The American contribution to attachment theory: John Bowlby's WHO trip to the USA in 1950 and the development of his ideas on separation and attachment.

This paper explores John Bowlby's foundational contributions to attachment theory, particularly his fascination with 'separation' and its impact on child development. Tracing the origins of Bowlby's interest to his personal experiences and his exposure to ideas of mental hygiene and child guidance in the 1930s, it underscores the alignment of his ideas with key figures in the English school of psychoanalysis. The central narrative of this paper unfolds during Bowlby's 1950 WHO research trip, investigating orphaned and separated children in Europe and the USA. Utilizing archival materials from the Wellcome Library in London, the authors offer unique insights into Bowlby's journey, highlighting his evolving views on mother-child separation through interactions with his American colleagues. This comprehensive exploration sheds light on Bowlby's pioneering work, emphasizing the American influence on his ideas, and the evolving theoretical framework that continues to shape our understanding of child development and attachment today.

A network analysis involving mental difficulties, cognition, physical fitness, 24-hour movement components, fatness, and sociodemographic factors in children.

Background: Evidence supports the beneficial linear influence of diverse lifestyle behaviors on brain health since childhood; however, multiple behaviors -and not only one-simultaneously affect such outcomes. Therefore, the aim was to explore the multivariate relationship through a network analysis among mental difficulty and cognitive function with physical fitness (PF), 24-h movement components, fatness, and sociodemographic factors in children. Methods: Cross-sectional study involved 226 children (52.2 % boys) aged between six and 11 years. Mental difficulties were evaluated through the Strengths and Difficulties Questionnaire and cognitive function by the Raven's Colored Progressive Matrices Test. The body mass index and PF were assessed according to the procedures suggested by the Proesp-Br, while moderate-to vigorous-intensity physical activity (MVPA) using accelerometry. The socioeconomic level, sleep, and screen time were evaluated by questionnaires. A network analysis was carried out to evaluate the associations among variables and establish centrality measures. Results: Age and PF moderated the negative relationship between cognitive function and MVPA. Furthermore, the direct and inverse relationship between cognitive function and mental difficulties appears to be affected by the 24-h movement components. Finally, age, PF, and screen time are the nodes with higher values of expected influence, indicating more sensitivity to interventions for decreasing mental difficulty and improving cognitive function. Conclusion: Mental health and cognitive function were moderated by the multivariate interaction among age, PF, and the three 24-h movement components. Nonetheless, centrality measures from the network analysis suggest that PF, MVPA, and screen time are crucial nodes in order to implement future interventions.

A tale of four countries: How Bowlby used his trip through Europe to write the WHO report and spread his ideas.

Attachment theory, developed by child psychiatrist John Bowlby, is considered a major theory in developmental psychology. Attachment theory can be seen as resulting from Bowlby's personal experiences, his psychoanalytic education, his subsequent study of ethology, and societal developments during the 1930s and 1940s. One of those developments was the outbreak of World War II and its effects on children's psychological wellbeing. In 1950, Bowlby was appointed WHO consultant to study the needs of children who were orphaned or separated from their families for other reasons and needed care in foster homes or institutions. The resulting report is generally considered a landmark publication in psychology, although it subsequently met with methodological criticism. In this paper, by reconstructing Bowlby's visit to several European countries, on the basis of notebooks and letters, the authors shed light on the background of this report and the way Bowlby used or neglected the findings he gathered.

Adapting Evidence-Based Teen Pregnancy Programs to Be LGBT-Inclusive: Lessons Learned.

CONTEXT: Lesbian, gay, bisexual, and transgender (LGBT) youth show higher rates of sexual risk behaviors than heterosexual and cisgender youth; yet, most school-based sexual health education is largely heteronormative and cisnormative and does not recognize the spectrum of sexual and gender identity. New York City's Departments of Health and Education collaborated to create an LGBT-inclusive supplement to the Reducing the Risk curriculum and implement it in 21 South Bronx high schools. METHOD: Teachers completed an electronic survey to report the number of students reached and an online log to measure curriculum adherence. Students were administered an anonymous 74-item pre- and posttest to measure demographics, sexual health knowledge, and student satisfaction with the curriculum. Chi-square and t tests were used to assess differences in student demographics and changes in knowledge scores. RESULTS: Reducing the Risk was implemented in 21 schools reaching 230 classes and 5,673 students; with 161 classes receiving the supplement. Teachers reported completing an average of 70% of LGBT supplement activities. Students who received the supplement reported higher satisfaction and greater knowledge scores than students who did not. CONCLUSION: New York City experience shows that being more inclusive of LGBT teens while implementing preexisting evidence-based sexual and reproductive health programs is possible and replicable.

Eugenics, medicine and psychiatry in Peru.

Eugenics was defined by Galton as 'the science which deals with all influences that improve the inborn qualities of a race'. In Peru, eugenics was related to social medicine and mental hygiene, in accordance with the neo-Lamarckian orientation, that predominated in Latin America. Peruvian eugenists assumed the mission of fighting hereditary and infectious diseases, malnutrition, alcoholism, drug addiction, prostitution, criminality and everything that threatened the future of the 'Peruvian race'. There were some enthusiastic advocates of 'hard' eugenic measures, such as forced sterilization and eugenic abortion, but these were never officially implemented in Peru (except for the compulsory sterilization campaign during the 1995-2000 period). Eugenics dominated scientific discourse during the first half of the twentieth century, but eugenic discourse did not disappear completely until the 1970s.

Creating a new psychiatry: on the origins of non-institutional psychiatry in the USA, 1900-50.

This paper examines the early origins of the shift away from institutional psychiatry in the USA. It focuses on the period between 1900 and 1950. Attention is paid to the role of neurologists and disaffected asylum doctors in the early emergence of extra-institutional practice; to the impact of the National Committee for Mental Hygiene and Thomas Salmon; to the limited role of psychoanalysis during most of this period; and to the influence of the Rockefeller Foundation's decision to focus most of its effort in the medical sciences on psychiatry.

From mental hygiene to mental health: ideology, discourses and practices in Franco's Spain (1939-75).

Based on an analysis of the discourses, the ideological appropriation and the practical influence of mental hygiene in Spanish psychiatry during the early years of the Francoist regime, this article examines its decline and subsequent replacement by the new concept of mental health promoted by the World Health Organization and other international bodies from the mid-twentieth century. The old approach, essentially focused on the prophylaxis of insanity within the framework of a set of interventionist policies of social defence, was thus transformed from the beginning of the 1960s into a much more ambitious and comprehensive project which sought to promote the psychosocial balance and performance of individuals in the context of increasingly socialized health-related discourses and networks of care.

The effect of the compassion levels of healthcare workers on their psychological well-being.

BACKGROUND: A sense of compassion has a core importance in health service delivery. Research on the psychological impact of being compassionate on healthcare workers is limited. OBJECTIVE: This research aims to examine the effect of compassion levels of healthcare workers on their psychological well-being. METHODS: This was a cross-sectional and descriptive study. The population of the research consists of health personnel working throughout Ankara, the capital. The study was carried out with 414 healthcare workers. A personal information form, compassion scale and psychological well-being scale were used in the research questionnaire. RESULTS: A positive and significant relationship was found between compassion and psychological well-being scores. It was determined that compassion positively affected psychological well-being levels. The level of compassion showed that there was a significant difference between the groups according to the variables of gender, family structure, job satisfaction and whether they would choose the same profession again. The level of psychological well-being was found to be significantly different between the groups in education, job satisfaction and making the same profession choice again. CONCLUSION: It is a professional requirement that health professionals in patient care have a sense of compassion and reflect this feeling in their conduct. Research shows that the greater the compassion, the higher the psychological well-being. Therefore, undertaking training initiatives to make healthcare workers more compassionate can contribute to patient care and at the same time to the psychological well-being of healthcare workers.

Ask the Doctor: Mental Hygiene Among the Young in Fin-de-Siècle Finland.

The turn of the twentieth century in Finland saw an increasing number of popular articles and books on health, which were published within the broader framework of 'social hygiene' and aimed at children, young people and their families. This article examines how young people articulated concerns about their own mental health in the context of these campaigns to improve social hygiene. Based on an extensive body of original sources consisting of medical advisory material and letters written by the young, the study reveals how young people saw themselves in this health context-especially when writing about their 'nerves' or 'nervousness'. Drawing on more recent methodological investigations in the history of childhood, this study adds the much-needed perspective of the young people themselves as subjects experiencing these problems, to counterbalance the otherwise exclusively expert discourses on the subject of mental hygiene.

Revisiting mental hygiene: Josef Lundahl's interpretation of modern psychiatry in Sweden at the beginning of the twentieth century.

The concept of mental hygiene is historically intertwined with eugenics and what it meant both ideologically and for the care of the mentally ill. A closer investigation of the concept and of the historical context shows that different interpretations existed simultaneously. The aim of this essay is to highlight the literary and scientific works of a Swedish psychiatrist, Josef Lundahl, an advocate of the mental hygiene concept. A close reading of his texts is used to provide an example of how the concept of mental hygiene was understood by a psychiatrist and practitioner of mental hygiene. The practice of child-care and out-patient care that Lundahl founded in Visby is far from what we now associate with mental hygiene in the past.

Insomnia among female flight attendants: Related factors and its association with mental health.

BACKGROUND: Sleep and mental health are very important in the aviation industry. Reports show that gender is one of the risk factors of insomnia, and most Asian flight attendants are female. Therefore, it is necessary to understand insomnia, and the correction to mental health among female flight attendants. OBJECTIVE: To investigate the prevalence of insomnia in female flight attendants and its association with mental health. METHODS: We used a cross-sectional design. We recruited 412 female flight attendants with more than 3 months of working experience. We collected the socio-demographic and work-related data, measured insomnia and mental health by the Athens Insomnia and Brief Symptom Rating Scales. Descriptive statistics, single-factor analysis of variance, Pearson's correlation analysis, and structural equation modeling were performed to analyze the relationships. RESULTS: There are 45.4% of female flight attendants having insomnia, and 24.8% had suspicious insomnia. The most considerable and serious insomnia problem was falling asleep (15.3%, 4.9%). Factors related to insomnia include smoking, drinking, family load (e.g., housekeeping and caring for family), economic stress and late-night/early morning workdays during last month. Also, insomnia had a direct association with mental health (T = 17.11, p < 0.001). CONCLUSION: We found that insomnia is negatively correlated with the above factors and mental health. We recommend that airline industries can run their sleep-education programs and provide relevant mental-health-promotion programs for flight attendants.

Can a brief session of the online coronavirus disease 2019 destigmatization program reduce stigma among survivors? A randomized controlled trial.

Background: Stigmatization has taken a heavy toll on the mental health and quality of life of the survivors of coronavirus disease 2019 (COVID-19). To address this issue, we proposed a brief, self-directed, reflective, and practical destigmatization intervention. The current study aimed to investigate the efficacy of the online COVID-19 destigmatization program (OCDP) in mitigating stigma among the survivors of COVID-19. Methods: This study was conducted on 142 survivors of COVID-19 before their discharge from Vajra Hospital from July 2022 to November 2022. The participants were randomly assigned between the intervention group (n = 71), who attended the 40-min OCDP, and the control group (n = 71), who received standard mental health care. The primary outcome was the efficacy of OCDP in reducing stigmatization. A COVID-19 stigma questionnaire was administered to assess stigmatization in the intervention and control groups immediately before and after the program during follow-up on days 7, 14, and 28. The secondary outcome was the efficacy of the program in alleviating negative emotions according to the Depression Anxiety Stress Scale 21 questionnaire. Results: Compared with the control group, the intervention group had a more prominent reduction in the overall stigma score on day 7 (p = 0.002) and day 14 (p = 0.028). The intervention group had a more evident reduction in enacted stigma (day 7, p = 0.04), internalized stigma (day 7, p = 0.008; day 14, p < 0.028), and perceived external stigma (day 7, p = 0.002) than the control group. However, there was no significant difference in terms of disclosure concern between the intervention and control groups. Furthermore, the reduction in depression, anxiety, and stress between the two groups did not significantly differ. Conclusion: Online COVID-19 destigmatization program provided prior to hospital discharge is an effective tool in reducing stigmatization, particularly within the first 2 weeks after reintegration into society, among the survivors of COVID-19.

Political dimensions of 'the psychosocial': The 1948 International Congress on Mental Health and the Mental Hygiene Movement.

The Foucauldian sociologist Nikolas Rose has influentially argued that psychosocial technologies have offered means through which the ideals of democracy can be made congruent with the management of social life and the government of citizens in modern Western liberal democracies. This interpretation is contested here through an examination of the 1948 International Congress on Mental Health held in London and the mental hygiene movement that organised it. It is argued that, in Britain, this movement's theory and practice represents an uneasy and ambiguous attempt to reconcile visions of 'the modern' with 'the traditional'. The mental hygienist emphasis on the family is central. Here it appears as a forcing-house of the modern self-sustaining individual. Mental hygienists cast the social organisation of 'traditional' communities as static, with rigid authority frustrating both social progress and the full emergence of individual personality. Yet mental hygienists were also concerned about threats to social cohesion and secure personhood under modernity. If the social organisation of 'traditional' communities was patterned by the archetype of the family, with its personal relations of authority, mental hygienists compressed these relations into the 'private' family. Situated here they became part of a developmental process of mental adjustment through which 'mature', responsible citizens emerged. This reformulation of the family's centrality for the social order informed mental hygienist critiques of the growth of state power under existing forms of democracy, as well as suspicion of popular political participation or protest, and of movements towards greater egalitarianism.

Mental Health Outcomes and Mental Hygiene in the COVID-19 Era: A Cross-Sectional Study Among Healthcare Workers from a Regional Hospital in Ghana.

PURPOSE: The COVID-19 pandemic is affecting healthcare workers (HCWs) in unique ways which include the risk of infection and subsequent transmission to their colleagues and families, the issue of vulnerability due to lack of PPEs and access to equipment needed to provide best care for patients, moral injury in making triage decisions, the lack of professional and/or social support and psychological burdens during this period. This study thus investigates the mental health outcomes (fear, depression, anxiety, and stress) and mental hygiene among HCWs in Ghana in this COVID-19 era. METHODS: The study adopted a descriptive cross-sectional design. RESULTS: Our findings revealed a shared count of psychological outcomes among HCWs in Ghana. State anxiety was a prominent psychological outcome among HCWs. Being a female HCW was significantly associated with state anxiety. Correlation analysis showed a positive and significant relationship among all the psychological outcomes at P<0.05 and 0.01. There were no mental hygiene systems and/or structures in place at the regional hospital. CONCLUSION: It is recommended that healthcare facilities and systems must swiftly implement and establish mental hygiene structures for their HCWs in this period of the pandemic to secure holistic, balanced life, and professional support for HCWs now and beyond this pandemic.

The Effectiveness of Plaza Dancing on Psychological Well-Being and Ill-Being: A Systematic Review and Meta-Analysis.

Evidence suggests that participation in plaza dancing may affect mental health. This study for the first time quantified the relationships between plaza dancing and psychological well-being and ill-being. We systematically searched PubMed, Web of Science, CNKI, Wanfang, and VIP to identify relevant studies published from the databases since their inception to July 25, 2021. The standardized mean differences (SMDs) of pre-to-post intervention data were calculated in the meta-analysis. Subgroup and meta-regression analyses were performed to test the potential moderating effects of age, outcome classification, measurement instruments, district, publication year, total sample size, and the duration, frequency, and length of the square dance intervention. A total of 25 original articles met all the eligibility criteria and were included in the review, and 17 studies were included in the meta-analysis. The meta-analysis revealed that plaza dancing improved psychological well-being (pooled SMD = 0.76; 95% CI: 0.58, 0.95; I 2 = 86.9%) and reduced psychological ill-being (pooled SMD = -0.84; 95% CI: -1.00, -0.68; I 2 = 64.8%). The study participants' age and district did not seem to affect the effectiveness of the plaza dancing intervention. The duration and frequency of plaza dancing affected the association between square dance and psychological well-being (duration, ß = -0.044; 95% CI: -0.085, -0.004; frequency, ß = 0.122; 95% CI: 0.024, 0.221) and psychological ill-being (duration, ß = -0.029; 95% CI: -0.040, -0.018; frequency, ß = 0.154; 95% CI: 0.030, 0.278). Plaza dancing has a significant positive effect on psychological well-being and psychological ill-being, and the effects are moderated by intervention modality. Generalizing plaza dancing interventions to promote psychological well-being and prevent or treat psychological ill-being is needed. Systematic Review Registration: [www.crd.york.ac.uk/prospero], identifier [CRD42021272016].

[The Maimonides mental health regime (1138-1204): nine centuries ahead.] / El régimen de salud mental de Maimónides (1138-1204): nueve siglos por delante.

According to the World Health Organization (WHO), mental health is a fundamental component of a healthy lifestyle. Currently this notion has become universal and has permeated the public consciousness, society and the political agenda of public health programs. In Spain, as a result of the pandemic due to the Coronavirus Disease 2019 (COVID-19), this health issue has been revived and has also been the subject of parliamentary debates. This idea is not new because within the Greco-Roman medical tradition continued by the Arabs, all the great authors included in their texts chapters on general hygienic-dietary norms to lead a healthy life, their own medical genre called "health regimen". In Al-Andalus, the Jewish doctor Maimonides (1138-1204) was nine centuries ahead of the concept of mental health or hygiene of the soul and its disorders, topics now included in the field of psychology, psychiatry and psychosomatic medicine. Maimonides drew up a body of doctrine on mental disorders and systematized a complete management of them from a comprehensive view of the patient as a person, based on four preventive and therapeutic measures to achieve mental balance: a) a general health regime; b) mental and emotional re-education; c) measures to reduce anxiety; and d) specific antidepressant medication. These recommendations are the most original made up to then, even many of them are still valid today due to their modernity. In this historical context, Maimonides constitutes a scientific bridge between the Middle Ages and our era.

Según la Organización Mundial de Salud (OMS) la salud mental es un componente fundamental del estilo de vida saludable. Actualmente, esta noción se ha hecho universal y ha calado en la conciencia ciudadana, en la sociedad y en la agenda política de los programas de Salud Pública. En España, a consecuencia de la pandemia debida a la Enfermedad por Coronavirus 2019 (COVID-19), este asunto sanitario se ha reavivado y ha sido motivo también de debates parlamentarios. Esta idea no es nueva pues dentro de la tradición médica grecolatina, continuada por los árabes, todos los grandes autores incluyeron en sus textos capítulos acerca de normas higiénico-dietéticas generales para llevar una vida sana, género médico propio denominado "régimen de salud". En Al-Andalus, el médico judío Maimónides (1138-1204) se adelantó en nueve siglos al concepto de salud mental o higiene del alma y sus trastornos, temas incluidos ahora en el campo de la psicología, la psiquiatría y la medicina psicosomática. Maimónides confeccionó un cuerpo de doctrina sobre las afecciones psíquicas y sistematizó un manejo completo de las mismas desde una visión integral del paciente como persona, basado en cuatro medidas preventivas y terapéuticas para alcanzar el equilibrio psíquico: a) un régimen general de salud; b) reeducación mental y emocional; c) medidas para disminuir la ansiedad; y d) medicación específica antidepresiva. Estas recomendaciones son las más originales hechas hasta entonces. Incluso muchas de ellas siguen vigentes actualmente por su modernidad. En este contexto histórico Maimónides constituye un puente científico entre el Medievo y nuestra era.

Reduced COVID-19 hospitalizations among New York City residents following age-based SARS-CoV-2 vaccine eligibility: Evidence from a regression discontinuity design.

BACKGROUND: In clinical trials, several SARS-CoV-2 vaccines were shown to reduce risk of severe COVID-19 illness. Local, population-level, real-world evidence of vaccine effectiveness is accumulating. We assessed vaccine effectiveness for community-dwelling New York City (NYC) residents using a quasi-experimental, regression discontinuity design, leveraging a period (January 12-March 9, 2021) when ≥ 65-year-olds were vaccine-eligible but younger persons, excluding essential workers, were not. METHODS: We constructed segmented, negative binomial regression models of age-specific COVID-19 hospitalization rates among 45-84-year-old NYC residents during a post-vaccination program implementation period (February 21-April 17, 2021), with a discontinuity at age 65 years. The relationship between age and hospitalization rates in an unvaccinated population was incorporated using a pre-implementation period (December 20, 2020-February 13, 2021). We calculated the rate ratio (RR) and 95% confidence interval (CI) for the interaction between implementation period (pre or post) and age-based eligibility (45-64 or 65-84 years). Analyses were stratified by race/ethnicity and borough of residence. Similar analyses were conducted for COVID-19 deaths. RESULTS: Hospitalization rates among 65-84-year-olds decreased from pre- to post-implementation periods (RR 0.85, 95% CI: 0.74-0.97), controlling for trends among 45-64-year-olds. Accordingly, an estimated 721 (95% CI: 126-1,241) hospitalizations were averted. Residents just above the eligibility threshold (65-66-year-olds) had lower hospitalization rates than those below (63-64-year-olds). Racial/ethnic groups and boroughs with higher vaccine coverage generally experienced greater reductions in RR point estimates. Uncertainty was greater for the decrease in COVID-19 death rates (RR 0.85, 95% CI: 0.66-1.10). CONCLUSION: The vaccination program in NYC reduced COVID-19 hospitalizations among the initially age-eligible ≥ 65-year-old population by approximately 15% in the first eight weeks. The real-world evidence of vaccine effectiveness makes it more imperative to improve vaccine access and uptake to reduce inequities in COVID-19 outcomes.

Persistent disparities in SARS-CoV-2 test percent positivity by neighborhood in New York City, March 1-July 25, 2020.

PURPOSE: To examine neighborhood-level disparities in SARS-CoV-2 molecular test percent positivity in New York City (NYC) by demographics and socioeconomic status over time to better understand COVID-19 inequities. METHODS: Across 177 neighborhoods, we calculated the Spearman correlation of neighborhood characteristics with SARS-CoV-2 molecular test percent positivity during March 1-July 25, 2020 by five periods defined by trend in case counts: increasing, declining, and three plateau periods to account for differential testing capacity and reopening status. RESULTS: Percent positivity was positively correlated with neighborhood racial and ethnic characteristics and socioeconomic status, including the proportion of the population who were Latino and Black non-Latino, uninsured, Medicaid enrollees, transportation workers, or had low educational attainment. Correlations were generally consistent over time despite increasing testing rates. Neighborhoods with high proportions of these correlates had median percent positivity values of 62.6%, 28.7%, 6.4%, 2.8%, and 2.2% in the five periods, respectively, compared with 40.6%, 11.7%, 1.7%, 0.9%, and 1.0% in neighborhoods with low proportions of these correlates. CONCLUSIONS: Disparities in SARS-CoV-2 molecular test percent positivity persisted in disadvantaged neighborhoods during multiple phases of the first few months of the COVID-19 epidemic in NYC. Mitigation of the COVID-19 burden is still urgently needed in disproportionately affected communities.

MIND, Anti-Psychiatry, and the Case of the Mental Hygiene Movement's 'Discursive Transformation'.

During the 1970s the National Association for Mental Health (NAMH) re-labelled itself MIND, becoming a rights-based organisation, critiquing psychiatry and emphasising patients' citizenship. Its transformation has been coloured by attributions of the influence of anti-psychiatry. This article argues that the relevance of anti-psychiatry has been over-simplified. It examines MIND's history as part of the psychiatric strategy known as mental hygiene. This movement's agenda can be understood as paradigmatic of much that anti-psychiatry renounced. However, building on the sociologist Nick Crossley's description of the interactional nature of Social Movement Organisations in the psychiatric field, this article shows that a 'discursive transformation' can be deduced in core elements of mental hygienist thinking. This transformation of discourse clearly prefigured important elements of anti-psychiatry, and also fed into MIND's rights approach. But it must be appreciated on its own terms. Its distinctiveness under MIND is shown in its application to people with learning disabilities.

Civil commitment of persons with mental illness: Comparison of the Mental Healthcare Act 2017 with corresponding legislations of the USA.

The policies and procedures for the treatment of psychiatric patients are within the boundaries of ethical and legal principles of medical practice, with equal importance to human rights and values. Both in India and the USA, the Mental Health Legislation/Act guides psychiatrists in performing their duty toward the patients within this framework. The objective of this review was to compare the Indian Mental Healthcare Act (MHCA) of 2017 with mental health legislations currently existing in the USA, taking New York State Mental Hygiene Law as an example. The evolution of the American mental health legislation over the years was reviewed, including the aspects of involuntary admissions and segregating the psychiatric patients from the community. Over the years, the assessment and treatment approaches inclined toward patient's "rights and liberty" such as assessment of competency to make decisions, the involvement of family members and mandatory requirement of procedure to be followed during admission, inpatient care, and discharge. The current American mental health system is compared and contrasted with MHCA 2017. In the context of existing American mental health legislation and practical issues, this review tried to anticipate possible shortcomings or difficulties that can occur during the implementation of MHCA 2017. Several differences and similarities exist between the two legislations. Added to this, in America itself, there are smaller variations in mental health legislation in each state, albeit the general principles remain the same. Whether this is going to be the case in India once the individual states form the rules is worth a consideration.