Mental health

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.

Objective:Child abuse can have devastating mental health consequences. Fortunately, not all individuals exposed to child abuse will suffer from poor mental health. Understanding what factors are related to good mental health following child abuse can provide evidence to inform prevention of impairment. Our objectives were to 1) describe the prevalence of good, moderate, and poor mental health among respondents with and without a child abuse history; 2) examine the relationships between child abuse and good, moderate, and poor mental health outcomes; 3) examine the relationships between individual- and relationship-level factors and better mental health outcomes; and 4) determine if individual- and relationship-level factors moderate the relationship between child abuse and mental health.Method:Data were from the nationally representative 2012 Canadian Community Health Survey: Mental Health (n = 23,395; household response rate = 79.8%; 18 years and older). Good, moderate, and poor mental health was assessed using current functioning and well-being, past-year mental disorders, and past-year suicidal ideation.Results:Only 56.3% of respondents with a child abuse history report good mental health compared to 72.4% of those without a child abuse history. Individual- and relationship-level factors associated with better mental health included higher education and income, physical activity, good coping skills to handle problems and daily demands, and supportive relationships that foster attachment, guidance, reliable alliance, social integration, and reassurance of worth.Conclusions:This study identifies several individual- and relationship-level factors that could be targeted for intervention strategies aimed at improving mental health outcomes following child abuse.

Addressing mental health needs: an integral part of COVID-19 response.

To examine the separate and joint associations of physical activity and levels of physical, mental, and social health with long-term all-cause and cardiovascular disease (CVD) mortality in older adults. A cohort of 4008 individuals representative of the non-institutionalized population of Spain aged 60years and older was analyzed. Information on physical activity was self-reported. Physical and mental health were assessed with the SF-36 questionnaire, and social health with a 4-item score on network structure and social engagement. Participants were categorized as being in a good, intermediate, or poor health according to tertiles of the score in each health dimension. Analyses were performed with Cox regression and adjusted for main confounders, including levels in the other two health dimensions. Over a median follow-up of 14 years, a total of 1811 deaths occurred, 674 due to CVD. Hazard ratios (95% confidence interval) for all-cause mortality were 1.35 (1.18-1.55), 1.18 (1.02-1.36), and 1.37 (1.18-1.58) for poor vs. good physical, mental, and social health, respectively (all p trend < 0.001). Being physically active was associated with a 28% (15-39%), 31% (19-42%), and 19% (5-31%) lower all-cause mortality in participants with poor physical, mental, and social health, respectively. In each health dimension, physically active individuals with poor health showed a similar or lower all-cause mortality than those who had intermediate or good health but were physically inactive. Results for CVD mortality were similar to those for all-cause death. Physical activity might attenuate the excess all-cause and CVD mortality associated with poor physical, mental, and social health.

Back to table of contents Previous article Next article Government NewsFull AccessSenate Committee Solicits Input on State of MH SystemLeslie SinclairLeslie SinclairSearch for more papers by this authorPublished Online:15 Mar 2013https://doi.org/10.1176/appi.pn.2013.3b13AbstractExperts tell a Senate committee that the mental health system is overburdened, many patients don’t get needed help, and earlier and improved detection could change that reality.The Senate Health, Education, Labor, and Pensions (HELP) Committee, convened a meeting January 24 to discuss—for the first time in six years—the mental health of Americans. Prompted by the Newtown, Conn., school shooting and in anticipation of the changes the Affordable Care Act will bring about, committee members solicited input at the hearing they dubbed “Assessing the State of America’s Mental Health System.”“It seems to me that the questions before us are ‘who needs help’ and ‘who’s there to provide the help’,” said Sen. Lamar Alexander (R-Tenn.), the committee’s ranking member.Pamela Hyde, J.D., administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), was the first to provide testimony. “Behavioral health is a public-health issue, not a social issue, and it can be tackled and addressed with an effective public-health approach,” she said, while noting that SAMHSA’s National Survey on Drug Use and Health indicates that only 38 percent of adults with diagnosable mental health problems and only 11 percent of those with diagnosable substance use disorders receive treatment.“Prevention works, treatment is effective, and people do, in fact, recover,” she stressed, but obstacles including cost, access, and recognition of mental health disorders are the primary reasons treatment is not received by many who need it. Hyde pointed to upcoming changes associated with the Affordable Care Act that will extend the reach of mental health treatment to more Americans, saying “Medicaid is already the largest payer of mental health services, and the Affordable Care Act will extend Medicaid coverage to as many as 17 million hardworking Americans.”Thomas Insel, M.D., director of the National Institute of Mental Health (NIMH), also presented testimony and emphasized that most mental disorders begin early in life, yet patients often wait years for diagnosis and treatment. “The lesson we have learned from cancer and heart disease, diabetes and AIDS, is that the secret to having the best outcomes is early detection and early intervention…yet we don’t do that.” Moving forward, NIMH will support research on earlier diagnosis and quicker delivery of appropriate treatment, be it behavioral or pharmacological, he said. Medical Director James H. Scully Jr., M.D., submitted testimony on behalf of APA. “This hearing comes at a critical time when our leaders in government are faced with difficult choices about where to allocate limited resources,” he noted. “Nevertheless, I believe the current state of our nation’s mental health system is weak and demands immediate and significant attention by Congress and the administration.” Scully’s testimony presented five key areas through which the mental health system could be strengthened to ensure the mental health and well-being of all Americans:Mental Health Parity. APA urges issuance of a final rule on the Mental Health Parity and Addiction Equity Act of 2008. In the absence of a final rule, APA is concerned that access to critical mental health services will be jeopardized for millions of Americans. APA also supports reintroduction of the Medicare Mental Health Inpatient Equity Act, which would increase access to coverage for the most seriously mentally ill people. A Commission on Mental Health. APA supports the idea of a new commission—either presidential or congressional—to conceptualize how the nation’s mental health system can meet the needs of all Americans. Investing in Existing Mental Health System Components. APA supports investment in biomedical research, initiatives to develop and implement new treatments for addiction, and state block grants for mental health and substance use activities, suicide prevention, and jail-diversion programs for people with mental illness. Support for Graduate Medical Education. The ability of the U.S. mental health system to deliver high-quality care in a coordinated and cost-effective manner is dependent upon an appropriately trained workforce. As a physician specialty society, APA strongly supports the preservation of funding for both direct graduate medical education and indirect graduate medical education, programs that support 16,000 residencies each year. Early Intervention and Prevention Services for Youth. As a vulnerable population, children and adolescents are especially in need of early intervention and prevention services.Scully also brought to the committee’s attention the initiative APA launched through the American Psychiatric Foundation, called “Typical or Troubled?,” to train school personnel to make the distinction between students who are “just being adolescents” and students who demonstrate early signs of mental illness, saying “this program represents the type of early intervention and prevention strategy that could serve as a national model.” ■A video of the committee hearing as well as written testimony are posted at http://www.help.senate.gov/hearings/hearing/?id=b2048a10-5056-a032-529c-340d7ae5f237. Scully’s testimony is posted at http://www.psychiatry.org/advocacy--newsroom/advocacy/apa-submits-testimony-to-congress-on-the-state-of-americas-mental-health-system. ISSUES NewArchived

Meso-level Comparison of Mental Health Service Availability and Use in Chile and Spain

There has been increased global concern about the human rights violations experienced by people with mental disorders. The aim of this study was to analyse Uganda's mental health care system through a human rights lens. A survey of the existing mental health system in Uganda was conducted using the WHO Assessment Instrument for Mental Health Systems. In addition, 62 interviews and six focus groups were conducted with a broad range of mental health stakeholders at the national and district levels. Despite possessing a draft mental health policy that is in line with many international human rights standards, Uganda's mental health system inadequately promotes and protects, and frequently violates the human rights of people with mental disorders. The mental health legislation is offensive and stigmatizing. It is common for people accessing mental health services to encounter physical and emotional abuse and an inadequate quality of care. Mental health services are inequitably distributed. Within Ugandan society, people with mental disorders also frequently experience widespread stigma and discrimination, and limited support. Promoting and protecting the rights of people with mental disorders has ethical and public health imperatives. A number of policy, legislative and service development initiatives are required.

Background: COVID-19 prevention and mitigation efforts were abrupt and challenging for most countries with the protracted lockdown straining socioeconomic activities. Marginalized groups and individuals are particularly vulnerable to adverse effects of the pandemic such as human rights abuses and violations which can lead to psychological distress. In this review, we focus on mental distress and disturbances that have emanated due to human rights restrictions and violations amidst the pandemic. We underscore how mental health is both directly impacted by the force of pandemic and by prevention and mitigation structures put in place to combat the disease.Methods: We conducted a review of relevant studies examining human rights violations in COVID-19 response, with a focus on vulnerable populations, and its association with mental health and psychological well-being. We searched PubMed and Embase databases for studies between December 2019 to July 2020. Three reviewers evaluated the eligibility criteria and extracted data.Results: Twenty-four studies were included in the systematic inquiry reporting on distress due to human rights violations. Unanimously, the studies found vulnerable populations to be at a high risk for mental distress. Limited mobility rights disproportionately harmed psychiatric patients, low-income individuals, and minorities who were at higher risk for self-harm and worsening mental health. Healthcare workers suffered negative mental health consequences due to stigma and lack of personal protective equipment and stigma. Other vulnerable groups such as the elderly, children, and refugees also experienced negative consequences.Conclusions: This review emphasizes the need to uphold human rights and address long term mental health needs of populations that have suffered disproportionately during the pandemic. Countries can embed a proactive psychosocial response to medical management as well as in existing prevention strategies. International human rights guidelines are useful in this direction but an emphasis should be placed on strengthening rights informed psychosocial response with specific strategies to enhance mental health in the long-term. We underscore that various fundamental human rights are interdependent and therefore undermining one leads to a poor impact on the others. We strongly recommend global efforts toward focusing both on minimizing fatalities, protecting human rights, and promoting long term mental well-being.

In British Columbia (BC), Canada, mental health reforms over the last decade have moved back and forth between calls for practices that restrict human rights and those that are rooted in equity and social justice. In this article, we explore some of these tensions and their implications for human rights and equity in mental health care by critically analyzing three policies guiding mental health reform in BC using an intersectionality-based policy framework. Specifically, we interrogate the effects of a biomedical and individualized framing of mental health and substance use. We argue that such a framing is buttressed by neoliberal ideology and lays the groundwork for public and professional acceptance of coercive practices with particular consequences for Indigenous and racialized populations. This framing is juxtaposed with a holistic wellness and trauma-informed policy framework anchored by an understanding of the impact of colonization. However, what is missing in both policy framings is a full account of the documented ongoing human rights violations experienced by many people accessing BC’s mental health system. Our analysis shows how applying an intersectionality-based policy framework allows for a deeper exploration of the complex, interlocking systems of power and oppression that give rise to these human rights violations. We conclude with a discussion of the important role that decolonizing and intersectional approaches play for capturing the complexities of systemic inequities and advancing mental healthcare that protects and promotes mental wellbeing and human rights.

In August 2006, a year after Hurricane Katrina, the first acute inpatient public psychiatric unit for adults was opened in New Orleans to serve patients referred from local emergency departments. This article describes the clinical and administrative experiences of providing inpatient care in post-Katrina New Orleans, including the increased demand for programs to treat patients with co-occurring disorders, the expanded scope of practice for psychiatrists to include primary care, and ongoing staff shortages in a traumatized and displaced workforce. Lessons learned in regard to disaster planning and recovery are also discussed.

The likelihood of arrest appeared substantial among persons with severe mental illness, but the bulk of offending appeared concentrated in a small group of persons and among persons with sociodemographic features similar to those of offenders in the general population. Data such as these could provide a platform for designing jail diversion and other services to reduce both initial and repeat offending among persons with serious mental illness.

Report Calls for Overhaul Of Crippled MH System

Barriers to Recovery and Recommendations for Change: The Pennsylvania Consensus Conference on Psychiatry's Role

Good mental health is the foundation of children and young people's emotional and intellectual growth, underpinning the development of confidence, independence and a sense of self worth which is vital to their future. However, today one in 10 children aged between five and 16 years have a clinically diagnosable mental health problem and research shows that these children and young people have the poorest life chances of any group of young people.The most recent national survey of mental health among children and young people in Britain was carried out over a decade ago. The 2004 report by the Office for National Statistics, published by the Health and Social Care Information Centre,1 revealed high levels of mental health problems, including depression, stress and anxiety, psychosis, eating disorders and self-harm.The period of time that has elapsed since this last survey suggests that, despite the worrying statistics it contains, insufficient attention has been paid to the mental health of this age group. The government's recent pledge of £1.25 billion by 2020 to support improvements in children and young people's mental health and wellbeing, along with £150 million for eating disorder services, is evidence of a sea-change.The ambition over the next five years for children and young people's mental health, according to National Health Service (NHS) England, is to support clinical commissioning groups (CCGs) to work with partners to build effective, evidence-based outcome-focused Child and Adolescent Mental Health Services (CAMHS), working in collaboration with children, young people and families.Meanwhile, according to the Mental Health Foundation,2 one of the 'most obvious, yet under-recognised factors in the development of major trends in mental health is the role of nutrition'. The charity points to a body of evidence 'growing at a rapid pace' suggesting that good nutrition is essential for mental health and that a number of mental health conditions may be influenced by dietary factors.It says,As well as its impact on short and long-term mental health, the evidence indicates that food plays an important contributing role in the development, management and prevention of specific mental health problems such as depression, schizophrenia, attention deficit hyperactivity disorder.The Foundation adds that nearly twothirds of those who do not report daily mental health problems eat fresh fruit or fruit juice every day, compared with less than half of those who do report daily mental health problems. This pattern is similar for fresh vegetables and salad. Those who report some level of mental health problem also eat fewer healthy foods (fresh fruit and vegetables, organic foods and meals made from scratch) and more unhealthy foods (chips and crisps, chocolate, ready meals and takeaways).Rethink Mental Illness3 further suggests that the increase in use of many additives, food colourings and processed foods - alongside the general rush to eat meals, often while running between different activities - have all played a role in unhealthy eating. These changes, it says, have been linked to some people experiencing mood changes, being irritable and being unable to concentrate.While both the findings of the Mental Health Foundation and Rethink are referring to the population at large, rather than children and young people specifically, a 2012 systematic review of 12 epidemiological studies to determine whether an association exists between diet quality and patterns and mental health in children and adolescents found evidence of a 'significant, cross-sectional relationship between unhealthy dietary patterns and poorer mental health in children and adolescents'.4 The authors observed a consistent trend for the relationship between good-quality diet and better mental health and 'some evidence for the reverse'.While healthy eating has been shown to impact positively on the mental health of children and young people, the relationship between physical activity and general aspects of psychological wellbeing, self esteem and the management of anxiety and depression and behaviour is also well documented. …

10.1176/appi.ps.59.1.105