Prioritizing Public Mental Health

To perform scoping review of the existing literature available specific to child and adolescent mental health in Tanzania. An extensive literature search of PubMed, Scopus, MEDLINE and EMBASE was undertaken to identify studies that focussed specifically on mental illness in children and young people in Tanzania. This included neurological and functional disorders, affective disorders, psychosis, epidemiological, intervention and treatment-based studies. Qualitative analysis of the studies was then undertaken to assess what is currently known about the subject and how reliable this information is and to identify areas for further research. Of 23 studies were included in the final synthesis, which could be broadly split into studies focussing on the prevalence and incidence of child and adolescent mental illness, hypothesised causes and correlations, identified treatments and interventions and qualitative studies of human experience. There is a dearth of published research regarding child and adolescent mental health in Tanzania. Although some high-quality studies allow us good insight into the epidemiology of mental illness, interventional studies are often small and low-power, and significant correlational relationships are yet to be drawn. There is significant scope for further child and adolescent mental health research in Tanzania.

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.

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

To provide a model to estimate human resource needs for community-based mental health services in South Africa. A situation analysis was conducted of current community-based mental health service provision in South Africa, which comprise outpatient and emergency services, residential care and day care. Service utilisation rates and staffing needs were estimated for two levels of service coverage, using data from the situation analysis, local epidemiological studies and consultation with key stakeholders. For a population of 100,000 people, 7.3-23.8 full-time equivalent staff would be required to provide services in outpatient services, 14.9-41.6 in day care and 11.5-23.0 in residential care at minimum and full coverage levels respectively. The model can facilitate rational planning by requiring transparency and accountability in the assumptions used. This method can be adapted to a range of countries, by entering relevant country data. The model fills a gap, particularly in low- and middle-income countries, where community-based mental health services are sparse, and decisions regarding allocations to them are hampered by a lack of good quality data. The results of the model are limited by the quality of data and the assumptions upon which the modelling are based.

Individuals with serious mental illness often are unable to access consumer- and family-oriented community care, resulting in repeated hospitalizations, incarceration, and homelessness. The "medical home" concept was developed in primary care to provide accessible and accountable services for individuals with chronic medical conditions. Building on the work done in primary care, the authors propose a "mental health home." The model of care incorporates medical home characteristics, such as access to and coordination of services, integration of primary and preventive care, adoption of recovery orientation and evidence-based practices, and family and community outreach. Barriers to and strategies for implementation of mental health homes are discussed.

A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"

BackgroundThis study explores the impact of community-based health literacy interventions on the health and mental well-being of disadvantaged young Africans in Zambia, Sierra Leone, Rwanda, and South Africa. The pandemic has exacerbated mental health problems amongst children and young people, underscoring the urgent need for equitable access to mental healthcare resources. Emphasizing the importance of equitable access to mental healthcare resources, the research addresses educational and income disparities in low- and middle-income countries (LMICs), particularly amongst young Africans with disabilities or vulnerabilities.MethodsThe study comprised 1,624 young Africans, of whom 1,592 were surveyed, while 191 later participated in in-depth interviews and focus groups. Additionally, 32 participants exclusively joined focus groups. Participants were recruited to complete the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS), WHO-5 Well-being Index, Pandemic Anxiety Scale (PAS), and Self-rating of Happiness, as well as semi-structured interviews or focus groups.ResultsThe findings highlight the significance of tailored health literacy interventions in addressing mental health challenges and promoting well-being in marginalized African communities. In the sample, 43.1% (686) reported to have at least a physical disability or serious health condition and 51.4% (818) had special educational needs (SENs). Mental health scores were significantly lower in participants with two or more physical disabilities and pre-existing mental health problems. Factors significantly associated with poor mental health included poor health literacy, physical disabilities, and pre-existing mental health problems. Four main themes were generated from the thematic analysis: early childhood trajectories and mental illness experiences; positionality, open communication, and mental illness experience; mental illness experience, emotional honesty, and social stratification; and spirituality, cultural beliefs, and mental illness experience.ConclusionThe study emphasizes the need for context-specific, culturally appropriate health literacy interventions to support the mental health and well-being of young Africans in LMICs. By focusing on the lived experiences of disadvantaged groups, the research contributes to a better understanding of effective strategies for promoting health literacy and addressing health inequalities in African communities during and after health emergencies.

Among the leading causes of disability worldwide, mental health disorders account for 14% of the global disease burden. The burden is the same in Pakistan, where an estimated 24 million people are living with mental health conditions including depression and anxiety[1]. However, mental health is one of the least researched areas in public health, both locally and globally. Progress continues to be held back by stigma, lack of awareness and lack of resources which persistently widen the treatment gap. This needs a paradigm shift especially in the realm of mental health awareness and access to treatment as they become central pillars of global and national health initiatives[2]. The Unyielding Stigma: Stigma is an insidious barrier to help seeking behaviors and perpetuates this cycle of neglect. In Pakistan, cultural taboos and religious misconceptions of mental illness view it as a personal weakness or a result of supernatural forces, which discourages people from seeking professional help[3]. As in India, global studies show that fewer than 30 per cent of adolescents were able to identify depression, with just 1.3% identifying psychosis or schizophrenia as mental health conditions. Stigma not only prevents people from seeking care, but it also reinforces systemic inadequacies[4]. Reduction of stigma has been shown through educational interventions. In Pakistan, 'Taskeen' (mental health awareness campaign) have tried to normalize conversations around the mental health. In U.S. colleges, targeted education campaigns have had a big impact: attitudes towards mental illness have become much more positive, people feel less embarrassed, and they think it's less of an illness you can't cure. While such efforts need to be scaled up to reach rural and underserved populations, however, they are also addressing some of the most pressing concerns of the modern world[5]. Addressing the Treatment Gap: Despite this, there is an alarmingly high treatment gap—how much of the population living with mental illness receives care—of over 76% to 85% in low- and middle-income countries (LMICs) including Pakistan. Among the contributing factors are a disastrous dearth of trained professionals, with only one psychiatrist for every 100,000 people in Pakistan, a lack of integration of mental health into primary care, and the broken nature of service delivery[6]. These gaps have been addressed by Pakistan’s National Mental Health Programme as well as community-based initiatives. Community health workers, including "Lady Health Workers" trained to deliver mental health interventions in low resource settings, have successfully been task shifted for mental health[7]. Technology globally leads to scalable solutions for improved access and outreach, i.e. from telemedicine platforms like 'Sehat Kahani' in Pakistan to app-based tools. Mental health awareness is a cornerstone of education. In Pakistan, inclusion of mental health literacy into school curricula may help to normalize talk about mental health from a young age. Public figures speaking out about their mental health challenges, such as cricket star Shoaib Akhtar doing so, have shown how media can influence the way people think[8]. Higher education institutions also have a critical role to play globally. Researchers have also found that college course work in abnormal psychology increases awareness, as well as decreases stigmatization. Such programs can be expanded to all disciplines, creating a culture of understanding and early intervention[9]. Building Sustainable Solutions: The path forward requires a multi-pronged approach: Policy Integration: Mental health must be integrated into primary health care frameworks, and universal access must be provided in line with the guidance for governments. Mental health should be another non communicable disease added to Pakistan’s health policy[10]. Community Engagement: Community involvement to challenge stigma and culturally sensitive care should be considered a priority for grassroots programs. In Pakistan, one can reach out to religious leaders and others local influencers in order to bridge the cultural barriers[11]. Technological Innovation: Digital platforms and artificial intelligence can help closed the service delivery gap and offer data driven insights for policy making. For instance, platforms like “DoctHERS” in Pakistan have helped offering mental health services through telemedicine[12]. Funding and Research: Mental health research investment, particularly in LMICs, is essential to the production of context specific solutions and the scaling of evidence based interventions[11]. CONCLUSION Once, when the WHO’s first Director-General, D r. Brock Chisholm, said: “Mental health is the first step toward true physical health.” This, of course, is true to this day, especially in Pakistan where mental health challenges intersect so closely with societal, economic and cultural factors. There has been incremental progress, but the global and national communities have not fully recognized to what extent this scale of a mental health crisis. It is imperative that attention is put on awareness combined with robust and sustainable interventions. We need mental health to go beyond its current marginality and take up a place as a core domain of global and national health strategy. Stigma can only be dismantled by governments, policymakers, civil society, and investment in scalable solutions that achieve equitable access to care. If societies prioritize mental health, it helps not just individuals but also the social and economic fabric of societies. The time to act is now. We can only bridge the gap between the now and a healthier, more inclusive future if we do it collectively.

Low- and middle-income countries (LMICs) struggle with the highest burden of mental health disorders, along with an often unequal distribution of resources, including specialist care.1 This situation can translate into unequal access to mental health care in different regions within these countries. Also, and due to a multitude of reasons, referral patterns in LMICs are often a barrier to the timely provision of care for people with a mental disorder.2 The early identification and initial management of a mental disorder plays a significant role in determining its prognosis; hence, it is vital to establish prompt access to specialist care whenever necessary. In this letter, we would like to emphasize the importance of establishing a strong referral system for people with a mental disorder and the pivotal role that telecare could play in this regard. Telecare, in particular telepsychiatry, could assist with addressing existing mental healthcare access inequities in LMICs and prove useful in reducing time delays in the referral process. For example, eConsults or asynchronous electronic communications could allow specialized care to be relayed through the local healthcare provider (LHP) to the service user via electronic means. In an eConsult, the LHP sends the psychiatric provider a focused clinical question or a prerecorded video of an interview via email, which is then responded with a clear recommendation. This asynchronous electronic communication could reduce the gap between health professionals, assisting the LHP in providing mental healthcare locally, and expediting the referral process when necessary. Moreover, since patients tend to seek mental health care from their LHP, eConsults could improve the levels of adherence to this care.3 In situations where the psychiatric provider must lead the provision of care, interactive videoconferencing—or synchronous communications—can further complement local healthcare services. Interactive videoconferencing can enable the provision of specialized mental health care at a distance. It could be provided to clinically supervised settings—like mental health units or primary care services—or not clinically supervised settings—like a service user's home—without the need for the service user to move great distances to access the needed care. This service, along with the eConsults, could expedite access to specialized care when required while also allowing service users to continue accessing their local support networks. In summary, telepsychiatry could easily complement the existing network of mental healthcare delivery in LMICs and prove vital in reducing healthcare access inequities.4 There are, however, some challenges that may need to be addressed first, such as confidentiality and security limitations. In addition, not everybody will have the necessary resources and digital literacy to liaise with a psychiatric provider.5 It will be important to ensure the necessary technical conditions (e.g., internet, computer, or smartphone) are present. Funding also remains a challenge in LMICs, with many countries allocating less than 1% of their overall health budget to mental health.1 Also, providing mental health care that caters to the service user's cultural needs, particularly to the most vulnerable sectors of these countries, is of the utmost importance, and may require further training.6 Thus, access to the necessary resources, including human and material resources, and appropriate formal training should first be ensured to avoid contributing to existing inequities. To conclude, early diagnosis and treatment of mental health disorders is pivotal in mental health care. In contexts where there is unequal access to specialist care, as is often the case in LMICs, we recommend the adoption of telepsychiatry. Telepsychiatry, whether in the form of asynchronous or synchronous communications, could ensure easy access to specialist care and a swift referral process, thus securing timely access to specialized mental health care and reducing healthcare access inequities in LMICs. In LMICs, a high burden of mental health disorders is often met with an unequal distribution of resources, including psychiatric specialist care, a situation that translates into inequitable access to mental healthcare. Timely access to care has a substantial impact on the prognosis of a mental health disorder, and thus, it is imperative to address these inequities. Telepsychiatry could prove a valuable tool in this task, as it could help optimize resource allocation, enable access to specialist care at a distance, and allow a swift referral process. There may be some barriers ahead, such as access to funding and a need for further training in the use of telecommunication technologies and cultural responsiveness in the provision of telecare. Still, the integration of telepsychiatry in advanced psychiatric nursing practice could assist in reducing healthcare access inequities and improving clinical outcomes for the population. The authors declare that there are no conflict of interests.

Two years after SARS-COV-2 was declared a public health emergency, global estimates of excess deaths from the Institute for Health Metrics and Evaluation indicate that 18·2 million people died due to the pandemic by Dec 31, 2021—three times higher than official records suggest. 100 million people have been plunged into extreme poverty by the pandemic, according to World Bank estimates. While the true burden of COVID-19 is being unravelled, is a mental health crisis being unmasked? The pandemic has exposed long-standing gaps and a global underinvestment in mental health care and prevention, disproportionately affecting young people and women.

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.

The central place of psychiatry in health care worldwide.

IntroductionAustralians in rural and remote areas experience poorer health status compared with many metropolitan residents, due partly to inequitable access to primary health care (PHC) services. Building on recent research that identified PHC services which all Australians should be able to access regardless of where they live, this paper aims to define the population thresholds governing which PHC services would be best provided by a resident health worker, and to outline attendant implementation issues.MethodsA Delphi method comprising panellists with expertise in rural, remote and/or Indigenous PHC was used. Five population thresholds reflecting Australia’s diverse rural and remote geography were devised. Panellists participated in two electronic surveys. Using a Likert scale, they were asked at what population threshold each PHC service should be provided by a resident health worker. A follow-up focus group identified important underlying principles which guided the consensus process.ResultsResponse rates were high. The population thresholds for core PHC services provided by a resident worker were less in remote communities compared with rural communities. For example, the population threshold for ‘care of the sick and injured,’ was ≤100 for remote compared with 101–500 for rural communities. For ‘mental health’, ‘maternal/child health’, ‘sexual health’ and ‘public health’ services in remote communities the population threshold was 101–500, compared to 501–1000 for rural communities. Principles underpinning implementation included the fundamental importance of equity; consideration of social determinants of health; flexibility, effective expenditure of resources, tailoring services to ensure consumer acceptability, prioritising services according to need, and providing services as close to home as possible.ConclusionThis research can assist policy makers and service planners to determine the population thresholds at which PHC services should be delivered by a resident health worker, to allocate resources and provide services more equitably, and inform consumers about PHC services they can reasonably expect to access in their community.This framework assists in developing a systematic approach to strategies seeking to address existing rural–urban health workforce maldistribution, including the training of generalists as opposed to specialists, and providing necessary infrastructure in communities most in need.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-015-0228-1) contains supplementary material, which is available to authorized users.

Cancer Risk Factors Among Adults with Serious Mental Illness

Back to table of contents Previous article Next article Professional NewsFull AccessMHA Ranks States on Prevalence of MH Disorders, Access to CareLinda M. RichmondLinda M. RichmondSearch for more papers by this authorPublished Online:18 Dec 2018https://doi.org/10.1176/appi.pn.2018.12a16AbstractThe report concluded that far too many people are not receiving the services they need to live healthy and productive lives. The states that ranked highest overall on access to mental health care—with the lowest prevalence of mental illness—were Minnesota, Maine, Massachusetts, New Jersey, and Vermont, according to the “State of Mental Health in America 2019” report by Mental Health America (MHA).States were assigned an overall mental health ranking based on 15 measures involving prevalence of mental illness, including serious thoughts of suicide and substance use disorder, and access to care, including health insurance status, mental health coverage, and mental health workforce availability.The state that ranked lowest was Nevada, followed by Idaho, Oregon, Mississippi, and Alaska.Now in its fifth year, the annual report provides a snapshot of mental health status and access to care among youth and adults and monitors trends. The report analyzes national survey results from all 50 states and the District of Columbia from the Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention, as well as other state and federal sources.The report also ranked states based on their availability of “mental health providers,” defined as psychiatrists, psychologists, social workers, counselors, marriage/family therapists, and advanced practice nurses specializing in mental health care. In the top-ranked states, the ratio of state residents to mental health providers was close to 200 to 1 (Massachusetts, District of Columbia, Maine, Oregon, and Vermont), but in the lowest-ranked states there were at least four to six times as many residents for every provider (Alabama, Texas, West Virginia, Georgia, and Arizona).Key PointsOther findings in the Mental Health America report “State of Mental Health in America 2019” include the following:Adults with any mental health illness: 18 percentAdults with any mental illness who are uninsured: 12 percentAdults with a severe mental illness: 4 percentAdults with serious thoughts of suicide: 4 percentAdults who reported a past-year substance use disorder: 8 percentYouth who reported a past-year substance use disorder: 5 percentThe shortage of mental health providers has resulted in many individuals not accessing care or relying on emergency room services for psychiatric care. More than half of psychiatrists will reach retirement age within seven years, which could exacerbate the shortage if many of them decide to retire.“Integrating primary care and behavioral health services is key for early identification and intervention but is only part of the solution. Primary care providers cannot fill the void created by a lack of psychiatrists,” the MHA report noted.Twenty percent of adults with any mental illness were not able to receive the treatment they needed, and this number has not declined since 2011, MHA reported. Some barriers included cost of care, lack of insurance or limited coverage of mental health services, and a shortage of mental health providers.The report showed alarming increases in serious suicidal ideation among adults and major depression among youth. The number of adults reporting serious thoughts of suicide was more than 9.8 million (4 percent nationwide) this year, an increase of 200,000 people since 2017. Among young people, nearly 13 percent of youth had at least one past-year major depressive episode, up from 9 percent in 2017.“Despite mental health being something that more and more people are talking about, far too many people are still suffering,” said Paul Gionfriddo, MHA president and CEO. “People are simply not receiving the treatment they need to live healthy and productive lives—and too many don’t see a way out.”When it comes to unmet mental health needs, there was a wide disparity between the highest ranked states (Hawaii, Alabama, Texas, Nebraska, and Maine), where nearly 16 percent to 17 percent of adults reported unmet mental health care needs, and the lowest ranked states (Nevada, New Hampshire, Oregon, and Idaho) and the District of Columbia, where 25 percent to 26 percent did not receive needed services.The report also uncovered some good news: Under the Affordable Care Act, the U.S. continues to see a decline in the number of Americans who are uninsured, with a nearly 3 percent reduction from last year. In fact, 46 states reported a reduction in the number of adults with any mental illness who lack insurance. The largest reductions were seen in South Carolina, Missouri, Arkansas, and Arizona, all of which had a 6 percent to 7 percent decline in adults with mental illness who had no insurance coverage.Youth with mental illness seemed to fare far worse than adults when it came to access to care: Close to two-thirds of youth with major depression (62 percent) did not receive any mental health treatment, MHA reported. Only one-quarter of youth with severe depression receive consistent treatment, defined as seven to 21 visits in a year. Late recognition of mental illness in primary care settings and limited coverage of mental health services often prevent youth from receiving timely and effective treatment.Nationwide, less than 1 percent of students (0.8) were identified as having an Individual Education Program (IEP) for emotional disturbance (ED). “If states were doing a better job of identifying whether youth had emotional difficulties that could be better supported through an IEP, the average rate would be closer to 8 percent instead of 0.8 percent,” MHA wrote. “Early identification for IEPs is critical. IEPs provide the services and support students with ED need to receive a high-quality education.” The top five states (Vermont, Minnesota, Massachusetts, Wisconsin, and Pennsylvania) identified 15 students to 27 students per 1,000 as having an IEP for ED, and the lowest-performing five states (Alabama, Arkansas, Louisiana, Utah, South Carolina) identified 2 students to 4 students per 1,000.■The report, “The State of Mental Health in America 2019,” can be accessed here. ISSUES NewArchived