Samantha Battams

Mental health and barriers to the achievement of the ‘right to health’

This paper explores issues relating to access to physical and mental health care for people with mental health problems in light of Australias endorsement in 2008 of the Convention of the Rights of Persons with Disabilities, which established the right to health and to health care. Interviews were conducted with 10 key stakeholders with legal, policy, clinical and advocacy roles within South Australia and at a national and international level. Participants identified several barriers to the achievement of the right to health for people with mental illness, with discussion highlighting the legal definition of rights, governance of health and mental health, and structural barriers to receipt of care as the primary barriers. The data are explored in relation to social models of disability.

Workplace risk factors for anxiety and depression in male-dominated industries: a systematic review.

Background and Aims: Working conditions are an important health determinant. Employment factors can negatively affect mental health (MH), but there is little research on MH risk factors in male-dominated industries (MDI). Method: A systematic review of risk factors for anxiety and depression disorders in MDI was undertaken. MDI comprised ≥ 70% male workers and included agriculture, construction, mining, manufacturing, transport and utilities. Major electronic databases (CINAHL, Cochrane Library, Informit, PsycINFO, PubMed and Scopus) were searched. Each study was categorised according to National Health and Medical Research Councils hierarchy of evidence and study quality was assessed according to six methodological criteria. Results: Nineteen studies met the inclusion criteria. Four categories of risk were identified: individual factors, team environment, work conditions and work–home interference. The main risk factors associated with anxiety and depression in MDI were poor health and lifestyles, unsupportive workplace relationships, job overload and job demands. Some studies indicated a higher risk of anxiety and depression for blue-collar workers. Conclusion: Substantial gaps exist in the evidence. Studies with stronger methodologies are required. Available evidence suggests that comprehensive primary, secondary and tertiary prevention approaches to address MH risk factors in MDI are necessary. There is a need for organisationally focused workplace MH policies and interventions.

What works in school-based alcohol education: A systematic review

Background: Considerable attention has been focused on the impact of young people’s alcohol use. To address this, schools often implement alcohol and drug education and there are many potential programmes to choose from. Objective: The aim of this study was to identify evidence-based alcohol education programmes for schools. Methods: A systematic review was undertaken of school-based programmes that targeted alcohol within a school setting and included at least one alcohol behaviour or knowledge change outcome. Six-hundred seventy-five abstracts were screened resulting in 454 studies assessed for eligibility, with 70 studies, evaluating 40 individual programmes, included in the final review. Results: Of the 40 programmes, 3 had good evidence of a positive effect. They included CLIMATE Schools (Australia), Project ALERT (USA) and All Stars (USA). Of the others, 4 showed some evidence of positive effect, 1 had no evidence of effect, 29 were inconclusive and 2 showed negative outcomes, such as increases in alcohol use. Although many programmes were evaluated, very few had sufficient evidence to be able to endorse their widespread implementation in schools. Conclusion: Three programmes included in the review had sufficient positive outcomes to be recommended for implementation, and four showed good outcomes in some areas. Schools should consider these results when deciding on introducing alcohol education. Overall, the evidence base is broad but relatively weak and further research is required, focusing on programmes identified as having good or potentially good outcomes.

Child wellbeing and protection concerns and the response of the alcohol and other drugs sector in Australia

Abstract There are growing concerns regarding child wellbeing and protection across many countries. This paper assesses the legitimacy of these concerns in the Australian context and explores the relationship between alcohol and other drugs (AOD) use by parents and child wellbeing and protection. The paper considers evidence on the relationship between AOD use by parents and child wellbeing and protection. It examines the potential role of the AOD sector in child welfare outcomes, in the context of social determinants of health. To date, relatively little attention has been directed towards the relationship between AOD misuse and both child and adolescent wellbeing and protection matters, although the AOD sector has an important preventative role for child and adolescent wellbeing and protection. Intersectoral and Family Sensitive Policy and Practices within AOD services are important to this ‘secondary prevention’ role, however there are many barriers to the achievement of such strategies. Developments in Family Sensitive Policy and Practice must be intersectoral and will require additional resources. Cross-sectoral workforce development and retention strategies, which include training in child development theories and approaches in the AOD sector, and addressing stigmatizing attitudes towards parenting AOD clients across sectors, are also necessary.

The physical health of people with mental illness and ‘the right to health’

Abstract An overview of literature was conducted on the ‘right to health’ for people with a mental illness, with a main focus on physical health. This included a review of key online databases for articles on the ‘right to health’, conducted for 2000–2010. This paper provides evidence on the poor health status of people with mental illness. It then considers international human rights legislation and their context, including tensions presented by mental health legislation in terms of human rights. Dimensions of the ‘right to health’, issues and obstacles to fulfilment of the ‘right to health’, and opportunities and obstacles in the Australian context are explored. There are many barriers to the recognition of right to health for the mentally ill. However, the new UN Convention on Persons with Disability offers some hope for the ‘right to health’ to be considered through legislative review and national policy.

The Right to Health, International Human Rights Legislation and Mental Health Policy and Care Practices for People with Psychiatric Disability

This article is based on research which examined the current and potential impact of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) on Australian and South Australian legislation and policy. A particular focus was on the ‘right to health’ for people with a psychiatric disability. Ten interviews were conducted with professionals from law, psychiatry, government and service user advocacy, working at state, national (Australian) and international levels. It addresses three key themes: the rights of people with psychiatric and other disabilities; perceptions of the rollout of the United Nations Convention on the Rights of Persons with Disabilities (CRPD); and the impact on current policy and practice of the ‘right to health’.

Power asymmetries, policy incoherence and noncommunicable disease control - a qualitative study of policy actor views

ABSTRACT Noncommunicable diseases (NCDs) kill 40 million people each year and are the cause of 70% of global deaths annually. Proximal risk factors include tobacco use, physical inactivity, the harmful use of alcohol and consumption of unhealthy food, which are shaped by the social and economic conditions of daily life, known as the social and commercial determinants of health. It is well recognised within the global health community that policy coherence across all levels of government at the national and international level is required to address NCDs. To date, however, there has been little coherence between health and trade policy, which directly affects access to unhealthy or healthy commodities. This paper explores policy actors’ views of the challenges in achieving coordinated and coherent NCD policy across health and trade sectors. Drawing on interviews (n = 18) with key policy actors and using a policy framework that focuses on ideas, power and the ‘deep core’ of neoliberalism, we identify the role of competing frames, power asymmetries and interests in constraining policy coherence. We also find differences between NCD risk factor domains. Tobacco control was highlighted as one area of generally successful coherence internationally. In contrast, alcohol and nutrition were identified as areas with little coherence. Industry power, the role of evidence, presence of absence of a treaty, the extent of coordinated advocacy and leadership by intergovernmental organisations were key factors influencing coherence. In light of these constraints, the role of advocacy by non-governmental organisations was highlighted as the key for much-needed policy change.

Editorial: Public Mental Health Policy, Mental Health Promotion, and Interventions Which Focus on the Social Determinants of Mental Health

The 2006 United Nations convention on the rights of persons with disabilities (CRPD) (1) enshrined a range of rights, with the aim of ensuring independence and full social inclusion for people with disabilities. The convention is based on a “social model” of disability, which underscores the role of social environments and systems in contributing to disability; it thus moves beyond a “medical model” where the focus is on individual deficits associated with disability, or a “charity model” that highlights need and dependency of people with disabilities (2, 3). The CRPD covers people with disability arising from mental disorders, who are particularly vulnerable to rights violations (4). The human rights outlined in the CRPD cover “positive rights” such as access to employment, social, and health services, as well as so-called “negative rights” such as the right to refuse treatment and the deprivation of liberty (5). However, it has been noted that there is an undue attention on “negative rights” in treatment services (5), and limited capacity for the law to guarantee “positive rights” (2). Battams and Henderson note (5) that: