Tag: Mental Health Policy & Strategy

What is the Mental Health Gap Action Programme (mhGAP)?

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Introduction

The World Health Organisation (WHO) Mental Health Gap Action Programme (mhGAP) aims at scaling up services for mental, neurological and substance use disorders for countries especially with low- and middle-income.

Background

Mental, neurological, and substance use disorders are common in all regions of the world, affecting every community and age group across all income countries. While 14% of the global burden of disease is attributed to these disorders, most of the people affected – 75% in many low-income countries – do not have access to the treatment they need.

As such, the programme asserts that with proper care, psychosocial assistance and medication, tens of millions could be treated for depression, schizophrenia, and epilepsy, prevented from suicide and begin to lead normal lives – even where resources are scarce.

The following overview is from the WHO ‘mhGAP Mental Health Gap Programme: Scaling Up Care for Mental, Neurological, and Substance Use Disorders’ published on 01 January 2008:

Mental, neurological and substance use disorders are highly prevalent and burdensome globally. The gap between what is urgently needed and what is available to reduce the burden is still very wide.

WHO recognizes the need for action to reduce the burden, and to enhance the capacity of Member States to respond to this growing challenge. mhGAP is WHO’s action plan to scale up services for mental, neurological and substance use disorders for countries especially with low and lower middle incomes. The priority conditions addressed by mhGAP are: depression, schizophrenia and other psychotic disorders, suicide, epilepsy, dementia, disorders due to use of alcohol, disorders due to use of illicit drugs, and mental disorders in children. The mhGAP package consists of interventions for prevention and management for each of these priority conditions.

Successful scaling up is the joint responsibility of governments, health professionals, civil society, communities, and families, with support from the international community. The essence of mhGAP is building partnerships for collective action. A commitment is needed from all partners to respond to this urgent public health need and the time to act is now!

References/Further Reading

WHO mhGAP Mental Health Gap Action Programme: Scaling Up Care for Mental, Neurological, and Substance Use Disorders (WHO site; published 01 January 2008).

Outline of the Mental Health Gap Action Programme (mhGAP) (WHO site).

Clinical Review: WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: A Systematic Review of Evidence from Low and Middle-Income Countries (BMJ Journals: Evidence-Based Mental Health).

Book: London and Its Asylums, 1888-1914 – Politics and Madness

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Book Title:

London and Its Asylums, 1888-1914 – Politics and Madness.

Author(s): Robert Ellis.

Year: 2020.

Edition: First (1ed).

Publisher: Palgrave Macmillan.

Type(s): Hardcover and Kindle.

Synopsis:

This book explores the impact that politics had on the management of mental health care at the turn of the nineteenth and twentieth centuries. 1888 and the introduction of the Local Government Act marked a turning point in which democratically elected bodies became responsible for the management of madness for the first time.

With its focus on London in the period leading up to the First World War, it offers a new way to look at institutions and to consider their connections to wider issues that were facing the capital and the nation.

The chapters that follow place London at the heart of international networks and debates relating to finance, welfare, architecture, scientific and medical initiatives, and the developing responses to immigrant populations.

Overall, it shines a light on the relationships between mental health policies and other ideological priorities.

Beyond Paranoia & Panic: Mental Health Strategies to Combat the Psychological Impact of COVID-19

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Research Paper Title

Mental Health Strategies to Combat the Psychological Impact of COVID-19 Beyond Paranoia and Panic.

Background

On 30 January 2020, the World Health Organisation (WHO) declared the outbreak of coronavirus disease 2019 (COVID-19) an international public health emergency after the number of cases soared across 34 regions in Mainland China and surpassed that of severe acute respiratory syndrome (SARS) in 2003.

The virus was believed to have originated from a wholesale seafood market in the city of Wuhan in the province of Hubei towards the end of December 2019.

Shortly after, the number of cases increased exponentially in Wuhan and nearby cities and provinces before spreading throughout the world.

Located approximately 3,432 km from the epicentre of Wuhan, Singapore is a densely populated city-state of 5.7 million who saw 1,592,612 international visitors in 2019; of these, 380,933 were visitors from Mainland China.

After a tourist from Wuhan was identified as the first case of COVID-19 infection on 23 January 2020 in Singapore, the country responded decisively by initiating a series of public health measures to contain the outbreak that included travel advisories, restriction of entry into the country by individuals who had travelled to Mainland China in the preceding 2 weeks, mandatory quarantine for contact cases and rigorous contact tracing of individuals linked to confirmed COVID-19 cases.

You can access the full article here.

Reference

Ho, C.S., Chee, C.Y. & Ho, R.C. (2020) Mental Health Strategies to Combat the Psychological Impact of COVID-19 Beyond Paranoia and Panic. Annals of the Academy of Medicine, Singapore. 49(3), pp.155-160.

College Students & Substance Use: Do They Require different Strategies for Prevention & Intervention?

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Research Paper Title

Cumulative Risk of Substance Use in Community College Students.

Background

Substance use in community college students has been explored in only a handful of studies.

Differences in population characteristics and substance use between 2- and 4-year students suggest that different factors may promote and thwart this behaviour.

Cumulative risk is a parsimonious methodology that provides better model stability and more statistical power, yet it has only been recently used in substance use research.

The aim of this study is to investigate multiple aspects of substance use risk in a population in need of substance use prevention and intervention services.

Methods

The researchers conducted a cross-sectional study of community college students (N = 288; 75% female) examining the relative contributions of different domains of cumulative risk (eg, life stressors, academic stressors, and mental health diagnoses) to develop different profiles of risk across substance use classes (ie, alcohol, cigarette, marijuana, and hard drug use).

Results

Cumulative risk analyses indicated that alcohol and tobacco use were associated with the domains of life stressors and peer/family substance use, marijuana use with peer/family substance use and stressful childhood experiences, and hard drug use with peer/family substance use, lack of social support, low access to care, and stressful childhood experiences.

Conclusions

Different strategies for prevention and intervention may be necessary to effectively address different forms of substance use in this population.

Scientific Significance

The risk domain profiles related to specific drugs may lead to targeted interventions to reduce substance use in community college students.

Reference

Salgado García, F., Bursac, Z. & Derefinko, K.J. (2020) Cumulative Risk of Substance Use in Community College Students. The American Journal on Addictions. 29(2), pp.97-104. doi: 10.1111/ajad.12983. Epub 2020 Jan 3.

Are Community-Based Psychiatric Services Essential to Mental Health?

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Research Paper Title

The Relationship Between Hospital and Community Psychiatry: Complements, Not Substitutes?

Background

Community-based psychiatric services are essential to mental health.

For decades, researchers, advocates, and policy makers have presumed that expanding the supply of these services hinges on reducing the supply of hospital-based care.

Cross-national data from the World Health Organisation call this presumption into question.

Community and hospital psychiatry appear to be complements, not substitutes.

Reference

Perera, I.M. (2020) The Relationship Between Hospital and Community Psychiatry: Complements, Not Substitutes? Psychiatric Services (Washington, D.C.). doi: 10.1176/appi.ps.201900086. [Epub ahead of print].

Health Policies: Consider the Direct & Indirect Cross-effects between Mental Health & Physical Health

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Research Paper Title

The relationship between physical and mental health: A mediation analysis.

Background

There is a strong link between mental health and physical health, but little is known about the pathways from one to the other.

The researchers analyse the direct and indirect effects of past mental health on present physical health and past physical health on present mental health using lifestyle choices and social capital in a mediation framework.

Methods

They use data on 10,693 individuals aged 50 years and over from six waves (2002-2012) of the English Longitudinal Study of Ageing.

Mental health is measured by the Centre for Epidemiological Studies Depression Scale (CES) and physical health by the Activities of Daily Living (ADL).

Results

The researchers find significant direct and indirect effects for both forms of health, with indirect effects explaining 10% of the effect of past mental health on physical health and 8% of the effect of past physical health on mental health.

Physical activity is the largest contributor to the indirect effects.

There are stronger indirect effects for males in mental health (9.9%) and for older age groups in mental health (13.6%) and in physical health (12.6%).

Conclusions

Health policies aiming at changing physical and mental health need to consider not only the direct cross-effects but also the indirect cross-effects between mental health and physical health.

Reference

Ohrnberger, J., Fichera, E. & Sutton, M. (2017) The relationship between physical and mental health: A mediation analysis. Social Science & Medicine (1982). 195, pp.42-49. doi: 10.1016/j.socscimed.2017.11.008. Epub 2017 Nov 8.