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1.
The reporting of child sexual abuse (CSA) and physician-patient sexual
relationships (PPSR) are currently the focus of professional, legal and media
attention in several countries. This paper briefly reviews mental health policies
on these issues and reports on a WPA survey of them. While the WPA Madrid
Declaration permits breaching confidentiality for mandatory reporting of CSA
and clearly prohibits PPSR, it is not known how or to what extent these policies
are implemented in WPA Member Societies’ countries. It is also not known
whether policies or laws exist on these topics nationally or to what extent
psychiatrists and the public are aware of them. Representatives of WPA Member
Societies were e-mailed a survey about issues pertaining to CSA and PPSR.
Fifty-one percent of 109 countries replied. All reporting countries had laws
or policies regarding the reporting of CSA, but this was often voluntary (63%)
and without protection for reporting psychiatrists either by law (29%) or
by Member Societies (27%). A substantial number of psychiatric leaders did
not know the law (27%) or their Society’s policy (11%) on these matters.
With respect to PPSR, some reporting countries lacked laws or policies about
PPSR with current (17%) or past (56%) patients. Fewer than half of responding
representatives believed that their Society’s members or the public
were well informed about the laws and policies pertaining to CSA or PPSR.
There is clearly a wide range of laws, policies and practices about CSA and
PPSR in WPA Member Societies’ countries. There is a need in some countries
for laws or supplemental policies to facilitate the protection of vulnerable
child and adult patients through clear, mandatory reporting policies for CSA
and PPSR. Mechanisms to protect and support reporting psychiatrists should
also be developed where they do not already exist. There is also a need in
some countries to develop strategies to improve the education of psychiatrists,
trainees, and the public on these issues. 相似文献
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Lessons learned in developing community mental health care
in Latin American and Caribbean countries
DENISE RAZZOUK GUILHERME GREG��RIO RENATO ANTUNES JAIR DE JESUS MARI 《World psychiatry》2012,11(3):191-195
This paper summarizes the findings for the Latin American and Caribbean
countries of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid
in the Implementation of Community Mental Health Care. It presents an overview
of the provision of mental health services in the region; describes key experiences
in Argentina, Belize, Brazil, Chile, Cuba, Jamaica and Mexico; and discusses
the lessons learned in developing community mental health care. 相似文献
5.
This paper summarizes the findings for the African Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. We present an overview of mental health policies, plans and programmes in the African region; a summary of relevant research and studies; a critical appraisal of community mental health service components; a discussion of the key challenges, obstacles and lessons learned, and some recommendations for the development of community mental health services in the African region. 相似文献
6.
McGeorge P 《World psychiatry》2012,11(2):129-132
This paper summarizes the findings for the Australasia and Pacific Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. We present an overview of mental health services in the region; discuss policies, plans and programmes; chart progress towards achieving community-oriented services, and detail the lessons learned. 相似文献
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This paper summarizes the findings for North America of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. Community mental health has evolved over five decades in the United States and Canada. The United States has led the world in innovation and spending, but provide variable quality of care; Canada has steadily developed a more uniform public health system for less cost. Lessons learned from North America include: team-based approaches and other evidence-based practices, when implemented with high fidelity, can improve outcomes in routine mental health care settings; recovery ideology and peer support enhance care, though they have not been studied rigorously; effective community-based care for people with serious mental disorders is expensive. 相似文献
9.
International Advisory Group for the Revision of ICD- Mental andBehavioural Disorders 《World psychiatry》2011,10(2):86-92
The World Health Organization (WHO) is revising the ICD-10 classification
of mental and behavioural disorders, under the leadership of the Department
of Mental Health and Substance Abuse and within the framework of the overall
revision framework as directed by the World Health Assembly. This article
describes WHO’s perspective and priorities for mental and behavioural
disorders classification in ICD-11, based on the recommendations of the International
Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders.
The WHO considers that the classification should be developed in consultation
with stakeholders, which include WHO member countries, multidisciplinary health
professionals, and users of mental health services and their families. Attention
to the cultural framework must be a key element in defining future classification
concepts. Uses of the ICD that must be considered include clinical applications,
research, teaching and training, health statistics, and public health. The
Advisory Group has determined that the current revision represents a particular
opportunity to improve the classification’s clinical utility, particularly
in global primary care settings where there is the greatest opportunity to
identify people who need mental health treatment. Based on WHO’s mission
and constitution, the usefulness of the classification in helping WHO member
countries, particularly low- and middle-income countries, to reduce the disease
burden associated with mental disorders is among the highest priorities for
the revision. This article describes the foundation provided by the recommendations
of the Advisory Group for the current phase of work. 相似文献
10.
HEATHER STUART 《World psychiatry》2008,7(3):185-188
People who live with mental illnesses are among the most stigmatized groups in society. In 1996, in recognition of the particularly harsh burden caused by the stigma associated with schizophrenia, the WPA initiated a global anti-stigma program, Open-the-Doors. In 2005, a WPA Section on Stigma and Mental Health was created, with a broader mandate to reduce stigma and discrimination caused by mental disabilities in general. In light of these impor-tant developments, and the growing public health interest in stigma reduction, this paper reflects on the past perspectives that have led us to our current position, reviews present activities and accomplishments, and identifies challenges that the Section members will face in their future efforts to reduce the stigma caused by mental disorders. 相似文献
11.
Fiona J. Charlson Sandra Diminic Crick Lund Louisa Degenhardt Harvey A. Whiteford 《PloS one》2014,9(10)
The world is undergoing a rapid health transition, with an ageing population and disease burden increasingly defined by disability. In Sub-Saharan Africa the next 40 years are predicted to see reduced mortality, signalling a surge in the impact of chronic diseases. We modelled these epidemiological changes and associated mental health workforce requirements. Years lived with a disability (YLD) predictions for mental and substance use disorders for each decade from 2010 to 2050 for four Sub-Saharan African regions were calculated using Global Burden of Disease 2010 study (GBD 2010) data and UN population forecasts. Predicted mental health workforce requirements for 2010 and 2050, by region and for selected countries, were modelled using GBD 2010 prevalence estimates and recommended packages of care and staffing ratios for low- and middle-income countries, and compared to current staffing from the WHO Mental Health Atlas. Significant population growth and ageing will result in an estimated 130% increase in the burden of mental and substance use disorders in Sub-Saharan Africa by 2050, to 45 million YLDs. As a result, the required mental health workforce will increase by 216,600 full time equivalent staff from 2010 to 2050, and far more compared to the existing workforce. The growth in mental and substance use disorders by 2050 is likely to significantly affect health and productivity in Sub-Saharan Africa. To reduce this burden, packages of care for key mental disorders should be provided through increasing the mental health workforce towards targets outlined in this paper. This requires a shift from current practice in most African countries, involving substantial investment in the training of primary care practitioners, supported by district based mental health specialist teams using a task sharing model that mobilises local community resources, with the expansion of inpatient psychiatric units based in district and regional general hospitals. 相似文献
12.
Mentalizing is the process by which we make sense of each other and ourselves,
implicitly and explicitly, in terms of subjective states and mental processes.
It is a profoundly social construct in the sense that we are attentive to
the mental states of those we are with, physically or psychologically. Given
the generality of this definition, most mental disorders will inevitably involve
some difficulties with mentalization, but it is the application of the concept
to the treatment of borderline personality disorder (BPD), a common psychiatric
condition with important implications for public health, that has received
the most attention. Patients with BPD show reduced capacities to mentalize,
which leads to problems with emotional regulation and difficulties in managing
impulsivity, especially in the context of interpersonal interactions. Mentalization
based treatment (MBT) is a time-limited treatment which structures interventions
that promote the further development of mentalizing. It has been tested in
research trials and found to be an effective treatment for BPD when delivered
by mental health professionals given limited additional training and with
moderate levels of supervision. This supports the general utility of MBT in
the treatment of BPD within generic mental health services.Borderline personality disorder (BPD) is a complex and serious mental disorder
characterized by a pervasive pattern of difficulties with emotion regulation
and impulse control, and instability both in relationships and in selfimage 1. It represents a serious public health problem,
because it is associated with suicide attempts and self harm, both of which
are consistent targets of mental health services. Recurrent suicidal behaviour
is reported in 69-80% of patients with BPD, and suicide rates are estimated
to be up to 10% 2. BPD is a common condition that is thought to occur globally with a prevalence
of 0.2-1.8% in the general population 3.
Higher prevalence rates are found in clinical populations. Moran et al 4 found a prevalence rate of 4-6% among primary
care attenders, suggesting that people with BPD are more likely to visit their
general practitioner. Chanen et al 5 reported
a prevalence rate of 11% in adolescent outpatients and 49% in adolescent inpatients.
The highest prevalence has been found in people requiring the most intensive
level of care, with a rate of 60-80% among patients in forensic services 6-7. The high prevalence and increased suicide rate in patients with BPD make
an unassailable argument that effective treatment needs to be developed and
that treatment has to be widely available. Whilst a number of treatments for
BPD have been shown to be moderately effective in randomized controlled trials,
it remains of considerable concern that most of them require extensive training,
making them unavailable to most patients. Mentalization based treatment (MBT)
was developed with this in mind. It requires relatively little additional
training on top of general mental health training, and has been implemented
in research studies by community mental health professionals, primarily nurses,
with limited training given modest levels of supervision. 相似文献
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Ryan McBain Daniel J. Norton Jodi Morris M. Taghi Yasamy Theresa S. Betancourt 《PLoS medicine》2012,9(1)
Background
Neuropsychiatric conditions comprise 14% of the global burden of disease and 30% of all noncommunicable disease. Despite the existence of cost-effective interventions, including administration of psychotropic medicines, the number of persons who remain untreated is as high as 85% in low- and middle-income countries (LAMICs). While access to psychotropic medicines varies substantially across countries, no studies to date have empirically investigated potential health systems factors underlying this issue.Methods and Findings
This study uses a cross-sectional sample of 63 LAMICs and country regions to identify key health systems components associated with access to psychotropic medicines. Data from countries that completed the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) were included in multiple regression analyses to investigate the role of five major mental health systems domains in shaping medicine availability and affordability. These domains are: mental health legislation, human rights implementations, mental health care financing, human resources, and the role of advocacy groups. Availability of psychotropic medicines was associated with features of all five mental health systems domains. Most notably, within the domain of mental health legislation, a comprehensive national mental health plan was associated with 15% greater availability; and in terms of advocacy groups, the participation of family-based organizations in the development of mental health legislation was associated with 17% greater availability. Only three measures were related with affordability of medicines to consumers: level of human resources, percentage of countries'' health budget dedicated to mental health, and availability of mental health care in prisons. Controlling for country development, as measured by the Human Development Index, health systems features were associated with medicine availability but not affordability.Conclusions
Results suggest that strengthening particular facets of mental health systems might improve availability of psychotropic medicines and that overall country development is associated with affordability. Please see later in the article for the Editors'' Summary 相似文献15.
Christina Mangurian Grace C. Niu Dean Schillinger John W. Newcomer James Dilley Margaret A. Handley 《Implementation science : IS》2017,12(1):134
Background
Individuals with severe mental illness (e.g., schizophrenia, bipolar disorder) die 10–25 years earlier than the general population, primarily from premature cardiovascular disease (CVD). Contributing factors are complex, but include systemic-related factors of poorly integrated primary care and mental health services. Although evidence-based models exist for integrating mental health care into primary care settings, the evidence base for integrating medical care into specialty mental health settings is limited. Such models are referred to as “reverse” integration. In this paper, we describe the application of an implementation science framework in designing a model to improve CVD outcomes for individuals with severe mental illness (SMI) who receive services in a community mental health setting.Methods
Using principles from the theory of planned behavior, focus groups were conducted to understand stakeholder perspectives of barriers to CVD risk factor screening and treatment identify potential target behaviors. We then applied results to the overarching Behavior Change Wheel framework, a systematic and theory-driven approach that incorporates the COM-B model (capability, opportunity, motivation, and behavior), to build an intervention to improve CVD risk factor screening and treatment for people with SMI.Results
Following a stepped approach from the Behavior Change Wheel framework, a model to deliver primary preventive care for people that use community mental health settings as their de facto health home was developed. The CRANIUM (cardiometabolic risk assessment and treatment through a novel integration model for underserved populations with mental illness) model focuses on engaging community psychiatrists to expand their scope of practice to become responsible for CVD risk, with significant clinical decision support.Conclusion
The CRANIUM model was designed by integrating behavioral change theory and implementation theory. CRANIUM is feasible to implement, is highly acceptable to, and targets provider behavior change, and is replicable and efficient for helping to integrate primary preventive care services in community mental health settings. CRANIUM can be scaled up to increase CVD preventive care delivery and ultimately improve health outcomes among people with SMI served within a public mental health care system.16.
Susie Dzakpasu Seyi Soremekun Alexander Manu Guus ten Asbroek Charlotte Tawiah Lisa Hurt Justin Fenty Seth Owusu-Agyei Zelee Hill Oona M. R. Campbell Betty R. Kirkwood 《PloS one》2012,7(11)
Background
Many sub-Saharan countries, including Ghana, have introduced policies to provide free medical care to pregnant women. The impact of these policies, particularly on access to health services among the poor, has not been evaluated using rigorous methods, and so the empirical basis for defending these policies is weak. In Ghana, a recent report also cast doubt on the current mechanism of delivering free care – the National Health Insurance Scheme. Longitudinal surveillance data from two randomized controlled trials conducted in the Brong Ahafo Region provided a unique opportunity to assess the impact of Ghana’s policies.Methods
We used time-series methods to assess the impact of Ghana’s 2005 policy on free delivery care and its 2008 policy on free national health insurance for pregnant women. We estimated their impacts on facility delivery and insurance coverage, and on socioeconomic differentials in these outcomes after controlling for temporal trends and seasonality.Results
Facility delivery has been increasing significantly over time. The 2005 and 2008 policies were associated with significant jumps in coverage of 2.3% (p = 0.015) and 7.5% (p<0.001), respectively after the policies were introduced. Health insurance coverage also jumped significantly (17.5%, p<0.001) after the 2008 policy. The increases in facility delivery and insurance were greatest among the poorest, leading to a decline in socioeconomic inequality in both outcomes.Conclusion
Providing free care, particularly through free health insurance, has been effective in increasing facility delivery overall in the Brong Ahafo Region, and especially among the poor. This finding should be considered when evaluating the impact of the National Health Insurance Scheme and in supporting the continuation and expansion of free delivery care. 相似文献17.
The World Health Organization (WHO) has for long proposed the development of community-based mental health services worldwide. However, the progress toward community mental health care in most African countries is still hampered by a lack of resources, with specialist psychiatric care essentially based in large, centrally located mental hospitals. It is again time to reconsider the direction of mental health care in Africa. Based on a small inquiry to a number of experienced mental health professionals in sub-Saharan Africa, we discuss what a community concept of mental health care might mean in Africa. There is a general agreement that mental health services should be integrated in primary health care. A critical issue for success of this model is perceived to be provision of appropriate supervision and continuing education for primary care workers. The importance of collaboration between modern medicine and traditional healers is stressed and the paper ends in a plea for WHO to take the initiative and develop mental health services according to the special needs and the socio-cultural conditions prevailing in sub-Saharan Africa. 相似文献
18.
Background
Inappropriate overuse of antibiotics contributes to antimicrobial resistance (AMR), yet policy implementation to reduce inappropriate antibiotic use is poor in low and middle-income countries.Aims
To determine whether public sector inappropriate antibiotic use is lower in countries reporting implementation of selected essential medicines policies.Materials and Methods
Results from independently conducted antibiotic use surveys in countries that did, and did not report implementation of policies to reduce inappropriate antibiotic prescribing, were compared. Survey data on four validated indicators of inappropriate antibiotic use and 16 self-reported policy implementation variables from WHO databases were extracted. The average difference for indicators between countries reporting versus not reporting implementation of specific policies was calculated. For 16 selected policies we regressed the four antibiotic use variables on the numbers of policies the countries reported implementing.Results
Data were available for 55 countries. Of 16 policies studied, four (having a national Ministry of Health unit on promoting rational use of medicines, a national drug information centre and provincial and hospital drugs and therapeutics committees) were associated with statistically significant reductions in antibiotic use of ≥20% in upper respiratory infection (URTI). A national strategy to contain antibiotic resistance was associated with a 30% reduction in use of antibiotics in acute diarrheal illness. Policies seemed to be associated with greater effects in antibiotic use for URTI and diarrhea compared with antibiotic use in all patients. There were negative correlations between the numbers of policies reported implemented and the percentage of acute diarrhoea cases treated with antibiotics (r = -0.484, p = 0.007) and the percentage of URTI cases treated with antibiotics (r = -0.472, p = 0.005). Major study limitations were the reliance on self-reported policy implementation data and antibiotic use data from linited surveys.Conclusions
Selected essential medicines policies were associated with lower antibiotic use in low and middle income countries. 相似文献19.
Molly E. Lasater Madeleine Beebe Nicole E. Warren Fatoumata Souko Mariam Keita Sarah M. Murray Judith K. Bass Pamela J. Surkan Peter J. Winch 《Culture, medicine and psychiatry》2018,42(4):930-945
Perinatal mental health problems such as depression and anxiety are prevalent in low and middle-income countries. In Mali, the lack of mental health care is compounded by few studies on mental health needs, including in the perinatal period. This paper examines the ways in which perinatal women experience and express mental distress in rural Mali. We describe a process, relying on several different qualitative research methods, to identify understandings of mental distress specific to the Malian context. Participants included perinatal women, maternal health providers, and community health workers in rural southwest Mali. Participants articulated several idioms of distress, including gèlèya (difficulties), tôôrô (pain, suffering), hamin (worries, concerns), and dusukasi (crying heart), that occur within a context of poverty, interpersonal conflict, and gender inequality. These idioms of distress were described as sharing many key features and operating on a continuum of severity that could progress over time, both within and across idioms. Our findings highlight the context dependent nature of experiences and expressions of distress among perinatal women in Mali. 相似文献
20.
Fadi El-Jardali Lama Bou Karroum Lamya Bawab Ola Kdouh Farah El-Sayed Hala Rachidi Malak Makki 《PloS one》2015,10(8)