Mental Health and the Law

Old age is a time when individuals can feel unity, integrity and reflection of their lives. If not, this will lead to inequality and can even result in pathology, a kind of mental illness (Latifah, 2010). According to Depkomindo 2010, elderly people in Indonesia in 2008 numbered 23 million people, while neglected elderly people reached 1.7 million to 2 million people. Mental health problems in the elderly can originate from 4 aspects, namely physical, psychological, social and economic. These problems can include emotional instability, irritability, easily feeling harassed, disappointed, unhappy, feelings of loss and uselessness. Elderly people with these problems are vulnerable to experiencing psychiatric disorders such as depression, anxiety (anxiety), psychosis (insanity) or drug addiction. In general, elderly mental health problems are adjustment problems. This adjustment is due to a change from the previous situation (still physically strong, working and earning) to a decline. The elderly are also identified with decreased endurance, physical activity and experiencing various kinds of diseases. The elderly will need medication, the amount or type of which depends on the disease they are suffering from. The more illnesses the elderly have, the more types of medication are needed. The large number of types of medication will cause problems, including the possibility of requiring compliance or causing confusion in using or how to take medication. Besides that, it can increase the risk of drug side effects or drug interactions. Providing good nutrition and adequate physical activity is very necessary for the elderly. This is done with the consideration that the elderly need adequate nutrition and sufficient physical activity to support and maintain health. Several factors that influence nutritional needs include: reduced ability to digest food, reduced taste, and food absorption factors.In this outreach activity for the elderly, it is hoped that the elderly in Gonilan village will benefit from what the instructors have conveyed about the importance of adequate nutrition and physical activity to maintain the health of the elderly. These include awareness in fulfilling healthy nutrition, healthy food processing, and adequate portions for the elderly

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

10.1176/appi.ps.59.1.105

Introduction Although mental health problems are common in the workplace, discrimination against mental health is still prominent. Characteristics of one’s own occupation can influence aspects of stigma and attitudes to mental health problems in the workplace context, but there are limited studies examining differences in them between occupational groups. Objectives We investigated occupational differences in mental health stigma, and attitudes to both mental and physical health in the workplace. Methods Data from the British Social Attitudes 2015 survey were used. Logistic regression models were conducted to investigate associations between occupational categories and stigma as measured by desire for social distance, as well as attitudes towards mental and physical health in the workplace. Occupational categories were based on the National Statistics Socio-economic Classification. Measures for attitudes to mental and physical health in the workplace include whether paid work is good for mental and physical health, how soon one should return to work following depression, whether work can help speed recovery from depression, whether one’s medical history should affect their promotion, including depression, schizophrenia and diabetes. Desire for social distance from people with depression and schizophrenia was measures using unlabelled vignettes. Results We found occupational differences in attitudes towards mental and physical health in the workplace, but not in levels of stigma. People in lower supervisory and technical (group 4), semi-routine and routine (group 5) occupations were more likely to have negative attitudes towards mental and physical health in the workplace compared to managerial and professional occupations (group 1). Both occupation groups were less likely than group 1 to believe that paid work is good for mental health (group 4: odds ratio (OR) = 0.38, 95% confidence interval (CI) = 0.24-0.61; group 5: OR = 0.34, 95% CI = 0.24-0.49). They were also less likely to believe that people with depression should return to work when they can do some or most of the job (group 4: OR = 0.67, 95% CI = 0.48-0.94; group 5: OR = 0.52, 95% CI = 0.41-0.66). People in group 5 were less likely to believe that paid work is good for physical health (OR = 0.69, 95% CI = 0.53 to 0.89) and that having schizophrenia should not affect promotion at work (OR = 0.78, 95% CI = 0.62-0.97) than group 1. Conclusions Our study reinforced the importance of job characteristics on attitudes to mental health in the workplace. First, employers need to invest more in improving their employees’ well-being. Second, governments should provide more support and resources for small companies to help them develop mental health policies and practices. Third, modifications need to be made to improve job control for employees and to ensure enough reasonable adjustments can be made. Disclosure of Interest G. Cheung: None Declared, A. Ronaldson: None Declared, C. Henderson Consultant of: C.H. has received consulting fees from Lundbeck and educational speaker fees from Janssen.

The central place of psychiatry in health care worldwide.

The Link Between Homeless Women's Mental Health and Service System Use

Information about mental health systems is essential for mental health planning to reduce the burden of neuropsychiatric disorders. Unfortunately, many low- and middle-income countries lack systematic information on their mental health systems. The objectives, scope, structure, and contents of mental health assessment and monitoring instruments commonly used in high-income countries may not be appropriate for use in middle- and low-income countries. The World Health Organization (WHO) has recently developed the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), a comprehensive assessment tool for mental health systems designed for middle- and low-income countries. WHO-AIMS was developed through an iterative process that included input from in-country and international experts on the clarity, content, validity, and feasibility of the instrument, as well as a pilot trial. The resulting instrument, WHO-AIMS 2.2, consists of six domains: policy and legislative framework, mental health services, mental health in primary care, human resources, public information and links with other sectors, and monitoring and research. These domains address the ten recommendations of the World Health Report 2001 through 28 facets and 155 items. All six domains need to be assessed to form a basic, yet broad, picture of a mental health system, with a focus on health sector activities. WHO-AIMS provides essential information for mental health policy and service delivery. Countries will be able to develop information-based mental health policy and plans with clear baseline information and targets. Moreover, they will be able to monitor progress in implementing reform policies, providing community services, and involving consumers, families, and other stakeholders in mental health promotion, prevention, care and rehabilitation. This article provides an overview of the rationale, development process, and potential uses and benefits of WHO-AIMS.

ABSTRACTThis presentation will focus on the importance of addressing mental health in the overall response to the Deepwater Horizon Oil Spill. Emphasis will be placed on evidence based, integrated mental and behavioral health services in primary care clinics as an essential component of physical and mental health care. Community surveillance data collected by LSUHSC Department of Psychiatry in the fall of 2010 and one year post spill revealed increased symptoms of depression, anxiety, and posttraumatic stress compared to national norms. Symptoms were higher for individuals directly impacted by the spill. The Mental and Behavioral Health Capacity Project (MBHCP), part of the Gulf Region Health Outreach Program (GRHOP), was developed across the four impacted states of Louisiana, Mississippi, Alabama, and Florida.In collaboration with the Primary Care Capacity Project (PCCP) and other GRHOP projects, it is designed to decrease disparities in care and develop an evidence-based system of integrated mental and behavioral health services within primary care clinics. In Louisiana, seven impacted parishes, culturally diverse and predominantly rural, were designated for services. Louisiana MBHCP (MBHCP-LA) is applying established principles of collaborative care combining on-site and telemedicine consultation, training, therapeutic services, and care management. It is working with PCCP to develop and utilize a technologically advanced telemedicine system to integrate mental and behavioral health into electronic health records to meet physical and mental health needs. Preliminary analysis of screening and follow-up data beginning in May 2013 from 303 clients who completed measures at intake into services indicates that integrating mental health services in primary care clinics resulted in significant decreases at follow-up in reported depression, generalized anxiety, and posttraumatic stress disorder symptoms. The data showed that the greater the decrease in reported depression, anxiety, and posttraumatic stress symptoms at follow-up, the greater the decrease in physical health symptoms. While the MBHCP-LA integration of mental and behavioral health in primary care clinics in parishes heavily impacted by the Deepwater Horizon Oil Spill has been in place for less than a year, the outcomes are promising in reducing both behavioral and physical health symptoms. The clinics are reporting greater comfort in addressing mental and behavioral health problems as well as more resilience by having mental and behavioral health partners. MBHCP-LA will continue to evaluate improvement in physical and mental health symptoms as well as resilience and quality of life by more fully addressing mental and behavioral health concerns.

County-Level Estimates of Need for Mental Health Professionals in the United States

Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence

Children and youth face major gaps in access to mental and behavioral health services. Rates of identification of mental health conditions in the pediatric population continue to lag well behind what we know about the prevalence of these conditions. In addition, most children and youth with identified disorders do not get adequate treatment. Conservative figures place prevalence of diagnosable mental health conditions as at least 20% of the pediatric population, rising with older age. Increasing stress on families also leads to more needs for prevention and mental health promotion. And the separation between mental and physical health ignores much evidence of the substantially higher rates of mental and behavioral health conditions among children and youth with physical health conditions (2–3 times the rates found among pediatric patients without physical health conditions).1,2 Some access problems reflect major limitations in the mental health workforce (far too few child psychiatrists, psychologists, developmental-behavioral pediatricians, and other mental health professionals). Workforce limitations in turn reflect the weak financial base for children’s mental health services, providing relatively few incentives for young people to enter the children’s mental … Address correspondence to James M. Perrin, MD, MassGeneral Hospital for Children, 125 Nashua St, #860, Boston, MA 02114. E-mail: jperrin{at}mgh.harvard.edu

The need for mental health care among children and adolescents in Iran, as in other low and middle income countries (LAMIC) remains mostly unmet. In this paper, we sought to provide an overview of the extent of unmet need and mental health services in Iran. We also aimed to propose approaches to address this gap. We reviewed the published epidemiologic studies of child and adolescent mental and behavioral health problems in Iran. We also examined the current status of child mental health services and the gaps between current needs and available services based on published literature that included papers published in scientific journals, as well as governmental and other administrative reports. The contextual issues relevant to child mental health care were also explored, as well as the possibilities to introduce new or scale up promising services. Child and adolescent mental and behavioral health problems are highly prevalent in Iran. Different studies have estimated that 16.7% to 36.4% of children and adolescents suffer from one or more mental health problems. However, there is a serious scarcity of resources to meet this need. Available services are delivered by independent public organizations (e.g., Ministry of Health, Welfare Organization, and Ministry of Education) or private sector with inefficient communication and collaboration among them and no mandatory national mental health policy. Available specialized child and adolescent services are mostly confined to small inpatient units and university outpatient facilities in larger cities, and there is a scarce evidence for the effectiveness of the available services. Expansion of primary care's role in timely detection and management of child and adolescent mental health problems, implementation of task-shifting and -sharing initiatives, as well as improved collaboration among responsible governmental and non-governmental sectors are some of the most promising future venues to improve mental health care for the Iranian youth.

Predictors of Likelihood and Intensity of Past-Year Mental Health Service Use in an Active Canadian Military Sample

There is limited empirical evidence on the extent to which perceived public stigma prevents individuals from using mental health services, despite substantial recent policy interest in this issue. This study investigated associations between perceived public stigma and mental health care seeking. This study used cross-sectional survey data from a representative sample of undergraduate and graduate students (N=2,782) at one university. A five-item scale was used to assess perceived public stigma toward mental health service use. Perceived need for help in the past 12 months and current presence of depressive and anxiety disorders were also assessed. Perceived stigma was higher among males, older students, Asian and Pacific Islanders, international students, students with lower socioeconomic status backgrounds, and students with current mental health problems. Perceived stigma was also higher among those without any family members or friends who had used mental health services and among those who believed that therapy or medication is not very helpful. Perceived stigma was negatively associated with the likelihood of perceiving a need for mental health services, but only among younger students. Among those with probable depressive or anxiety disorders, there was no evidence that perceived stigma was associated with service use. These results suggest that, at least in this population, perceived stigma may not be as important a barrier to mental health care as the mental health policy discourse currently assumes.

The Role of Providers in Mental Health Services Offered to American-Indian Youths