Tonga national emergency medical team response to the 2022 Hunga Tonga-Hunga Ha'apai volcanic eruption and tsunami: the first deployment of the Tonga Emergency Medical Assistance Team (TEMAT).

Problem: The undersea Hunga Tonga-Hunga Ha'apai volcano erupted on 15 January 2022, causing a tsunami that affected Tonga as well as other countries around the Pacific rim. Tonga's international borders were closed at the time due to the coronavirus disease pandemic, but clinical surge support was needed to respond to this disaster. Context: Tonga's Ministry of Health formed the Tonga Emergency Medical Assistance Team (TEMAT) in 2018 to provide clinical care and public health assistance during disasters, outbreaks and other health emergencies. TEMAT was activated for the first time in January 2022 to respond to medical and public health needs following the eruption and tsunami. Action: On 16 January 2022, a five-person TEMAT advance team was deployed to conduct initial damage assessments and provide casualty care. Subsequently, TEMAT rotations were deployed to provide clinical care and public health support across the Ha'apai island group for over 2 months. Outcome: TEMAT deployed to the islands most affected by the volcanic eruption and tsunami within 24 hours of the event, providing emergency clinical, psychosocial and public health services across four islands. TEMAT reported daily to the Ministry of Health and National Emergency Management Office, providing critical information for response decision-making. All TEMAT actions were documented, and an after-action review was conducted following the deployment. Discussion: TEMAT's deployment in response to the 2022 volcanic eruption and tsunami highlighted the importance of national emergency medical teams that are prepared to respond to a range of emergency events.

WHO Mental Health Gap Action Programme implementation in the Small Island Development States: experience from the Pacific and English-speaking Caribbean countries.

Owing to the relatively small population sizes and remoteness of the Small Island Development States (SIDS), their mental health systems face many common difficulties. These include having few mental health specialists per country, limited access to mental health services and low awareness. To overcome these limitations, the World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP), which aims to decrease the treatment gap by training non-specialists, was implemented in more than 20 Pacific and English-speaking Caribbean countries. Many lessons were learnt from the experience. Mental health specialist support is crucial, and online training and supervision could be a solution. mhGAP training proved to be effective to improve knowledge and attitude, but close monitoring and supervision are needed to change clinical practice. Awareness raising and mental health service capacity building need to occur simultaneously. To realise sustainable development goals, countries need to invest more in mental health, especially in human resources; mhGAP will be one effective solution.

Lessons learned in developing community mental health care in East and South East Asia.

This paper summarizes the findings for the East and South East Asia Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Im-plementation of Community Mental Health Care. The paper presents a description of the region, an overview of mental health policies, a critical ap-praisal of community mental health services developed, and a discussion of the key obstacles and challenges. The main recommendations address the needs to campaign to reduce stigma, integrate care within the general health care system, prioritize target groups, strengthen leadership in policy mak-ing, and devise effective funding and economic incentives.

Family support in assertive community treatment: an analysis of client outcomes.

Assertive Community Treatment (ACT) is an outreach-based case management model that assists people with severe mental illness through an intensive and integrated approach. In this program, a multidisciplinary team provides medical and psychosocial services. The purpose of this study was to examine the effectiveness of the following two ACT intervention strategies: "replacement" (supporting the clients) versus "backup" (supporting family members who provide care to clients). Admission days, psychiatric symptoms, quality of life, self-efficacy, and service satisfaction ware evaluated as outcome variables. To identify effective methods of supporting family members, clients living with family were divided into two groups based on the amount and types of services received-the backup group and the replacement group. ANCOVA was used to compare the outcomes between the two groups. The replacement group displayed significantly better psychiatric symptoms, social functioning, self-efficacy, and service satisfaction scores. No differences in admission days or quality of life were found. Clients provided more support directly to clients themselves than to family members was found to have better client outcomes in improving psychiatric symptoms, social functioning, and self-efficacy, resulting in higher levels of service satisfaction. This indicates that society should reduce the responsibility of the family and share responsibility for the care of people with mental illness to effectively improve outcomes for people with mental illnesses.

[Assertive community treatment in Japan: results of fidelity measurements].

Mental health system reform oriented toward realizing the transition from "institution-based medical treatment" to "community-based care" is now taking place in Japan. Although the number of psychiatric beds is slow to decrease, community resources are increasing, and differentiation of those services is the next challenge. Assertive Community Treatment (ACT) is a service which provides 24/7 community outreach by a multidisciplinary team to persons with severe mental illness. Currently, some 10 to 15 ACT teams are providing services in Japan; this number is far from adequate. This is due to the lack of direct funding for ACT in the current mental health system. However, ACT is increasing as a result of combining available funding sources, such as psychiatric home visit nursing and welfare funding. The ACT Network, a voluntary association, was established to disseminate ACT and ensure its quality. Fidelity scales measure faithfulness to the original model. DACTS, a fidelity scale developed in the U.S., is widely used to measure ACT fidelity. In Japan, ACT Network implements a Japanese version of fidelity measurement for ACT around Japan. Results of fidelity measurements of 12 ACT teams in 2009 showed that the ACT teams were providing services which adhered more closely to the original model than in the previous year, but problems remained. Some issues, such as increasing care management in services, can be addressed through maturation of ACT teams, but other issues, such as relatively low service density and allocation of employment specialists, cannot be resolved without a funding mechanism. To disseminate ACT and support more people with severe mental illness in the community, it is necessary to build ACT into the community mental health system with sufficient funding, and to monitor its quality using measures such as fidelity scales.

Evaluating outcomes of the child and adolescent psychiatric unit: A prospective study.

BACKGROUND: The aims of this prospective study are to clarify the outcomes of child psychiatric inpatient treatment and to identify factors associated with patient improvement. METHODS: The attending psychiatrist used the Children's Global Assessment Scale (CGAS) to assess youths at admission to and discharge from a child and adolescent psychiatric unit in Japan(N = 126, mean age = 12.8, SD = 1.9). Hospital records gathered sociodemographic and clinical variables. In addition, youths and their primary caregivers assessed themselves using the Youth Self Report (YSR) and the Child Behavior Checklist (CBCL), respectively. Longitudinal analyses compared each scales' baseline and discharge scores. We also examined factors associated with changes in functioning (CGAS). RESULTS: Longitudinal comparisons revealed that CGAS, CBCL and YSR scores showed improvement over time (CGAS: t = -14.40, p = 0.00; CBCL: t = 3.80, p = 0.00; YSR: t = 2.40, p = 0.02). Linear regressions determined that the factors associated with improvement in CGAS included age, lower CGAS scores at admission, frequency of group therapy and psychiatric diagnosis. CONCLUSIONS: This evaluation of children and adolescents in an inpatient unit demonstrated clinical improvement over time and identified factors associated with said improvement.

WPA guidance on steps, obstacles and mistakes to avoid in the implementation of community mental health care.

This paper provides guidance on the steps, obstacles and mistakes to avoid in the implementation of community mental health care. The document is intended to be of practical use and interest to psychiatrists worldwide regarding the development of community mental health care for adults with mental illness. The main recommendations are presented in relation to: the need for coordinated policies, plans and programmes, the requirement to scale up services for whole populations, the importance of promoting community awareness about mental illness to increase levels of help-seeking, the need to establish effective financial and budgetary provisions to directly support services provided in the community. The paper concludes by setting out a series of lessons learned from the accumulated practice of community mental health care to date worldwide, with a particular focus on the social and governmental measures that are required at the national level, the key steps to take in the organization of the local mental health system, lessons learned by professionals and practitioners, and how to most effectively harness the experience of users, families, and other advocates.

Development of a clinical pathway for long-term inpatients with schizophrenia.

Clinical pathways have been defined as an optimal sequencing and timing of interventions by staff for a particular diagnosis or procedure, designed to better utilize resources, maximize quality of care and minimize delays. The aim of the present study was to develop a clinical pathway for long-term inpatients with schizophrenia. A review of clinical records was conducted for 17 patients with schizophrenia who had stayed in one psychiatric hospital for >1 year, and who remained in the community >3 months after hospital discharge. A review of clinical routine records was conducted. The discharge process of each patient was expressed in a clinical pathway around phases and care components. They were integrated into one clinical pathway. The discharge process was divided into assessment and goalsetting, preparation, and discharge phases. Care components included discharge planning, daily activity, living environment, health management, and basic life skills. Discharge planning was an important care component that was combined with all three phases. A clinical pathway was developed from reviewing past patient records, and discharge planning was found to be an important care component, which was combined with all three phases: assessment and goalsetting, preparation, and discharge. Further study is needed to examine the validity of the pathway for use in other hospitals.

The ongoing development of community mental health services in Japan: utilizing strengths and opportunities.

OBJECTIVE: The aim of this study was to identify opportunities for the development of best practice community mental health care models in Japan using key information extracted from the Asia-Pacific Community Mental Health Development Project, site visits conducted on community mental health models, and discussion on service delivery with mental health leaders in government, clinical services and community. CONCLUSION: In terms of hospital-based care, Japan has the highest number of psychiatric beds and highest ratio of beds per capita in the world. Strategies to address the disproportionate balance of mental health service components are clearly needed. While progress and initiatives in community-based mental health services are promising, there are significant challenges facing the mental health system in Japan. There is a need to expand the scope, quantity and distribution of best practice community mental health services in Japan. The available funding and human resource could be further directed to effective and culturally appropriate community-based services. Increased leadership capacity and confidence in the mental health workforce at all levels should be addressed effectively.

Asian models of excellence in psychiatric care and rehabilitation.

In Asia, like other regions, the circumstances for psychiatric care and rehabilitation impose various limitations on us. However, committed professionals have been creating innovative models of excellence, which are culturally appropriate and clinically effective. In this paper, seven innovative models of psychiatric care and rehabilitation are presented. The Nitte project in India provides a comprehensive free rural psychiatric service, while transforming the 'brain drain' problem to 'brain circulation' cooperation. Through Social Enterprises in Hong Kong recovered clients are trained and employed. Senior Peer Counselling in Singapore emphasizes the relief of emotional distress by psychological methods and the primacy of communication in the healing or therapeutic relationship. Seoul Mental Health 2020, an epoch-making project in Korea, has increased the coverage rate of community mental health centres remarkably. Yuli Psychiatric Rehabilitation Model in Taiwan helps long-term inpatients to get reintegrated into the community. In Japan, models of excellence for community-based psychiatry have been developed at local government, hospital and community/NGO levels. Chinese Psychiatry Online, an excellent website, provides public education, resource searching, self-testing and consultation services for the public along with various contents for professionals. We must disseminate information about models of excellence which provide great benefit to the people who suffer from psychiatric illness without high expenses.

Symptom dimensions and needs of care among patients with schizophrenia in hospital and the community.

The purpose of the present paper was to examine the psychiatric symptom dimensions related to needs of care among patients with schizophrenia in hospital and in the community. Subjects were 217 patients with F2 ICD-10 diagnoses. Hospital patients included 102 inpatients (47.0%) in psychiatric long-term care units. Community patients included 115 outpatients (53.0%) living in their homes or residential facilities. Psychiatrists used the Brief Psychiatric Rating Scale (BPRS) to assess patients' psychiatric symptoms. Formal care providers assessed needs of care using a scale developed by the Committee on Case Management Guidelines for People with Mental Disabilities in Japan. Instrumental Activities of Daily Living (IADL) self-performance and difficulty were also measured using a scale from the Minimum Data Set-Home Care (MDS-HC). Multiple regression analyses were applied, using the symptom dimensions as dependent variables and needs of care as independent variables. Patient group (hospital or community) was also used as an independent variable. Hospital patients demonstrated more severe psychiatric symptoms and greater needs of care than community patients. Multiple regression analyses showed that the total needs of care were greater among male patients (B = 0.142, P = 0.005), hospital patients (B = 0.310, P < 0.001), patients with poor IADL self-performance (B = 0.217, P = 0.047), and patients with severe negative symptoms (B = 0.240, P = 0.002; R(2) = 0.515). The present results suggested an association between negative symptoms and needs of care in schizophrenia. Hospital patients had greater needs of care, even though their psychiatric symptoms were controlled for. Further research should examine the relationships between psychiatric symptoms and needs of care in a cohort study following patients when hospitalized and when living in the community.

Validity of childhood disintegrative disorder apart from autistic disorder with speech loss.

In order to test clinical validity of DSM-IV childhood disintegrative disorder (CDD), 10 CDD children (mean age = 8.2 years, SD = 3.8; 7 male and 3 female) and 30 age- and gender-matched children with DSM-IV autistic disorder (AD) with speech loss (SL) (ADSL) were compared on 24 variables not directly related to CDD criteria. Compared with the ADSL children, the CDD children showed fearfulness significantly more frequently during the period of SL; displayed epilepsy significantly more frequently and stereotypy significantly more prominently at first visit on average about 6 years after SL; and had significantly less uneven intellectual profile at first visit to support the validity of CDD to a certain extent. No significant difference in the retardation level at first visit between the two groups suggested no worse short-term outcome in CDD than ADSL, although a long-term prospective study to compare them from infancy is needed.