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.

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.

Multidisciplinary teams (MDTs) are conventionally recommended in mental health
care literature as an important way to offer holistic treatment provision to patients. This
study aims to explore multidisciplinary teamwork in contemporary mental health
settings, particularly what aids and hinders the process of multidisciplinary teamworking,
and the social work contribution in such teams. In order to attain an in-depth
exploration of these phenomena, a single case study design was employed. Within this
design, data were generated through semi-structured interviews and structured
observation of a mental health MDT in Ireland. These data were analysed using
interpretative phenomenological analysis. The research highlights how the concept of
mental illness is contested within this MDT, with the medical model dominant within
an environment of fluid working arrangements. Professional role blurring and
stereotyping were found to impact the division of labour on this team, with role
negotiation found to be an integral part of retaining a professional’s practice identity.
This research raises concerns for social work’s capacity to function within mental
health MDTs in Ireland, and highlights ways in which social work educators might
respond in order to empower Irish social workers to meet the challenges of mental
health multidisciplinary teamworking.

Background: Whilst current policy is replete with recovery language and references to the need for services to create a sense of hope and optimism, there is less understanding about how such hope may be engendered within services. We propose that an understanding of compassion is necessary to appreciate what actually stimulates hope-inspiring practices.

Aims: An examination of the continuing relevance of compassion to mental health care and an exploration of its place within modern mental health policy and practice.

Methods: A review of the compassion deficit in mental health care and a critical examination of whether the direction of current mental health policy in the UK is likely to facilitate compassionate care.

Results: Compassion needs to be viewed not merely as an individual expression or property but something
which must be nurtured in context, through relationships, cultures and healing environments. However, current mental health policy and practice does not appear to prioritise the development of
such contexts.

Conclusion: Attention to fostering compassion would help to shift the language of “recovery” (or “wellbeing”) beyond the twin dangers of rhetoric and/or imposing preconceived definitions, models or expectations of what recovery “should” be. Therefore, the development of compassionate contexts should have a stronger place in modern mental health practice and policy."

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...

"Abstract - In the next years, dementias will have a great incidence in Latin America. However, the social protection and health systems from most of the countries seem to be unprepared for that challenge. In this paper, the need to design and execute public policies in the approach of dementias is grounded. Two perspectives of these disorders’ approach are presented: a neuropathological from the assistance paradigm and other psychosocial, in a human rights paradigm. Likewise, some obstacle for the politics’ elaboration are pointed out, among them, social prejudice about elderly, that are negatively enhanced by the stigmas about mental illnesses. Finally, some guiding principles are presented to the elaboration of public policies, based on good practices from a human rights perspective.

Key words: Demetia, Alzheimer, Mental Health, Public Policies
Full text in Spanish

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.

Background: Policies generate accountability in that they offer a standard against which government performance can be assessed. A central question of this study is whether ideological imprint left by policy is realized in the time following its adoption. National mental health policy expressly promotes the notion of deinstitutionalization, which mandates that individuals be cared for in the community rather than in institutional environments. Methods: We investigate whether mental health policy adoption induced a transformation in the structure of mental health systems, namely psychiatric beds, using panel data on 193 countries between 2001 and 2011. Results: Our striking regression results demonstrate that late-adopters of mental health policy are more likely to reduce psychiatric beds in mental hospitals and other biomedical settings than innovators, whereas they are less likely than non-adopters to reduce psychiatric beds in general hospitals. Conclusions: It can be inferred late adopters are motivated to implement deinstitutionalization for technical efficiency rather than social legitimacy reasons.

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.

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 paper examines conflicts in polices in England and Wales pertaining to the demand for alternative, non-medical crisis support for those experiencing ‘psychosis’. We examine
the limitations of current treatment, policy and legislative frameworks in supporting these demands. In particular, we focus on the limitations of prevailing conceptualisations of ‘human rights’, ‘social inclusion’ and ‘recovery’. These concepts, we argue, are embedded within a broader treatment framework which renders medication as mandatory and all other treatment modalities as inherently subsidiary, and a broader policy framework which is complicit with bio-medical orthodoxies of ‘mental illness’ and prioritises treatment compliance and compulsion. Therefore, in order to advance a ‘human rights’ approach to mental health policy, we argue that reigning orthodoxies inherent within policy and practice must be explicitly challenged to open up spaces for the availability of alternatives.

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.

Public mental health deals with mental health promotion, prevention of mental disorders and suicide, reducing mental health inequalities, and governance and organization of mental health service provision. The full impact of mental health is largely unrecognized within the public health sphere, despite the increasing burden of disease attributable to mental and behavioral disorders. Modern public mental health policies aim at improving psychosocial health by addressing determinants of mental health in all public policy areas. Stigmatization of mental disorders is a widespread phenomenon that constitutes a barrier for help-seeking and for the development of health care services, and is thus a core issue in public mental health actions. Lately, there has been heightened interest in the promotion of positive mental health and wellbeing. Effective programmes have been developed for promoting mental health in everyday settings such as families, schools and workplaces. New evidence indicates that many mental disorders and suicides are preventable by public mental health interventions. Available evidence favours the population approach over high-risk approaches. Public mental health emphasizes the role of primary care in the provision of mental health services to the population. The convincing evidence base for population-based mental health interventions asks for actions for putting evidence into practice.

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.

In this article we draw upon the work of governmentality and cultural risk theorists (Foucault
1991; Rose 1999; Dean 1999; Lupton 1999) and feminist research into women’s experience of
depression (Stoppard, 2000) to develop a gendered analysis of recent Australian mental health
policies. We explore the power-knowledge relations that shape current policy directions, and
hence the thinking that guides health professionals, in relation to women’s experience of
depression and emotional distress in society today. Policy discourses are a means through which
neo-liberal rule is exercised in relation to women’s emotional lives as a population and as
individuals identified as ‘at risk’ of mental disorder. Yet, a sociocultural analysis of the
gendered experience of depression has been largely ignored within mental health policy that
draws upon biomedical and psychological discourses aimed at the prevention, identification and
treatment of disorder. We ask where, in this contemporary regime of truth, is there room for
women to ask critical questions about their own experiences of selfhood and emotions in
contemporary culture, and importantly, to be heard?

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.