Increases in incidents involving so-called confused persons have brought attention to the potential costs of recent changes to public mental health (PMH) services in the Netherlands. Decentralized ...under the (Community) Participation Act (2014), local governments must find resources to compensate for reduced central funding to such services or "innovate." But innovation, even when pressure for change is intense, is difficult. This perspective paper describes experience during and after an investigation into a particularly violent incident and murder. The aim was to provide recommendations to improve the functioning of local PMH services. The investigation concluded that no specific failure by an individual professional or service provider facility led to the murder. Instead, also as a result of the Participation Act that severed communication lines between individuals and organizations, information sharing failures were likely to have reduced system level capacity to identify risks. The methods and analytical frameworks employed to reach this conclusion, also lead to discussion as to the plausibility of an unconventional solution. If improving communication is the primary problem, non-hierarchical information, and organizational networks arise as possible and innovative system solutions. The proposal for debate is that traditional "health system" definitions, literature and narratives, and operating assumptions in public (mental) health are 'locked in' constraining technical and organization innovations. If we view a "health system" as an adaptive system of economic and social "networks," it becomes clear that the current orthodox solution, the so-called integrated health system, typically results in a "centralized hierarchical" or "tree" network. An overlooked alternative that breaks out of the established policy narratives is the view of a 'health systems' as a non-hierarchical organizational structure or 'Open Network.' In turn, this opens new technological and organizational possibilities in seeking policy solutions, and suggests an alternative governance model of huge potential value in public health both locally and globally.
Community-based participatory media projects form a promising new strategy for mental health promotion that can help address the mental health-gap identified by the World Health Organization. (2008b) ...mhGAP, Mental Health Gap Action Programme: Scaling Up Care for Mental, Neurological and Substance Use Disorders. World Health Organization, Geneva. In this article we present an ethnographic study about a participatory media project that was developed to promote mental health in selected Dutch low socio-economic status neighborhoods. Through narrowcastings (group film viewings), participant observation and interviews we mapped the ways in which the media project effected and facilitated the collective sense-making process of the audience with regard to sources of stress impacting mental health and opportunities for action. These determinants of mental health are shaped by cultural dimensions, since the cultural context shapes everyday experiences of stress as well as the resources and skills to manage them. Our analysis shows that the media project engaged cultural resources to challenge stressful social scripts. We conclude that more attention should be paid to cultural narratives in a community to understand how health promotion strategies can support social resilience.
This article offers a critical analysis of how to address social inequalities in mental health. In public mental health, inequalities are commonly construed as a problem of reach, implying that ...existing mental health expertise often fails to reach low-income groups. We discuss two critiques on the 'reach-paradigm' in mental health promotion: the impoverishment of idioms of distress and the tendency to transform complex political issues into clinical ones that are assumed to be backed by evidence. Furthermore, we present the findings of our ethnographic research of an alternative approach to mental health promotion that used media storytelling focused on local knowledge and social context. Our analysis is guided by anthropological research on idioms of distress and sociological literature on health promotion and social inequalities.
Most of the street-based children are not educated beyond primary school and their living conditions are based on begging and doing odd jobs in the market and streets. Forty-six percent of the ...on-the-street children live with one parent, and 97 percent of the of-the-street children have lost contact with their parents. The on-the-street children have a higher percentage of family sector networks than the of-the-street children and the shelter or institutionalized children. Generally, school children still have strong family ties.
Street children are a high priority for health policy and service planning in Kenya. Poverty, wars, famine and disease have resulted in street children having a persistent presence in African cities ...and towns. The Maastricht Social Network Analysis (MSNA) was implemented as the core instrument in a battery to measure the health status of the street children. Owing to the absence of census data of street children in Kenya and the difficulty in tracking this mobile population, we implemented a mixed snowball and convenience sampling design to recruit research subjects. Three hundred street and orphanage children, and 100 primary school children as a control group, were included in the study. The MSNA provided a social diagnosis that complements the clinical diagnosis of the health status of the sample. Only one main methodological question is presented: is the MSNA applicable to describe the personal social networks of (1) children and of (2) people living in a Kenyan culture? Qualitative field observations, key informant interviews and focus groups inform the adaptation of the MSNA instrument, and improve its face validity. A case series analysis is presented. The main result is that the street children population consists of distinct subgroups defined by the UNICEF classification as ‘on’ and ‘of’ the street and by gender. Street children networks have some notable deficiencies depending on the subgroup. Constant across the groups is the deficiency of service providers in their networks. The conclusion is that the MSNA is a suitable instrument for obtaining a social diagnosis and gathering other useful information that helps in understanding the social and health backgrounds, status and daily experiences of Kenyan scavenging street children. Applying the MSNA protocol was successful in the diagnosis and interpretation of the findings.
This paper reviews aspects of Letten F. Saugstad's Maturation Theory in relation to the Kraepelinian dichotomy and psychiatric classification. The maturation theory is based on existing neuroscience, ...cross-national and mental health case register data and offers an innovative alternative to current etiological formulations. The maturational theory holds (1) that manic depressive illness relates to early maturation and (2) the schizophrenic syndrome relates to late maturation. The foundation of these processes lies in cerebral pruning of excitatory synapses particularly at puberty but also at a number of earlier crucial periods in development. The process of synaptic pruning has by puberty eliminated some 40% of the synapses, leading to the disappearance of glutematergic excitatory synapses without apparently appreciably influencing inhibitory GABAergic neurons. As a consequence, early maturation is related to the manic-depressive syndrome and characterized by increased neural excitability. Conversely, late maturation is related to schizophrenia characterized by diminished neural activity. Saugstad demonstrates using cross-national and neuroscience studies the multifactoral and environmental influences on rates of maturation and thereby mental illness. Using these data Saugstad reasons her agreement with the Kraepelinian dichotomy based on the existence of two extremes in brain structure and function developed through interactions between the person and the environment.
Major depressive disorder (MDD) is characterized by high negative affect (NA) and low positive affect (PA), but little is known about emotional reactivity in daily life. The authors used experience ...sampling methodology to investigate changes in NA and PA following minor daily events in MDD compared with healthy participants. Contrary to expectation, MDD participants did not report more frequent negative events, although they did report fewer positive events. Multilevel regression showed that both NA and PA responses to negative events were blunted in the MDD group, whereas responses to positive events were enhanced. NA responses to negative events persisted longer in MDD participants. Depressed participants with a positive family history or longer current episodes showed relatively greater NA responses to negative events.
How can we enhance activation? Studying should be a challenging, yet rewarding activity for students who intend to graduate. The Flow theory (Csikszentmihalyi, 1990, 1997) predicts that differential ...levels of perceived challenge and skill (flow) are related to optimized mental states and increased activation. However, the influence of concurrent mental states and specific environmental cues for this state of optimal experience is unknown. In this study we explore the contextual and subjective determinants of flow in relation to activation in studying, and compare this with sports and watching TV or listening to the radio. Method: 43 undergraduate students at the University of Maastricht were assessed with the Experience Sampling Method for one week (Delespaul, 1995). At random moments 10 times each day subjects evaluated the social context, activities, and mood states. Analyses were done with multilevel random regression techniques. Results: We replicated the predicted flow-related patterns in activation and emotions. While overall activation was increased in high challenging moments (β = 0.51; 95% CI: 0.36, 0.19), this effect was less pronounced during study (β = -0.16; 95% CI: -0.25, -0.07). Skills levels did not affect activation (β = -0.01; 95% CI: -0.06, 0.05). Concurrent emotions were independently and additionally related to activation (Δχ2(4) = 117.12, p < 0.0001). Unexpectedly, activation increased with demotivation (β = -0.12; 95% CI: 0.16, 0.07). We found highly significant and additional effects of context for all the activities (study: χ2 = 732.63; p < 0.0001; R2 = 0.30; active leisure: χ2 = 753.40; p < 0.0001; R2 = 0.31; and passive leisure: χ2 = 555.86; p < 0.0001; R2 = 0.24). Conclusions. The Flow theory is a valuable model leading to predictions of optimal experience as well as activation. However, the dynamics of activity engagement are more complex and related to concurrent emotions and context. In the Dutch student culture, escaping boredom or compulsory duties seems to drive individuals more than pursuing flow.
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