Enhancing mental health pre-service training with the WHO mhGAP Intervention Guide: experiences learned and the way forward.

There is currently a high global demand for mental health professionals, including child and adolescent mental health professionals. In 2020, the World Health Organization (WHO) published "Enhancing mental health pre-service training with the mhGAP-Intervention Guide: experiences and lessons learned" to address the proposition of implementing Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) materials and principles as a component of pre-service training. By integrating the mhGAP-IG within pre-service training, future healthcare providers will acquire theoretical knowledge and early exposure to practical knowledge and will be better prepared for their future work.Examples demonstrate that mhGAP-IG pre-service training can be successfully implemented in diverse settings and in various pre-service training programs. It can be used in small group learning activities and short courses, taught through lectures, used as a clinical tool to teach students (i.e. medical, nursing students) and medical doctors in training. We can enhance pre-service training with the mhGAP-IG and contribute to a learning environment, which nurtures knowledge and skills required to help people with mental health needs.

Family responses to a child with schizophrenia: An Indonesian experience.

Indonesian culture puts a high value on family bonding. Therefore, support and encouragement for each family member is high that any problems are the responsibility of the whole family. This paper explores the implications of the phenomena whether is a schizophrenic child in the family affected the parental relationship in Indonesian family and trying to find out the implication of parental relationship on medication adherence. This was a cross-sectional study which involved 180 parents of children with schizophrenia and parents with aged matched non-schizophrenic children as a control group; consisting of 45 parents of children with schizophrenia and 135 parents of non-schizophrenic children. The parental relationship was examined by using the Indonesian version of Family Adaptability and Cohesion Evaluation Scale IV (Indonesian version of FACES IV). Our study revealed that 75.6% parents of children with schizophrenia experienced a healthy parental relationship compared to 94.80% in the parents of non-schizophrenic children group. The most prevalent of unhealthy relationship among parents of children with schizophrenia was chaotic disengagement. Parental adherence to give medication for their child with schizophrenia was better if they had a healthy parental relationship. In conclusion, a small number of Indonesian parents with schizophrenic children experienced an unhealthy parental relationship. Therefore, psycho-education and supportive psychotherapy still needed to facilitate those families to express their emotion adapt and cope.

Displacement as a predictor of functional impairment in tsunami-exposed children.

Thirty months after the Indian Ocean tsunami of 26 December 2004, thousands of families in Aceh Province, Indonesia, remained in temporary barracks while sanitation conditions and non-governmental organisation support deteriorated. This study sought to determine the factors associated with functional impairment in a sample of 138 displaced and non-displaced Acehnese children. Using multivariate linear regression models, it was found that displacement distance was a consistent predictor of impairment using the Brief Impairment Scale. Exposure to tsunami-related trauma markers was not significantly linked with impairment in the model. Paternal employment was a consistent protective factor for child functioning. These findings suggest that post-disaster displacement and the subsequent familial economic disruption are significant predictors of impaired functioning in children's daily activities. Post-disaster interventions should consider the disruption of familiar environments for families and children when relocating vulnerable populations to avoid deleterious impacts on children's functioning.

The living environment and children's fears following the Indonesian tsunami.

The tsunami that struck South-east Asia on 26 December 2004 left more than 500,000 people in Aceh, Indonesia, homeless and displaced to temporary barracks and other communities. This study examines the associations between prolonged habitation in barracks and the nature of fears reported by school-age children and adolescents. In mid-2007, 30 months after the tsunami, the authors interviewed 155 child and parent dyads. Logistic regression analysis was used to compare the fears reported by children and adolescents living in barracks with those reported by their peers who were living in villages. After adjusting for demographic factors and tsunami exposure, the data reveals that children and adolescents living in barracks were three times more likely than those living in villages to report tsunami-related fears. The study demonstrates that continued residence in barracks 30 months after the tsunami is associated with higher rates of reporting tsunami-related fears, suggesting that barracks habitation has had a significant impact on the psychological experience of children and adolescents since the tsunami.

Learning Difficulties and Working Memory Deficits among Primary School Students in Jakarta, Indonesia.

OBJECTIVE: There are multiple possible etiologies for learning difficulties in children. There is growing evidence that many students identified as having learning difficulties have significant working memory deficits. To determine, in a sample of primary school students in Jakarta, Indonesia, the prevalence of learning difficulties and learning difficulties co-morbid with working memory deficits. METHODS: Subjects (N=423) were recruited via proportional random sampling from 27 primary schools. The first stage was a cross-sectional study of these students, while the second stage was a case-control study comparing all students with learning difficulties and working memory deficits with controls matched by school type, grade level, and gender. RESULTS: Among the students, whose mean age was 9.34 years (1.78), 13.7% had a learning difficulty, while 8.04% had a learning difficulty with working memory deficit. The odds ratio of comorbid working memory deficit (in the face of a learning difficulty) was 7.0 (χ(2)= 35.96, p<0.001). CONCLUSION: Learning difficulties and comorbid working memory deficits were relatively common among primary school students. Efforts should be made to identify these students and provide timely assistance, in order to optimize their educational success and mental health outcomes.

Child and adolescent mental health worldwide: evidence for action.

Mental health problems affect 10-20% of children and adolescents worldwide. Despite their relevance as a leading cause of health-related disability in this age group and their longlasting effects throughout life, the mental health needs of children and adolescents are neglected, especially in low-income and middle-income countries. In this report we review the evidence and the gaps in the published work in terms of prevalence, risk and protective factors, and interventions to prevent and treat childhood and adolescent mental health problems. We also discuss barriers to, and approaches for, the implementation of such strategies in low-resource settings. Action is imperative to reduce the burden of mental health problems in future generations and to allow for the full development of vulnerable children and adolescents worldwide.

Treated prevalence of and mental health services received by children and adolescents in 42 low-and-middle-income countries.

BACKGROUND: Little is known about the treated prevalence and services received by children and adolescents in low- and middle-income countries (LAMICs). The purpose of this study is to describe the characteristics and capacity of mental health services for children and adolescents in 42 LAMICs. METHODS: The World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS), a 155-indicator instrument developed to assess key components of mental health service systems, was used to describe mental health services in 13 low, 24 lower-middle, and 5 upper-middle-income countries. Child and adolescent service indicators used in the analysis were drawn from Domains 2 (mental health services), 4 (human resources), and 5 (links with other sectors) of the WHO-AIMS instrument. RESULTS: The median one-year treated prevalence for children and adolescents is 159 per 100,000 population compared to a treated prevalence of 664 per 100,000 for the adult population. Children and adolescents make up 12% of the patient population in mental health outpatient facilities and less than 6% in all other types of mental health facilities. Less than 1% of beds in inpatient facilities are reserved for children and adolescents. Training provided for mental health professionals on child and adolescent mental health is minimal, with less than 1% receiving refresher training. Most countries (76%) organize educational campaigns on child and adolescent mental health. CONCLUSIONS: Mental health services for children and adolescents in low- and middle-income countries are extremely scarce and greatly limit access to appropriate care. Scaling up of services resources will be necessary in order to meet the objectives of the WHO Mental Health Gap Action (mhGAP) program which identifies increased services for the treatment of child mental disorders as a priority.

Global child mental health: what can we learn from countries with limited financial resources?

In 1977 the World Health Organization recommended that every country throughout the world should have a national plan for child mental health. The United Nations Convention on the Rights of the Child has been another important stimulus for child mental health policies and services in many countries. Adopted unanimously by the United Nations General Assembly in 1989 and instituted as international law in 1990, the Convention is an agreement on the basic protections that should be accorded to children. Adopted in 1961, the European Social Charter is the major European treaty that secures children's rights. In 1996 the Charter was revised and expanded to include a list of core obligations of the contracting parties relating to the recognition of social, legal and economic rights for children and young persons.

Challenges in international collaboration in child and adolescent psychiatry.

International collaboration in child and adolescent psychiatry has historically been weak and fragmented. The field has also lagged in developing remedies for improving collaboration. This article identifies barriers to successful collaboration and examines problems in the areas of finance, professional development, knowledge dissemination, professional organisations, public policy and the political environment, priority setting, nomenclature, as well as ethical challenges. The article then identifies some promising initiatives and proposes solutions to improve international collaboration in child and adolescent mental health.

Skills of the surgeon, eye of an artist, mind of the analyst.

Plastic and reconstructive surgery challenges the surgeon in ways often difficult to comprehend. Not only does the surgeon have to perfect the appropriate techniques for the surgical intervention, but he/she also assesses the patient with the eye of the artist and the mind of a psychoanalyst. Working with children and adolescents and their parents requires even more complex skills because it is required to assume the position of the parent to interpret their wishes, hopes, and fears. Over decades, John Mulliken has been the exemplar of the surgeon able to take on these manifold challenges. Dr Mulliken's special focus on healing the cleft lip and palate has offered to generations of young people and their families a life freer of the complex and sometimes devastating consequences of living with a deformity. Moving for ever earlier intervention, Dr Mulliken broke new ground surgically but from a psychological perspective offered the chance to avoid a host of psychological problems. Dr Mulliken's surgical intervention for nevi and other vascular malformations has had a long-lasting psychological impact on the lives of children. This article traces the place of plastic and surgical reconstructive surgery as a field intertwined with the psychological development of the individual and describes the ways in which Dr Mulliken's approaches have enhanced the well-being of so many.