http://www.ijmhs.com The latest research articles published by International Journal of Mental Health Systems 2010-07-28T00:00:00Z This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ Background: The prevalence of tobacco use among individuals with mental illness remains a serious public health concern. Tobacco control has received little attention in community mental health despite the fact that many individuals with mental illness are heavy smokers and experience undue tobacco-related health consequences. Methods: This qualitative study used methods of discourse analysis to examine the perceptions of health care providers, both professionals and paraprofessionals, in relation to their roles in tobacco control in the community mental health system. Tobacco control is best conceptualised as a suite of policies and practices directed at supporting smoke free premises, smoking cessation counselling and limiting access to tobacco products. The study took place following the establishment of a new policy that restricted tobacco smoking inside all mental health facilities and on their grounds. Ninety one health care providers participated in open-ended interviews in which they described their role in tobacco control. The interview data were analyzed discursively by asking questions such as: what assumptions underlie what is being said about tobacco? Results: Five separate yet overlapping discursive frames were identified in which providers described their roles. Managing a smoke free environment emphasised the need to police and monitor the smoke free environment. Tobacco is therapeutic was a discourse that underscored the putative value of smoking for clients. Tobacco use is an individual choice located the decision to smoke with individual clients thereby negating a role in tobacco control for providers. It's someone else's role was a discourse that placed responsibility for tobacco control with others. Finally, the discourse of tobacco control as health promotion located tobacco control in a range of activities that are used to support the health of clients. Conclusions: This study provides insights into the complex factors that shape tobacco control practices in the mental health field and reinforces the need to see practice change as a matter that extends beyond the individual. The study findings highlight discourses structured by power and powerlessness in environments in which health care providers are both imposing and resisting the smoke free policy http://www.ijmhs.com/content/4/1/23 Joy Johnson Barbara Moffat Leslie Malchy International Journal of Mental Health Systems 2010, 4:23 2010-07-28T00:00:00Z doi:10.1186/1752-4458-4-23 International Journal of Mental Health Systems 1752-4458 4 23 2010-07-28T00:00:00Z PDF Background: In the first half of 2009, a population of 300,000 in the Vanni, northern Sri Lanka underwent multiple displacements, deaths, injuries, deprivation of water, food, medical care and other basic needs caught between the shelling and bombings of the state forces and the LTTE which forcefully recruited men, women and children to fight on the frontlines and held the rest hostage. This study explores the long term psychosocial and mental health consequences of exposure to massive, existential trauma. Methods: This paper is a qualitative inquiry into the psychosocial situation of the Vanni displaced and their ethnography using narratives, poems, drawings and observations obtained through participant observation; in depth interviews; key informant, family and extended family interviews; focus groups using a prescribed, semi structured open ended questionnaire and media reports. Results: The narratives, drawings, letters and poems as well as data from observations, key informant interviews, extended family and focus group discussions and media reports show considerable impact at the family and community. The family and community relationships, networks, processes and structures are destroyed. There develops collective symptoms of despair, passivity, silence, loss of values and ethical mores, amotivation, dependency on external assistance, but also resilience and post-traumatic growth. Conclusions: Considering the severity of family and community level adverse effects and implication for resettlement, rehabilitation, and development programmes; interventions for healing of memories, psychosocial regeneration of the family and community structures and processes are essential. http://www.ijmhs.com/content/4/1/22 Daya Somasundaram International Journal of Mental Health Systems 2010, 4:22 2010-07-28T00:00:00Z doi:10.1186/1752-4458-4-22 International Journal of Mental Health Systems 1752-4458 4 22 2010-07-28T00:00:00Z PDF Background: Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative in nature and based in tertiary health institutions. At primary health care level, there is either absence of, or fragmented health services. Aims: The aim of this paper was to explore health providers' views about mental health integration into primary health care. Methods: A mixed methods, structured survey was conducted of 111 health service providers in primary health care centres, drawn from one urban setting (Lusaka) and one rural setting (Mumbwa). Results: There is strong support for integrating mental health into primary health care from care providers, as a way of facilitating early detection and intervention for mental health problems. Participants believed that this would contribute to the reduction of stigma and the promotion of human rights for people with mental health problems. However, health providers felt they require basic training in order to enhance their knowledge and skills in providing health care to people with mental health problems. Recommendations: It is recommended that health care providers should be provided with basic training in mental health in order to enhance their knowledge and skills to enable them provide mental health care to patients seeking help at primary health care level. Conclusion: Integrating mental health services into primary health care is critical to improving and promoting the mental health of the population in Zambia. http://www.ijmhs.com/content/4/1/21 Lonia Mwape Alice Sikwese Augustus Kapungwe Jason Mwanza Alan Flisher Crick Lund Sara Cooper International Journal of Mental Health Systems 2010, 4:21 2010-07-25T00:00:00Z doi:10.1186/1752-4458-4-21 International Journal of Mental Health Systems 1752-4458 4 21 2010-07-25T00:00:00Z PDF Background: It has been proposed that gains would be made in the validity of the psychiatric classification system if many of the present 'neurotic' or personality disorders were subsumed into two over-arching groups, externalising and emotional disorders. If diagnostic sub-categories from the first digit coding structures within ICD-10 do, in fact, share clinical phenomenology that align with the major externalising/emotional distinction, this further supports the proposal and contributes to face validity. The aim of the study was to examine the distribution of particular psychopathology within and between two proposed over-arching groupings - externalising and emotional disorders - in a clinical sample.MethodThe distributions of HoNOS derived information in relation to the proposed clusters of emotional disorders and extrinsic disorders are examined. Results: Statistically significant differences in profiles between the emotional and the externalising groupings are consistent with the proposed classification development. The HoNOS (Health of Nation Outcome Scale) measures of self harm, depression, aggression, occupational/leisure problems and drug and alcohol consumption are the five most significant discriminators between the two groups.DiscussionThe details of the profile differences within the two over arching groups suggest that further examination is required. Useful work could include examination in credibly large and unselected patient populations of the factor structure demonstrated in non patient samples. Prospective comprehensive trials of the contributions the proposed classification could make to clinical decision making would also help illuminate this area. http://www.ijmhs.com/content/4/1/20 Graham Mellsop Alison Bower Sandra Baxendine International Journal of Mental Health Systems 2010, 4:20 2010-07-15T00:00:00Z doi:10.1186/1752-4458-4-20 International Journal of Mental Health Systems 1752-4458 4 20 2010-07-15T00:00:00Z XML Background: Although most donor and development agency attention is focussed on communicable diseases in Kenya, the importance of non-communicable diseases including mental health and mental illness is increasingly apparent, both in their own right and because of their influence on health, education and social goals. Mental illness is common but the specialist service is extremely sparse and primary care is struggling to cope with major health demands. Non health sectors e.g. education, prisons, police, community development, gender and children, regional administration and local government have significant concerns about mental health, but general health programmes have been surprisingly slow to appreciate the significance of mental health for physical health targets. Despite a people centred post colonial health delivery system, poverty and global social changes have seriously undermined equity. This project sought to meet these challenges, aiming to introduce sustainable mental health policy and implementation across the country, within the context of extremely scarce resources. Methods: A multi-faceted and comprehensive programme which combined situation appraisal to inform planning, sustained intersectoral policy dialogue at national and regional level; establishment of a health sector system for coordination, supervision and training of at each level (national, regional, district and primary care); development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at national, regional, district and local levels; public education; and integration of mental health into health management systems. Results: The programme has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, annual operational plans, mental health policy guidelines to accompany the general health policy, tobacco legislation, adaptation of the WHO primary care guidelines for Kenya, primary care training, construction of a quality system of roles and responsibilities, availability of medicines at primary care level, some strengthening of intersectoral liaison with police, prisons and schools, and public education about mental health. Conclusions: The project has demonstrated the importance of using a multi-faceted and comprehensive programme to promote sustainable system change, key elements of which include a focus on the use of rapid appropriate assessment and treatment at primary care level, strengthening the referral system, interministerial and intersectoral liaison, rehabilitation, social inclusion, promotion and advocacy to mobilize community engagement. http://www.ijmhs.com/content/4/1/19 David Kiima Rachel Jenkins International Journal of Mental Health Systems 2010, 4:19 2010-06-28T00:00:00Z doi:10.1186/1752-4458-4-19 International Journal of Mental Health Systems 1752-4458 4 19 2010-06-28T00:00:00Z XML Background: The aim of this study was to investigate in members of the Chinese community in Melbourne the impact of Mental Health First Aid (MHFA) training on knowledge about mental disorders and on attitudes to people with mental illness. The hypotheses were that at the end of the training participants would have increased knowledge of mental disorders and related treatments, and decreased negative attitudes towards people with mental disorders. Methods: Respondents were 108 participants of three MHFA training workshops for the Chinese community in Melbourne conducted by a qualified MHFA trainer. Participants completed the research questionnaire prior to the commencement of the training (pre-test) and at its completion (post-test). The questionnaires assessed participants' ability to recognize a mental disorder (depression and schizophrenia) described in the vignettes, knowledge about the professional help and treatment, and negative attitudes towards people with mental illness. Results: Between pre- and post-test there was significant improvement in the recognition of mental disorders, beliefs about treatment became more concordant with health professionals, and negative attitudes reduced. Conclusion: The MHFA training course for general members of the Chinese community in Melbourne produced significant positive change in the level of mental health literacy and reductions in stigmatizing attitudes. The evidence from this study, together with the accumulated evidence of the benefits of MHFA training in the general Australian community, suggests that this approach should be scaled up to a level where it can have an impact on the whole of the Chinese community in Australia. http://www.ijmhs.com/content/4/1/18 Angus Lam Anthony Jorm Daniel Wong International Journal of Mental Health Systems 2010, 4:18 2010-06-24T00:00:00Z doi:10.1186/1752-4458-4-18 International Journal of Mental Health Systems 1752-4458 4 18 2010-06-24T00:00:00Z XML Background: Following a situation appraisal in 2001, a six year mental health reform programme (Egymen) 2002-7 was initiated by an Egyptian-Finnish bilateral aid project at the request of a former Egyptian minister of health, and the work was incorporated directly into the Ministry of Health and Population from 2007 onwards. This paper describes the aims, methodology and implementation of the mental health reforms and mental health policy in Egypt 2002-2009. Methods: A multi-faceted and comprehensive programme which combined situation appraisal to inform planning; establishment of a health sector system for coordination, supervision and training of each level (national, governorate, district and primary care); development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at each level; integration of mental health into health management systems; and dedicated efforts to improve forensic services, rehabilitation services, and child psychiatry services. Results: The project has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, mental health masterplan (policy guidelines) to accompany the general health policy, updated Egyptian mental health legislation, Code of Practice, adaptation of the WHO primary care guidelines, primary care training, construction of a quality system of roles and responsibilities, availability of medicines at primary care level, public education about mental health, and a research programme to inform future developments. Intersectoral liaison with education, social welfare, police and prisons at national level is underway, but has not yet been established for governorate and district levels, nor mental health training for police, prison staff and teachers. Conclusions: The bilateral collaboration programme initiated a reform programme which has been sustained beyond the end of the funding. The project has demonstrated the importance of using a multi-faceted and comprehensive programme to promote sustainable system change, key elements of which include a focus on the use of rapid appropriate treatment at primary care level, strengthening the referral system, interministerial and intersectoral liaison, rehabilitation, and media work to mobilize community engagement. http://www.ijmhs.com/content/4/1/17 Rachel Jenkins Ahmad Heshmat Nasser Loza Inkeri Siekkinen Eman Sorour International Journal of Mental Health Systems 2010, 4:17 2010-06-24T00:00:00Z doi:10.1186/1752-4458-4-17 International Journal of Mental Health Systems 1752-4458 4 17 2010-06-24T00:00:00Z XML Background: Torture continues to be a global problem and there is a need for prevention and rehabilitation efforts. There is little available data on torture survivors from studies designed and conducted by health professionals in low income countries. This study is a collaboration between five centres from Gaza, Egypt, Mexico, Honduras and South Africa who provide health, social and legal services to torture survivors, advocate for the prevention of torture and are part of the network of the International Rehabilitation Council for Torture Victims (IRCT). Methods: Socio-demographic, clinical and torture exposure data was collected on the torture survivors attending the five centres at presentation and then at three and six month follow-up periods. This sample of torture survivors is presented using a range of descriptive statistics. Change over time is demonstrated with repeated measures analysis of variance. Results: Of the 306 torture survivors, 23% were asylum seekers or refugees, 24% were socially isolated, 11% in prison. A high level of traumatic events was experienced. 64% had suffered head injury whilst tortured and 24% had ongoing torture injury problems. There was high prevalence of symptoms of anxiety, depression, post traumatic stress as well as medically unexplained somatic symptoms. The analysis demonstrates a modest drop in symptoms over the six months of the study. Conclusions: Data showed that the torture survivors seen in these five centres had high levels of exposure to torture events and high rates of clinical symptoms. In order to provide effective services to torture survivors, health professionals at torture rehabilitation centres in low income countries need to be supported to collect relevant data to document the needs of torture survivors and to evaluate the centres' interventions. http://www.ijmhs.com/content/4/1/16 Helen McColl Craig Higson-Smith Sarah Gjerding Mostafa Omar Basma Abdel Rahman Mona Hamed Aida El Dawla Miriam Fredericks Nicole Paulsen Gugu Shabalala Carmen Low-Shang Fernando Perez Liliana Colin Aurora Hernandez Eliomara Lavaire Arely Zuniga Lucia Calidonio Carmen Martinez Yasser Abu Jamei Zeyad Awad International Journal of Mental Health Systems 2010, 4:16 2010-06-18T00:00:00Z doi:10.1186/1752-4458-4-16 International Journal of Mental Health Systems 1752-4458 4 16 2010-06-18T00:00:00Z XML Few psychosocial and mental health care systems have been reported for children affected by political violence in low- and middle income settings and there is a paucity of research-supported recommendations. This paper describes a field tested multi-layered psychosocial care system for children (focus age between 8-14 years), aiming to translate common principles and guidelines into a comprehensive support package. This community-based approach includes different overlapping levels of interventions to address varying needs for support. These levels provide assessment and management of problems that range from the social-pedagogic domain to the psychosocial, the psychological and the psychiatric domains. Specific intervention methodologies and their rationale are described within the context of a four-country program (Burundi, Sri Lanka, Indonesia and Sudan). The paper aims to contribute to bridge the divide in the literature between guidelines, consensus & research and clinical practice in the field of psychosocial and mental health care in low- and middle-income countries. http://www.ijmhs.com/content/4/1/15 Mark Jordans Wietse Tol Ivan Komproe Dessy Susanty Anavarathan Vallipuram Prudence Ntamatumba Amin Lasuba Joop de Jong International Journal of Mental Health Systems 2010, 4:15 2010-06-16T00:00:00Z doi:10.1186/1752-4458-4-15 International Journal of Mental Health Systems 1752-4458 4 15 2010-06-16T00:00:00Z XML Background: There is scant knowledge of the involvement of developing country pharmacists in mental healthcare. The objectives of this study were: to examine the existing role of Ghanaian community and hospital pharmacists in the management of mental illness, and to determine the barriers that hinder pharmacists' involvement in mental healthcare in Ghana.MethodA respondent self-completion questionnaire was randomly distributed to 120 superintendent community pharmacists out of an estimated 240 pharmacists in Kumasi, Ashanti Region of Ghana. A purposive sampling method was utilized in selecting two public psychiatric hospital pharmacists in Accra, the capital city of Ghana for a face-to-face interview. A semi-structured interview guide was employed. Results: A 91.7% response rate was obtained for the community pharmacists' questionnaire survey. Approximately 65% of community pharmacists were not involved in mental health provision. Of the 35% who were, 57% counseled psychiatric patients and 44% of these dispensed medicines for mental illness. Perceived barriers that hindered community pharmacists' involvement in the management of mental health included inadequate education in mental health (cited by 81% of respondents) and a low level of encounter with patients (72%). The psychiatric hospital pharmacists were mostly involved in the dispensing of medicines from the hospital pharmacy. Conclusion: Both community and hospital pharmacists in Ghana were marginally involved in the provision of mental healthcare. The greatest barrier cited was inadequate knowledge in mental health. http://www.ijmhs.com/content/4/1/14 Frances Owusu-Daaku Afia Marfo Edmund Boateng International Journal of Mental Health Systems 2010, 4:14 2010-06-15T00:00:00Z doi:10.1186/1752-4458-4-14 International Journal of Mental Health Systems 1752-4458 4 14 2010-06-15T00:00:00Z XML