Making progress in mental health policy in conservative times: one step at a time

Policy development and challenges of global mental health: a systematic review of published studies of national-level mental health policies

BACKGROUND

Mental health policy can be an essential and powerful tool to improve a population's mental health. However, around one third of countries do not possess a mental health policy, and there are large disparities in population coverage rates between high- and low-income countries. The goal of this study is to identify the transition and implementation challenges of mental health policies in both high-income countries (HICs) as well as middle- and low-income countries (MLICs).

METHODS

PubMed, Cochrane Library and Campbell Library were searched from inception to 31 December 2017, for studies on implemented mental health policies at the national level. Abstracts and the main texts of papers were double screened, and extracted data were analysed through thematic synthesis.

RESULTS

A total of 93 papers were included in this study, covering 24 HICs, 28 MLICs and 5 regions. Studies on mental health policies, especially those of MLICs, kept increasing, but MLICs were still underrepresented in terms of publication quantity and study frequency. Based on the included studies, nine policy domains were summarized: service organizing, service provision, service quality, human resources, legislation and human rights, advocacy, administration, surveillance and research, and financing and budgeting. HICs incrementally enriched their policy content in all domains over centuries of development; following HICs' experience, mental health policies in MLICs have boomed since the 1990s and quickly extended to all domains. Implementation problems in HICs were mainly related to service organizing and service provision; for MLICs, more severe implementation problems converged on financing and budgeting, administration and human resources.

CONCLUSIONS

Mental health policy developments in both HICs and MLICs present a process of diversification and enrichment. In terms of implementation, MLICs are faced with more and greater challenges than HICs, especially in funding, human resources and administration. Therefore, future efforts should not only be made on helping MLICs developing mental health policies, but also on promoting policy implementation under MLICs' local context.

Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre

Objectives

This study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention.

Methods

We conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care.

Results

Service users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical needs assistance. Frequent service users valued relational responsiveness, a non-judgmental stance, and a recovery orientation in case managers.

Conclusion

Interventions for frequent service users in mental health may be enhanced by focusing on the engagement of formal and informal social supports, practical needs assistance, system navigation, advocacy and intermediation, and attention to the recovery goals of service users.

New endeavors, risk taking, and personal growth in the recovery process: findings from the STARS study

OBJECTIVE

This study examined consumers' perspectives on the role of personal growth-related risk taking in the recovery process and on clinicians' roles in patients' decisions to take on new activities and opportunities. Clinical approaches cited by patients as most helpful in making significant changes were also identified.

METHODS

A total of 177 members of a nonprofit health plan (93 women and 85 men), ranging in age from 16 to 84 years, participated in a mixed-methods exploratory study of recovery among individuals with serious mental illness (schizophrenia, schizoaffective disorder, bipolar disorder, and affective psychosis). Participants completed four in-depth semistructured interviews over 24 months; interviews were transcribed verbatim and coded for content by study staff. Data were analyzed using a modified grounded theory approach.

RESULTS

The most helpful discussions about new endeavors occurred in the context of healthy, collaborative, mutually trusting clinician-patient relationships. Advice was accepted when clinicians listened well, knew patients' capabilities and interests, and pushed gently at a pace that was comfortable for patients. Knowledge gained by clinicians in the context of good relationships with patients provided a firm grounding for approaching the delicate balance of providing helpful levels of support and encouragement without pushing consumers so hard that it caused difficulties.

CONCLUSIONS

Enduring, strong, collaborative relationships provide a healthy framework for discussions between patients and clinicians about taking on new activities, roles, or responsibilities and increase the likelihood that new activities and opportunities will be planned and carried out in ways that promote, rather than endanger, recovery.

New endeavors, risk taking, and personal growth in the recovery process: findings from the STARS study

OBJECTIVE

This study examined consumers' perspectives on the role of personal growth-related risk taking in the recovery process and on clinicians' roles in patients' decisions to take on new activities and opportunities. Clinical approaches cited by patients as most helpful in making significant changes were also identified.

METHODS

A total of 177 members of a nonprofit health plan (93 women and 85 men), ranging in age from 16 to 84 years, participated in a mixed-methods exploratory study of recovery among individuals with serious mental illness (schizophrenia, schizoaffective disorder, bipolar disorder, and affective psychosis). Participants completed four in-depth semistructured interviews over 24 months; interviews were transcribed verbatim and coded for content by study staff. Data were analyzed using a modified grounded theory approach.

RESULTS

The most helpful discussions about new endeavors occurred in the context of healthy, collaborative, mutually trusting clinician-patient relationships. Advice was accepted when clinicians listened well, knew patients' capabilities and interests, and pushed gently at a pace that was comfortable for patients. Knowledge gained by clinicians in the context of good relationships with patients provided a firm grounding for approaching the delicate balance of providing helpful levels of support and encouragement without pushing consumers so hard that it caused difficulties.

CONCLUSIONS

Enduring, strong, collaborative relationships provide a healthy framework for discussions between patients and clinicians about taking on new activities, roles, or responsibilities and increase the likelihood that new activities and opportunities will be planned and carried out in ways that promote, rather than endanger, recovery.