The Italian Psychiatric Reform of 1978 is reviewed here in terms of national/regional mental health (MH) policies and with the help of epidemiological data. The reform law was essentially a framework ...one, and Italy's 21 regions were called to draft detailed organizational norms and to implement their systems. This explains a relevant interregional variability, despite several national MH plans. In a recent survey, compliance with national standards found homogeneous implementation on structural parameters but quite a variable one on functional parameters (continuity, coordination, accessibility, specialization). Epidemiological data show the impact of regional variability on the quality of treatment provided. Because of discrepancies among regional information systems, we analyze data from six Italian regions, where regional case registers have long been implemented, focusing on adult population prevalence and incidence rates and outpatient-inpatient care. Indicators of service use and some national MH documents are discussed in relation to the system's future prospects.
To determine the prevalence rates and characteristics of past-year mental health consultation for Ontario’s adult (18 + years old) immigrant populations. The Canadian Community Health Survey (CCHS) ...2012 was used to calculate the prevalence rates of past-year mental health consultation by service provider type. Characteristics associated with mental health consultation were determined by carrying out multivariable logistic regression analysis on merged CCHS 2008–2012 data. Adult immigrant populations in Ontario (n = 3995) had lower estimated prevalence rates of past-year mental health consultation across all service provider types compared to Canadian-born populations (n = 14,644). Amongst those who reported past-year mental health consultation, 57.89% of Ontario immigrants contacted their primary care physician, which was significantly higher than the proportion who consulted their family doctor from Canadian-born populations (45.31%). The factors of gender, age, racial/ethnic background, education level, working status, food insecurity status, self-perceived health status, smoking status, alcohol drinking status, years since immigration, and age at time of immigration were significantly associated with past-year mental health consultation for immigrant populations. Ontario’s adult immigrant populations most commonly consult their family doctor for mental health care. Potential exists for expanding the mental health care role of primary care physicians as well as efforts to increase accessibility of specialized mental health services. Integrated, coordinated care where primary care physicians, specialized mental health professionals, social workers, and community educators, etc. working together in a sort of “one-stop-shop” may be the most effective way to mitigate gaps in the mental health care system. In order to effectively tailor mental health policy, programming, and promotion to suit the needs of immigrant populations initiatives that focus on the connection between physical and mental health and migration variables such as length of stay in Canada, years since immigration, and other important migration variables (beyond the scope of the CCHS which require further study) need to be developed. Examination of the social determinants of mental health is critical to understand how we can best serve the mental health needs of Ontario’s immigrant populations.
Rising levels of burnout and poor well‐being in healthcare staff are an international concern for health systems. The need to improve well‐being and reduce burnout has long been acknowledged, but few ...interventions target mental healthcare staff, and minimal improvements have been seen in services. This review aimed to examine the problem of burnout and well‐being in mental healthcare staff and to present recommendations for future research and interventions. A discursive review was undertaken examining trends, causes, implications, and interventions in burnout and well‐being in healthcare staff working in mental health services. Data were drawn from national surveys, reports, and peer‐reviewed journal articles. These show that staff in mental healthcare report poorer well‐being than staff in other healthcare sectors. Poorer well‐being and higher burnout are associated with poorer quality and safety of patient care, higher absenteeism, and higher turnover rates. Interventions are effective, but effect sizes are small. The review concludes that grounding interventions in the research literature, emphasizing the positive aspects of interventions to staff, building stronger links between healthcare organizations and universities, and designing interventions targeting burnout and improved patient care together may improve the effectiveness and uptake of interventions by staff.
In-patients in crisis report poor experiences of mental healthcare not conducive to recovery. Concerns include coercion by staff, fear of assault from other patients, lack of therapeutic ...opportunities and limited support. There is little high-quality evidence on what is important to patients to inform recovery-focused care.AimsTo conduct a systematic review of published literature, identifying key themes for improving experiences of in-patient mental healthcare.
A systematic search of online databases (MEDLINE, PsycINFO and CINAHL) for primary research published between January 2000 and January 2016. All study designs from all countries were eligible. A qualitative analysis was undertaken and study quality was appraised. A patient and public reference group contributed to the review.
Studies (72) from 16 countries found four dimensions were consistently related to significantly influencing in-patients' experiences of crisis and recovery-focused care: the importance of high-quality relationships; averting negative experiences of coercion; a healthy, safe and enabling physical and social environment; and authentic experiences of patient-centred care. Critical elements for patients were trust, respect, safe wards, information and explanation about clinical decisions, therapeutic activities, and family inclusion in care.
A number of experiences hinder recovery-focused care and must be addressed with the involvement of staff to provide high-quality in-patient services. Future evaluations of service quality and development of practice guidance should embed these four dimensions.Declaration of interestK.B. is editor of British Journal of Psychiatry and leads a national programme (Synergi Collaborative Centre) on patient experiences driving change in services and inequalities.
Mental Health Disparities Among College Students of Color Lipson, Sarah Ketchen; Kern, Adam; Eisenberg, Daniel ...
Journal of adolescent health,
September 2018, 2018-Sep, 2018-09-00, 20180901, Volume:
63, Issue:
3
Journal Article
Peer reviewed
Understanding the mental health needs of students of color is a growing priority on college and university campuses nationwide. This study aims to capture the state of mental health among students of ...color, including the prevalence of mental health problems and treatment utilization.
The sample is comprised of 43,375 undergraduate and graduate students at 60 institutions that participated in the survey-based Healthy Minds Study from 2012 to 2015. These data include over 13,000 students of color; we look separately at African-American, Latinx, Asian/Asian American, and Arab/Arab American students. Data are analyzed at the individual level using bivariate and multivariate modeling to elucidate variations across race/ethnicity. We examine symptom prevalence (measured by validated screens such as the Patient Health Questionnaire-9 for depression), help-seeking behaviors, and related factors (including knowledge and stigma).
Across race/ethnicity, we find modest variation in symptom prevalence and larger variation in service utilization. Overall, treatment use is lower among students of color relative to white students, even when controlling for other variables in regression models. Asian/Asian American students have the lowest prevalence of treatment, at only 20% among those with apparent mental health conditions. Attitudes related to mental health treatment also vary significantly and help to explain the primary findings.
College students of color represent a disparities population based on greater levels of unmet mental health needs relative to white students. This paper takes an important step toward understanding these needs and points to implications for future research and practice.
This study aimed to systematically review the current body of research on parent and caregiver mental health literacy. Electronic databases were searched in January 2018 with 21 studies meeting ...inclusion criteria. A narrative synthesis of quantitative and qualitative studies was conducted. Findings across studies suggest that parents and caregivers had limited mental health knowledge. Factors associated with help-seeking included cultural and religious beliefs, financial and knowledge barriers, fear and mistrust of treatment services, and stigma. Notable limitations include non-representative samples, cross-sectional research designs, and use of inconsistent and non-validated study measures. Research would benefit from more diverse samples, an increased focus on prevention, and controlled trials of educational programmes targeting mental health literacy.
Coronavirus disease (COVID-19) presents two urgent health problems: the illness caused by the virus itself and the anxiety, panic and psychological problems associated with the pandemic. Both ...problems present substantial challenges for our patients, their families, our multidisciplinary teams and our psychiatrist colleagues. We need good psychiatry, now more than ever.
ABSTRACT
BACKGROUND:
Stigmatizing attitudes toward mental illness and low mental health literacy have been identified as links to social adversity, and barriers to seeking and adhering to treatment ...among adolescents suffering from mental illness. Prior research has found that it is possible to improve these outcomes using school‐based mental health awareness interventions. The purpose of this study was to review empirical literature pertaining to universal mental health awareness interventions aiming to improve mental health related outcomes among students enrolled in US K‐12 schools, especially minorities vulnerable to health disparities.
METHODS:
PsycINFO, Cochrane Library, PUBMED, and reference lists of relevant articles were searched for K‐12 school‐based mental health awareness interventions in the United States. Universal studies that measured knowledge, attitudes, and/or help‐seeking pertinent to mental health were included.
RESULTS:
A total of 15 studies were selected to be part of the review. There were 7 pretest/post‐test case series, 5 nonrandomized experimental trial, 1 Solomon 4‐groups, and 2 randomized controlled trial (RCT) designs. Nine studies measuring knowledge, 8 studies measuring attitudes, and 4 studies measuring help‐seeking, indicated statistically significant improvements.
CONCLUSIONS:
Although results of all studies indicated some level of improvement, more research on implementation of universal school‐based mental health awareness programs is needed using RCT study designs, and long‐term follow‐up implementation.
Racial and ethnic disparities in mental health care access in the United States are well documented. Prior studies highlight the importance of individual and community factors such as health ...insurance coverage, language and cultural barriers, and socioeconomic differences, though these factors fail to explain the extent of measured disparities. A critical factor in mental health care access is a local area's organization and supply of mental health care providers. However, it is unclear how geographic differences in provider organization and supply impact racial/ethnic disparities. The present study is the first analysis of a nationally representative U.S. sample to identify contextual factors (county-level provider organization and supply, as well as socioeconomic characteristics) associated with use of mental health care services and how these factors differ across racial/ethnic groups. Hierarchical logistic models were used to examine racial/ethnic differences in the association of county-level provider organization (health maintenance organization (HMO) penetration) and supply (density of specialty mental health providers and existence of a community mental health center) with any use of mental health services and specialty mental health services. Models controlled for individual- and county-level socio-demographic and mental health characteristics. Increased county-level supply of mental health care providers was significantly associated with greater use of any mental health services and any specialty care, and these positive associations were greater for Latinos and African-Americans compared to non-Latino Whites. Expanding the mental health care workforce holds promise for reducing racial/ethnic disparities in mental health care access. Policymakers should consider that increasing the management of mental health care may not only decrease expenditures, but also provide a potential lever for reducing mental health care disparities between social groups.
► Mental health care disparities persist after accounting for geographic variation. ► HMO penetration and mental health provider supply facilitate access for Latinos and African-Americans in the U.S. ► Increasing HMO enrollment and the supply of mental health specialists has potential to reduce mental health care disparities.
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