Mental Health Policy

Over the last decade state prisons have experienced unprecedented growth and many demographic changes. At the same time, courts are requiring states to provide mental health screening and treatment to prisoners. Findings from recent studies indicate that the prevalence of mental illness is higher in prisons than in the community, and comorbidity is common. Our ability to generalize from these studies is limited, however, because of major shifts in the demographic mix in prisons during the past decade. New studies on the prevalence of mental illness in prisons, which consider these recent changes would help planners allocate funds and staff to more effectively meet the needs of these individuals.

This article will provide a brief historical background to mental health law in order to gain a greater sense of the significance of international human rights law to civil commitment legislation today. Historical context will help to identify the purpose and objectives of mental health law, which in turn assist in weighing into the major debates currently underway. The United Nations Convention on the Rights of Persons with Disability (CRPD), in particular, has brought major changes to the way mental health law is understood, including strengthening longstanding critiques, and adding novel critical perspectives. Three 'eras' of mental health law are examined: the pre-modern origins of mental health law and 19th century regulation; the 'medicalising' shift of the 20th century; and deinstitutionalisation and 'rights-based legalism'. These distinct periods of thought will help to critically assess what appears to be a new reform era in which international human rights law will set a new agenda for transforming or even abolishing mental health law as it currently stands.

"Mental disorders are widespread, cause
tremendous individual suffering and have far
reaching economical consequences. Increasing
awareness of these facts has led the European
Commission to publish a Green Paper
“Improving the mental health of the populations
– towards a strategy on mental health for the
European Union”, which stresses the importance
of measures for promoting mental health and
preventing mental disorders.
The Green Paper focuses on mental health
promotion in children and families as well as at
the work place; on the prevention of mental
disorders; on promoting the social inclusion of
mentally ill or disabled people, on the protection
of their fundamental rights and their dignity, and
on the improvement of information and
knowledge on mental health in the EU. It is
stressed that evaluated interventions should have
priority and that exchange of information
between member states is essential.
The provision of health services is not a topic of
the Green Paper, since the European Commission
has no mandate for the organization of health
care. The establishment of a common market and
the harmonization of legalization in the member
states have also contributed to a need for a
common policy on mental health promotion and
mental disorder prevention. The Green Paper
underscores the need for appropriate measures in
all societal sectors, if the status of the mental
health of the population is to be improved. It is
expected that, based on the Green Paper and the
results of the ensuing discussion process, the
European Commission will publish an EU
strategy on mental health in autumn 2007."

BACKGROUND: Although effective treatment modalities for mental health problems currently exist in Nigeria, they remain irrelevant to the 70% of Nigeria's 120 million people who have no access to modern mental health care services. The nation's Health Ministry has adopted mental health as the 9th component of Primary Health Care (PHC) but ten years later, very little has been done to put this policy into practice. Mental Health is part of the training curriculum of PHC workers, but this appears to be money down the drain. AIMS OF THE STUDY: To review the weaknesses and problems with existing mode of mental health training for PHC workers with a view to developing a cost-effective model for integration. METHODS: A review and analysis of current training methods and their impact on the provision of mental health services in PHC in a rural and an urban local government area in Nigeria were done. An analysis of tested approaches for integrating mental health into PHC was carried ...

The members of the National Association of State Mental Health Program Directors (NASMHPD) believe that seclusion and restraint, including “chemical restraints," are safety interventions of last resort and are not treatment interventions. Seclusion and restraint should never be used for the purposes of discipline, coercion, or staff convenience, or as a replacement for adequate levels of staff or active treatment. The use of seclusion and restraint creates significant risks for people with psychiatric disabilities. These risks include serious injury or death, retraumatization of people who have a history of trauma, and loss of dignity and other psychological harm. In light of these potential serious consequences, seclusion and restraint should be used only when there exists an imminent risk of danger to the individual or others and no other safe and effective intervention is possible. (Endorsed by the State Mental Health Directors, July 13, 1999). (NASMHPD 1999, NASMHPD Position Statement on Seclusion and Restraint. Alexandria, VA: National Technical Assistance Center for State Mental Health Planning.)

Objective: Postpartum depression continues to be under-treated. This project identified state policies that have been enacted regarding peripartum mental health and assessed how effective they might be. Methods: A systematic search strategy was used to detect state-level legislative initiatives. Legislative tracking resources were used to determine which were enacted. Policies were sorted into categories. Related evidence was reviewed to gauge the impact of each category. Results: Thirteen states have enacted one or more state-level peripartum mental health policies. Categories include patient education mandates, depression screening mandates, mandated task force, and public awareness campaigns. Those mandating screening include Illinois, Massachusetts, New Jersey, and West Virginia. Related outcomes evidence suggests a very limited impact. Conclusions: Several states have enacted policies addressing peripartum mental health, but these are probably not influencing clinical outcomes. Home visits with a mental health component are effective for postpartum depression; state policies could support home visits.

This report summarises the co-design process that was undertaken in early 2020 towards the formation of a new Service Model for Personality Disorders in Western Australia.
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Kelly Clark and Karen Wellington were engaged to facilitate a co-design process to systematically engage people with lived experience, carers and family members and clinicians in the development
of a service model for personality disorders. The purpose of this document is to report back on the co-design process, the findings that emerged and the changes that were suggested for the service
model.

The initial ‘design question’ was to seek development of a state-wide, beyond-clinical model of service for all personality disorders in Western Australia. The assumption of the question was tested,
as all design questions are, through the co-design process. When this had been examined through the co-empathise, co-discover, and the co-define stages, the renewed Problem Definition was:
“How do we make a system work for people with personality disorders - with an emphasis on continuity of philosophy rather than specific treatments?”.
During the co-design process, strengths, weaknesses and possible improvements of the lived experience, carer, clinical and non-clinical professional experience were identified. For lived experience individuals and carers, what current works is: patience, empathy, compassion and
validation from others, an increased understanding of PD, peer support, stable relationships and practical needs being met. What doesn’t work, is the lack of fit with the current array of available treatments. What is needed, is more empathy, compassion, validation and understanding, increased reliability of the system, more personalised and accessible services that give choice and agency, and more support for families and carers. For clinical and non-clinical professionals, what currently
works is professional training, increased understanding and support for reflective practice. What doesn’t work is a lack of knowledge leading to fear and stigma of BPD and burnout. What is needed is more opportunities, time and space for continued training, development and reflective practise, and for all treatments on offer to be evidence-based. For all, what is needed is more personalised and tailored approaches, and a systemic assumption (ie, from clinicians, bosses, peers, and
consumers) that each person is doing the best they can with what they have.

During the co-design process, a ‘prototype’ was created, in the form of a set of Narrative Cards that described potential key principles, features and elements of a future service model. The key principles, features and elements that are described in the Narrative Cards, arose from the
‘empathise’ and ‘discover’ phases of the co-design process. Thus the Narrative Cards developed through this co-design process are the consensus points of hundreds and hundreds of data points
collected throughout the process. The feedback gathered on the cards during Workshop 3 show additional data relating to the iteration of the model presented in the cards. The feedback from the Design Team on the Narrative Cards captures where there are agreements and differences between various stakeholders’ needs, aspirations, visions and ideas and the evidence base for a service model. The Narrative Cards describe points of reference for continuing the design process in
developing a system which works for people with personality disorder in Western Australia.

Based on the Narrative Card set, and the feedback provided, the following elements for a future
service model were most strongly prioritised:
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● A philosophy of care that is co-developed and used by all services in the State. This philosophy of care enabled each patient/consumer to have services within the system tailored to them, rather than them feeling the need to tailor themselves to the system.
● Improvements to the primary care response
● Clinicians and non-clinical professionals being given time, space and support for self-reflection
For the Project Reference Group, together with the funding and facilitating bodies, to fully and practically answer the question posed in the Problem Definition, an implementation strategy will need to be designed and systematically implemented. It is recommended that the above elements to a future service model be prioritised in the next steps, and the elements within all 30 Narrative Cards be considered. In summary, this will need to be the beginning of a hope filled journey to a
time when everyone in WA is able to receive support in relation to personality disorders.

Note on Scope
During the co-design process the co-design facilitators raised the matter of the enormous scope of the initial co-design question (changes to the state-wide service model for all personality disorders). This report discusses a co-design process that involved predominantly those from the Perth metropolitan area, and predominantly in relation to Borderline Personality Disorder (BPD).

Very little information is available on budget and financing of mental health services in the world. During year 2001, WHO collected information from all countries on resources available for mental health care as a part of Project Atlas. The present report seeks to describe the situation regarding federal budgets and financing of mental health care at the country level. It also examines the association between relative allocation of health budget to mental health and mental health policy, programme and resource indicators in 89 countries. The information was collected through a questionnaire (with an accompanying glossary) that was sent to the mental health focal point in the Ministry of Health of each country. Eighty nine countries provided information on their mental health budget as a proportion of health budget. In addition, information was obtained on policy, programme and mental health resource indicators (beds, personnel, services to special population and availability of dru...

There is a large body of literature examining the determinants of juvenile crime, which highlights economic, family, peer, and educational factors associated with delinquency and recidivism, and the important roles of social service and educational systems. Two factors, substance abuse and mental illness are also potentially important. The observed high correlations between crime, substance abuse and poor mental health suggests that factors which reduce substance abuse and improve mental health may also be effective in reducing criminal activities. The purpose of this paper is to examine the effectiveness of mental health and substance abuse treatment in reducing crimes committed by juveniles. This paper uses detention data in conjunction with substance abuse and mental health treatment data for youth enrolled in the Colorado state foster care program over a three year period. Duration models are used to examine the structural determinants of detention. We analyze the impact of trea...

Background: Although an abundance of literature exists regarding the attitudes and cultural competency of nurses toward people with mental illness, there is scarcity in the literature on these concepts in relation to Filipino nurses. Thus, this review aims to determine the attitudes and cultural competency of Filipino nurses caring for patients with mental illness. Methods: This scoping review was guided by Arksey and O'Malley's framework. Electronic databases of ProQuest and Ebscohost and the gray literatures were searched from July to August 2018 including the reference lists of eligible articles. Results: Fourteen articles met the inclusion criteria. The information and evidences on Filipino nurses' attitudes (n=11) towards patients with mental illness were limited; mostly extrapolations from the empirical studies and gray literatures on Filipino nurses in other countries and alongside other nurses with different nationalities. Evidences that suggest Filipino nurses are culturally competent (n=3) did not represent that of the nurses caring for patients with mental illness in the Philippines. Conclusion: Given mixed evidences and limited data in the literature, further research is essentially needed to improve quality nursing care and the development of interventions intended to reduce mental illness stigma which can be integrated in the community, school, workplace and other settings in the Philippines.

This article examines deficiencies and innovations in the Tennessee criminal justice system from the point of arrest to the point of release from incarceration.  It focuses on both the moral and financial benefits of adopting policies which better address the significant issues mentally ill criminal offenders face.

Over the last decade state prisons have experienced unprecedented growth and many demographic changes. At the same time, courts are requiring states to provide mental health screening and treatment to prisoners. Findings from recent studies indicate that the prevalence of mental illness is higher in prisons than in the community, and comorbidity is common. Our ability to generalize from these studies is limited, however, because of major shifts in the demographic mix in prisons during the past decade. New studies on the prevalence of mental illness in prisons, which consider these recent changes would help planners allocate funds and staff to more effectively meet the needs of these individuals.

An overview of the history of Asian American psychology is provided by reviewing the context for the development of the field as well as the early founding of the Asian American Psychological Association (AAPA). The presidents of AAPA as well as key events and conferences are noted. The involvement of AAPA leaders in national mental health policies and activities are reviewed. The substantive areas of Asian American psychology and the education and training of Asian American psychologists are also discussed. The article ends with some comments about the future of Asian American psychology.

Focusing on Thailand, we give a historical overview of LGBT identities and issues, highlight psychological, psychiatric and nursing research on LGBT mental health and services, and review LGBT-related policy statements of professional associations and state-affiliated instances dealing with mental health. Our review demonstrates that stigma, victimisation and familial rejection in Thailand are linked to stress, depression,
substance use and suicidality among Thai LGBT people. Research has insufficiently covered transgender men, bisexuals and intersex people. Access to mental health services and their appropriateness are impeded by generic factors (e.g. overcrowded services, stigma, and confidentiality concerns) and low practitioner knowledge of LGBT issues, stereotyping of LGBT clients, and anticipation of practitioners not being accepting or understanding LGBT identities. LGBT-related policy statements have been issued by state-affiliated bodies,
but not by professional associations. While sometimes supportive, many policy documents have used stigmatising terminology and perpetuated anti-LGBT prejudice. LGBT-specific counselling and health services have been established, therapeutic strategies have been investigated and information on LGBT issues has been disseminated, but LGBT sensitivity remains to be mainstreamed in Thai health and counselling
services. Providing training on LGBT issues, publicising the Yogyakarta Principles and getting professional associations engaged with LGBT issues are among the ways forward.

What is mental health? Mental health requires the development of cognitive, emotional, and social skills for which educational settings make an ideal context. Mental health may be defined as a state of wellbeing in which every individual realises their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community (WHO). Thus, mental health is not just the absence of illness. Importance of mental health in education Educational settings promote mental health when they provide children and adolescents with a sense of identity and self-respect, direction and meaning in life, mastery, belonging, safety, social support and participation. Good mental health is associated with better educational and behavioural outcomes. A range of effective interventions are available to promote mental health and to prevent and reduce mental illness. However, very few children and adolescents receive such interventions in the school setting. Benefits of incorporating mental health into educational policies Mental health promoting pre-schools and schools have a wide range of positive impacts on children's development, including large impacts on educational outcomes and equity. Incorporating mental health into educational policies contributes to developing, maintaining and protecting society's most potent and least developed resource, the mental health of children. There is solid evidence that the cost-benefit ratio of mental health interventions in educational settings is very favourable. Recommendations • Provide a system of affordable, available and accessible high quality public day-care centres for all children. • Implement evidence based anti-bullying programs and whole-school based interventions to promote mental health and wellbeing, and prevent mental disorders in school. • Routinely assess day-care centres and schools on whether they promote mental health, providing young people with a sense of identity and self-respect, direction and meaning in life, mastery, belonging, safety, social support and participation. • Include children, adolescents and their families in planning school environments which promote mental health and wellbeing. • Collect regularly data on children's and adolescents' mental wellbeing and any problems. • Train school staff to support children's psychosocial development. • Include mental health promotion in national school curriculum. Key messages • The mental health of Europe's children and adolescents is its most potent yet least systematically developed resource. • The mental health and wellbeing of children and adolescents has a value in its own right, and children and adolescents should not only be seen as future adults. • The educational setting is the most important arena outside the family for the development of children's mental health. • Solid evidence is now available to guide day-care centres, pre-schools, and schools in how to promote social-emotional learning and wellbeing, and how to reduce and prevent mental distress, violence, bullying, conflict and aggression. However, few children and adolescents receive such interventions. • Inclusion of mental health in educational policies-nationally, regionally and locally-has a very favourable cost-benefit ratio as it releases large societal resources in terms of wellbeing, cognitive, emotional and social skills (" mental capital "), which again have a broad range of positive impacts, including educational outcomes.

The paper presents an historical critical policy analysis of deinstitutionalisation and the introduction of neoliberal forms of governance in mental health policy. It focuses particularly on a major period of policy reform in the 1980s and 1990s in Victoria, Australia. Many of the particularities of the Victorian experience can be generally observed with deinstitutionalisation throughout the world. In particular, the policy discourse of rights and entitlements, consumer choice and empowerment, at times stood in tension with the service void created by the transition from large, standalone psychiatric institutions, to dispersed forms of service provision outside the hospital. Further, certain policy features could be seen to perpetuate patterns of coercion, abuse and neglect. This article offers a number of potential lessons for mental health law, policy and practice today, which is poised for further advances of neoliberal governance, including through the policy of personalised services, individualised disability funding and human rights-based reform.

The federal Mental Health Parity Act of 1996 requires insurers to offer the same benefits for mental disorders and substance abuse as they would for physical disorders, including any annual or lifetime limitations and restrictions placed upon such coverage. This report examines actuarial studies, the current state of parity legislation across the nation, cost of treatment issues, and the impact on Florida should parity legislation be passed.

Suggested Citation
Bruce Lubotsky Levin, Ardis Hanson, and Richard Coe. "Mental health parity: National and state perspectives 2001: A report to the Florida Legislature" Tampa, FL: The Louis de la Parte Florida Mental Health Institute Jul. 2001.
Available at: http://works.bepress.com/ardis_hanson/77

Albania’s mental health sector is shaped by global mental health reform efforts as well as by the general societal changes taking place in the country during the postsocialist period. An understanding of contextual challenges is crucial to the creation of effective mental health services and the promotion of public mental health in the country. I open this paper with a historical overview of the development of Western and socialist psychiatry in the Albanian context. I continue with an analysis of postsocialist mental health reform, a complex process in which local and international actors seek to transform the Albanian mental health sector from an institutional system characterized by isolation, stigma, and abuse, to one that embraces community-based services, consumer and caregiver empowerment. Finally, I present the impact of these processes on mental health institutions, family and community members, and consumers, drawing on 50 semi-structured interviews and 30+ hours of participant observation conducted in central and southeastern Albania (Elbasan, Korče, and Tirana) during the summer of 2013.

Mental Health in All Policies (MHiAP) is an approach to promote population mental health and wellbeing by initiating and facilitating action within different non-health public policy areas. MHiAP emphasises the impacts of public policies on mental health determinants, strives to reduce mental health inequalities, aims to highlight the opportunities offered by mental health to different policy areas, and reinforces
the accountability of policy-makers for mental health impact. The MHiAP approach can be applied at all administrative levels, ranging from local authorities to the EU level.

The EU Joint Action for Mental Health and Wellbeing set out to map, assess, disseminate and pilot good practices within an MHiAP approach. In this respect, the term mental health incorporates both mental wellbeing and mental disorder. Mental health is perceived as an important resource for the
wellbeing of individuals, families and societies, according to the World Health Organization (WHO) definition of mental health. The Joint Action is underpinned by the notion that mental health is more crucial today than it has ever been. This is due to its broad range of impacts and due to the increase in
mental capacity required by the transition from a society dominated by manual work into an information
society, and by the notion that a range of cost-effective public mental health interventions exists but are not widely implemented.

Mental health has a substantial and broad set of impacts across policy areas. Mental disorders constitute one third of the disease burden in Europe, a figure which is on the increase. Not only do mental disorders cause a significant loss of work days and decrease in European productivity, but also immense
individual and family suffering. Mental disorders also have profound negative effects on academic achievements. A shift in this trend requires coordinated implementation of a range of effective public mental health interventions to promote mental wellbeing and prevent mental disorders.

Many individual, familial and societal determinants of mental health lie in non-health policy domains such as social policy, taxation, education, employment and community design. It is now recognised that the very foundations of mental health are laid down early in life and are later supported by positive
nurturing, high social capital, a good work life and a sense of meaning. Many of these factors can be enhanced through the MHiAP approach in non-health sectors and, therefore, remain important targets for mental health promotion and mental disorder prevention interventions. Examples of effective
interventions to promote population mental health include interventions in local communities, parenting support and home visiting programmes as well as school based programmes.

Lessons learned from the promotion of physical health indicate that the road to improved mental health among populations lies less in the investment in late-coming mental health services, but more in a co-ordinated public mental health programme to implement large-scale promotion and prevention activities.

Globalisation and European integration have strengthened the influence of international actors on health determinants and thus reduced the power and opportunities of national health policies. Increasingly, mental health determinants lie in the areas of EU policy and international agreements. EU legislation and actions in many non-health fields can have a decisive impact on the mental health of EU citizens. This calls for an active civic society to minimise potential negative mental health impacts and to create strong local communities which are conducive to mental health.

ABSTRAK Tingginya angka penolakan pasien rawat inap di Rumah Sakit Jiwa Provinsi Jawa Barat yang mencapai 300-400 pasien per tahun (1.1) tidak sejalan dengan angka kinerja rumah sakit pada tahun 2013. Penelitian bertujuan menggambarkan cetak biru pelayanan pasien dalam mendapatkan pelayanan rawat inap dan menemukan titik potensi perbaikan dengan pengamatan pada lima unit pelayanan yang terlibat. Penelitian ini adalah penelitian kualitatif dengan teknik penelitian operasional. Hasil penelitian yaitu diperolehnya desain cetak biru pelayanan pasien untuk pasien rawat jalan atau pasien gawat darurat yang memerlukan rawat inap, dan penolakan pasien dapat dikurangi dengan menetapkan aturan penggunaan instrumen PANSS-EC (Positive and Negative Syndrome Scale-Excited Component) untuk menilai status pasien. Kata kunci: cetak biru pelayanan, penolakan pasien, rumah sakit jiwa. ABSTRACT The in-patient refusal number in West Java Province Psychiatric Hospital which reach 300-400 patient per year (1) , doesn't go along with the hospital achievement number in 2013. This research is aimed to describe a Service-Blueprints for inpatients services and investigate potential points for improvement by observings five service units that are involved. This is a qualitative research with operational research technique. The results are a set of service-blueprints design for outpatients or emergency patients, who need hospitalization, and establishing the use of Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) instrument as a tool for determining the patient status can significantly lower patient refusal.