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Patterson AS, Clark MA, Rogers AV. Network power and mental health policy in post-war Liberia. Health Policy Plan 2024; 39:486-498. [PMID: 38544412 PMCID: PMC11095261 DOI: 10.1093/heapol/czae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 03/01/2024] [Accepted: 03/20/2024] [Indexed: 05/16/2024] Open
Abstract
This article traces the influence of network power on mental health policy in Liberia, a low-income, post-conflict West African country. Based on key informant interviews, focus group discussions and document analysis, the work uses an inductive approach to uncover how a network of civil society groups, government officials, diasporans and international NGOs shaped the passage, implementation and revision of the country's 2009 and 2016 mental health policies. With relations rooted in ties of information, expertise, resources, commitment and personal connections, the network coalesced around a key agent, the Carter Center, which connected members and guided initiatives. Network power was evident when these actors channelled expertise, shared narratives of post-war trauma and mental health as a human right, and financial resources to influence policy. Feedback loops appeared as policy implementation created new associations of mental health clinicians and service users, research entities and training institutes. These beneficiaries offered the network information from lived experiences, while also pressing their own interests in subsequent policy revisions. As the network expanded over time, some network members gained greater autonomy from the key agent. Network power outcomes included the creation of government mental health institutions, workforce development, increased public awareness, civil society mobilization and a line for mental health in the government budget, though concerns about network overstretch and key agent commitment emerged over time. The Liberian case illustrates how networks need not be inimical to development, and how network power may facilitate action on stigmatized, unpopular issues in contexts with low state capacity. A focus on network power in health shows how power can operate not only through discrete resources such as funding but also through the totality of assets that network linkages make possible.
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Affiliation(s)
- Amy S Patterson
- Carl Biehl Professor of International Affairs, Department of Politics, University of the South, Sewanee, TN 37375, United States
| | - Mary A Clark
- Department of Political Science, Tulane University, New Orleans, LA 70118, United States
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Larrieta J, Wuerth M, Aoun M, Bemme D, D'souza N, Gumbonzvanda N, Esponda GM, Roberts T, Yoder-Maina A, Zamora E, Qureshi O, Giacaman R. Equitable and sustainable funding for community-based organisations in global mental health. Lancet Glob Health 2023; 11:e327-e328. [PMID: 36716753 DOI: 10.1016/s2214-109x(23)00015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/14/2022] [Accepted: 01/03/2023] [Indexed: 01/30/2023]
Affiliation(s)
| | - Milena Wuerth
- Centre for Society and Mental Health, King's College London, London, UK
| | - May Aoun
- Save the Children, Fairfield, CT, USA
| | - Dörte Bemme
- Centre for Society and Mental Health, King's College London, London, UK
| | - Nicole D'souza
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | - Georgina Miguel Esponda
- SHM Foundation, London WC1R 4EB, UK; Centre for Society and Mental Health, King's College London, London, UK
| | - Tessa Roberts
- Centre for Society and Mental Health, King's College London, London, UK
| | | | - Emilia Zamora
- Escuela de Psicología, Universidad de las Américas, Quito, Ecuador
| | | | - Rita Giacaman
- Birzeit University, West Bank, occupied Palestinian territory
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Diaz-Castro L, Suarez-Herrera JC, Gonzalez-Ruiz OO, Orozco-Nunez E, Sanchez-Dominguez MS. Governance in mental healthcare policies during the COVID-19 pandemic in Mexico. Front Public Health 2023; 11:1017483. [PMID: 36960375 PMCID: PMC10029603 DOI: 10.3389/fpubh.2023.1017483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Abstract
The COVID-19 pandemic has become the greatest burden of disease worldwide and in Mexico, affecting more vulnerable groups in society, such as people with mental disorders (MD). This research aims to analyze the governance processes in the formulation of healthcare policies for people with MD in the face of the COVID-19 pandemic. An analytical qualitative study, based on semi-structured interviews with key informants in the healthcare system was conducted in 2020. The study followed the theoretical-methodological principles of the Governance Analytical Framework (GAF). The software ATLAS.ti-V.9 was used for inductive thematic analysis, classifying themes and their categories. To ensure the proper interpretation of the data, a process of triangulation among the researchers was carried out. The findings revealed that in Mexico, the federal Secretary of Health issued guidelines for mental healthcare, but there is no defined national policy. Decision-making involved multiple actors, with different strategies and scopes, depending on the type of key-actor and their level of influence. Majority of informants described a problem of implementation in which infection control policies in the psychiatric population were the same as in the general populations which decreased the percentage of access to healthcare during the pandemic, without specific measures to address this vulnerable population. The results suggest that there is a lack of specific policies and measures to address the needs of people with mental disorders during the COVID-19 pandemic in Mexico. It also highlights the importance of considering the role of different actors and their level of influence in the decision-making process.
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Affiliation(s)
- Lina Diaz-Castro
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Directorate of Epidemiological and Psychosocial Research, Mexico City, Mexico
- *Correspondence: Lina Diaz-Castro
| | - Jose Carlos Suarez-Herrera
- KEDGE Business School, Entrepreneurship and Sustainable Development, Department of Strategy, Marseille, France
| | | | - Emanuel Orozco-Nunez
- Medical Sciences, National Institute of Public Health, Health Systems Research Center, Cuernavaca, Mexico
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Hasking P, Lewis SP, Staniland L, Mirichlis S, Hird K, Gray N, Arai M, Pemberton E, Preece D, Boyes M. Further Silencing the Voiceless: The Role of Gatekeepers in Accessing Information About Self-Injury. J Nerv Ment Dis 2023; 211:5-10. [PMID: 36596286 DOI: 10.1097/nmd.0000000000001575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
ABSTRACT Gatekeepers play a pivotal role in protecting individuals under their care and are central to keeping people safe and away from harm. In the field of nonsuicidal self-injury (NSSI), a range of gatekeepers exist, including those who protect access to vulnerable research participants, those who protect school children, those charged with making decisions about funding priorities, and those in charge of clinical care for people who self-injure. The aim of this commentary is to outline the roles these different gatekeepers have in protecting access to research participants, access to NSSI knowledge, and access to clinical care for individuals who self-injure. We provide examples in which gatekeepers may present barriers and offer solutions for how to work with gatekeepers for mutual benefit.
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Affiliation(s)
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, Ontario, Canada
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Iemmi V. Establishing political priority for global mental health: a qualitative policy analysis. Health Policy Plan 2022; 37:1012-1024. [PMID: 35763373 PMCID: PMC9384251 DOI: 10.1093/heapol/czac046] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/09/2022] [Accepted: 06/10/2022] [Indexed: 11/21/2022] Open
Abstract
Mental disorders represent the leading cause of disability worldwide, yet they remain a low global health priority. This paper uses a case study methodology and different data sources (35 interviews and documents) to analyse factors that have shaped the generation of political priority for global mental health over the past three decades (1990–2020) and their changes over time. The Shiffman and Smith framework on determinants of political priority for global health issues is used to organize data into themes: actor power, ideas, political context and issue characteristics. Global mental health has gained political attention, especially over the past decade, yet support remains limited. Findings reveal that actor power is undermined by a fragmented policy community, the absence of one guiding institution or coordination mechanism and little civil society mobilization. Public portrayal of the issue is divided, hampered by the absence of a common understanding by the community and by stigma. Some policy windows have been missed and a strong global governance structure is lacking. Credible indicators and evidence on simple cost-effective solutions, especially in low- and middle-income countries, are scarce. However, opportunities are arising, including an increasing number of leaders and grassroots organizations, multiple arguments for action and integrated solutions resonating with broader audiences, widening political support at the national level, an emerging global governance structure and an expanding evidence base on the scale of the problem and available solutions. The results point to three technical and four political challenges that advocates need to address to increase political support over the next decade.
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Affiliation(s)
- Valentina Iemmi
- Department of Health Policy, London School of Economics and Political Science, Houghton St., London WC2A 2AE, UK
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Larrieta J, Miguel Esponda G, Gandhi Y, Simpson N, Biriotti M, Kydd A, Eaton J, Ryan GK. Supporting community-based mental health initiatives: insights from a multi-country programme and recommendations for funders. BMJ Glob Health 2022; 7:bmjgh-2022-008906. [PMID: 35537763 PMCID: PMC9092131 DOI: 10.1136/bmjgh-2022-008906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/13/2022] [Indexed: 11/19/2022] Open
Abstract
Community-based mental health initiatives are uniquely positioned to understand the mental health needs of their local population and provide relevant, culturally appropriate and sustainable responses. However, at the grassroots level, mental health initiatives in low- and middle-income countries face key challenges, such as inadequate funding, barriers to demonstrating impact and difficulty engaging with stakeholders. The Ember Mental Health programme establishes 12-month partnerships with community-based mental health initiatives in low- and middle-income countries to support them to address these challenges, grow and achieve sustainability. This paper outlines a longitudinal qualitative study conducted to evaluate the 2020-2021 Ember Mental Health programme. Data were collected from March 2020 to March 2021 through semistructured interviews conducted with 11 initiatives at various time points throughout their Ember Mental Health partnership. A framework approach was used to analyse all data in its original language. Findings indicated that initiatives particularly benefited from provision of side-by-side mentorship; opportunities for skills strengthening and strategic thinking; occasions to network with other like-minded initiatives and/or experts in global mental health; and support on team empowerment and well-being. Based on these findings, we put forward various recommendations for funders and other stakeholders working to support community-based mental health initiatives in low- and middle-income countries. Through establishing collaborative partnerships that challenge more top-down, traditional funder–grantee relationships, it is possible to support the rich ecosystem of initiatives working to address the mental health needs of communities.
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Affiliation(s)
| | - Georgina Miguel Esponda
- SHM Foundation, London, UK.,Health Services and Population Research, King's College London, London, UK.,ESRC Centre for Society and Mental Health, King's College London, London, UK
| | | | - Nikita Simpson
- SHM Foundation, London, UK.,London School of Economics and Political Science, London, UK
| | | | | | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK.,CBM Global Disability and Inclusion, Amsterdam, Netherlands
| | - Grace Kathryn Ryan
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
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Poudyal A, Gurung D, Kohrt BA. Evidence-based approaches for promoting gender equity in global mental health research: Study protocol for social network analysis of researchers in Nepal. SSM - MENTAL HEALTH 2021; 1:None. [PMID: 34957425 PMCID: PMC8654682 DOI: 10.1016/j.ssmmh.2021.100032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022] Open
Abstract
There are increasing efforts for capacity building of researchers in low- and middle-income countries (LMIC) to foster local ability to conduct high quality research. However, female researchers remain underrepresented in scientific communities, particularly in LMIC where they have limited networking and mentorship opportunities. This protocol is for a Social Network Analysis (SNA) to evaluate if gender-sensitive, need-based capacity building can improve researchers' networking and mentorship opportunities in Nepal. The conceptual framework is informed by Social Cognitive Career Theory. Cross-sectional and longitudinal SNA are used to a) assess individual researchers’ network characteristics and their association with academic productivity; and b) examine if the association of network characteristics and academic productivity is mediated by self-efficacy and outcome expectations. Recruitment is designed to include early-career and senior researchers conducting mental health research, as well as students interested in pursuing a career in mental health research. The network characteristics will be mapped for approximately 150 researchers in working in Nepal. SNA characteristics in the network (individual density, homophily, and centrality) will be compared with academic productivity (total peer reviewed publications, h-index), including mediation effects via self-efficacy and outcome expectations. Ultimately, this study will generate information to design more evidence-based strategies for capacity building of a gender-equitable research workforce in global mental health.
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Affiliation(s)
- Anubhuti Poudyal
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA.,Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Dristy Gurung
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, UK.,Transcultural Psychosocial Organization, Balutwatar, Kathmandu, Nepal
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC, USA.,Transcultural Psychosocial Organization, Balutwatar, Kathmandu, Nepal
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Iemmi V. Global collective action in mental health financing: Allocation of development assistance for mental health in 142 countries, 2000-2015. Soc Sci Med 2021; 287:114354. [PMID: 34492405 DOI: 10.1016/j.socscimed.2021.114354] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/06/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
Collective action between international donors is central to the mobilisation of global solidarity in global health. This is especially important in mental health where resources remain extremely limited. In this paper I investigate global collective action in mental health financing, looking at the responsiveness of international donors to mental health needs in low- and middle-income countries (LMICs). I analyse factors at the level of recipient countries (needs, interests, policy environment) associated with allocation of development assistance for mental health (DAMH) using a two-part regression model applied to a time series cross-sectional dataset of 142 LMICs between 2000 and 2015. Findings reveal that international donors' disbursements are not well aligned with mental health needs of recipient countries, and, moreover, contextual factors might be playing more prominent roles in resource allocation. Countries are more likely to receive DAMH if they experience significant outbreaks of infectious diseases or have lower gross domestic product (GDP) per capita and lower market openness. Selected recipient countries are more likely to receive higher DAMH amounts per capita if they have lower GDP per capita, higher government health expenditure, or higher mortality rates due to conflicts or natural disasters. Past DAMH recipients are more likely to be selected and, when selected, to receive higher DAMH amounts per capita. My results demonstrate that more holistic collective action amongst international donors is required to address mental health needs in LMICs. Investments should better reflect needs, particularly during and after emergencies such as COVID-19, and could be amplified by leveraging synergies across other health conditions and sectors.
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Affiliation(s)
- Valentina Iemmi
- Department of Health Policy, London School of Economics and Political Science, London, UK; Department of Social Policy, London School of Economics and Political Science, London, UK.
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