Mental health services Research Papers (original) (raw)

Letters from readers are welcome. They will be published at the editor's discretion as space permits and will be subject to editing. They should not exceed 500 words with no more than three authors and five references and should include the writer's telephone number and e-mail address. Letters related to material published in Psychiatric Services, which will be sent to the authors for possible reply, should be sent to Howard H. Goldman, M.D., Ph.D., Editor, Psychiatric Services, American Psychiatric Association, 1000 Wilson Blvd., Suite 1825, Arlington, VA 22209-3901; fax, 703-907-1095; e-mail, psjournal@psych.org. Letters reporting the results of research should be submitted online for peer review (mc.manuscriptcen tral.com/appi-ps).

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- Semantics, Schizophrenia, Bipolar Disorder, Vocabulary

Note: It is the policy of the Canadian Psychiatric Association to review each position paper, policy statement and clinical practice guideline every five years after publication or last review. Any such document that has been published more than five years ago and does not explicitly state it has been reviewed and retained as an official document of the CPA, either with revisions or as originally published, should be considered as a historical reference document only.

- by Albina Veltman
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- Psychology, Medicine, Comorbidity, Canadian Psychiatry

Over the past decade the approaches adopted towards the mental health care of refugees by a range of national and international healthcare organisations have been the subject of a sustained and growing critique. Much of this critique has focused on the way in which Western psychiatric categories have been ascribed to refugee populations in ways which, critics argue, pay scant attention to the social, political and economic factors that play a pivotal role in refugees' experience. Rather than portraying refugees as ''passive victims'' suffering mental health problems, critics have argued that attention should be given to the resistance of refugees and the ways in which they interpret and respond to experiences, challenging the external forces bearing upon them. In this paper a range of issues concerning the mental health care of refugees will be examined. These include the role of psychiatric diagnosis in relation to refugees' own perceptions of their need and within the context of general health and social care provision. In examining services the emergence of new paradigms in mental health care is identified. These include the growth of holistic approaches that take account of refugees' own experiences and expressed needs and which address the broader social policy contexts in which refugees are placed. A three-dimensional model for the analysis of the interrelationship between ''macro'' level institutional factors in the mental health of refugees and the individual treatment of refugees within mental health services is proposed. #

- by Charles Watters
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- Sociology, Psychiatry, Anthropology, Social Policy

Economic and social pressures are driving Japan to reform its mental health services. Traditionally, psychiatric services in Japan have been custodial. Reimbursement has been principally fee-for-service, with incentives that encourage hospital-based care. Reform measures are beginning to promote the concept of "normalization," in which the mentally ill are seen to be disabled, like persons with physical disabilities. New practices including deinstitutionalization, differentiation of services, revisions in payment, and quality assessment are being introduced. This article provides an overview of the current status of Japanese mental health services, summarizes policy dilemmas, and identifies priority areas for intervention. (HARVARD REV PSYCHIATRY 1999;7:208-215.)

- by Lloyd Sederer and +1
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- Cognitive Science, Forecasting, Japan, Adolescent
- by D. Russell Crane and +1
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- Psychology, Family Therapy, Social Work, Program Development

This article reviews the literature on psychotherapy outcome research and discusses the relationship between those findings and the tenets of the consumer-driven recovery model. The research provides compelling evidence for practitioners to abandon the current emphasis on diagnosis and theory, model, and technique in favor of a partnership with clients that leverages the common factors and places emphasis on the alliance. Empirical support of the shortcomings of evidence-based practices is provided. Use of outcome and alliance feedback to inform the work and shift to practice-based evidence is offered as a practice that is informed by the research and honors the recovery model's call for consumer-driven mental health services.

- by Julie Tilsen and +1
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- Sociology, Social Work, Community-Based Mental Health Services, Evidence Based Medicine

The United States is a country of immigrants. With the exception of Native-Americans, every other American is, or descends from, an immigrant. First and second generation immigrant children are the most rapidly growing segment of the American population, with the great majority of this population being of non-European origin. This paper reviews the unique risk factors and mental health needs of our new immigrant populations, as well as treatment and services approaches to address their unique needs.

- by Morton Beiser
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- Psychology, Mental Health, Social Support, Native American

This study examined risk and determinants of rehospitalization of children and adolescents (n = 186) following a first psychiatric hospitalization. It specifically examined the role of postdischarge services. Data were collected for a 30-month follow-up period through structured telephone interviews with caregivers and case record abstractions. 43% of youth experienced readmissions during the follow-up period. Risk of rehospitalization was highest during the first 30 days following discharge and remained elevated for 3 months. 72% of youth received 284 postdischarge services during the follow-up period, which significantly reduced the risk of rehospitalization. Longer first hospitalizations and a higher risk score at admission increased risk.

- by RL Smith
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- Psychology, Risk, Mental Health Policy, Adolescent

People with severe mental illness suffer more physical comorbidity than the general population, which can require a tailored approach to physical health care discussions within mental health care planning. Although evidence pertaining to service user and carer involvement in mental health care planning is accumulating, current understanding of how physical health is prioritised within this framework is limited. Understanding stakeholder experiences of physical health discussions within mental health care planning, and the key domains that underpin this phenomena is essential to improve quality of care. Our study aimed to explore service user, carer and professional experiences of and preferences for service user and carer involvement in physical health discussions within mental health care planning, and develop a conceptual framework of effective user-led involvement in this aspect of service provision. Six focus groups and four telephone interviews were carried out with twelve serv...

- by Karina Lovell
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- Focus Groups, United Kingdom, Mental Disorders, Mental health services
- by Maurizio Coletti
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- Psychology, Medicine, United States, Patient Compliance
- by Dan J Stein
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- Information Systems, Health Promotion, Leadership, Health Policy

Background: Broad community access to high quality evidence-based primary mental health care is an ongoing challenge around the world. In Australia one approach has been to broaden access to care by funding psychologists and other allied health care professionals to deliver brief psychological treatments to general practitioners' patients. To date, there has been a scarcity of studies assessing the efficacy of social worker delivered psychological strategies. This study aims to build the evidence base by evaluating the impact of a brief educational intervention on social workers' competence in delivering cognitive behavioural strategies (strategies derived from cognitive behavioural therapy).

- by Lynette Joubert and +1
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- Social Work, Community-Based Mental Health Services, Health Care, Health Reform

At national, state, and local levels, there is increasing recognition of the importance of identifying and responding to the mental health needs of youths in the juvenile justice system, as policymakers and practitioners struggle to find ways to address causes and correlates of juvenile crime and delinquency. The proposed guidelines for mental health assessment provide explicit information about how, why, and when to obtain mental health information on justice youths at each important juncture in processing.

- by Joseph Cocozza
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- Criminal Law, Mental Health, Juvenile Justice, Juvenile Delinquency

Youth shifting to adult mental health services often report experiencing frustrations with accessing care that adequately replaces the youth services they had received. This systematic review assesses the peer reviewed evidence on services/programs aimed at addressing youth to adult transitions in mental health services. Findings suggest little data exists on the effectiveness of transition services/programs. While the available evidence supports meetings between youth and youth caseworkers prior to transitions occurring, it also verifies that this is not common practice. Other identified barriers to effective transitions were categorized as logistical (ineffective system communication), organizational (negative incentives), and related to clinical governance.

- by TRAM NGUYEN
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- Psychology, Adolescent, Medicine, Young Adult

Intellectual disability is known to be associated with a high incidence of psychiatric co-morbidity and problem behaviours. However, there are many challenges in trying to meet the mental health needs of people with an intellectual disability, and these are often not adequately addressed in Singapore's current healthcare system. This article outlines the present service provisions for this area in the country and details the importance of, as well as difficulties in the integration of health and social care measures in service development and delivery.

- by Rathi Mahendran
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- Special Education, Mental Health, Health Care, Singapore

Mental health in China is a great concern given the large number of patients and huge social and economic costs. The one-month prevalence rate of adult mental disorder in China is about 17.5%. Over 170 million adults have one or more types of mental disorder. Of this, 16 million people are estimated to have serious mental diseases. Over 90% of patients with serious mental diseases in China have not been given proper medical treatment. Over 60% of suicide cases in China are associated with mental disorders and suicide is the most significant reason for death between 19 and 34 years old in China. This paper reviews the mental health care condition in China and discusses policy implications, given current import issues for mental health care. We review research literature for mental health care in China and collect reports from various published sources. Under-supply of the mental health services is the most pivotal issue for policymakers. The utilization of mental health care services...

- by Jiwei Qian
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- Psychology, China, Health Policy, Medicine
- by Željko Bjelajac
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- Violence, Social Problems, Medicine, Prostitution

Introduction and Aims. Consumer participation in decision-making about service planning is common in certain health services in Australia but is thought to be largely underdeveloped in drug treatment services. This paper (1) describes the current practices within Australian drug treatment services that aim to include consumers in service planning and provision; and (2) determines how much consumers know about the existing opportunities for involvement. Design and Method. Sixty-four randomly selected service providers (representing 64 separate services) completed interviews about the current arrangements for consumer participation within their services (response rate ¼ 82%). A total of 179 consumers completed interviews assessing their knowledge of the consumer participation activities available at the service they attended. Results. Consumer participation activities were not uncommon in drug treatment services, although the existing activities were concerned largely with providing information to or receiving information from consumers. Activities that included consumers in higher forms of involvement, such as those in which consumers took part in decision-making, were largely uncommon. Consumers had a considerable lack of knowledge about the participation activities available to them, revealing a lack of communication between providers and consumers. Conclusions. While service providers were making efforts to engage consumers in service planning and provision (despite the general lack of State or Commonwealth policy directives and extra funding to do so), these appear ineffectual because of poor communication between providers and consumers. As a starting point, a critical part of any meaningful consumer participation initiative must include systems to ensure that consumers know about available opportunities.

- by Annie Madden
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- Business, Communication, Australia, Health Planning

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.

- by Emilio Ovuga
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- Mental Health, Primary Health Care, Health Care, Medicine

Despite increasing calls for shared decision making (SDM), the precise mechanisms for its attainment are unclear. Sharing decisions in mental health care may be especially complex. Fluctuations in service user capacity and significant power differences are particular barriers. We trialled a form of facilitated SDM that aimed to generate patients' treatment preferences in advance of a possible relapse. The 'Joint Crisis Plan' (JCP) intervention was trialled in four mental health trusts in England between 2008 and 2011. This qualitative study used grounded theory methods to analyse focus group and interview data to understand how stakeholders perceived the intervention and the barriers to SDM in the form of a JCP. Fifty service users with psychotic disorders and 45 clinicians participated in focus groups or interviews between February 2010 and November 2011. Results suggested four barriers to clinician engagement in the JCP: (i) ambivalence about care planning; (ii) percep...

- by Waquas Waheed
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- Psychology, Nursing, Decision Making, Focus Groups

We conducted a prospective trial randomizing 75 physicians to either a control or intervention arm to evaluate the impact of providing patient-reported information on anxiety and other mental health symptoms and disorders to primary care physicians. Five hundred seventy-three patients of the study physicians who met entry criteria were randomized to either usual care or usual care supplemented with feedback of patient-reported mental health information to physicians. This mental health information was derived from initial patient-reported questionnaires completed in waiting rooms of physicians contracted to a mixed-model health maintenance organization in Colorado. Main outcome measures included impact of intervention on rates of (1) chart notation of anxiety, depression, or other mental health diagnoses or symptoms; (2) referral to mental health specialists; (3) prescription of psychotropic medications; (4) hospitalization; and (5) office visits during a 5-month observation period....

- by Susan Mathias
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- Mental Health, Family Practice, Medicine, Anxiety

This study was planned to investigate the effect of a self-awareness education program on the self-efficacy and sociotropyautonomy characteristics of nurses in a psychiatry clinic. The sample was composed of 22 nurses who worked in a psychiatry clinic. Three forms were used for research data collection: descriptive characteristics form, self-efficacy scale (SES), and sociotropyautonomy scale (SAS). A statistically significant difference was found in the psychiatric unit nurses' mean SES and SAS scores before and after receiving the education for increasing their self-awareness. On the basis of these findings, it is recommended that an education program for increasing self-awareness be implemented because it affects increasing the personal characteristics of selfefficacy and sociotropyautonomy.

- by esra engin
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- Education, Quality of life, Turkey, Learning

In this paper, we describe the use of an aim-based outcome measure used in routine outcome monitoring of child and adolescent psychotherapy within a child and adolescent mental health service. We present empirical evidence drawn from a cohort of 34 child and adolescent patients which demonstrates a statistically significant and clinically meaningful improvement in ratings of the Goal-Based Outcomes Measure.

- by J. Catty
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- Psychotherapy, Adolescent, Group Psychotherapy, Multidisciplinary

Background: In 2008, the Netherlands Psychiatric Association authorized a guideline "consultation psychiatry." Aim: To set a standard for psychiatric consultations in nonpsychiatric settings. The main objective of the guideline is to answer three questions: Is psychiatric consultation effective and, if so, which forms are most effective? How should a psychiatric consultations be performed? What increases adherence to recommendations given by the consulting psychiatrist? Method: Systematic literature review. Results: Both in general practice and in hospital settings psychiatric consultation is effective. In primary care, the effectiveness of psychiatric consultation is almost exclusively studied in the setting of "collaborative care." Procedural guidance is given on how to perform a psychiatric consultation. In this guidance, psychiatric consultation is explicitly looked upon as a complex activity that requires a broad frame of reference and adequate medical and pharmacological expertise and experience and one that should be performed by doctors. Investing in a good relation with the general practitioner, and the use of a "consultation letter" increased efficacy in general practice. In the hospital setting, investing in liaison activities and an active psychiatric follow-up of consultations increased adherence to advice. Conclusion: Psychiatric consultations are effective and constitute a useful contribution to the patients' treatment. With setting a standard consultations will become more transparent and checkable. It is hoped that this will increase the quality of consultation psychiatry.

- by Harm Marwijk
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- Psychiatry, Mental Health, Primary Health Care, Treatment

The research reported in this special issue addresses important areas for the continued development of empirically supported school-based treatments. Although advances in the development and evaluation of treatment services have occurred, there is little public demand for the widespread dissemination of these treatments. In this commentary, the authors draw data from historical examples, related research, and personal experience to demonstrate the need to create a societal mandate for change. They present specific implications for future areas of research and the type of public education and marketing campaign that will be needed to create a demand for empirically supported school-based treatments.

- by Steven W. Evans
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- Psychology, Adolescent, Child, United States

Clubhouses and consumer-run drop-in centers (CRDIs) are two of the most widely implemented models of consumer-centered services for persons with serious mental illness. Differences in structure and goals suggest that they may be useful to different types of consumers. Information on what types of consumers use which programs would be useful in service planning. This study analyzes data from the authors' NIMH-funded research on 31 geographically matched pairs of clubhouses and CRDIs involving more than 1,800 consumers to address the following question: are there significant differences in the characteristics and outcomes of members of clubhouses versus CRDIs? Results from multilevel analyses indicated that clubhouse members were more likely to be female, to receive SSI/SSDI, to report having a diagnosis of schizophrenia, and to live in dependent care; and they reported both a greater number of lifetime hospitalizations and current receipt of higher intensity traditional MH services. Controlling for differences in demographic characteristics, psychiatric history, and mental health service receipt, clubhouse members also reported higher quality of life and were more likely to report being in recovery. CRDI consumers were more likely to have substance abuse histories. Possible reasons for the differences are discussed. The results suggest that CRDIs are a viable alternative to more traditional mental health services for individuals who might not otherwise receive mental health services.

- by Peter Macfarlane
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- Social Work, Quality of life, Treatment Outcome, Substance Abuse
- by Kimberly Hoagwood
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- Program Evaluation, Psychology, Linguistics, Cognitive behavior therapy

To measure total public and private expenditures on mental health in each province. Data for expenditures on mental health services were collected in the following categories: physician expenditures (general and psychiatrist fees for service and alternative funding), inpatient hospital (psychiatric and general), outpatient hospital, community mental health, pharmaceuticals, and substance abuse. Data for 2 years, 2003 and 2004, were collected from the Canadian Institute for Health Information (hospital inpatient and fees for service physicians), the individual provinces (pharmaceuticals, alternative physician payments, hospital outpatient, and community), and the Canadian Centre on Substance Abuse. Totals were expressed in terms of per capita and as a percentage of total provincial health spending. Total spending on mental health was 6.6billion,ofwhich6.6 billion, of which 6.6billion,ofwhich5.5 billion was from public sources. Nationally, the largest portion of expenditures was for hospitals, followed by community me...

- by Arto Ohinmaa
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- Canada, Canadian, Mental Disorders, Mental health services
- by John Landsverk
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- Psychology, Social Work, Sexual Abuse, Child abuse and neglect

To determine the association of parent, family, and adolescent variables with adolescent mental health service need and utilization. Method: Correlates of adolescent mental health service utilization, self-perceived need and unmet need were investigated in a general population sample of 1,120 Dutch adolescents aged 11 to 18 years (78% response rate). Results: 3.1% of the sample had been referred for mental health services within the preceding year, and 3.8% reported unmet need. 7.7% of adolescents at risk for psychopathology, and 17.8% of those indicating a need for help, had been referred. Family stress and adolescent's self-reported problems were most strongly associated with service need and utilization. Internalizing problems, female gender, and low education level were associated with self-perceived unmet need.

- by Peter Verhaak
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- Adolescent, Child, Needs Assessment, Netherlands

In this evaluation of a method of assessing competence in Motivational Interviewing (MI), participants were asked to interview an actor simulating a substance abuser who was ambivalent about an important issue. The interviews were videotaped and subsequently rated for competence in MI using the Motivational Interviewing Treatment Integrity code (MITI). Ratings of 43 interviews made independently by trained judges found high levels of inter-rater agreement. Ratings of 11 pairs of interviews carried out by the same interviewer with different simulated patients, a mean of 26 days apart, resembled each other closely. Participants who had been trained in MI were significantly more competent than others. There was a significant association between researchers' and patients' ratings of the extent to which the interviewer demonstrated the spirit of MI. These findings imply that the assessment method produces reasonably reliable and valid ratings of competence in MI and can be used for both clinical and research purposes. D

- by Gerald Bennett and +1
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- Psychology, Nonparametric Statistics, United Kingdom, Motivational Interviewing

This paper summarizes an initial exploratory study undertaken to consider the ministry of New Zealand chaplaincy personnel working within the mental health care context. This qualitative research (a first among New Zealand mental health care chaplains) was not concerned with specific health care institutions per se, but solely about the perspectives of chaplains concerning their professional contribution and issues they experienced when trying to provide pastoral care to patients, families, and clinical staff involved in mental health care. Data from a single focus group indicated that chaplains were fulfilling various WHO-ICD-10AM pastoral interventions as a part of a multidisciplinary and holistic approach to mental health care; however, given a number of frustrations identified by participants, which either impeded or thwarted their professional role as chaplains, a number of improvements were subsequently identified in order to develop the efficiency and effectiveness of chaplaincy and thus maximize the benefits of pastoral care to patients, families, and clinical staff. Some implications of this exploratory study relating to mental health care chaplaincy, ecclesiastical organizations, health care institutions, and government responsibilities and the need for further research are noted.

- by Laura Chahda
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- Christianity, Spirituality, Focus Groups, Quality of life
- by Kathryn Magruder
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- Primary Care, Psychiatry, Sexual Abuse, Mental Health

This study examines the relationship between institutional ¢scal strain and the availability of opiate substitution therapy (eg, methadone maintenance), an e¡ective but relatively expensive treatment for heroin addiction. An observational design was used to examine the association of changes in funding and changes in provision for treating opiate addiction at 29 VA Medical Centers (VAMCs). We hypothesized that VAMCs experiencing greater ¢scal strain would show reduced availability of opiate substitution treatment. Administrative records from each of 29 VAMCs that provided opiate substitution therapy in both Fiscal Year (FY) 1995 and FY 1999 were used to measure changes in the availability of this service, ie, the percent change in total patients treated, annual visits per patient, and total services delivered. Institutional ¢scal strain was measured by the percent decline in per capita funding at four levels at each VAMC: the entire medical center, all mental health programs, all substance abuse programs (inpatient and outpatient), and outpatient substance abuse programs alone. The total number of patients receiving opiate substitution increased from 5,549 in FY 1995 to 6,884 in FY 1999, annual visits per patient decreased by 16%, and the total number of units of services increased by 4%. There were no signi¢cant relationships between changes in the delivery of opiate substitution services and changes in per capita funding at any 220

- by George Woody
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- Psychology, Financial management, Health Services, United States

Literature concur that there is a disparity between epidemiological prevalence and mental health services (MHS) utilization rates for Latino and Asian Americans. This study adapted the behavioral model of health service use to examine factors associated with MHS use among Latino and Asian Americans. The model consists of predisposing, enabling, and need factors. This study used the National Latino and Asian American Study data, including six ethnic groups. The outcome measure for this study was the use of MHS in the past 12 months. Age, sex, and education predicted higher odds of MHS use among Latinos, none of which were significant among Asians. Needs factors were strongly associated with higher odds of MHS use among Latinos and Asians.

- by Bita Ghafoori and +1
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- Psychology, Pediatrics, Social Work, Health Behavior

The gap between service need and service use for youth with behavioral health problems is well documented. Although provider perception of need predicts service access, studies have found low associations between youth report and provider perception. This paper posits that provider perception of functioning mediates the relationship between youth need as measured by symptoms and provider assessment of that need. Interviews concerning service need and use with 792 14-18-year olds, and surveys of 222 of their providers, were analyzed through structural equation models. Functioning mediated the path from symptoms to assessment when contextual variables were not included in the model, but did not explain additional service use. However, when both contextual factors and functioning were included, the path from functioning to assessment was not significant and less service variance was explained (46% vs. 55%) than in a model not including functioning. Functioning may explain the relations...

- by Arlene Stiffman and +1
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- Psychology, Health Services Research, Adolescent, United States
- by Barbara Tomenson
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- Social Support, Adolescent, Hospitals, Mental Disorders
- by Helen Christensen
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- Psychotherapy, Australia, Treatment Outcome, Telemedicine

Background: Service user perspectives are essential for the evaluation and development of mental health services. Service users expressing less satisfaction with services subsequently have poorer treatment outcomes. Aims: To measure satisfaction with services following psychiatric admission, and to explore its relationship with a number of clinical and service factors. Methods: A multi-centre observational study was conducted across three mental health services in Ireland. Service users were interviewed and provided with self-report questionnaires. The Client Satisfaction Questionnaire (CSQ-8) was used to measure treatment satisfaction. Results: The overall level of satisfaction with services was good (CSQ-8 mean score 24.5). Service users who were admitted involuntarily, who experienced physical coercion and lower levels of procedural justice were less satisfied. A better therapeutic relationship, improved insight and better functioning were associated with higher levels of treatment satisfaction. Conclusion: Mental health services should implement strategies to ameliorate the effects of factors associated with lower levels of treatment satisfaction.

- by Eric Roche and +2
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- Psychology, Mental Health, Patient Satisfaction, Mental health services

Method: A group of psychiatrists from the region evaluated the status of psychiatry at the end of 2004 based on data from their countries and information available on WHO homepages. Results: There is a shift from traditional in-patient facilities towards outpatient and community services as evidenced by a decreasing number of hospital beds. Economic pressures affect the financing of psychiatric services, and reimbursement for novel psychotropics. Political changes were followed by updated legislation. Psychiatric training, pre-, postgraduate and continuous medical education, are gradually being transformed. Scientific output as measured by publications in peer-reviewed journals has been significantly lower than in the West. Conclusion: The major changes in the period of transition documented in the review pose new challenges for psychiatry.

- by N. Sartorius
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- Psychiatry, Eastern Europe, Bulgaria, Medicine

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- by Monica Fitzgerald
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- Psychology, Behavior Modification, Mental Health, Evidence

BackgroundMental health is of special importance regarding socioeconomic inequalities in health. On the one hand, mental health status mediates the relationship between economic inequality and health; on the other hand, mental health as an "end state" is affected by social factors and socioeconomic inequality. In spite of this, in examining socioeconomic inequalities in health, mental health has attracted less attention than physical health. As a first attempt in Iran, the objectives of this paper were to measure socioeconomic inequality in mental health, and then to untangle and quantify the contributions of potential determinants of mental health to the measured socioeconomic inequality.MethodsIn a cross-sectional observational study, mental health data were taken from an Urban Health Equity Assessment and Response Tool (Urban HEART) survey, conducted on 22 300 Tehran households in 2007 and covering people aged 15 and above. Principal component analysis was used to measu...

- by setareh forouzan
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- Psychology, Adolescent, Medicine, Iran

The purpose of this article is to review the research status of illicit drug use and its data sources in Latin America, with particular attention to the research that has been produced in the past 15 years in epidemiology of illicit drug use, services utilization, and relationship between HIV and drug use. This article complements the series of articles that are published in this same volume which examine drug abuse research (epidemiology, prevention, and treatment) and HIV prevention in Latinos residing in the United States. This review resulted from extensive international and national searches using the following databases: Current Contents Connect, Social and Behavioral Sciences; EBSCO; EMBASE(R) Psychiatry; Evidence Based Medicine (through OVID); Medline, Neurosciences, PsychINFO, Pubmed, BIREME/PAHO/WHO-Virtual Health Library, and SciELO. Papers selected for further review included those published in Spanish, English, and Portuguese in peer-reviewed journals. From the evidence reviewed, it was found that the published research literature is heavily concentrated on descriptive epidemiologic surveys, providing primarily prevalence rates and general information on associated factors. Evidence on patterns of service delivery and HIV prevention and treatment is limited. The cumulative scope of this research clearly indicates variability in quantity and quality of research across Latin American nations and the need for greater uniformity in data collection elements, methodologies, and the creation of international collaborative research networks.

- by william vega
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- Epidemiology, Evidence Based Medicine, Peer Review, Medicine

Neuroleptic medication and sexuality: the forgotten aspect of education and care Discussing issues of sexuality is a challenging and difficult issue for many health care workers. When it comes to sexuality and people with mental health problems there seems to be a dual taboo. Mental health nurses are ideal members of the health care team to talk to service users about issues as sensitive as sexuality and the side effects of medication that impact on sexual health. However, in both clinical practice and the nursing literature, the side effects of medications that impact on sexual function are often ignored and unspoken about. This paper examines the impact of both conventional and atypical neuroleptic medication on sexual function and discusses the probable causes of such effects. The possible reasons why health care professionals are reluctant to discuss side effects impacting on sexual health with service users are explored and emphasis is placed on the need for mental health nurses to respond to requests from service users for more education and discussion in the area of sexuality and sexual health.

- by Agnes Higgins
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- Communication, Sexuality, Prejudice, Sexual Health

The purpose of the research programme introduced in this article is to provide new knowledge regarding comprehensive multisectoral approaches to breaking the negative cycle of poverty and mental ill-health. The programme undertakes an analysis of existing mental health policies in four African countries (Ghana, South Africa, Uganda, Zambia), and will carry out and evaluate interventions to assist in the development and implementation of mental health policies in those countries, over a five-year period. The four countries in which the programme is being conducted represent a variety of scenarios in mental health policy development and implementation.

- by Victor Doku
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- Psychology, Cognitive Science, Health Psychology, Poverty

Objective: To describe the development of a community-based mental health service, the patterns of care provided by this new service established in 1978 and its costs.Method: The South-Verona Psychiatric Case Register, the South-Verona Outcome Project and studies designed to assess costs provided process and outcome data.Results: This paper summarizes descriptive statistics as well as the results of some evaluative studies conducted over the last 25 years in Verona, Italy. It reports patterns of care provided over the years by this new, comprehensive community-based service, targeted to the severely mentally ill but available also to all other residents in the area who need mental health care.Conclusion: Developing community-based mental health care requires a series of coordinated actions that need to be pursued over a long period of time. Service evaluation, including costs assessment, is an important part of this exercise.

- by Antonio Lasalvia
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- Mental Health, Community-Based Mental Health Services, Forecasting, Evaluation