Community Mental Health E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: World Psychiatric Association
• Sprache: Englisch

Seitenzahl: 394

Veröffentlichungsjahr: 2011

Beschreibung

There are wide inconsistencies between, and even within, countries in how community-orientated care is defined and interpreted. The analysis presented in this book take as a starting point an evidence-based balanced care model in which services are provided in community settings close to the populations served, with hospital stays being reduced as far as possible, usually located in acute wards in general hospitals. The surprising conclusion from the research is that the same problems arise in all countries, regardless of resource status, and thus the recommendations of this book apply to mental health provision everywhere. This book reviews the implementation of community-orientated care using the balanced care model. It summarizes the steps, obstacles and mistakes that have been encountered in the implementation of community mental health care worldwide and presents guidelines on how to avoid them. It proposes realistic and achievable recommendations for the development and implementation of community-orientated mental health care over the next ten years. These guidelines will be of practical use to psychiatrists and other mental health and public health practitioners at all levels worldwide, including policy makers, commissioners, funders, non-governmental organisations, service users and carers. A core message of the book is that the mental health sector will more powerfully advocate for better services in future through strong and unified alliances, especially with powerful representation from consumer/service user and carer groups. Community-orientated care draws on a wide range of practitioners, providers, care and support systems (both professional and non-professional), though particular components may play a larger or lesser role in different settings depending on the local context and the available resources, especially trained staff. Research by a WPA task force has demonstrated that most of the challenges are common and global, but with local variations. The book is therefore relevant to psychiatrists and mental health workers in developed countries who are trying to deliver better health care on reduced budgets and for those in the developing economies who are in the position to modernise their mental health care. It provides clear, concise guidance on policy and practice decisions, learning from what has and has not worked in regions in the world. The book contains many tables documenting the evidence, supported by an essential reference list, and a Key Points summary for each chapter. Highly Commended in the Psychiatry section of the href="http://bma.org.uk/about-the-bma/bma-library/medical-book-awards/medical-book-awards-winners-listing">2012 BMA Book Awards.

Leseprobe

Contents

Cover

Series

Title Page

Copyright

List of Contributors

Foreword

Acknowledgements

Section 1: Introduction

Chapter 1: Global mental health: the context

Introduction

What is community-oriented mental health care?

Fundamental values and human rights

How information has been gathered for this book

Key points in this chapter

References

Chapter 2: Description of the world regions

Introduction

Africa

Australasia and South Pacific

Europe

Latin America and Caribbean

South Asia

East and South-East Asia

Key points in this chapter

References

Chapter 3: Overview of mental health policies worldwide

Introduction

Europe

Latin America and the Caribbean

Africa

South Asia

East and South-East Asia

Australasia and South Pacific

Key points in this chapter

References

Section 2: Implementation of community mental health services

Chapter 4: The current provision of community mental health services

Introduction

Africa

Australasia and South Pacific

Europe

North America

Latin America and the Caribbean

South Asia

East and South-East Asia

Key points in this chapter

References

Chapter 5: Policies, plans, and programs

Key points in this chapter

References

Chapter 6: Scaling up services for whole populations

Treatment gap

Global mental health research

Estimating needs and priority-setting

Key points in this chapter

References

Chapter 7: Stigma, discrimination, and community awareness about mental illnesses

Introduction

Understanding stigma and discrimination

Global patterns of stigma and discrimination

Community awareness about mental illnesses

Key points in this chapter

References

Chapter 8: Developing a consensus for engagement

Stakeholders in mental health care

Key points in this chapter

References

Chapter 9: Human and financial resources

Human resources

Financial resources

Key points in this chapter

References

Chapter 10: Development, organization, and evaluation of services

Developing services

Organizational issues

Service evaluation

The Balanced Care Model

Key points in this chapter

References

Section 3: Recommendations

Chapter 11: Lessons learned and recommendations for the future

Introduction

Mistakes identified across regions

Lessons learned and recommendations across regions

Africa

Australasia and South Pacific

Europe

North America

Latin America and Caribbean

South Asia

East and South-East Asia

Key points in this chapter

References

Appendix A: Terminologies

People with mental disorders

Overview and definitions of community mental health services

References

Appendix B: Questions from a survey conducted with regional experts in the Africa region

Appendix C: Internet resources

Global Web sites

Web sites for the Africa region

Web sites for the Australasia and South Pacific region

Web sites for the Europe region

Web sites for the North America region

Web sites for the Latin America and Caribbean region

Index

Other recent World Psychiatric Association titles

Special Populations

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Contemporary Topics in Women's Mental Health: global perspectives in a changing societyEdited by Prabha S. Chandra, Helen Herrman, Marianne Kastrup, Marta Rondon, Unaiza Niaz, Ahmed Okasha, Jane Fisher ISBN: 9780470754115

Parenthood and Mental Health: A bridge between infant and adult psychiatryEdited by Sam Tyano, Miri Keren, Helen Herrman and John Cox ISBN: 978-0-470-74722-3

Approaches to Practice and Research

Religion and Psychiatry: beyond boundariesEdited by Peter J Verhagen, Herman M van Praag, Juan José López-Ibor, John Cox, Driss Moussaoui ISBN: 9780470694718

Psychiatric Diagnosis: challenges and prospectsEdited by Ihsan M. Salloum and Juan E. Mezzich ISBN: 9780470725696

Recovery in Mental Health: reshaping scientific and clinical responsibilitiesBy Michaela Amering and Margit Schmolke ISBN: 9780470997963

Handbook of Service User Involvement in Mental Health Research

Edited by Jan Wallcraft, Beate Schrank and Michaela Amering

ISBN: 9780470997956

Psychiatrists and Traditional Healers: unwitting partners in global mental health

Edited by Mario Incayawar, Ronald Wintrob and Lise Bouchard,

ISBN: 9780470516836

Depression and Comorbidity

Depression and Diabetes

Edited by Wayne Katon, Mario Maj and Norman Sartorius

ISBN: 9780470688380

Depression and Heart Disease

Edited by Alexander Glassman, Mario Maj and Norman Sartorius

ISBN: 9780470710579

Depression and Cancer

Edited by David W. Kissane, Mario Maj and Norman Sartorius

ISBN: 9780470689660

World Psychiatric AssociationEvidence and Experience in PsychiatrySeries

Series Editor: Helen Herrman, WPA Secretary for Publications, University of Melbourne, Australia

Post-traumatic Stress Disorder

Edited by Dan J. Stein, Matthew Friedman and Carlos Blanco

ISBN: 9780470688977

Depressive Disorders, 3e

Edited by Helen Herrman, Mario Maj and Norman Sartorius

ISBN: 9780470987209

Substance Abuse Disorders

Edited by Hamid Ghodse, Helen Herrman, Mario Maj and Norman Sartorius

ISBN: 9780470745106

Schizophrenia 2e

Edited by Mario Maj, Norman Sartorius

ISBN: 9780470849644

Dementia 2e

Edited by Mario Maj, Norman Sartorius

ISBN: 9780470849637

Obsessive-Compulsive Disorders 2e

Edited by Mario Maj, Norman Sartorius, Ahmed Okasha, Joseph Zohar

ISBN: 9780470849668

Bipolar Disorders

Edited by Mario Maj, Hagop S Akiskal, Juan José López-Ibor, Norman Sartorius

ISBN: 9780471560371

Eating Disorders

Edited by Mario Maj, Kathrine Halmi, Juan José López-Ibor, Norman Sartorius

ISBN: 9780470848654

Phobias

Edited by Mario Maj, Hagop S Akiskal, Juan José López-Ibor, Ahmed Okasha

ISBN: 9780470858332

Personality Disorders

Edited by Mario Maj, Hagop S Akiskal, Juan E Mezzich

ISBN: 9780470090367

Somatoform Disorders

Edited by Mario Maj, Hagop S Akiskal, Juan E Mezzich, Ahmed Okasha

ISBN: 9780470016121

This edition first published 2011, © 2011 by John Wiley & Sons, Ltd.

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Library of Congress Cataloging-in-Publication Data

Global mental health : putting community care into practice / Graham Thornicroft … [et al.]. p. ; cm. Includes bibliographical references and index. ISBN 978-1-119-99865-5 (pbk.) 1. Community mental health services. 2. World health. I. Thornicroft, Graham. [DNLM: 1. Community Mental Health Services. 2. Health Policy. 3. Mental Disorders. 4. Mental Health. 5. World Health. WM 30.6] RA790.5.G55 2011 362.196′89—dc23 2011023058

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF: 9781119979210; Wiley Online Library: 97811199979203; ePub: 9781119952145; Mobi: 9781119952152

List of Contributors

Africa Atalay Alem Department of Psychiatry, Faculty of Medicine Addis Ababa University Addis Ababa Ethiopia

Charlotte Hanlon Department of Psychiatry, Faculty of Medicine Addis Ababa University Addis Ababa Ethiopia

Dawit Wondimagegn Department of Psychiatry, Faculty of Medicine Addis Ababa University Addis Ababa Ethiopia

Australasia and South Pacific Peter McGeorge Urban Mental Health Research Institute Inner City Health Program St Vincent's Hospital Sydney, Australia

Europe Elizabeth Barley Health Service and Population Research Department Institute of Psychiatry King’s College London London UK

Ann Law Health Service and Population Research Department Institute of Psychiatry King’s College London London UK

Maya Semrau Health Service and Population Research Department Institute of Psychiatry King’s College London London UK

Graham Thornicroft Health Service and Population Research Department Institute of Psychiatry King’s College London London UK

North America Robert E. Drake Dartmouth Medical School Lebanon, NH USA

Eric Latimer Douglas Hospital, Psychiatry Department McGill University Montreal, QC Canada

Latin America and Caribbean Renato Antunes Dos Santos Department of Psychiatry Universidade Federal de São Paulo São Paulo Brazil

Guilherme Gregorio Department of Psychiatry Universidade Federal de São Paulo São Paulo Brazil

Jair Mari Department of Psychiatry Universidade Federal de São Paulo São Paulo Brazil

Denise Razzouk Department of Psychiatry Universidade Federal de São Paulo São Paulo Brazil

South Asia R. Padmavati Schizophrenia Research Foundation (SCARF) Chennai Tamil Nadu India

R. Thara Schizophrenia Research Foundation (SCARF) Chennai Tamil Nadu India

East and South-East Asia Hiroto Ito National Institute of Mental Health National Centre of Neurology and Psychiatry Tokyo Japan

Yutaro Setoya National Institute of Mental Health National Centre of Neurology and Psychiatry Tokyo Japan

Yuriko Suzuki National Institute of Mental Health National Centre of Neurology and Psychiatry Tokyo Japan

Foreword

The development of community mental health care is currently ongoing, or at least planned, in many countries worldwide. The World Psychiatric Association (WPA) supports this process, aimed at allowing persons with mental disorders to have services available as close as possible to their locality, to be treated in the least restrictive environment, and to maintain their links within the community. We expect the implementation of community mental health care to improve patients' clinical outcomes, subjective quality of life, and satisfaction with care.

Experience has shown that the steps to be followed, the obstacles to be removed, and the mistakes to be avoided in the implementation of community mental health care are remarkably similar worldwide. The WPA decided therefore to establish a task force with the mandate to produce guidance on those issues, intended for psychiatrists, other mental health professionals, and policy makers of all countries of the world. This task force, led by Graham Thornicroft and including experts from all continents, completed the guidance in early 2010. The text was published in the June 2010 issue of World Psychiatry, the official journal of the WPA [1], and was posted on the Association's Web site. The guidance has since been translated into several languages, and all the translations have been uploaded on to the same Web site. The document is being extremely well received by the WPA Member Societies (i.e. national psychiatric societies) and by the psychiatric community, and there are already indications that it is being perused by administrators and policy makers from several countries.

Although the steps, obstacles, and mistakes to avoid in the implementation of community mental health care are very similar worldwide, there are regional and national differences, depending on a variety of factors, including the availability of human and financial resources, the level of priority assigned to mental health care by local administrators, and the attitudes of the general population towards mental disorders. It was therefore felt necessary to complement the WPA guidance with documents that delineate the mental health scenario in the various regions of the world and to provide specific recommendations for the development of community mental health services in those regions. A series of papers focusing on the implementation of community mental health care in Africa, Australasia and South Pacific, Europe, North America, Latin America and Caribbean, South Asia, and East and South-East Asia was therefore commissioned and is being published in World Psychiatry.

The present volume represents an extension of that series, providing an overview of mental health policies, plans, and programs, a summary of relevant research efforts, a critical appraisal of community mental health service components, and a discussion of the key challenges, obstacles, and lessons learned in the various regions of the world, followed by some recommendations for the future, based on evidence and experience.

We believe that this book represents a very useful resource for all mental health professionals and for all policy makers involved in the mental health field. They will find here not only a picture of the current situation (which can be found, although in bits and pieces, elsewhere) and an outline of the principles of community mental health care (also available in many international documents), but also (and this is unique) a distillate of the experience of several professionals who have been active in community mental health care for decades and are willing to share what they have learned with their colleagues worldwide. The book is recommended to residents in psychiatry and trainees in other mental health professions, who will find it a treasure trove of information and ideas not generally available in textbooks or manuals used in their training.

Professor Mario MajPresident of the World Psychiatric Association

Reference

[1] Thornicroft G, Alem A, Dos Santos RA, et al. WPA guidance on steps, obstacles and mistakes to avoid in the implementation of community mental health care. World Psychiatry 2010;9:67–77.

Acknowledgements

The work which led to this book was commissioned by Professor Mario Maj, President of the World Psychiatric Association, and we are most grateful to Professor Maj for his strong support in establishing the Task Force which undertook it. The authors are pleased to acknowledge the rich contributions of all members of the regional teams that contributed to the various chapters, as given in the List of Contributors.

SECTION 1

Introduction

CHAPTER 1

Global mental health: the context

Introduction

Mental health problems are common, with over 25% of people worldwide developing one or more mental disorders at some point in their life [1]. They make an important contribution to the global burden of disease, as measured by disability-adjusted life years (DALYs). In 2004, for example, neuropsychiatric disorders accounted for 13.1% of all DALYs worldwide, with unipolar depressive disorder alone contributing 4.3% towards total DALYs. In addition, 2.1% of total deaths worldwide were directly attributed to neuropsychiatric disorders. Suicide contributed a further 1.4% towards total deaths, with 86% of all suicides being committed in low- and middle-income countries (LAMICs) each year [2]. A systematic review of psychological autopsy studies of suicide reported a median prevalence of mental disorder in suicide completers of 91% [3]. Life expectancy is up to 20 years lower in people with mental health problems than in those without, due to their higher levels of physical illnesses and far poorer health care [4]. Mental health problems therefore place a substantial burden on individuals and their families worldwide, in terms of both diminished quality of life and reduced life expectancy. The provision of any (let alone high-quality) mental health care is vital in reducing this burden [5].

It is in this context that the aim of this book is to present guidance on the steps, obstacles and mistakes to be avoided in the implementation of community mental health care, and to make realistic and achievable recommendations for the development and implementation of community-oriented mental health care worldwide over the next 10 years. We intend that this guidance will be of practical use to the whole range of mental health and public health practitioners at all levels, including policy makers, commissioners, funders, nongovernmental organizations (NGOs), service users and carers. Although a global approach has been taken, the focus is mainly upon LAMICs, as this is where challenges are most severe and most pronounced.