The Yad Sarah geriatric dental clinic, a different model

Introduction: There are not sufficient dental services for elderly people around the world. Yad Sarah is an Israel‐wide network of volunteers aiding sick, elderly, isolated and housebound people with an array of services aimed at making home care possible. It provides medical and social services to more than 380 000 elderly persons per year and in addition, lends medical equipment free of charge, has day rehabilitation centres, legal aid council for seniors, provides transportation for the disabled, meal deliveries and geriatric dental services. Materials and methods: The latter are equipped with five dental units (one mobile unit) and a dental laboratory. During the 5 years from 2000 to 2004 the dental services provided dental care for 3890 elderly patients with the main clinic located in Jerusalem. Patients pay an average of 70% of the cost price of their dental care, with the difference being subsidised by Yad Sarah. Of the 515 patients who applied for treatment in 2004, 54% possessed natural teeth in both jaws, 28% were fully edentulous, 12% were edentulous in the maxilla and 6% were edentulous in the mandible. Females applied for dental treatment more often than the male population. Older patients (75–101 years old) required oral care at their homes or at old age residences, more frequently than the younger age groups (60–74 years old). Conclusion: Dental treatment was administered by 70 volunteer dental surgeons, two certified dental hygienists and dental hygienist students. The clinical staff was provided with a comprehensive in‐service training in geriatric dentistry during the 3‐year service learning period. A survey in 2004 showed that 83% of the selected patients were satisfied, compared with 14% who were not. The reasons for satisfaction were, mainly, the personal relationship with the attending staff (41%) and the professional ability of the dental team (46%).     

Patient characteristics that may predict the likelihood of the presence of mental health problems in patients attending the general outpatient clinic of a tertiary hospital in South-South Nigeria

Background A considerable number of patients seen in general outpatient clinics (GOPC) are known to suffer from psychiatric rather than physical disorders. Studies have shown that doctors working in these clinics have difficulty in making accurate ratings of mental health problems in their patients and have poor knowledge of psychiatric diagnosis. Accurate recognition of psychiatric symptoms in a patient is essential for specific diagnosis and successful management. There is a need for the use of an easy tool such as the12-item General Health Questionnaire (GHQ-12) for screening and identification of psychopathologies especially in a busy clinic setting like the GOPC. Aside from psychometric screening tools, patients' sociodemographic characteristics such as gender, age, marital status, occupation, education etc. have been found to be of value in predicting those at risk.Objectives This study seeks to correlate GHQ 'caseness' with sociodemographic factors and to compare physician diagnosis with GHQ diagnosis.Subjects and method Three-hundred and twenty-two respondents were recruited for the study by a systematic random sampling method. Using a cut off score of three on both the English and Efik translation versions of the GHQ-12, 'cases' and 'non-cases' generated were compared with the same classification as identified by the GOPC doctors. Identification rates for both groups were calculated and the coefficients determined using a two-by-two contingency table. Sociodemographic correlates were determined by statistical comparison of the classifications in both groups.Results Statistically significant differences in sociodemographic characteristics of respondents were found for age (χ(2)=48.97; P <0.05) and education (χ(2)=45.64; P=0.05) using their GHQ-12 scores, and for occupation (χ(2)=37.90; P <0.05) among those seen by the GOPC doctors. A further comparison of identified 'cases' and 'non-cases' by doctors again revealed significant difference for age (χ(2)=7.151; P <0.05). Sex as a sociodemographic characteristic showed no statistically significant difference though a greater percentage of females (57.3%) were observed as 'high scorers' as compared to their male counterparts (42.7%). The GHQ-12 identified 46.6% 'cases' while the GOPC doctors identified 6.8% among the attendees with a diagnostic sensitivity of 8% and a specificity of 94%, respectively.Conclusion Belonging to the 18-39 years age group, being employed and having less than 12 years of education were the patients' characteristics that suggested the likelihood of the presence of mental health problems.This study also revealed that despite the high proportion of psychiatric morbidity (46.6%) in the GOPC of the University of Calabar Teaching Hospital (UCTH) rate of detection by the clinic doctors was low (6.8%).It is recommended that primary care doctors should be alerted to the possibility that clinically significant psychiatric morbidity may be present in GOPC attendees. The correlation between patients' sociodemographic parameters and presence of mental health problems could be informative and should be given adequate attention during consultation.     

Measuring and improving the quality of mental health care: a global perspective

Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology‐based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments. We describe several innovations that are underway worldwide which can mitigate these barriers. Based on these experiences, we offer several recommendations for improving quality of mental health care. Health care payers and providers will need a portfolio of validated measures of patient‐centered outcomes across a spectrum of conditions. Common data elements will have to be developed and embedded within existing electronic health records and other information technology tools. Mental health outcomes will need to be assessed more routinely, and measurement‐based care should become part of the overall culture of the mental health care system. Health care systems will need a valid way to stratify quality measures, in order to address potential gaps among subpopulations and identify groups in most need of quality improvement. Much more attention should be devoted to workforce training in and capacity for quality improvement. The field of mental health quality improvement is a team sport, requiring coordination across different providers, involvement of consumer advocates, and leveraging of resources and incentives from health care payers and systems.     

Reform of mental health care in Serbia: ten steps plus one

Disastrous events in the country and the region caused a 13.5% increasein the prevalence of mental and behavioral disorders in Serbia in the lastfew years, thus making them the second largest public health problem. Dueto prolonged adversities, the health system has deteriorated and is facingspecific challenges. However, the reform of mental health care has been initiated,with a lot of positive movements such as the preparation of a national policyfor mental health care and a law for protection of mentally ill individuals.The transformation of mental health services has started, with an accent oncommunity care, antistigma campaigns and continuing education. Based on anassessment carried out by the National Committee on Mental Health, serviceprovision, number of professionals working in services, funding arrangements,pathways into care, user/carer involvement and other specific issues are reported.     

Reducing the treatment gap for mental disorders: a WPA survey

The treatment gap for people with mental disorders exceeds 50% in all countries of the world, approaching astonishingly high rates of 90% in the least resourced countries. We report the findings of the first systematic survey of leaders of psychiatry in nearly 60 countries on the strategies for reducing the treatment gap. We sought to elicit the views of these representatives on the roles of different human resources and health care settings in delivering care and on the importance of a range of strategies to increase the coverage of evidence-based treatments for priority mental disorders for each demographic stage (childhood, adolescence, adulthood and old age). Our findings clearly indicate three strategies for reducing the treatment gap: increasing the numbers of psychiatrists and other mental health professionals; increasing the involvement of a range of appropriately trained non-specialist providers; and the active involvement of people affected by mental disorders. This is true for both high income and low/middle income countries, though relatively of more importance in the latter. We view this survey as a critically important first step in ascertaining the position of psychiatrists, one of the most influential stakeholder communities in global mental health, in addressing the global challenge of scaling up mental health services to reduce the treatment gap.     

Designing and scaling up integrated youth mental health care

Mental ill‐health represents the main threat to the health, survival and future potential of young people around the world. There are indications that this is a rising tide of vulnerability and need for care, a trend that has been augmented by the COVID‐19 pandemic. It represents a global public health crisis, which not only demands a deep and sophisticated understanding of possible targets for prevention, but also urgent reform and investment in the provision of developmentally appropriate clinical care. Despite having the greatest level of need, and potential to benefit, adolescents and emerging adults have the worst access to timely and quality mental health care. How is this global crisis to be addressed? Since the start of the century, a range of co‐designed youth mental health strategies and innovations have emerged. These range from digital platforms, through to new models of primary care to new services for potentially severe mental illness, which must be locally adapted according to the availability of resources, workforce, cultural factors and health financing patterns. The fulcrum of this progress is the advent of broad‐spectrum, integrated primary youth mental health care services. They represent a blueprint and beach‐head for an overdue global system reform. While resources will vary across settings, the mental health needs of young people are largely universal, and underpin a set of fundamental principles and design features. These include establishing an accessible, “soft entry” youth primary care platform with digital support, where young people are valued and essential partners in the design, operation, management and evaluation of the service. Global progress achieved to date in implementing integrated youth mental health care has highlighted that these services are being accessed by young people with genuine and substantial mental health needs, that they are benefiting from them, and that both these young people and their families are highly satisfied with the services they receive. However, we are still at base camp and these primary care platforms need to be scaled up across the globe, complemented by prevention, digital platforms and, crucially, more specialized care for complex and persistent conditions, aligned to this transitional age range (from approximately 12 to 25 years). The rising tide of mental ill‐health in young people globally demands that this focus be elevated to a top priority in global health.     

The roots of the concept of mental health

This paper reviews the origins of the current concept of mental health, starting from the mental hygiene movement, initiated in 1908 by consumers of psychiatric services and professionals interested in improving the conditions and the quality of treatment of people with mental disorders. The paper argues that, more than a scientific discipline, mental health is a political and ideological movement involving diverse segments of society, interested in the promotion of the human rights of people with mental disorders and the quality of their treatment.     

WPA guidance on steps,obstacles and mistakes to avoid in the implementation of community mental health care

This paper provides guidance on the steps, obstacles and mistakes to avoidin the implementation of community mental health care. The document is intendedto be of practical use and interest to psychiatrists worldwide regarding thedevelopment of community mental health care for adults with mental illness.The main recommendations are presented in relation to: the need for coordinatedpolicies, plans and programmes, the requirement to scale up services for wholepopulations, the importance of promoting community awareness about mentalillness to increase levels of help-seeking, the need to establish effectivefinancial and budgetary provisions to directly support services provided inthe community. The paper concludes by setting out a series of lessons learnedfrom the accumulated practice of community mental health care to date worldwide,with a particular focus on the social and governmental measures that are requiredat the national level, the key steps to take in the organization of the localmental health system, lessons learned by professionals and practitioners,and how to most effectively harness the experience of users, families, andother advocates.     

某军校学员心理健康情况调查分析

目的：了解军校学员心理健康状况,为军校心理辅导工作提供理论依据,提高军校教育管理水平,有效预防学员在校期间由于压力、情绪等因素造成的心理问题。方法：使用DXC-6型多项群体心理测评仪,对某军校不同年级1332名学员进行卡特尔16种人格个性因素测验。结果：①1332名被测试学员16PF得分总体呈现”五高三低”。②不同年级的学员在16PF多项因子上得分有差异（P〈0．05）。研究生在C、M、O等因子得分明显高于大三学员,而在A、F、H等得分明显低于大三学员（P〈0．05）;研究生在C因子得分明显高于大四学员（P〈0．05）,F、G、Y2因子得分明显低于大四学员（P〈0．05）,而在A、M、O、H这些因子的得分差异无统计学意义（P〉0．05）;大三学员在A、H、X2等得分明显高于大四学员,而在M、O、Q1等得分明显低于大四学员（P〈0．05）。结论：军校学员的整体心理健康水平良好;本科学员（尤其是大三学员）的心理健康水平明显优于研究生;大三的学员在乐群性、敢为性、实验性、忧虑性等方面优于大四学员,和大四学员相比,大三学员更喜欢探索新生事物。     

Integrating mental health into primary health care in Iraq

The Ministry of Health in Iraq is undertaking a systematic programme to integrate mental health into primary care in order to increase population access to mental health care. This paper reports the evaluation of the delivery of a ten day interactive training programme to 20% of primary care centres across Iraq. The multistage evaluation included a pre- and post-test questionnaire to assess knowledge, attitudes and practice in health workers drawn from 143 health centres, a course evaluation questionnaire and, in a random sample of 41 clinics, direct observation of health workers skills and exit interviews of patients, comparing health workers who had received the training programme with those from the same clinics who had not received the training. Three hundred andseventeen health workersparticipated in the training, which achieved an improvement in test scores from 42.3% to 59%. Trained health workers were observed by research psychiatrists to have a higher level of excellent skills than the untrained health workers, and patient exit interviews also reported better skills in the trained rather than untrained health workers. The two week course has thus been able to achieve significant change, not only in knowledge, but also in subsequent demonstration of trained practitioners practical skills in the workplace. Furthermore, it has been possible to implement the course and the evaluation despite a complex conflict situation.     

The social determinants of mental health and disorder: evidence,prevention and recommendations

People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.     

Lessons learned in developing community mental health care in Africa

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.     

Factors predicting drop‐out in community mental health centres

This study aimed to identify treatment, therapist and patient factors associated with dropping out of treatment in four outpatient mental health services. The experimental group comprised all 789 individuals who attended for the first time the mental health services during one year and dropped out of treatment in the same year or during the two following ones. The control group consisted of the same number of individuals, chosen at random from patients who, in the same year, attended for the first time the services and did not subsequently drop out of treatment. The overall drop-out rate was 33.2%. According to logistic regression analysis, the predictive factors of dropping out were: being treated in a particular centre, the involvement of more than one therapist in treatment, having no previous history of psychiatric disorders, being young and being male.     

Oral health and treatment needs in a non-institutionalized elderly population: Experience of a dental school associated geriatric clinic

The purpose of this study is to report oral and dental findings in a population of independent geriatric patients, who were treated at the Geriatric Dental Clinic, School of Dental Medicine, Tel Aviv University. The study group consisted of 221 patients, 31.2% males and 68.8% females. The mean age was 75.3 years. Of the patients, 75% were edentulous. The most frequent complaint was pain associated with wear of dentures, and the most frequent mucosal lesion was traumatic ulcer (51%). Most dentures were of poor quality (77%). The mean denture age was 9.7 years, increasing as the patient's age increased. Denture hygiene was good in 59%, fair in 11% and poor in 30%. The mean number of visits at the Geriatric Clinic was 5.5 per patient.     

Integration of child mental health services to primary care: challenges and opportunities

In the first decade of this new millennium, health professionals are faced with a rapidly increasing need for child mental health services and changing models of service provision. This gives us a unique opportunity to make provision for services where it has not been available before, or to improve upon the existing services. This paper examines the challenges and opportunities while attempting to integrate child mental health services to primary care.     

Priorities for mental health research in Europe: A survey among national stakeholders' associations within the ROAMER project

Within the ROAMER project, funded by the European Commission, a survey was conducted with national associations/organizations of psychiatrists, other mental health professionals, users and/or carers, and psychiatric trainees in the 27 countries of the European Union, aiming to explore their views about priorities for mental health research in Europe. One hundred and eight associations/organizations returned the questionnaire. The five most frequently selected research priorities were early detection and management of mental disorders, quality of mental health services, prevention of mental disorders, rehabilitation and social inclusion, and new medications for mental disorders. All these areas, except the last one, were among the top ten research priorities according to all categories of stakeholders, along with stigma and discrimination. These results seem to support the recent argument that some rebalancing in favor of psychosocial and health service studies may be needed in psychiatric research.     

Barriers in the mind: promoting an economic case for mental health in low- and middle-income countries

In recent years, policy makers in high-income countries have placed an increasing emphasis on the value of maintaining good mental health, recognizing the contribution that this makes to quality of life, whilst ever more mindful of the socio-economic consequences of poor mental health. The picture in many other parts of the world is much less encouraging; policy attention and resources are still directed largely at communicable diseases. We reflect on some of the challenges faced in these countries and outline the role that economic evidence could play in strengthening the policy case for investment in mental health. Clearly this should include assessment of the economic impact of strategies implemented outside, as well as within the health sector. The ways in which mental health services are delivered is also of critical importance. Non-governmental organizations (NGOs) have long been shown to be key stakeholders in the funding, coordination and delivery of these services in high-income countries. Their role in low- and middle-income countries, where infrastructure and policy focus on mental health are more limited, can be even more vital in overcoming some of the barriers to the development of mental health policy and practice.