Governance and mental health: contributions for public policy approach

Mutual Aid Groups for Loneliness, Psychosocial Disability, and Continuity of Care

The objective of the present study was to evaluate the effectiveness of mutual help groups in continuity of care, loneliness and psychosocial disability in a Colombian context. For this, a quasi-experimental design is used, with pre- and post-intervention assessments due to non-randomized participant allocation. The study involved 131 individuals with mental disorders. The Psychosocial Disability Scale, The Alberta Scale of Continuity of Services in Mental Health, the UCLA Scale and the Zarit Caregiver Burden Scale were employed. The intervention was based on the core components of mutual aid groups. Significant differences (p < 0.001) were observed for the study variables, particularly in Loneliness, Continuity of Care, and various domains of psychosocial disability. A large effect size was found for these variables after the intervention. Most variables exhibited a moderate to large effect. This study demonstrates the effectiveness of mutual groups facilitated by mental health personnel at the primary care level.

"Here, I am More than Just Symptoms Combined": Mental Health Services from the Perspective of Community Rehabilitation Groups

In response to the rise in mental disorders, psychosocial and community approaches have been proposed, complementing traditional clinical services. The present research aimed to understand the perception of individuals attending community-based strategies regarding mental health services as part of the approach to mental disorders in Colombia. Two workshops were conducted with 30 individuals with mental disorders (depression, anxiety and bipolar disorder), who were members of community strategies. A thematic analysis was conducted. The theme resulting from the analysis shows Community mental health within the healthcare system, which consisted of categories such as Group Amplifying Actions for Health and Groups as Complementary to Other Forms of Care. It is emphasized that the healthcare system should establish bridges with community mental health strategies and actively engage in their strengthening processes to enhance the outcomes of pharmacological interventions and even psychotherapeutic interventions. Bidirectional learning approach is proposed between community-based mental health services and clinical settings within the healthcare system. Community strategies can make an important contribution to complex processes in the health system.

Governance in mental healthcare policies during the COVID-19 pandemic in Mexico

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.

Health care providers' perceptions of barriers to perinatal mental healthcare in South Africa

BACKGROUND

Perinatal mental disorders are a leading contributor to morbidity and mortality during pregnancy and postpartum, and are highly treatable when identified early. However, many women, especially in low and middle-income countries, lack access to routine identification and treatment of mental illness in public health settings. The prevalence of perinatal depression and anxiety disorders, common mental disorders, is three times higher for South African women relative to women in high-income countries. The public health system has begun to integrate mental health into maternal care, making South Africa a relevant case study of perinatal mental healthcare. Yet studies are few. We sought to investigate healthcare providers' perceptions of the barriers to early identification and screening of common perinatal mental disorders in public health facilities in South Africa.

METHODS

Employing qualitative methods, we used purposive sampling to identify study participants, supplemented by snowball sampling. From September 2019-June 2020, we conducted in-depth interviews with 24 key informants in South Africa. All interviews were recorded and transcribed verbatim. We used a thematic approach to generate initial analytical themes and then conducted iterative coding to refine them. We adapted a delivery systems' framework to organise the findings, depicted in a conceptual map.

RESULTS

Reported barriers to early identification and treatment of mental illness in the perinatal period encompassed four levels: (1) structural factors related to policies, systems and resources; (2) socio-cultural factors, including language and cultural barriers; (3) organisational factors, such as lack of provider preparation and training and overburdened clinics; and (4) individual patient and healthcare provider factors.

CONCLUSION

Barriers act across multiple levels to reduce quality mental health promotion and care, thereby creating an environment where inequitable access to identification of mental disorders and quality mental health services was embedded into systems and everyday practice. Integrated interventions across multiple levels are essential to improve the early identification and treatment of mental illness in perinatal women in South Africa. We provide recommendations derived from our findings to overcome barriers at each of the four identified levels.

[Analysis of Governance in the Implementation of the Chilean Community Mental Health ModelAnálise da governança na implementação do modelo comunitário de saúde mental no Chile]

El presente artículo describe y analiza el rol que ha jugado la gobernanza en el desarrollo del modelo comunitario de salud mental en Chile. Se describen y analizan cinco dimensiones de la gobernanza: 1) el desarrollo de una serie de estrategias para favorecer la participación de los usuarios de servicios de salud mental ha logrado resultados insuficientes; 2) la implementación de tres planes nacionales de salud mental, que han mantenido la misma visión estratégica a lo largo de tres décadas, han contribuido a aumentar la accesibilidad a la atención comunitaria de las personas con enfermedades mentales y disminuir el rol de los hospitales psiquiátricos; 3) la inexistencia de una ley de salud mental persiste aún como un desafío, aunque haya sido parcialmente compensada por distintas leyes y decretos; 4) las regulaciones en la asignación de los recursos financieros, la formación del recurso humano y las directrices técnicas han contribuido a mejorar el acceso y la calidad de la atención; y 5) la construcción progresiva de un sistema de información en salud mental ha permitido conocer principalmente las tasas de acceso, las brechas de tratamiento y las inequidades geográficas. La experiencia chilena confirma la importancia de aplicar un conjunto de estrategias y mecanismos de gobernanza, para favorecer el desarrollo y el funcionamiento de los servicios de salud mental. El tipo de estrategias y mecanismos de gobernanza podrán variar en los distintos países según los contextos y las ventanas de oportunidades.