http://www.ijmhs.com The latest research articles published by International Journal of Mental Health Systems 2013-05-06T00:00:00Z Depression is among the most common psychiatric conditions in primary health care, and constitutes an important part of the global disease burden. However, it is difficult to obtain comparable data on depression worldwide and models for treatment and intervention need to be locally adapted. We conducted a narrative review of research literature on factors that influence depression screening, diagnosis and treatment among the Vietnamese population. This explorative approach included studies describing: a) culturally or contextually specific risk-factors for depression; b) any depression treatment seeking or treatment acceptability/adherence aspects or; c) depression screening among Vietnamese patients. We searched the PubMed and Cinahl databases, as well as relevant Vietnamese peer-reviewed journals and this produced 20 articles that were included in the review. Our findings indicate the importance of considering somatic symptoms when screening for depression in Vietnam as well as the use of culturally adapted and dimensional screening instruments. Our study confirms that depression reflects chronic social adversity, and thus an approach to mental health management that focuses solely on individual pathology will fail to address its important social causes. Further studies should elucidate whether neurasthenia is a commonly used illness label among Vietnamese patients that coincides with depression. The tendency among Vietnamese to seek traditional Vietnamese medicine and meditation practice when experiencing emotional distress was supported by our findings. http://www.ijmhs.com/content/7/1/15 Maria Niemi Mats Målqvist Kim Giang Peter Allebeck Torkel Falkenberg International Journal of Mental Health Systems 2013, null:15 2013-05-06T00:00:00Z doi:10.1186/1752-4458-7-15 /content/figures/1752-4458-7-15-toc.gif International Journal of Mental Health Systems 1752-4458 ${item.volume} 15 2013-05-06T00:00:00Z XML IntroductionIn recent years the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology has often been used by international or national health authorities, or scientific societies, for developing evidence-based treatment recommendations. However, the GRADE approach has never been used by practicing physicians who aim at harmonizing their prescribing behaviours paying due attention to the best available evidence. This paper describes the experience of a working group of psychiatrists who adopted the GRADE approach to develop clinical recommendations on the use of psychotropic drugs in specialist mental healthcare.Case descriptionThe project was conducted in the Department of Mental Health of Verona, Italy, a city located in the north of Italy. At the beginning of 2012, psychiatrists with a specific interest in the rational use of psychotropic drugs were identified and appointed as members of a Guideline Development Group (GDG). The first task of the GDG was the identification of controversial areas in the use of psychotropic drugs, the definition of scoping questions, and the identification of outcomes of interest. The GDG was supported by a scientific secretariat, who searched the evidence, identified one or more systematic reviews matching the scoping questions, and drafted GRADE tables.Discussion and evaluationOn the basis of efficacy, acceptability, tolerability and safety data, considering the risk of bias and confidence in estimates, and taking also into consideration preferences, values and practical aspects in favour and against the intervention under scrutiny, a draft recommendation with its strength was formulated and agreed by GDG members. Recommendations were submitted for consideration to all specialists of the Department, discussed in two plenary sessions open to the whole staff, and finally approved at the end of 2012. Conclusion: The present project of guideline development raised several challenging and innovating aspects, including a “bottom-up” approach, as it was motivated by reasons that found agreement among specialists, those who developed the recommendations were those who were supposed to follow them, and values, preferences and feasibility issues were considered paying due attention to local context variables. http://www.ijmhs.com/content/7/1/14 Giovanni Ostuzzi Irene Bighelli Barbara-Vanessa Carrara Nicola Dusi Giuseppe Imperadore Camilla Lintas Francesco Nifosì Michela Nosè Carlo Piazza Marianna Purgato Raffaella Rizzo Corrado Barbui International Journal of Mental Health Systems 2013, null:14 2013-05-02T00:00:00Z doi:10.1186/1752-4458-7-14 /content/figures/1752-4458-7-14-toc.gif International Journal of Mental Health Systems 1752-4458 ${item.volume} 14 2013-05-02T00:00:00Z XML Background: The shift from asylum to community care for mental health patients has burdened the providers of primary health care and, more than all, families. As a result, numerous studies [Soc Psychiatry Psychiatr Epidemiol 31:345–348, 1995, J Health Socisl Behav 36:138–150, 1995] have focused on the burden of care experienced by family members living with individuals with severe mental disorders. This kind of provision, also extols a significant cost to the society at large in terms of significant direct and indirect costs. A cost that may be even higher in times of severe socio-economic crisis.MethodologyThis study, firstly, aims to examine the burden that the family members experience by caring for individuals with schizophrenia and the identification of the parameters, in a micro and macro level, that affect family burden. Secondly, this study aims to investigate whether the welfare state will be fit to help vulnerable groups as the one studied, especially during economic crisis periods when austerity measures are being implemented into welfare systems. For data collection purposes this study employed the Involvement Evaluation Questionnaire [Schizophr Bull 1998, 24(4):609–618]. The sample consisted of caregivers either living in rural or urban areas of the district of Nicosia, the capital of the Republic of Cyprus. These people were attending regular meetings with their allocated Community Psychiatric Nurses (CPN) in Community Mental Health Centres (CMHC). Results: Analysis of covariance (ANCOVA) was applied with the tension, the supervision, the worry, and the encouragement entering as dependent factors. In each case, participant’s age, gender, marital status, income, number of people living in the same house with the participant, degree of relationship between the caregiver and the person suffering from severe mental disorder, the age of the relative, and the gender of the relative, were entered as independent factors. Four ANCOVAs were performed, one for each dimension of the family burden. The results from this analysis produced only one significant main effect of the gender of the relative on supervision [F(1,118) = 4.40, p = .011, etap2 = .053] with male relatives suffering from schizophrenia requiring higher supervision than female ones as their relative caregivers responses indicate. Conclusions: Consequently, families under great stress due to the reasons derived from the weaknesses of the welfare system described throughout this paper would give up and reject the mentally ill individuals who would become outcasts socially. Therefore, health systems need to aim to the development of psychosocial provisions for both family caregivers and patients as to decrease the family burden rates and increase the possibility of smooth transition to the society. http://www.ijmhs.com/content/7/1/13 Christos Panayiotopoulos Andreas Pavlakis Menelaos Apostolou International Journal of Mental Health Systems 2013, null:13 2013-05-02T00:00:00Z doi:10.1186/1752-4458-7-13 /content/figures/1752-4458-7-13-toc.gif International Journal of Mental Health Systems 1752-4458 ${item.volume} 13 2013-05-02T00:00:00Z XML Background: An increasing number of empirical studies indicate that infants, toddlers and preschoolers may suffer from non-transient mental illnesses featuring developmental psychopathology. A few innovative child psychiatric approaches have been developed to treat infants, toddlers and preschoolers and their families, but have not yet been conceptually presented and discussed in the framework of different healthcare systems. The organizational and clinical experience gained while developing specific approaches may be important across disciplines and guide future developments in psychiatric treatment of infants, toddlers, preschoolers and their families. Results: This article introduces the Preschool Family Day Hospital for Infants, Toddlers and Preschoolers and their Families at Münster University Hospital, Germany. This hospital is unique in the German healthcare system with regard to its social-service institution division of labor. Specifically, it uses an intermittent treatment approach and an integrated interactional family psychiatric approach to treat children and their parents as separate patients. This multidisciplinary, developmentally and family-oriented approach includes components of group treatments with children and separate treatments with parents. Specific techniques include video-assisted treatments of the parent–child interaction, psychiatric and psychotherapeutic treatments for parents, and conjoint family therapies that include both parents and siblings. Conclusions: The Family Day Hospital for infants, toddlers and preschoolers and their families offers innovative family-oriented treatments for those who suffer from a wide range of severe child psychiatric disorders that cannot be sufficiently treated in outpatient settings. Treatment is based on the need for family-oriented approaches to the early psychiatric treatment of infants, toddlers and preschoolers. Family day hospitals are an innovative approach to preschool child psychiatry that requires further evaluation. http://www.ijmhs.com/content/7/1/12 Tilman Furniss Jörg Müller Sandra Achtergarde Ida Wessing Marlies Averbeck-Holocher Christian Postert International Journal of Mental Health Systems 2013, null:12 2013-04-20T00:00:00Z doi:10.1186/1752-4458-7-12 /content/figures/1752-4458-7-12-toc.gif International Journal of Mental Health Systems 1752-4458 ${item.volume} 12 2013-04-20T00:00:00Z XML Over the last three decades significant efforts have been made in many European countries to move away from a mental health system dominated by institutional care towards one whereby the main emphasis is on providing care and support within the community. Although the time of starting the reforms, their pace, the political context, and the exact objectives varies substantially across Europe, practically all countries have been undergoing such major reforms aimed at establishing services in the community to replace institutional based care. Each country makes its own decisions about the necessary mental health services taking into account a range of factors including population needs, level of resources, flexibility and coordination of organizational structures, as well as local culture. These factors become an integral element of a national mental health policy and action plan, closely linked with national public health strategies.Greece has been modernizing an outdated mental health system, which was based on institutional care, over the last 20 years, by developing community-based mental health care. This article describes the methodology used for the evaluation of the Psychargos programme of the mental health reforms in Greece. Various forms of community-based mental health services have been developed including supported living facilities, community mental health centres and employment opportunities. http://www.ijmhs.com/content/7/1/11 Evangelia Loukidou Anastasios Mastroyannakis Tracey Power Graham Thornicroft Tom Craig Nick Bouras International Journal of Mental Health Systems 2013, null:11 2013-03-28T00:00:00Z doi:10.1186/1752-4458-7-11 /content/figures/1752-4458-7-11-toc.gif International Journal of Mental Health Systems 1752-4458 ${item.volume} 11 2013-03-28T00:00:00Z XML Background: The Australian Mental Health Professionals Network (MHPN) is fostering a collaborative, interdisciplinary approach to mental health care through the establishment of local interdisciplinary networks of mental health professionals. This paper reports on those factors seen by MHPN participants and staff as having affected the formation and continuation of interdisciplinary networks, and therefore the likely sustainability of these groups.MethodThe paper draws on qualitative data from focus groups with mental health professionals participating in MHPN activities and MHPN staff. Results: The findings suggest that MHPN’s approach to establishing sustainable interdisciplinary networks has been influenced by a number of factors at the micro-, meso-and macro levels. At the micro-level, factors such as clarity and structure of ongoing meetings, individual dynamics and the role of ‘champions’ can promote or constrain sustainability of ongoing networks. Those networks that had established following an initial workshop and had continued to meet as an interdisciplinary network tended to be led by well-respected co-ordinators, involve members who are enthusiastic and keen to learn from each other, have a flexible structure and meet regularly for a well-defined purpose. These features are underpinned by good communication between network members and with MHPN administration. At the meso- and macro-levels, the key issue relates to resourcing, as well as the wider policy context. Conclusions: The support and practical resources provided by MHPN have been crucial in guiding successful networks as they form and continue to meet on a regular basis. The networks have also required internal leadership and support, and a clear purpose in order to form and to continue their activities. These findings are consistent with the literature, which states that sustainability of programs is reliant on factors at the project design and implementation level, as well as on factors inherent within the host organization and at the wider community level. http://www.ijmhs.com/content/7/1/10 Kylie King Jo Christo Justine Fletcher Anna Machlin Angela Nicholas Jane Pirkis International Journal of Mental Health Systems 2013, null:10 2013-03-19T00:00:00Z doi:10.1186/1752-4458-7-10 /content/figures/1752-4458-7-10-toc.gif International Journal of Mental Health Systems 1752-4458 ${item.volume} 10 2013-03-19T00:00:00Z XML ObjectivesMental health disorders account for 13% of the global burden of disease, a burden that low-income countries are generally ill-equipped to handle. Research evaluating the association between mental health and employment in low-income countries, particularly in sub-Saharan Africa, is limited. We address this gap by examining the association between employment and psychological distress. Methods: We analyzed data from the Ghana Socioeconomic Panel Survey using logistic regression (N = 5,391 adults). In multivariable analysis, we estimated the association between employment status and psychological distress, adjusted for covariates. We calculated lost productivity from unemployment and from excess absence from work that respondents reported was because of their feelings of psychological distress.FindingsApproximately 21% of adults surveyed had moderate or severe psychological distress. Increased psychological distress was associated with increased odds of being unemployed. Men and women with moderate versus mild or no psychological distress had more than twice the odds of being unemployed. The association of severe versus mild or no distress with unemployment differed significantly by sex (P-value for interaction 0.004). Among men, the adjusted OR was 12.4 (95% CI: 7.2, 21.3), whereas the association was much smaller for women (adjusted OR = 3.8, 95% CI: 2.5, 6.0). Extrapolating these figures to the country, the lost productivity associated with moderate or severe distress translates to approximately 7% of the gross domestic product of Ghana. Conclusions: Psychological distress is strongly associated with unemployment in Ghana. The findings underscore the importance of addressing mental health issues, particularly in low-income countries. http://www.ijmhs.com/content/7/1/9 Maureen Canavan Heather Sipsma Achyuta Adhvaryu Angela Ofori-Atta Helen Jack Christopher Udry Isaac Osei-Akoto Elizabeth Bradley International Journal of Mental Health Systems 2013, null:9 2013-03-07T00:00:00Z doi:10.1186/1752-4458-7-9 /content/figures/1752-4458-7-9-toc.gif International Journal of Mental Health Systems 1752-4458 ${item.volume} 9 2013-03-07T00:00:00Z XML Background: Mental health services for Rivers State and surrounding States in the Niger Delta region of Nigeria are provided only at the neuropsychiatric Rumuigbo Hospital in Port Harcourt City, Rivers State, Nigeria. The study explored mental health nurses’ experiences of providing mental health services at the hospital in an attempt to understand policy implications, identify difficulties and challenges of delivering mental health care services. Methods: A qualitative study using in-depth interview was conducted among 20 mental health nurses working at the neuropsychiatric Rumuigbo Hospital. This was reviewed within the Townsend mental health policy template of context and resources domains. Results: A lack of political support and senior position in the Ministry of Health hinders service delivery, the prevalence of institutionalized stigma, a lack of training, and system failure to provide services at all levels of care is hampering service delivery. The inadequate allocation of resources for hospital renovations and equipment is preventing appropriate client care, as does the lack of funding for drugs, the cost of which makes them unaffordable, affecting clients staying on treatment. Conclusion: Education and training of mental health care professionals should be given priority to remedy human resource shortage, provide incentives to motivate health professionals for psychiatric practice, and move toward decentralization of care into general health care services. Information should be provided at all levels to overcome the myths surrounding the causes of mental illnesses, to reduce stigma and discrimination of the affected and their families. http://www.ijmhs.com/content/7/1/8 Izibeloko Jack-Ide Leana Uys Lyn Middleton International Journal of Mental Health Systems 2013, null:8 2013-02-15T00:00:00Z doi:10.1186/1752-4458-7-8 /content/figures/1752-4458-7-8-toc.gif International Journal of Mental Health Systems 1752-4458 ${item.volume} 8 2013-02-15T00:00:00Z XML Background: One of the most crucial steps towards delivering judicious and comprehensive mental health care is the formulation of a policy and plan that will navigate mental health systems. For policy-makers, the challenges of a high-quality mental health system are considerable: the provision of mental health services to all who need them, in an equitable way, in a mode that promotes human rights and health outcomes.MethodEquiFrame, a novel policy analysis framework, was used to evaluate the mental health policies of Malawi, Namibia, and Sudan. The health policies were assessed in terms of their coverage of 21 predefined Core Concepts of human rights (Core Concept Coverage), their stated quality of commitment to said Core Concepts (Core Concept Quality), and their inclusion of 12 Vulnerable Groups (Vulnerable Group Coverage). In relation to these summary indices, each policy was also assigned an Overall Summary Ranking, in terms of it being of High, Moderate, or Low quality. Results: Substantial variability was identified across EquiFrame’s summary indices for the mental health policies of Malawi, Namibia, and Sudan. However, all three mental health policies scored high on Core Concept Coverage. Particularly noteworthy was the Sudanese policy, which scored 86% on Core Concept Coverage, and 92% on Vulnerable Group Coverage. Particular deficits were evident in the Malawian mental health policy, which scored 33% on Vulnerable Group Coverage and 47% on Core Concept Quality, and was assigned an Overall Summary Ranking of Low accordingly. The Overall Summary Ranking for the Namibian Mental Health Policy was High; for the Sudanese Mental Health Policy was Moderate; and for the Malawian Mental Health Policy was Low. Conclusions: If human rights and equity underpin policy formation, it is more likely that they will be inculcated in health service delivery. EquiFrame may provide a novel and valuable tool for mental health policy analysis in relation to core concepts of human rights and inclusion of vulnerable groups, a key practical step in the successful realization of the Millennium Development Goals. http://www.ijmhs.com/content/7/1/7 Hasheem Mannan Shahla ElTayeb Malcolm MacLachlan Mutamad Amin Joanne McVeigh Alister Munthali Gert Rooy International Journal of Mental Health Systems 2013, null:7 2013-02-13T00:00:00Z doi:10.1186/1752-4458-7-7 /content/figures/1752-4458-7-7-toc.gif International Journal of Mental Health Systems 1752-4458 ${item.volume} 7 2013-02-13T00:00:00Z XML Background: A cluster randomised controlled trial (RCT) of a national Kenyan mental health primary care training programme demonstrated a significant impact for health workers on the health, disability and quality of life of their clients, despite a severe shortage of medicines in the clinics (Jenkins et al.:37–47, 2012). In order to better understand the potential reasons for the improved outcomes in the intervention group, the experiences of the participating health workers were explored through qualitative focus group discussions, as focus group methodology has been found to be a useful method of obtaining a detailed understanding of client and health worker perspectives within health systems (Sharfritz and Roberts. Health Transition Review 4:81-85, 1994). Methods: Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 10 health workers from the intervention group clinics where staff had received the training programme, and 10 health workers from the control group where staff had not received the training during the earlier randomised controlled trial. Results: These focus group discussions suggest that the health workers in the intervention group perceived an increase in their communication, diagnostic and counselling skills, and that the clients in the intervention group noticed and appreciated these enhanced skills, while health workers and clients in the control group were both aware of the lack of these skills. Conclusion: Enhanced health worker skills conferred by the mental health training programme may be responsible for the significant improvement in outcome of patients in the intervention clinics found in the randomised controlled trial, despite the general shortage of medicines and other health system weaknesses. These findings suggest that strengthening mental health training for primary care staff is worthwhile even where health systems are not strong and where the medicine supply cannot be guaranteed.Trial registrationISRCTN 53515024 http://www.ijmhs.com/content/7/1/6 Rachel Jenkins Caleb Othieno Stephen Okeyo Julyan Aruwa Jan Wallcraft Ben Jenkins International Journal of Mental Health Systems 2013, null:6 2013-02-04T00:00:00Z doi:10.1186/1752-4458-7-6 /content/figures/1752-4458-7-6-toc.gif International Journal of Mental Health Systems 1752-4458 ${item.volume} 6 2013-02-04T00:00:00Z XML