National Psychiatric Hospital No. 1 in Hanoi implemented a World Health Organization (WHO)-funded review of the CMHC program. The review consisted of a national workshop of 40 provincial hospitals leaders, site visits of several CMHC services and selective data from the national monitoring system and various community mental health stakeholders 4. After being initiated in all 64 provinces in Viet Nam, the program has driven the development of country-wide community mental health network and services 5. It has achieved a national coverage of 64%, reaching about 145,160 patients. The strengths identified include: better access to treatment for community patients especially from remote areas, thus reducing treatment gap; greater opportunities for rehabilitation and reintegration into community; and increased public awareness of mental illness. The main limitations concern human resource and facilities, scope of treatment, scale of service coverage and linkages with families and community. A framework for the revised model of community mental health care in Viet Nam was collaboratively developed by service providers and consultants, in line with best-practice recommendations in the region 6. This includes: broadening the scope of mental health care to include mental health promotion, prevention, and intervention at the primary care level; strengthening the partnership with community supports to deliver mental health services together with PHCs; and developing specialist mental health teams to initiate and support the service implementation in order to build local expertise and long-term sustainability. The revised CMHC program will strive for an integrated mental health service in the primary health system which is supported by strong community partnerships and reliable governance. Building the capacity of PHC staff to meet these aims requires significant initial investment but is likely to be a cost-effective and viable strategy in the long term.

The need for evaluation of mental health services is emphasized repeatedly by mental health leaders, state and federal officials, third-party payers, and others concerned with the quality and costeffectiveness of mental health care. Although a growing number of evaluation studies are being conducted, they are frequently criticized because of poor study design, lack of methodological rigor, and failure to produce information that has practical implications for improving mental health services. Hospital & Community Psychiatry asked several evaluation specialists to briefly discuss basic issues and approaches in mental health evaluation and to list books or articles that they consider particularly useful for mental health professionals with limited experience in conducting evaluation studies. We think their comments, presented here, are of interest to all who are concerned with improving the quality of mental health evaluation. The contributors are identified on page 731.

The initial onset of mental illness occurs most frequently in adolescence or early adulthood. In order to inform the development of mental health services tailored for youth, we sought to compare the characteristics of young (18-25 years old) and older (over 25 years old) adults following referral to a general adult community mental health team. All individuals referred to a Dublin-based community mental health team and offered an appointment between January 1 and December 31, 2016 were included in the study. Information in relation to engagement patterns, demographic characteristics and clinical characteristics was collected. A total of 298 appointments were offered during the study period among which 94 (31.6%) were for young adults. Significant differences in demographic and clinical characteristics between the two age groups were evident. Young adults were significantly less likely to have been prescribed psychotropic medication at the point of referral (63% vs. 82% respectively, χ2 = 12.30, p < .001). Older adults were four times more likely to demonstrate a good level of early engagement in treatment than young adults (AOR 4.00, 95% CI 1.11-14.37, p = .03). Young adults had distinct clinical needs and a lower level of engagement in the early stage of treatment compared with their older counterparts in this community team. Further research and stakeholder consultation is needed to more clearly identify the issues in relation to patient engagement. These insights will help to inform the development of youth-specific community mental health services.

Hospitalization Patterns for Psychiatric Disorders Across the Lifespan in Australia From July 1998 to June 2005