The mental health treatment gap-the difference between those with mental health need and those who receive treatment-is high in low- and middle-income countries. Task-shifting has been used to ...address the shortage of mental health professionals, with a growing body of research demonstrating the effectiveness of mental health interventions delivered through task-shifting. However, very little research has focused on how to embed, support, and sustain task-shifting in government-funded systems with potential for scale up. The goal of the Building and Sustaining Interventions for Children (BASIC) study is to examine implementation policies and practices that predict adoption, fidelity, and sustainment of a mental health intervention in the education sector via teacher delivery and the health sector via community health volunteer delivery.
BASIC is a Hybrid Type II Implementation-Effectiveness trial. The study design is a stepped wedge, cluster randomized trial involving 7 sequences of 40 schools and 40 communities surrounding the schools. Enrollment consists of 120 teachers, 120 community health volunteers, up to 80 site leaders, and up to 1280 youth and one of their primary guardians. The evidence-based mental health intervention is a locally adapted version of Trauma-focused Cognitive Behavioral Therapy, called Pamoja Tunaweza. Lay counselors are trained and supervised in Pamoja Tunaweza by local trainers who are experienced in delivering the intervention and who participated in a Train-the-Trainer model of skills transfer. After the first sequence completes implementation, in-depth interviews are conducted with initial implementing sites' counselors and leaders. Findings are used to inform delivery of implementation facilitation for subsequent sequences' sites. We use a mixed methods approach including qualitative comparative analysis to identify necessary and sufficient implementation policies and practices that predict 3 implementation outcomes of interest: adoption, fidelity, and sustainment. We also examine child mental health outcomes and cost of the intervention in both the education and health sectors.
The BASIC study will provide knowledge about how implementation of task-shifted mental health care can be supported in government systems that already serve children and adolescents. Knowledge about implementation policies and practices from BASIC can advance the science of implementation in low-resource contexts.
Trial Registration: ClinicalTrials.gov Identifier: NCT03243396. Registered 9th August 2017, https://clinicaltrials.gov/ct2/show/NCT03243396.
Adolescents living in low-resource settings lack access to adequate psychological care. The barriers to mental health care in low- and middle-income countries (LMIC) include high disease burden, low ...allocation of resources, lack of national mental health policy and child and adolescent mental health (CAMH) professionals and services, poverty, illiteracy and poor availability of adolescent friendly health services. WHO has recommended a stepped task shifting approach to mental health care in LMIC. Training of non-mental health specialists like peers, teachers, community health workers, paediatricians and primary care physicians by CAMH and framing country-specific evidence-based national mental health policies are vital in overcoming barriers to psychological care in LMIC. Digital technology and telemedicine can be used in providing economical and accessible mental health care services to adolescents.
The coronavirus disease 2019 (COVID-19) is profoundly affecting life around the globe. Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment ...in affected countries. These measures have the potential to threaten the mental health of children and adolescents significantly. Even though the current crisis can bring with it opportunities for personal growth and family cohesion, disadvantages may outweigh these benefits. Anxiety, lack of peer contact and reduced opportunities for stress regulation are main concerns. Another main threat is an increased risk for parental mental illness, domestic violence and child maltreatment. Especially for children and adolescents with special needs or disadvantages, such as disabilities, trauma experiences, already existing mental health problems, migrant background and low socioeconomic status, this may be a particularly challenging time. To maintain regular and emergency child and adolescent psychiatric treatment during the pandemic is a major challenge but is necessary for limiting long-term consequences for the mental health of children and adolescents. Urgent research questions comprise understanding the mental health effects of social distancing and economic pressure, identifying risk and resilience factors, and preventing long-term consequences, including-but not restricted to-child maltreatment. The efficacy of telepsychiatry is another highly relevant issue is to evaluate the efficacy of telehealth and perfect its applications to child and adolescent psychiatry.
There are numerous mental health threats associated with the current pandemic and subsequent restrictions. Child and adolescent psychiatrists must ensure continuity of care during all phases of the pandemic. COVID-19-associated mental health risks will disproportionately hit children and adolescents who are already disadvantaged and marginalized. Research is needed to assess the implications of policies enacted to contain the pandemic on mental health of children and adolescents, and to estimate the risk/benefit ratio of measures such as home schooling, in order to be better prepared for future developments.
Major depressive disorder (MDD) is a leading cause of disability worldwide.
To examine the: (a) 12-month prevalence of DSM-IV MDD; (b) proportion aware that they have a problem needing treatment and ...who want care; (c) proportion of the latter receiving treatment; and (d) proportion of such treatment meeting minimal standards.
Representative community household surveys from 21 countries as part of the World Health Organization World Mental Health Surveys.
Of 51 547 respondents, 4.6% met 12-month criteria for DSM-IV MDD and of these 56.7% reported needing treatment. Among those who recognised their need for treatment, most (71.1%) made at least one visit to a service provider. Among those who received treatment, only 41.0% received treatment that met minimal standards. This resulted in only 16.5% of all individuals with 12-month MDD receiving minimally adequate treatment.
Only a minority of participants with MDD received minimally adequate treatment: 1 in 5 people in high-income and 1 in 27 in low-/lower-middle-income countries. Scaling up care for MDD requires fundamental transformations in community education and outreach, supply of treatment and quality of services.
The rapid growth in the use of mobile phone applications (apps) provides the opportunity to increase access to evidence-based mental health care.
Our goal was to systematically review the research ...evidence supporting the efficacy of mental health apps for mobile devices (such as smartphones and tablets) for all ages.
A comprehensive literature search (2008-2013) in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, PsycINFO, PsycTESTS, Compendex, and Inspec was conducted. We included trials that examined the effects of mental health apps (for depression, anxiety, substance use, sleep disturbances, suicidal behavior, self-harm, psychotic disorders, eating disorders, stress, and gambling) delivered on mobile devices with a pre- to posttest design or compared with a control group. The control group could consist of wait list, treatment-as-usual, or another recognized treatment.
In total, 5464 abstracts were identified. Of those, 8 papers describing 5 apps targeting depression, anxiety, and substance abuse met the inclusion criteria. Four apps provided support from a mental health professional. Results showed significant reductions in depression, stress, and substance use. Within-group and between-group intention-to-treat effect sizes ranged from 0.29-2.28 and 0.01-0.48 at posttest and follow-up, respectively.
Mental health apps have the potential to be effective and may significantly improve treatment accessibility. However, the majority of apps that are currently available lack scientific evidence about their efficacy. The public needs to be educated on how to identify the few evidence-based mental health apps available in the public domain to date. Further rigorous research is required to develop and test evidence-based programs. Given the small number of studies and participants included in this review, the high risk of bias, and unknown efficacy of long-term follow-up, current findings should be interpreted with caution, pending replication. Two of the 5 evidence-based mental health apps are currently commercially available in app stores.
The book provides a foundation of knowledge on the social and environmental underpinnings of mental health and mental illnesses for clinical and policy decision making, with a goal to improve the ...mental health of individuals across diverse communities and the mental health of the nation.
Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative ...framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using frame-work analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries.
La mauvaise gouvernance a été identifiée comme un obstacle à l’intégration effective des soins de santé mentale dans les pays à revenu faible ou à revenu intermédiaire. La gouvernance comprend le cadre politique et législatif nécessaire pour promouvoir et protéger la santé mentale d’une population, ainsi que l’élaboration d’un système de santé et d’assurance de qualité afin d’assurer une mise en œuvre optimale des politiques. L’objectif de la présente étude est d’identifier les principaux défis, les besoins et les stratégies potentielles de gouvernance qui peuvent faciliter une intégration adéquate de la santé mentale dans les établissements de soins de santé primaires des pays à revenu faible ou à revenu intermédiaire. Des entrevues qualitatives avec des témoins privilégiés ont été réalisées avec 141 personnes dans six pays protagonistes du programme de recherche sur les systèmes émergents de santé mentale dans les pays à revenu faible ou intermédiaire (Emerald): l’ Éthiopie, l’Inde, le Népal, le Nigeria, l’Afrique du Sud et l’Ouganda. Les données ont été transcrites (et, le cas échéant, traduites en anglais) et analysées thématiquement à l’aide de l’analyse du cadre, d’abord au niveau des pays, puis synthétisées au niveau transfrontalier. Si tous les pays ont obtenu des résultats positifs en ce qui concerne la vision stratégique sous forme de mise œuvre de politiques nationales de santé mentale, les principales stratégies de gouvernance identifiées pour relever les défis sont les suivantes: renforcement des capacités des gestionnaires aux niveaux infranationaux afin d’élaborer et de mettre en œuvre des plans intégrés; consolidation des aspects clés des blocs essentiels du système de santé pour promouvoir la réactivité, l’efficacité et la productivité; développement de mécanismes efficaces de collaboration intersectorielle, ainsi que l’engagement de la communauté et des utilisateurs des services; et développement de modèles d’approches novatrices pour mieux se familiariser à la santé mentale et réduire la stigmatisation. L’insuffisance des financements constitue le plus grand défi à la bonne gouvernance. Outre la nécessité d’une bonne gouvernance globale du système de soins de santé, la présente étude identifie un certain nombre de stratégies spécifiques permettant d’améliorer la gouvernance des soins intégrés de santé mentale dans les pays à revenu faible ou à revenu intermédiaire.
治理不善是中低收入国家实现精神卫生保健有效整合的障 碍。治理包括提供必要的政策和法律框架来促进和保护人群 精神卫生, 以及通过卫生体系设计和质量保证来确保最佳政策 实施。本研究目的是辨明关键的治理挑战、需求和潜在策略, 有助于中低收入国家将精神卫生整合至初级保健中。关键知 情人定性访谈的对象共141名, 均参与了中低收入国家新兴精 神卫生体系 （Emerald） 研究项目。这些访谈对象来自六个 国家：埃塞俄比亚、印度、尼泊尔、尼日利亚、南非和乌干 达。转录访谈数据 （必要时翻译成英文）, 采用框架分析方法 分析主题, 首先进行国家层面分析, 然后整合至跨国家分析。 在战略方面, 所有国家均表现良好, 制定了全国精神卫生政策, 关键的治理策略解决以下问题：加强地方管理者制定和实施 整合规划的能力；强化基本卫生体系模块的关键部分, 以提高 反应性、效率和有效性；建立可操作的部门间合作机制, 提高 社区和服务使用者参与度；形成创新方法, 提高精神卫生知识 水平, 减少污名化。研究显示筹资不足是治理的最大挑战。除 卫生保健体系整体治理良好外, 本研究还明确了一些中低收入 国家改善治理、整合精神卫生保健的具体策略。
La mala gobernanza ha sido identificada como una barrera para la integración efectiva de la atención de salud mental en los países de ingresos bajos y medios. La gobernanza incluye proporcionar el marco político y legislativo necesario para promover y proteger la salud mental de una población, así como el diseño del sistema de salud y la garantía de la calidad para asegurar una implementación óptima de políticas. El objetivo de este estudio fue identificar los desafíos, necesidades y estrategias claves de la gobernanza, que podrían facilitar la integración adecuada de la salud mental en la atención primaria en los países de ingresos bajos y medios. Se realizaron entrevistas cualitativas con 141 informantes claves de seis países participantes en el programa de investigación de los sistemas emergentes de salud mental en países de bajos y medios ingresos (‘Emerald’): Etiopía, India, Nepal, Nigeria, Sudáfrica y Uganda. Los datos se transcribieron (y donde fue necesario, traducidos al inglés) y se analizaron temáticamente usando el análisis del marco, primero a nivel de país, luego se sintetizaron entre países. Si bien todos los países obtuvieron buenos resultados con respecto a la visión estratégica en la forma de desarrollo de las políticas nacionales de salud mental, las estrategias claves de gobernanza identificadas para abordar los desafíos incluyeron: el fortalecimiento de la capacidad de los gerentes a niveles subnacionales para desarrollar e implementar los planes integrados; el fortalecimiento de los aspectos claves de los elementos esenciales del sistema de salud para promover la capacidad de respuesta, la eficiencia y la eficacia; el desarrollo de mecanismos viables para la colaboración intersectorial, así como el compromiso de los usuarios en la comunidad y los servicios; y el desarrollo de enfoques innovadores para mejorar la alfabetización en salud mental y la reducción del estigma. Una financiación inadecuada surgió como el mayor desafío para la buena gobernanza. Además de la necesidad general de una buena gobernanza de un sistema de salud, este estudio identifica una serie de estrategias específicas para mejorar la gobernanza de la atención integral de salud mental en los países de ingresos bajos y medios.
Zones of social abandonment are emerging everywhere in Brazil’s big cities—places like Vita, where the unwanted, the mentally ill, the sick, and the homeless are left to die. This haunting, ...unforgettable story centers on a young woman named Catarina, increasingly paralyzed and said to be mad, living out her time at Vita. Anthropologist João Biehl leads a detective-like journey to know Catarina; to unravel the cryptic, poetic words that are part of the “dictionary” she is compiling; and to trace the complex network of family, medicine, state, and economy in which her abandonment and pathology took form. An instant classic, Vita has been widely acclaimed for its bold fieldwork, theoretical innovation, and literary force. Reflecting on how Catarina’s life story continues, this updated edition offers the reader a powerful new afterword and gripping new photographs following Biehl and Eskerod’s return to Vita. Anthropology at its finest, Vita is essential reading for anyone who is grappling with how to understand the conditions of life, thought, and ethics in the contemporary world.
Accessible summary
What is known on the subject?
During the COVID‐19 pandemic, there has been research considering the impact on medical healthcare professionals and the mental health needs of the ...general population. However, limited focus has been placed on mental health services or mental health staff providing care in the community and in hospitals. While nurses make up the largest section of the mental health workforce in the UK, the impact that this pandemic has had on their work has been largely ignored.
What the paper adds to existing knowledge?
This paper provides a unique insight into the experiences and impact that the COVID‐19 pandemic has had on mental health nurses across a range of community and inpatient settings to understand what has changed in their work and the care they can and do provide during this crisis. This includes exploring how services have changed, the move to remote working, the impact of the protective equipment crisis on nurses and the difficult working conditions facing those in inpatient settings where there is minimal guidance provided.
What are the implications for practice?
By understanding the impact the pandemic has had on mental health nursing care, we can understand the gaps in guidance that exist, the challenges being faced and the impact the crisis has had on care for mental health service users. By doing so, we can plan for the ongoing nature of this pandemic and the aftermath that the crisis may leave for our service users and workforce alike.
Introduction
While evidence has emerged concerning the impact of COVID‐19 on the general population and the challenges facing health services, much less is known regarding how the pandemic has directly affected the delivery of mental health nursing care.
Aim
This paper aimed to explore how COVID‐19 has affected the ability of mental health nurses to deliver care in community and inpatient mental health services in the UK.
Method
We investigated staff reports regarding the impact of the COVID‐19 pandemic on mental healthcare and mental health service users in the UK, using a mixed‐methods online survey. A total of 897 nurses across a range of inpatient and community settings participated.
Discussion
Key themes within the data explore the following: new ways of working; remote working; risks of infection/infection control challenges; and the impact on service users. Targeted guidelines are required to support mental health nurses providing care and support during a pandemic to people in severe mental distress, often in unsuitable environments.
Implications for Practice
Service developments need to occur alongside tailored guidance and support for staff welfare supported by clear leadership. These findings identify areas requiring attention and investment to prepare for future crises and the consequences of the pandemic.
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