Assuntos
Saúde Global/tendências , Transtornos Mentais/terapia , Saúde Mental/tendências , Desenvolvimento Sustentável/tendências , Objetivos , Financiamento da Assistência à Saúde , Humanos , Cooperação Internacional , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/economiaRESUMO
BACKGROUND: There are increasing efforts and attention focused on the delivery of mental health services in primary care in low resource settings (e.g., mental health Gap Action Programme, mhGAP). However, less attention is devoted to systematic approaches that identify and address barriers to the development and uptake of mental health services within primary care in low-resource settings. Our objective was to prepare for optimal uptake by identifying barriers in rural Liberia. The country's need for mental health services is compounded by a 14-year history of political violence and the largest Ebola virus disease outbreak in history. Both events have immediate and lasting mental health effects. METHODS: A mixed-methods approach was employed, consisting of qualitative interviews with 22 key informants and six focus group discussions. Additional qualitative data as well as quantitative data were collected through semi-structured assessments of 19 rural primary care health facilities. Data were collected from March 2013 to March 2014. RESULTS: Potential barriers to development and uptake of mental health services included lack of mental health knowledge among primary health care staff; high workload for primary health care workers precluding addition of mental health responsibilities; lack of mental health drugs; poor physical infrastructure of health facilities including lack of space for confidential consultation; poor communication support including lack of electricity and mobile phone networks that prevent referrals and phone consultation with supervisors; absence of transportation for patients to facilitate referrals; negative attitudes and stigma towards people with severe mental disorders and their family members; and stigma against mental health workers. CONCLUSIONS: To develop and facilitate effective primary care mental health services in a post-conflict, low resource setting will require (1) addressing the knowledge and clinical skills gap in the primary care workforce; (2) improving physical infrastructure of health facilities at care delivery points; and (3) implementing concurrent interventions designed to improve attitudes towards people with mental illness, their family members and mental health care providers.
Assuntos
Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Rural/organização & administração , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Atenção à Saúde/organização & administração , Família/psicologia , Feminino , Grupos Focais , Programas Governamentais/organização & administração , Pessoal de Saúde , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Libéria , Assistência Médica/organização & administração , Transtornos Mentais/psicologia , Atenção Primária à Saúde/organização & administração , Psicotrópicos/provisão & distribuição , Encaminhamento e Consulta/organização & administração , Estigma SocialRESUMO
BACKGROUND: Previous research suggests a disconnect on both policy and practice between advocates and state leaders in child mental health. AIM: To compare advocates' and state leader's perspectives and understanding on the three main themes in children's mental health policies: (i) state's initiatives to empower and engage families and youth in policy and practice; (ii) state's fiscal support for family and youth driven services; and (iii) policy challenges to improving children's mental health services and outcomes. STUDY DESIGN: This study draws on data from national surveys of State Children's Mental Health Directors (2006) and of state affiliates of Mental Health America (2007). RESULTS: The findings from 38 responses representing 19 states suggest differences between state leaders and advocates on their understanding of family and youth engagement, service access, quality and fiscal supports. While state directors and advocates seem to have similar understanding on the existence of states' efforts related to evidence-based practices, many advocates are unaware of the specifics of the strategies that states undertook or funded. Advocates also did not know which types of settings were eligible for reimbursement for children's services. CONCLUSIONS: Advocates lack some information that is vital to fulfilling their role. Policymakers seem unaware of key challenges that families face and therefore appear to be without critical information that fuels the agenda for advocates. The challenge for both set of actors is how to get beyond this information asymmetry to advance efforts to improve mental health.
Assuntos
Defesa da Criança e do Adolescente , Serviços de Saúde da Criança/organização & administração , Política de Saúde , Serviços de Saúde Mental/organização & administração , Criança , Serviços de Saúde da Criança/economia , Família , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Serviços de Saúde Mental/economia , Estados UnidosRESUMO
This paper examines racial and ethnic disparities in continuation of mental health services for children and youth in California and how English language proficiency moderates the effect of race/ethnicity on the continuation of service. While previous research indicated racial/ethnic or geographic disparities in accessing mental health services among children and youth, few studies specifically focused on the continuation of mental health care. The authors used administrative data from California county mental health services users under age 25. Applying logistic regression, English language proficiency was found to be the major determinant of continuation of mental health services in this age group. With the exception of children of Asian descent, non-English speaking children and youth of diverse racial/ethnic background were significantly less likely to continue receiving mental health services compared with White English-speaking peers, even after controlling for sociodemographic, clinical and county characteristics.
Assuntos
Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Saúde Mental/etnologia , Adolescente , California , Criança , Serviços Comunitários de Saúde Mental/organização & administração , Feminino , Acessibilidade aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Humanos , Idioma , Modelos Logísticos , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVE: This study examined the efforts of states' mental health authorities to promote the use of evidence-based practices through policy. METHODS: Data were drawn from three components of a national study, including a survey of state children's mental health directors (N=53), which was developed using a three-step process that involved stakeholders. RESULTS: Data from the directors' survey revealed that over 90% of states are implementing strategies to support the use of evidence-based practices. The scope of these efforts varies, with 36% reporting statewide reach. Further, states' strategies for implementing evidence-based practices are often not accompanied by comparable efforts to enhance information systems, even though enhancing such systems can bolster opportunities for successful implementation. CONCLUSIONS: Variability in the adoption of evidence-based practices, poor attention to information systems, and inconsistent fiscal policies threaten states' efforts to improve the quality of children's mental health services.