Harry Minas

Human resources for mental health care: current situation and strategies for action

A challenge faced by many countries is to provide adequate human resources for delivery of essential mental health interventions. The overwhelming worldwide shortage of human resources for mental health, particularly in low-income and middle-income countries, is well established. Here, we review the current state of human resources for mental health, needs, and strategies for action. At present, human resources for mental health in countries of low and middle income show a serious shortfall that is likely to grow unless effective steps are taken. Evidence suggests that mental health care can be delivered effectively in primary health-care settings, through community-based programmes and task-shifting approaches. Non-specialist health professionals, lay workers, affected individuals, and caregivers with brief training and appropriate supervision by mental health specialists are able to detect, diagnose, treat, and monitor individuals with mental disorders and reduce caregiver burden. We also discuss scale-up costs, human resources management, and leadership for mental health, particularly within the context of low-income and middle-income countries.

The future of cultural psychiatry: an international perspective.

Cultural psychiatry has evolved along 3 lines: 1) cross-cultural comparative studies of psychiatric disorders and traditional healing; 2) efforts to respond to the mental health needs of culturally diverse populations that include indigenous peoples, immigrants, and refugees; and 3) the ethnographic study of psychiatry itself as the product of a specific cultural history. These studies make it clear that culture is fundamental both to the causes and course of psychopathology and also to the effectiveness of systems of healing. The provision of mental health services in multicultural societies has followed different models that reflect their specific histories of migration and ideologies of citizenship. Globalization has influenced psychiatry through socioeconomic effects on the prevalence and course of mental disorders, changing notions of ethnocultural identity, and the production of psychiatric knowledge. A cultural perspective can help clinicians and researchers become aware of the hidden assumptions and limitations of current psychiatric theory and practice and can identify new approaches appropriate for treating the increasingly diverse populations seen in psychiatric services around the world.

The Lancet's series on global mental health: 1 year on.

A little over a year ago, The Lancet published a Series of five articles on Global Mental Health that documented the current evidence for global mental health, with a focus on low-income and middle-income countries.1–5 The final paper in the Series made a call to scale up evidence-based packages of services for people with mental disorders with a commitment to the protection of human rights.6 The Series and the call to action that concluded it has received support from leaders in world health (panel 1). 1 year on, we take stock of the effect of this Series, focusing on implementation of the call for action. Although 1 year is a short time to see substantial outcomes, and definitively attributing events to the Series is impossible, our objective is to discern the commitment of stakeholders and the general direction they are taking since publication. We consulted the members of an advisory group set up soon after the Series was published to track major events. Only events that explicitly cited or were based on The Lancets Series were counted. We have organised our findings in four broad themes: the effect on global advocacy; the effect on global-health programmes; the effect on policies, resources, and professional societies; and the launch of a new Movement for Global Mental Health.

Pasung: Physical restraint and confinement of the mentally ill in the community

BackgroundPhysical restraint and confinement (pasung) by families of people with mental illness is known to occur in many parts of the world but has attracted limited investigation. This preliminary observational study was carried out on Samosir Island in Sumatra, Indonesia, to investigate the nature of such restraint and confinement, the clinical characteristics of people restrained, and the reasons given by families and communities for applying such restraint.MethodsThe research method was cross-sectional observational research in a natural setting, carried out during a six-month period of working as the only psychiatrist in a remote district.ResultsFifteen cases of pasung, approximately even numbers of males and females and almost all with a diagnosis of schizophrenia were identified. Duration of restraint ranged from two to 21 years.Discussion and ConclusionThe provision of basic community mental health services, where there were none before, enabled the majority of the people who had been restrained to receive psychiatric treatment and to be released from pasung.

International journal of mental health systems: a bibliometric study.

BackgroundThe International Journal of Mental Health Systems (IJMHS) was launched in August 2007 and has recently been given a formal impact factor. This study uses bibliometric indicators to review the performance of the Journal against its original stated objectives and aspirations.MethodsAll articles published in IJMHS since publication commenced were included (n = 158). Selected bibliometric measures indicating Journal productivity, author affiliation, impact, geographic reach, and international collaboration were utilised.ResultsIJMHS published 158 articles in seven volumes over six years. Articles with three to five authors constitute the dominant authorship pattern, and authors’ affiliations are varied. IJMHS has received an impact factor of 1.06 from Thomson Reuters, and the SCImago Journal Ranking shows IJMHS to be well positioned in the four categories in which it is listed, including in comparisons with well-established BMC journals that have similar scientific interests. Geographic authorship patterns show contributions from a large number of countries, including many low- and middle-income countries.DiscussionManuscript submissions from a wide range of countries, including low- and middle-income countries, are mostly from academic institutions. Authors from some geographic areas of the world are significantly under-represented. The calculation of an impact factor and encouraging rankings on the SCImago Journal Rank index are expected to lead to increased submission of high quality manuscripts.ConclusionThe performance of IJMHS over the first six years is promising, and the Journal is on the way to achieving the aims set out in the inaugural Editorial. IJMHS will continue to enhance its current impact through a number of new initiatives, including the introduction of thematic series and a broader range of article categories.

Mental hospital reform in Asia: the case of Yuli Veterans Hospital, Taiwan

BackgroundYuli Veterans Hospital (YVH) has been the largest mental hospital for the patients with chronic and severe mental illness in Taiwan for the past 50 years. While this hospital used to be a symbol of hopelessness among patients and their families and an unspoken shame among Taiwan psychiatry and mental health circles it now represents an example of how an old, custodial hospital can be transformed into a very different institution. In this case study we will describe the features of this transformation, which, over the past 20 years, has aimed to help extended stay inpatients with severe mental illness to integrate into the local community of Yuli even though it is not their original home.MethodsUsing historical documents and oral narratives from Yuli inhabitants, workers and patients of YVH, we will offer a case study of the Yuli model.ResultsThere are four main components of the Yuli model: holistic medical support, vocational rehabilitation, case management, and the residential program. The four components help patients recover two essential features of their lives: vocational life and ordinary daily routines. As the process of recovery evolves, patients gradually regain inner stability, dignity, self-confidence, and a sense of control. The four components are critical to rebuild the structure and order of life of the patients and are indispensable and interdependent parts of one service package. They operate simultaneously to benefit the patients to the greatest degree possible.DiscussionThere are many challenges to the further development and financial viability of the model of services developed at YVH. There are also important questions concerning the replicability of the Yuli model in other sociocultural and service system contexts.ConclusionThis case study reveals the possibility of transforming a custodial mental hospital into a hospital providing high quality care. Hospital and community are not in opposition. They are part of a continuum of care for the patients. We reinterpret and redefine the boundary and function of hospital and community, and thereby create a new service model, the Yuli Model, to help patients to reintegrate into the community. The Yuli model, which particularly focuses on the needs of people with long-standing illness and prolonged hospital stay, illustrates one approach to linking hospital and community in a creative and constructive manner.

Evaluation of Mental Health First Aid training with members of the Vietnamese community in Melbourne, Australia

BackgroundThe aim of this project was to investigate in members of the Vietnamese community in Melbourne the impact of Mental Health First Aid (MHFA) training on attitudes to people with mental illness and on knowledge about mental disorders. Our hypotheses were that at the end of the training participants would have increased knowledge of mental disorders and their treatments, and decreased negative attitudes towards people with mental disorders.MethodsRespondents were 114 participants in two-day MHFA training workshops for the Vietnamese community in Melbourne conducted by two qualified MHFA trainers. Participants completed the research questionnaire prior to the commencement of the training (pre-test) and at its completion (post-test). The questionnaires assessed negative attitudes towards people with mental illness (as described in four vignettes), ability to recognise the mental disorders described in the vignettes, and knowledge about how to assist someone with one of these disorders. Responses to open-ended questions were content analysed and coded. To evaluate the effect of the training, answers to the structured questions and to the coded open-ended questions given at pre- and post-test were compared using McNemar tests for dichotomous values and Wilcoxon tests for other scores.ResultsBetween pre- and post-test there was significant improvement in recognition of mental disorders; more targeted and appropriate mental health first aid responses, and reduction in inappropriate first aid responses; and negative attitudes to the people described in the vignettes declined significantly on many items of the stigma scale.ConclusionA two-day, MHFA training course for general members of the Vietnamese community in Melbourne demonstrated significant reductions in stigmatising attitudes, improved knowledge of mental disorders and improved knowledge about appropriate forms of assistance to give to people in the community with mental disorder. There is sufficient evidence to scale up to a population level program for the Vietnamese community, and a need for longitudinal evaluation of such a scaled up program.

Why focus on mental health systems

The global situation for people with mental illness – in developing and developed countries – is dire. Legislative and human rights protections are frequently lacking. Mental health budgets are inadequate. There are insufficient numbers of skilled policy makers, managers and clinicians. Communities are poorly informed about mental health and illness and not well organised for purposes of advocacy. In most of the world, mental health services are inaccessible or of poor quality. Most people who would benefit from psychiatric treatment and rehabilitation do not have affordable access to such services. Leadership – at all levels – for mental health system development needs to be greatly strengthened.While mental health research attention and funds are devoted predominantly to neuroscience and clinical research, we believe that the highest global mental health research priority is mental health systems research. There is an urgent need to focus on the development of effective, appropriate, affordable mental health services. The evidence base for such development is currently weak.The International Journal of Mental Health Systems aims to stimulate greater attention to the central importance of building functioning mental health systems. Rapid publication and global reach through open access will make this journal a resource for all those who wish to contribute to such development.

Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes

BackgroundThe context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes.MethodsGeneral hospital health professionals in Malaysia were randomly allocated one of two vignettes, one describing a patient with mental illness and the other a patient with diabetes, and invited to complete a questionnaire examining attitudes and health care practices in relation to the case. The questionnaires completed by respondents included questions on demographics, training in mental health, exposure in clinical practice to people with mental illness, attitudes and expected health care behaviour towards the patient in the vignette, and a general questionnaire exploring negative attitudes towards people with mental illness. Questionnaires with complete responses were received from 654 study participants.ResultsStigmatising attitudes towards persons with mental illness were common. Those responding to the mental illness vignette (N = 356) gave significantly lower ratings on care and support and higher ratings on avoidance and negative stereotype expectations compared with those responding the diabetes vignette (N = 298).ConclusionsResults support the view that, in the Malaysian setting, patients with mental illness may receive differential care from general hospital staff and that general stigmatising attitudes among professionals may influence their care practices. More direct measurement of clinician behaviours than able to be implemented through survey method is required to support these conclusions.

Histopathological findings in cochlear implants in cats

This histopathological study on cats has shown that electrodes may be implanted into the cochlea through the round window or an opening drilled over the middle and apical turns without loss of the spiral ganglion cells or auditory nerve fibres. It has also shown that infection, leading to a labyrinthitis, was more likely to occur when an opening was drilled in the cochlea, and this could lead to a marked destruction of the cochlear structures, and loss of the spiral ganglion cells.