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Trang DTH, Ha BTT, Vui LT, Chi NTQ, Thi LM, Duong DTT, Hung DT, Cronin de Chavez A, Manzano A, Lakin K, Kane S, Mirzoev T. Understanding the barriers to integrating maternal and mental health at primary health care in Vietnam. Health Policy Plan 2024; 39:541-551. [PMID: 38597872 PMCID: PMC11145914 DOI: 10.1093/heapol/czae027] [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: 10/19/2023] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/11/2024] Open
Abstract
The prevalence of common perinatal mental disorders in Vietnam ranges from 16.9% to 39.9%, and substantial treatment gaps have been identified at all levels. This paper explores constraints to the integration of maternal and mental health services at the primary healthcare level and the implications for the health system's responsiveness to the needs and expectations of pregnant women with mental health conditions in Vietnam. As part of the RESPONSE project, a three-phase realist evaluation study, we present Phase 1 findings, which employed systematic and scoping literature reviews and qualitative data collection (focus groups and interviews) with key health system actors in Bac Giang province, Vietnam, to understand the barriers to maternal mental healthcare provision, utilization and integration strategies. A four-level framing of the barriers to integrating perinatal mental health services in Vietnam was used in reporting findings, which comprised individual, sociocultural, organizational and structural levels. At the sociocultural and structural levels, these barriers included cultural beliefs about the holistic notion of physical and mental health, stigma towards mental health, biomedical approach to healthcare services, absence of comprehensive mental health policy and a lack of mental health workforce. At the organizational level, there was an absence of clinical guidelines on the integration of mental health in routine antenatal visits, a shortage of staff and poor health facilities. Finally, at the provider level, a lack of knowledge and training on mental health was identified. The integration of mental health into routine antenatal visits at the primary care level has the potential help to reduce stigma towards mental health and improve health system responsiveness by providing services closer to the local level, offering prompt attention, better choice of services and better communication while ensuring privacy and confidentiality of services. This can improve the demand for mental health services and help reduce the delay of care-seeking.
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Affiliation(s)
- Do Thi Hanh Trang
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Bui Thi Thu Ha
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Le Thi Vui
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | | | - Le Minh Thi
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Doan Thi Thuy Duong
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Dang The Hung
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Anna Cronin de Chavez
- Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Kimberly Lakin
- Nossal Institute for Global Health Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia
| | - Sumit Kane
- Nossal Institute for Global Health Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia
| | - Tolib Mirzoev
- Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
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Cosgrove L, Montenegro C, Yarcia LE, D’Ambrozio G, Hannah J. "Reducing the Treatment Gap" Poses Human Rights Risks. Health Hum Rights 2024; 26:129-136. [PMID: 38933230 PMCID: PMC11197864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Affiliation(s)
- Lisa Cosgrove
- Professor in the Counseling Psychology Department and a faculty fellow at the Applied Ethics Center, University of Massachusetts Boston, United States, as well as co-founder of the Centre for Mental Health, Human Rights, and Social Justice, a multi-institutional platform dedicated to the study of rights-based approaches to mental health law, policy, and practices
| | - Cristian Montenegro
- Senior research fellow at the Wellcome Centre for Cultures and Environments of Health at the University of Exeter, UK, and a member of the Centre for Mental Health, Human Rights, and Social Justice
| | - Lee Edson Yarcia
- Senior lecturer at the College of Law at the University of the Philippines Diliman, Manila, Philippines; a drug policy expert at the United Nations Joint Programme for the Protection and Promotion of Human Rights in the Philippines; and a member of the Centre for Mental Health, Human Rights, and Social Justice
| | - Gianna D’Ambrozio
- Doctoral candidate in the Counseling Psychology Department at the University of Massachusetts Boston, United States
| | - Julie Hannah
- Director of the International Centre on Human Rights and Drug Policy at the University of Essex, Colchester, UK, and co-founder of the Centre for Mental Health, Human Rights, and Social Justice
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Mautang TWE, Suarjana IWG. The global and cultural context of using AI for mental health. J Public Health (Oxf) 2024; 46:e343. [PMID: 38061774 DOI: 10.1093/pubmed/fdad262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Affiliation(s)
- Theo Welly Everd Mautang
- Department of Public Health, Faculty of Sport Science and Public Health, Universitas Negeri Manado, Tondano, North Sulawesi 95618, Indonesia
| | - I Wayan Gede Suarjana
- Department of Public Health, Faculty of Sport Science and Public Health, Universitas Negeri Manado, Tondano, North Sulawesi 95618, Indonesia
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Adsul P, Shelton RC, Oh A, Moise N, Iwelunmor J, Griffith DM. Challenges and Opportunities for Paving the Road to Global Health Equity Through Implementation Science. Annu Rev Public Health 2024; 45:27-45. [PMID: 38166498 DOI: 10.1146/annurev-publhealth-060922-034822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Implementation science focuses on enhancing the widespread uptake of evidence-based interventions into routine practice to improve population health. However, optimizing implementation science to promote health equity in domestic and global resource-limited settings requires considering historical and sociopolitical processes (e.g., colonization, structural racism) and centering in local sociocultural and indigenous cultures and values. This review weaves together principles of decolonization and antiracism to inform critical and reflexive perspectives on partnerships that incorporate a focus on implementation science, with the goal of making progress toward global health equity. From an implementation science perspective, wesynthesize examples of public health evidence-based interventions, strategies, and outcomes applied in global settings that are promising for health equity, alongside a critical examination of partnerships, context, and frameworks operationalized in these studies. We conclude with key future directions to optimize the application of implementation science with a justice orientation to promote global health equity.
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Affiliation(s)
- Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA;
- Cancer Control and Population Science Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - April Oh
- National Cancer Institute, Rockville, Maryland, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Juliet Iwelunmor
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Kuhn E, Saleem M, Klein T, Köhler C, Fuhr DC, Lahutina S, Minarik A, Musesengwa R, Neubauer K, Olisaeloka L, Osei F, Reinhold AS, Singh I, Spanhel K, Thomas N, Hendl T, Kellmeyer P, Böge K. Interdisciplinary perspectives on digital technologies for global mental health. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002867. [PMID: 38315676 PMCID: PMC10843075 DOI: 10.1371/journal.pgph.0002867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Digital Mental Health Technologies (DMHTs) have the potential to close treatment gaps in settings where mental healthcare is scarce or even inaccessible. For this, DMHTs need to be affordable, evidence-based, justice-oriented, user-friendly, and embedded in a functioning digital infrastructure. This viewpoint discusses areas crucial for future developments of DMHTs. Drawing back on interdisciplinary scholarship, questions of health equity, consumer-, patient- and developer-oriented legislation, and requirements for successful implementation of technologies across the globe are discussed. Economic considerations and policy implications complement these aspects. We discuss the need for cultural adaptation specific to the context of use and point to several benefits as well as pitfalls of DMHTs for research and healthcare provision. Nonetheless, to circumvent technology-driven solutionism, the development and implementation of DMHTs require a holistic, multi-sectoral, and participatory approach.
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Affiliation(s)
- Eva Kuhn
- Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Maham Saleem
- Department of Prevention and Evaluation, Leibniz Institute of Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Thomas Klein
- Department of Psychiatry and Psychotherapy II, Ulm University, Guenzburg, Germany
| | - Charlotte Köhler
- Department of Data Science & Decision Support, European University Viadrina, Große, Frankfurt (Oder), Germany
| | - Daniela C. Fuhr
- Department of Prevention and Evaluation, Leibniz Institute of Prevention Research and Epidemiology-BIPS, Bremen, Germany
- Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- University of Bremen, Health Sciences, Bremen, Germany
| | - Sofiia Lahutina
- TUM Department of Sport and Health Sciences (TUM SG), Chronobiology and Health, Technical University of Munich, Munich, Germany
- TUM Institute for Advanced Study (TUM-IAS), Technical University of Munich, Garching, Germany
| | - Anna Minarik
- Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Charité –Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rosemary Musesengwa
- Department of Psychiatry and Welcome Centre for Ethics and Humanities, University of Oxford, Oxford, United Kingdom
| | | | - Lotenna Olisaeloka
- Institute for Global Health, University College London, London, United Kingdom
| | - Francis Osei
- Department of Health and Physical Activity, Professorship for Medical Sociology and Psychobiology, University of Potsdam, Potsdam, Germany
| | - Annika Stefanie Reinhold
- Medical Faculty Mannheim, Department of Public Mental Health, Central Institute of Mental Health (CIMH), Heidelberg University, Mannheim, Germany
| | - Ilina Singh
- Department of Psychiatry and Welcome Centre for Ethics and Humanities, University of Oxford, Oxford, United Kingdom
| | - Kerstin Spanhel
- Faculty of Medicine, Institute for Medical Psychology and Medical Sociology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Melbourne, Australia
| | - Tereza Hendl
- Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University in Munich, Munich, Germany
| | - Philipp Kellmeyer
- Department of Neurosurgery, University of Freiburg—Medical Center, Freiburg im Breisgau, Germany
- School of Business Informatics and Mathematics, University of Mannheim, Mannheim, Germany
| | - Kerem Böge
- Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Charité –Universitätsmedizin Berlin, Berlin, Germany
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Brooks C, Mirzoev T, Chowdhury D, Deuri SP, Madill A. Using evidence in mental health policy agenda-setting in low- and middle-income countries: a conceptual meta-framework from a scoping umbrella review. Health Policy Plan 2023; 38:876-893. [PMID: 37329301 PMCID: PMC10394497 DOI: 10.1093/heapol/czad038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/15/2023] [Accepted: 07/12/2023] [Indexed: 06/19/2023] Open
Abstract
The purpose of this article is to close the gap in frameworks for the use of evidence in the mental health policy agenda-setting in low- and middle-income countries (LMICs). Agenda-setting is important because mental health remains a culturally sensitive and neglected issue in LMICs. Moreover, effective evidence-informed agenda-setting can help achieve, and sustain, the status of mental health as a policy priority in these low-resource contexts. A scoping 'review of reviews' of evidence-to-policy frameworks was conducted, which followed preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Nineteen reviews met the inclusion criteria. A meta-framework was developed from analysis and narrative synthesis of these 19 reviews, which integrates the key elements identified across studies. It comprises the concepts of evidence, actors, process, context and approach, which are linked via the cross-cutting dimensions of beliefs, values and interests; capacity; power and politics; and trust and relationships. Five accompanying questions act as a guide for applying the meta-framework with relevance to mental health agenda-setting in LMICs. This is a novel and integrative meta-framework for mental health policy agenda-setting in LMICs and, as such, an important contribution to this under-researched area. Two major recommendations are identified from the development of the framework to enhance its implementation. First, given the paucity of formal evidence on mental health in LMICs, informal evidence based on stakeholder experience could be better utilized in these contexts. Second, the use of evidence in mental health agenda-setting in LMICs would be enhanced by involving a broader range of stakeholders in generating, communicating and promoting relevant information.
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Affiliation(s)
- Chloe Brooks
- School of Psychology, University of Leeds, Lifton Terrace, Leeds LS2 9JT, UK
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Diptarup Chowdhury
- Department of Clinical Psychology, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam 784001, India
| | - Sonia Pereira Deuri
- Department of Psychiatric Social Work, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam 784001, India
| | - Anna Madill
- School of Psychology, University of Leeds, Lifton Terrace, Leeds LS2 9JT, UK
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Votruba N, Praveen D, Mellers L, Rajan E, Thout SR, Arora V, Malik Y, Kashyap A, Majumdar S, Hirst J, Maulik PK. SMARThealth PRegnancy And Mental Health study: protocol for a situational analysis of perinatal mental health in women living in rural India. Front Glob Womens Health 2023; 4:1143880. [PMID: 37575961 PMCID: PMC10416114 DOI: 10.3389/fgwh.2023.1143880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction The situation for women experiencing mental health problems during pregnancy and postpartum in rural India is critical: a high burden of disease, a high estimated number of women are undiagnosed and untreated with mental health problems, a substantial gap in research on women's perinatal health, and severe stigma and discrimination. The SMARThealth Pregnancy study is a cluster randomised trial using a digital intervention to identify and manage anaemia, hypertension, and diabetes in the first year after birth in rural India. Within this study, the SMARThealth Pregnancy and Mental Health (PRAMH) study is a situational analysis to understand mental health problems during pregnancy and in the first year following birth in this population. Methods/design This situational analysis aims to analyse and to assess the context of perinatal mental health, health services, barriers, facilitators, and gaps in Siddipet district of Telangana state in India, to develop an implementation framework for a future intervention. A tested, standardised situational analysis tool will be adapted and applied to perinatal mental health in rural India. A desktop and policy review will be conducted to identify and analyse relevant mental health and pregnancy care policies at the national and state levels. We will conduct in-depth interviews with policymakers, planners, mental health professionals and other experts in perinatal mental health (n = 10-15). We will also conduct focus group discussions with key stakeholders, including women with perinatal mental health problems, their families and carers, and community health workers (n = 24-40). A theory of change workshop with key stakeholders will be conducted which will also serve as a priority setting exercise, and will clarify challenges and opportunities, priorities, and objectives for a pilot intervention study. The analysis of qualitive data will be done using thematic analysis. Based on the data analysis and synthesis of the findings, an implementation framework will be developed to guide development, testing and scale up of a contextually relevant intervention for perinatal mental health. Discussion The situational analysis will help to establish relationships with all relevant stakeholders, clarify the context and hypotheses for the pilot intervention and implementation.
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Affiliation(s)
- Nicole Votruba
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| | - Devarsetty Praveen
- The George Institute for Global Health India, New Delhi, India
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Lucy Mellers
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Eldho Rajan
- The George Institute for Global Health India, New Delhi, India
| | | | - Varun Arora
- Post Graduate Institute of Medical Science, Rohtak, India
| | - Yogender Malik
- Department of Psychiatry, Institute of Mental Health (IMH), University of Health Sciences PGIMS, Rohtak, India
| | - Aditya Kashyap
- SVS Institute of Neurosciences, Government Medical College, Siddipet, India
| | - Sreya Majumdar
- The George Institute for Global Health India, New Delhi, India
| | - Jane Hirst
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| | - Pallab K. Maulik
- The George Institute for Global Health India, New Delhi, India
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Kushniruk A, Zhang Z, Tian M, Mougenot C, Glozier N, Calvo RA. Preferences for a Mental Health Support Technology Among Chinese Employees: Mixed Methods Approach. JMIR Hum Factors 2022; 9:e40933. [PMID: 36548027 PMCID: PMC9816948 DOI: 10.2196/40933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/27/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Workplace mental health is under-studied in China, making it difficult to design effective interventions. To encourage the engagement with interventions, it is crucial to understand employees' motivation toward seeking help through technologies. OBJECTIVE This study aimed to understanding how Chinese employees view digital mental health support technology and how mental health support technology could be designed to boost the motivation of Chinese employees to use it. METHODS A mixed methods approach was used. In total, 458 Chinese employees (248/458, 54% female) in 5 industries (manufacturing, software, medical, government, and education) responded to a survey, and 14 employees and 5 managers were interviewed. RESULTS Government data and employee responses showed that mental health support in China is limited. In the workplace, Chinese employees experience a lower sense of autonomy satisfaction compared with competence and relatedness. Although managers and employees try to empathize with those who have mental health issues, discrimination and the stigma of mental illness are rife in Chinese workplaces. Digital technologies are perceived as a potential medium for mental health interventions; however, privacy is a major concern. CONCLUSIONS The results of this study demonstrated the potential of self-help digital mental health support for Chinese employees. Interdisciplinary cooperation between design engineers and mental health researchers can contribute toward understanding the issues that engage or disengage users with digital mental health interventions.
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Affiliation(s)
| | - Zheyuan Zhang
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Mu Tian
- Luye Medical Group, Shanghai, China
| | - Celine Mougenot
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Nick Glozier
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rafael A Calvo
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
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Pedro MR, Palha AP, Ferreira MA. Psychiatry and mental health teaching programs of eight portuguese-speaking schools of medicine: A comparative analysis. Front Public Health 2022; 10:936177. [PMID: 36420002 PMCID: PMC9676486 DOI: 10.3389/fpubh.2022.936177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022] Open
Abstract
Background Improvement of teaching methods in psychiatry has been the subject of permanent adaptation and innovation. Strengthening graduate education skills in psychiatry and mental health will allow physicians to have the knowledge, skills, and attitudes to carry out early diagnosis and treatment at primary healthcare settings, taking into consideration that the population should benefit from the best interventions by general practitioners. Objective The objective of this study was to examine how the undergraduate program of psychiatry and mental health subject in the schools of medicine of the Community of Portuguese-Speaking Countries in the three continents is structured. Methods The methods include a narrative description of the program of psychiatry, the workload, the delivery and assessment methods, and the ethical and socio-cultural aspects in psychiatry and research made by the director of the course of psychiatry in Portugal, Brazil, and Mozambique. Results Eight schools of medicine from Portugal, Brazil, and Mozambique participated in the study. All these schools use standards which are defined by the regulatory bodies of their countries. The teaching year varied between the third and the sixth. The workload varied between 140 and 224 h. Topics were addressed in presence or virtual methods. Combined qualitative and quantitative assessment is done to encompass competencies, skills and knowledge based on clinical histories, ongoing assessment, seminars, and final written tests. Ethical and socio-cultural aspects in various strands are taught to be linked to the local reality. Research is encouraged by using grants. Conclusion Teaching psychiatry follows global and national standards and is organized according to the reality of each country. Psychiatry departments from these three continents invest in teaching methodologies that encourage self-knowledge and the development of critical thinking, which is evaluated in a holistic context. The authors consider that the programs should have a workload according to the current burden of mental illness.
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Affiliation(s)
- Maria Rosel Pedro
- Departamento de Medicina, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique,*Correspondence: Maria Rosel Pedro
| | - Antonio Pacheco Palha
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Maria Amelia Ferreira
- Departamento de Ciências da Saúde Publica e Forenses e Educacao Medica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Ortega F, Müller MR. Negotiating human rights narratives in Global Mental Health: Autism and ADHD controversies in Brazil. Glob Public Health 2022; 17:3189-3203. [PMID: 34297640 DOI: 10.1080/17441692.2021.1957493] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Promoting evidence-based treatments and the human rights of people living with mental illness are the two pillars of Global Mental Health (GMH). Critics counter that human rights narratives must also include social justice frameworks. We draw on the cases of autism and ADHD in Brazil to discuss the role of human rights in mental health in the context of GMH. A human rights perspective involves citizenship rights for individuals living with mental distress and provides a framework to problematise the logic of GMH centred on individual rights and rights to treatment. We begin with an overview on human rights discussions in GMH and examine the introduction of human rights discourses in the Brazilian psychiatric reform. We then explore how autism and ADHD became priorities of GMH interventions as well as the constitution of two styles of activism and mobilisation of human rights around these conditions. One follows the universal public health logic and promotes health as a social right. The other follows the logic of parents' associations that redefined those conditions as forms of disability to advocate for specialised services and interventions. Finally, we discuss these forms of human rights mobilisation and their implications for Brazilian mental health and GMH.
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Affiliation(s)
- Francisco Ortega
- Catalan institution for Research and Advanced Studies (ICREA), Barcelona, Spain.,Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
| | - Manuela Rodrigues Müller
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro, Brazil
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