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EU mental health governance and citizen participation: a global governmentality perspective. HEALTH ECONOMICS POLICY AND LAW 2020; 16:38-50. [PMID: 32799952 DOI: 10.1017/s1744133120000262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the last three decades, a system of European Union mental health governance (EUMHG) emerged, via instruments including strategies for action, joint actions, pacts and high-level expert groups. It sponsored multiple projects, initiatives and research, and involved state, non-state and European institutional actors. This paper attempts to understand how EUMHG operated and the structure of political relations within it, attending especially to opportunities for citizen participation. It adopts a global governmentality approach that focuses on practices and discourses. It finds that EUMHG practices including benchmarks, best practices and risk-thinking reinforced larger EU policy goals of market-optimisation, and that the central discourses of de-institutionalisation (DI) and community mental health (CMH) shifted meaning over time, first apprehending mental health as a public-health goal, then targeting mental ill-health as a burden to states. Finally, it finds that non-governmental organisations' (NGOs) work within EUMHG rendered them both objects and subjects of government. Through these dynamics, citizens usually were positioned outside governance, and NGO identities were altered, though CMH's transformative potential remained. Citizen participation in EUMHG was heavily conditioned. NGO and citizen power will need vigilant protection in any future EUMHG.
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Beijer U, Scheffel Birath C, DeMartinis V, Af Klinteberg B. Facets of Male Violence Against Women With Substance Abuse Problems: Women With a Residence and Homeless Women. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:1391-1411. [PMID: 26637590 DOI: 10.1177/0886260515618211] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The aims of this study were to investigate the type and extent to which women with substance abuse problems have been exposed to male violence during their lifetime, and to examine possible differences between women with a residence (WR) and homeless women (HW). The total sample included 79 women (WR, n = 35; HW, n = 44; M age = 47.8 years). Of the total sample, 72 women (91%) had experienced different kinds of male violence, 88% from former partners, and 26% from male friends or acquaintances. Of the 72 women, 71% further reported "Countless occasions of violent events," and 36% had been forced to commit criminal acts. Abused women who had been forced to commit criminal acts were significantly more frequently found to be homeless, have reported parental alcohol and/or drug problems, have witnessed domestic violence in childhood, have been victims of sexual violence, have used illicit drugs as a dominant preparation, and have injected illicit drugs. Almost half of the abused women (46%) met criteria for posttraumatic stress disorder (PTSD), where HW showed an almost 4-time higher risk (RR 3.78) than WR. In conclusion there is a particular vulnerability in women with substance abuse to male violence, which has an important impact on their health status. Thus, from a public health perspective, it is suggested that for those women who have experienced male violence, treatment protocols need to include both assessing and addressing the impact of such experience in relation to substance abuse as well as concomitant health concerns.
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Geyti C, Maindal HT, Dalsgaard EM, Christensen KS, Sandbæk A. Mental health assessment in health checks of participants aged 30-49 years: A large-scale cohort study. Prev Med Rep 2018; 9:72-79. [PMID: 29348995 PMCID: PMC5767564 DOI: 10.1016/j.pmedr.2017.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 12/18/2017] [Indexed: 11/30/2022] Open
Abstract
Mental distress is an independent risk factor for illness related impairment. Awareness of mental health (MH) allows prevention, but early detection is not routinely performed in primary care. This cohort study incorporated MH assessment in a health promoting programme. We described the level of poor MH among health check participants, explored the potential for early intervention, and the potential for reducing social inequality in MH. The study was based on 9767 randomly selected citizens aged 30-49 years invited to a health check in Denmark in 2012-14. A total of 4871 (50%) were included; 49% were men. Poor MH was defined as a mental component summary score of ≤ 35.76 in the SF-12 Health Survey. Data was obtained from national health registers and health check. Participants with poor MH (9%) were more socioeconomic disadvantaged and had poorer health than those with better MH. Two thirds of men (64%) and half of women (50%) with poor MH had not received MH care one year before the health check. Among those with (presumably) unrecognized MH problems, the proportion of participants with disadvantaged socioeconomic characteristics was high (43-55%). Four out of five of those with apparently unacknowledged poor MH had seen their GP only once or not at all during the one year before the health check. In conclusion, MH assessment in health check may help identify yet undiscovered MH problems.
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Affiliation(s)
- Christine Geyti
- Research Unit for General Practice & Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark
- Corresponding author at: Research Unit for General Practice & Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark.Research Unit for General Practice & Section for General Medical PracticeDepartment of Public HealthAarhus UniversityBartholins Allé 2Aarhus CDK-8000Denmark
| | - Helle Terkildsen Maindal
- Section for Health Promotion and Health Services Research, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark
- Steno Diabetes Centre Copenhagen, Health Promotion Research, Niels Steensens Vej 2, 2820 Gentofte, Denmark
| | - Else-Marie Dalsgaard
- Research Unit for General Practice & Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark
| | - Kaj Sparle Christensen
- Research Unit for General Practice & Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark
| | - Annelli Sandbæk
- Research Unit for General Practice & Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark
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Abstract
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.
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Haro JM, Ayuso‐Mateos JL, Bitter I, Demotes‐Mainard J, Leboyer M, Lewis SW, Linszen D, Maj M, Mcdaid D, Meyer‐Lindenberg A, Robbins TW, Schumann G, Thornicroft G, Van Der Feltz‐Cornelis C, Van Os J, Wahlbeck K, Wittchen H, Wykes T, Arango C, Bickenbach J, Brunn M, Cammarata P, Chevreul K, Evans‐Lacko S, Finocchiaro C, Fiorillo A, Forsman AK, Hazo J, Knappe S, Kuepper R, Luciano M, Miret M, Obradors‐Tarragó C, Pagano G, Papp S, Walker‐Tilley T. ROAMER: roadmap for mental health research in Europe. Int J Methods Psychiatr Res 2014; 23 Suppl 1:1-14. [PMID: 24375532 PMCID: PMC6878332 DOI: 10.1002/mpr.1406] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Despite the high impact of mental disorders in society, European mental health research is at a critical situation with a relatively low level of funding, and few advances been achieved during the last decade. The development of coordinated research policies and integrated research networks in mental health is lagging behind other disciplines in Europe, resulting in lower degree of cooperation and scientific impact. To reduce more efficiently the burden of mental disorders in Europe, a concerted new research agenda is necessary. The ROAMER (Roadmap for Mental Health Research in Europe) project, funded under the European Commission's Seventh Framework Programme, aims to develop a comprehensive and integrated mental health research agenda within the perspective of the European Union (EU) Horizon 2020 programme, with a translational goal, covering basic, clinical and public health research. ROAMER covers six major domains: infrastructures and capacity building, biomedicine, psychological research and treatments, social and economic issues, public health and well-being. Within each of them, state-of-the-art and strength, weakness and gap analyses were conducted before building consensus on future research priorities. The process is inclusive and participatory, incorporating a wide diversity of European expert researchers as well as the views of service users, carers, professionals and policy and funding institutions.
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Affiliation(s)
- Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMMadridSpain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de LLobregatBarcelonaSpain
- Universitat de BarcelonaBarcelonaSpain
| | - José Luis Ayuso‐Mateos
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMMadridSpain
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP)Universidad Autónoma de MadridSpain
| | - Istvan Bitter
- Department of Psychiatry and PsychotherapySemmelweis UniversityBudapestHungary
| | - Jacques Demotes‐Mainard
- Institut National de la Santé et de la Recherche Médicale (INSERM U955)CreteilFrance
- ECRIN Coordination OfficeParisFrance
| | - Marion Leboyer
- Fondation FondaMentalCréteilFrance
- Institut National de la Santé et de la Recherche Médicale (INSERM U955)CreteilFrance
- URC Eco Ile‐de‐France (AP‐HP)ParisFrance
| | - Shôn W. Lewis
- School of Community Based MedicineThe University of ManchesterManchesterUK
| | - Donald Linszen
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EuronMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Mario Maj
- Department of PsychiatryUniversity of Naples SUNNaplesItaly
| | - David Mcdaid
- PSSRU, LSE Health and Social Care and European Observatory on Health Systems and PoliciesLondon School of Economics and Political ScienceLondonUK
| | | | - Trevor W. Robbins
- Department of Psychology, and Behavioural and Clinical Neuroscience InstituteUniversity of CambridgeCambridgeUK
| | - Gunter Schumann
- Institute of PsychiatryKing's College LondonLondonUK
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of PsychiatryKing's College LondonLondonUK
| | - Graham Thornicroft
- Institute of PsychiatryKing's College LondonLondonUK
- Health Services and Population Research Department, Institute of PsychiatryKing's College LondonLondonUK
| | | | - Jim Van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EuronMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Kristian Wahlbeck
- The Nordic School of Public Health (NHV)GothenburgSweden
- Finnish Association for Mental HealthHelsinkiFinland
- National Institute for Health and Welfare (THL)VaasaFinland
| | - Hans‐Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies (CELOS)Technische Universität DresdenGermany
| | - Til Wykes
- Institute of PsychiatryKing's College LondonLondonUK
- Department of Psychology, Institute of PsychiatryKing's College LondonLondonUK
| | - Celso Arango
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMMadridSpain
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de MedicinaUniversidad ComplutenseMadridSpain
| | - Jerome Bickenbach
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMMadridSpain
- Swiss Paraplegic Research CentreNottwilSwitzerland
| | - Matthias Brunn
- Fondation FondaMentalCréteilFrance
- URC Eco Ile‐de‐France (AP‐HP)ParisFrance
| | | | - Karine Chevreul
- Fondation FondaMentalCréteilFrance
- Institut National de la Santé et de la Recherche Médicale (INSERM U955)CreteilFrance
- URC Eco Ile‐de‐France (AP‐HP)ParisFrance
| | - Sara Evans‐Lacko
- Institute of PsychiatryKing's College LondonLondonUK
- Health Services and Population Research Department, Institute of PsychiatryKing's College LondonLondonUK
| | | | | | - Anna K Forsman
- The Nordic School of Public Health (NHV)GothenburgSweden
- National Institute for Health and Welfare (THL)VaasaFinland
| | - Jean‐Baptiste Hazo
- Fondation FondaMentalCréteilFrance
- URC Eco Ile‐de‐France (AP‐HP)ParisFrance
| | - Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies (CELOS)Technische Universität DresdenGermany
| | - Rebecca Kuepper
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EuronMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Mario Luciano
- Department of PsychiatryUniversity of Naples SUNNaplesItaly
| | - Marta Miret
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMMadridSpain
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP)Universidad Autónoma de MadridSpain
| | - Carla Obradors‐Tarragó
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMMadridSpain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de LLobregatBarcelonaSpain
| | | | - Szilvia Papp
- Department of Psychiatry and PsychotherapySemmelweis UniversityBudapestHungary
| | - Tom Walker‐Tilley
- Institute of PsychiatryKing's College LondonLondonUK
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of PsychiatryKing's College LondonLondonUK
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