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2.
Milbank Q ; 99(1): 62-90, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33463772

RESUMO

Policy Points That child and adolescent mental health services needs are frequently unmet has been known for many decades, yet few systemic solutions have been sought and fewer have been implemented at scale. Key among the barriers to improving child and adolescent mental health services has been the lack of well-organized primary mental health care. Such care is a mutual but uncoordinated responsibility of multiple disciplines and agencies. Achieving consensus on the essential structures and processes of mental health services is a feasible first step toward creating an organized system.


Assuntos
Serviços de Saúde da Criança/organização & administração , Serviços de Saúde Mental/organização & administração , Adolescente , Criança , Pré-Escolar , Crianças com Deficiência/legislação & jurisprudência , Acesso aos Serviços de Saúde , História do Século XX , Hospitalização/tendências , Humanos , Comunicação Interdisciplinar , Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/história , Serviços de Saúde Mental/legislação & jurisprudência , Estados Unidos/epidemiologia
4.
Int J Law Psychiatry ; 72: 101601, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32889420

RESUMO

The coronavirus pandemic, referred to here as Covid-19, has brought into sharp focus the increasing divergence of devolved legislation and its implementation in the United Kingdom. One such instance is the emergency health and social care legislation and guidance introduced by the United Kingdom Central Government and the devolved Governments of Wales, Scotland and Northern Ireland in response to this pandemic. We provide a summary, comparison and discussion of these proposed and actual changes with a particular focus on the impact on adult social care and safeguarding of the rights of citizens. To begin, a summary and comparison of the relevant changes, or potential changes, to mental health, mental capacity and adult social care law across the four jurisdictions is provided. Next, we critique the suggested and actual changes and in so doing consider the immediate and longer term implications for adult social care, including mental health and mental capacity, at the time of publication.several core themes emerged: concerns around process and scrutiny; concerns about possible changes to the workforce and last, the possible threat on the ability to safeguard human rights. It has been shown that, ordinarily, legislative provisions across the jurisdictions of the UK are different, save for Wales (which shares most of its mental health law provisions with England). Such divergence is also mirrored in the way in which the suggested emergency changes could be implemented. Aside from this, there is also a wider concern about a lack of parity of esteem between social care and health care, a concern which is common to all. What is interesting is that the introduction of CVA 2020 forced a comparison to be made between the four UK nations which also shines a spotlight on how citizens can anticipate receipt of services.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Legislação Médica/tendências , Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/legislação & jurisprudência , Pneumonia Viral/epidemiologia , Internação Compulsória de Doente Mental/legislação & jurisprudência , Humanos , Competência Mental/legislação & jurisprudência , Transtornos Mentais/terapia , Irlanda do Norte/epidemiologia , Pandemias , Reino Unido/epidemiologia
6.
Hist Psychiatry ; 31(4): 455-469, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32748672

RESUMO

This article discusses the Admission and Treatment Unit at Fair Mile Hospital, in Cholsey, near Wallingford, Berkshire (now Oxfordshire). This was the first new hospital to be completed in England following the launch of the National Health Service. The building was designed by Powell and Moya, one of the most important post-war English architectural practices, and was completed in 1956, but demolished in 2003. The article relates the commission of the building to landmark policy changes and argues for its historic significance in the context of the NHS and of the evolution of mental health care models and policies. It also argues for the need for further study of those early NHS facilities in view of current developments in mental health provision.


Assuntos
Arquitetura Hospitalar/história , Hospitais Psiquiátricos/história , Hospitais Estaduais/história , Medicina Estatal/história , Inglaterra , Política de Saúde/história , Política de Saúde/legislação & jurisprudência , História do Século XX , História do Século XXI , Hospitais Psiquiátricos/organização & administração , Humanos , Serviços de Saúde Mental/história , Serviços de Saúde Mental/legislação & jurisprudência , Medicina Estatal/organização & administração
10.
Infant Ment Health J ; 41(2): 166-177, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32242955

RESUMO

Selma Fraiberg's pioneering work with infants, toddlers, and families over 40 years ago led to the development of a field in which professionals from multiple disciplines learned to work with or on behalf of infants, very young children, their parents, and the relationships that bind them together. The intent was to promote social and emotional health through enhancing the security of early developing parent-child relationships in the first years of life (Fraiberg, 2018). Called infant mental health (IMH), practitioners from fields of health, education, social work, psychology, human development, nursing, pediatrics, and psychiatry specialize in supporting the optimal development of infants and the developing relationship between infants and their caregivers. When a baby is born into optimal circumstances, to parents free of undue economic and psychological stressors and who are emotionally ready to provide care and nurturing for an infant's needs, an IMH approach may be offered as promotion or prevention, with the goal of supporting new parent(s) in developing confidence in their capacity to understand and meet the needs of the tiny human they are coming to know and care for. However, when parental history is fraught with abandonment, loss, abuse or neglect, or the current environment is replete with economic insecurity, threats to survival due to interpersonal or community violence, social isolation, mental illness, or substance abuse, the work of the IMH therapist may require intervention or intensive treatment and becomes more psychotherapeutic in nature. The underlying therapeutic goal is to create a context in which the baby develops within the environment of a parent's nurturing care without the psychological impingement that parental history of trauma or loss or current stressors such as isolation, poverty, or the birth of a child with special needs, can incur.


Assuntos
Serviços de Saúde da Criança/história , Visita Domiciliar , Saúde do Lactente/legislação & jurisprudência , Serviços de Saúde Mental/história , Saúde Mental/legislação & jurisprudência , Cuidadores/psicologia , Criança , Serviços de Saúde da Criança/legislação & jurisprudência , Pré-Escolar , Feminino , História do Século XX , Humanos , Lactente , Recém-Nascido , Serviços de Saúde Mental/legislação & jurisprudência , Michigan , Relações Pais-Filho , Pais/psicologia
11.
Infant Ment Health J ; 41(2): 163-165, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32285498

RESUMO

This issue of the Infant Mental Health Journal presents the first papers from a tripartite evaluation study of state-sponsored infant mental health home visiting program in Michigan, United States. This series of studies has been led by Kate Rosenblum PhD and Maria Muzik MD, Department of Psychiatry, the University of Michigan and faculty from the Michigan Collaborative for Infant Mental Health Research for the State of Michigan, Department of Health and Human Services, Mental Health Services for Children, to fulfill the requirements of state legislation (State of Michigan Act No. 291, Public Acts of 2013) that required that all home visiting programs meet certain requirements to be established as an evidence-based practice. In this introduction, we provide a historical context for the delivery of infant mental health home visiting through the community mental health system in the state of Michigan.


Assuntos
Serviços de Saúde da Criança/história , Visita Domiciliar , Serviços de Saúde Mental/história , Saúde Mental/legislação & jurisprudência , Serviços de Saúde da Criança/legislação & jurisprudência , Pré-Escolar , Prática Clínica Baseada em Evidências , Feminino , História do Século XX , Humanos , Lactente , Cuidado do Lactente/legislação & jurisprudência , Saúde do Lactente/legislação & jurisprudência , Recém-Nascido , Serviços de Saúde Mental/legislação & jurisprudência , Michigan , Cuidado Pós-Natal , Desenvolvimento de Programas , Governo Estadual
12.
Rev Bras Enferm ; 73(1): e20180198, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32049238

RESUMO

OBJECTIVE: Identify the knowledge of mental health service managers about the national mental health policy. METHOD: This is a qualitative study conducted with 20 coordinators, who were submitted to a structured interview. Data were categorized in a thematic analysis using ALCESTE software. RESULTS: The results produced the following categories: Back to society: protagonism and autonomy of patients; Interprofessional team: assignments and activities; Structuring of a psychosocial care network; Challenges affecting the service; Distance between policy and practice. FINAL CONSIDERATIONS: Public managers demonstrated they are aware of the key concepts for effective structuring of a psychosocial care network based on patient protagonism and autonomy, the assignments and activities performed by interprofessional teams, and the challenges found while structuring a psychosocial care network.


Assuntos
Pessoal Administrativo/normas , Política de Saúde/legislação & jurisprudência , Serviços de Saúde Mental/legislação & jurisprudência , Competência Profissional/normas , Pessoal Administrativo/estatística & dados numéricos , Atitude do Pessoal de Saúde , Brasil , Pessoal de Saúde/psicologia , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Política de Saúde/tendências , Humanos , Relações Interprofissionais , Serviços de Saúde Mental/tendências , Competência Profissional/estatística & dados numéricos , Pesquisa Qualitativa
13.
Bull World Health Organ ; 98(1): 52-58, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31902962

RESUMO

The United Nations Convention on the Rights of Persons with Disabilities requires a paradigm shift from a medical model of disability to a social model that emphasizes overcoming the barriers to equality created by attitudes, laws, government policies and the social, economic and political environment. The approach adopted by the social model recognizes that people with psychosocial disabilities have the same right to take decisions and make choices as other people, particularly regarding treatment, and have the right to equal recognition before the law. Consequently, direct or supported decision-making should be the norm and there should be no substitute decision-making. Although recent mental health laws in some countries have attempted to realize a rights-based approach to decision-making by reducing coercion, implementing the Convention on the Rights of Persons with Disabilities can be challenging because it requires continuous refinement and the development of alternatives to coercion. This article reviews the impact historical trends and current mental health frameworks have had on the rights affected by the practice of involuntary treatment and describes some legal and organizational initiatives that have been undertaken to promote noncoercive services and supported decision-making. The evidence and examples presented could provide the foundation for developing a context-appropriate approach to implementing supported decision-making in mental health care.


Assuntos
Tomada de Decisões , Serviços de Saúde Mental/legislação & jurisprudência , Pessoas Mentalmente Doentes/legislação & jurisprudência , Direitos do Paciente/legislação & jurisprudência , Coerção , Serviços Comunitários de Saúde Mental/organização & administração , História do Século XX , História do Século XXI , Humanos , Tratamento Psiquiátrico Involuntário/história , Tratamento Psiquiátrico Involuntário/legislação & jurisprudência , Serviços de Saúde Mental/história , Aceitação pelo Paciente de Cuidados de Saúde , Direitos do Paciente/história , Apoio Social
14.
J Forensic Nurs ; 16(1): 47-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31834077

RESUMO

INTRODUCTION: Service providers' perspectives on female forensic mental health services have not been explored in Zimbabwe. This study examined how health service providers in forensic mental health in Zimbabwe understand and interpret rehabilitation of female forensic psychiatric patients. METHODS: An interpretive phenomenological study was completed. Service provider participants were selected via purposive sampling from two main Special Institutions. Data were collected using audio-recorded semistructured interviews and subjected to interpretive phenomenological analysis. FINDINGS: Two master themes evolved from interview data: (a) conflicting legal documents of care and management of female forensic psychiatric patients; and (b) the forensic mental health system's processes, procedures, and resources impacting female forensic psychiatric rehabilitation. DISCUSSION: Findings of the study call for the need to balance between public safety interests and fulfilling clinical rehabilitation objectives.


Assuntos
Atitude do Pessoal de Saúde , Serviços de Saúde Mental/organização & administração , Internação Compulsória de Doente Mental , Continuidade da Assistência ao Paciente/organização & administração , Feminino , Humanos , Entrevistas como Assunto , Serviços de Saúde Mental/legislação & jurisprudência , Zimbábue
15.
J Ment Health ; 29(2): 131-138, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28644738

RESUMO

Background: The Mental Capacity Act (2005) (MCA) provides a legal framework for advance planning for both health and welfare in England and Wales for people if they lose mental capacity, for example, through mania or severe depression.Aims: To determine the proportion of people with bipolar disorder (BD) who utilise advance planning, their experience of using it and barriers to its implementation.Methods: National survey of people with clinical diagnosis of BD of their knowledge, use and experience of the MCA. Thematically analysed qualitative interviews with maximum variance sample of people with BD.Results: A total of 544 respondents with BD participated in the survey; 18 in the qualitative study. 403 (74.1%) believed making plans about their personal welfare if they lost capacity to be very important. A total of 199 (36.6%) participants knew about the MCA. A total 54 (10%), 62 (11%) and 21 (4%) participants made advanced decisions to refuse treatment, advance statements and lasting power of attorney, respectively. Barriers included not understanding its different forms, unrealistic expectations and advance plans ignored by services.Conclusion: In BD, the demand for advance plans about welfare with loss of capacity was high, but utilisation of the MCA was low with barriers at service user, clinician and organisation levels.


Assuntos
Diretivas Antecipadas , Transtorno Bipolar/terapia , Política de Saúde , Acesso aos Serviços de Saúde , Serviços de Saúde Mental , Adolescente , Adulto , Diretivas Antecipadas/legislação & jurisprudência , Idoso , Inglaterra , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Legislação Médica , Serviços de Saúde Mental/legislação & jurisprudência , Pessoa de Meia-Idade , Pesquisa Qualitativa , Inquéritos e Questionários , País de Gales , Adulto Jovem
16.
Asia Pac Psychiatry ; 12(1): e12374, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31872576

RESUMO

People with mental illness may be unable to provide critical input about the care they wish to receive during a psychiatric crisis because of altered mental states. It is therefore imperative that clinicians seek to understand service users' wishes for care while they are well and able to provide meaningful input into the discussion. Achieving such an end may be done by discussing and completing a psychiatric advance directive. However, very few Asian countries have legislation that supports such advance directives. The present article seeks to give physicians more information about advance psychiatric directives and the potential role they could play to improve the healthcare provided in Asia to people at risk of losing capacity due to a mental illness. The degree to which mental health legislation supports psychiatric advance directives is documented for each country of South East Asia and Eastern Asia.


Assuntos
Diretivas Antecipadas , Transtornos Mentais/terapia , Serviços de Saúde Mental , Pessoas Mentalmente Doentes , Diretivas Antecipadas/legislação & jurisprudência , Ásia Sudeste , Extremo Oriente , Humanos , Serviços de Saúde Mental/legislação & jurisprudência , Pessoas Mentalmente Doentes/legislação & jurisprudência
17.
Artigo em Inglês | MEDLINE | ID: mdl-31795314

RESUMO

Most police Mental Health Act (Section 136) detentions in England and Wales relate to suicide prevention. Despite attempts to reduce detention rates, numbers have risen almost continually. Although Section 136 has been subject to much academic and public policy scrutiny, the topic of individuals being detained on multiple occasions remains under-researched and thus poorly understood. A mixed methods study combined six in-depth interviews with people who had experienced numerous suicidal crises and police intervention, with detailed police and mental health records. A national police survey provided wider context. Consultants with lived experience of complex mental health problems jointly analysed interviews. Repeated detention is a nationally recognised issue. In South East England, it almost exclusively relates to suicide or self-harm and accounts for a third of all detentions. Females are detained with the highest frequencies. The qualitative accounts revealed complex histories of unresolved trauma that had catastrophically damaged interviewee's relational foundations, rendering them disenfranchised from services and consigned to relying on police intervention in repeated suicidal crises. A model is proposed that offers a way to conceptualise the phenomenon of repeated detention, highlighting that long-term solutions to sustain change are imperative, as reactive-only responses can perpetuate crisis cycles.


Assuntos
Internação Compulsória de Doente Mental/estatística & dados numéricos , Serviços de Saúde Mental/legislação & jurisprudência , Polícia/estatística & dados numéricos , Comportamento Autodestrutivo/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , País de Gales , Adulto Jovem
18.
Int J Health Policy Manag ; 8(12): 711-722, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31779299

RESUMO

BACKGROUND: The global burden of mental health conditions has led to the implementation of new models of care for persons with mental illness. Recent mental health reforms in Peru include the implementation of a community mental health model (CMHM) that, among its core objectives, aims to provide care in the community through specialized facilities, the community mental health centers (CMHCs). Community involvement is a key component of this model. This study aims to describe perceptions of community engagement activities in the current model of care in three CMHCs and identify barriers and potential solutions to implementation. METHODS: A qualitative research study using in-depth semi-structured interviews with clinicians from three CMHCs and with policy-makers involved in the implementation of the mental health reforms was conducted in two regions of Peru. The interviews, conducted in Spanish, were digitally recorded with consent, transcribed and analyzed using principles of grounded theory applying a framework approach. Community engagement activities are described at different stages of patient care. RESULTS: Twenty-five full-time employees (17 women, 8 men) were interviewed, of which 21 were clinicians (diverse health professions) from CMHCs, and 4 were policy-makers. Interviews elucidated community engagement activities currently being utilized including: (1) employing community mental health workers (CMHWs); (2) home visits; (3) psychosocial clubs; (4) mental health workshops and campaigns; and (5) peer support groups. Inadequate infrastructure and financial resources, lack of knowledge about the CMHM, poorly defined catchment areas, stigma, and inadequate productivity approach were identified as barriers to program implementation. Solutions suggested by participants included increasing knowledge and awareness about mental health and the new model, implementation of peer-training, and improving productivity evaluation and research initiatives. CONCLUSION: Community engagement activities are being conducted in Peru as part of a new model of care. However, their structure, frequency, and content are perceived by clinicians and policy-makers as highly variable due to a lack of consistent training and resources across CMHCs. Barriers to implementation should be quickly addressed and potential solutions executed, so that scale-up best optimizes the utilization of resources in the implementation process.


Assuntos
Pessoal Administrativo/psicologia , Participação da Comunidade/psicologia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Pessoal de Saúde/psicologia , Serviços de Saúde Mental/legislação & jurisprudência , Pessoal Administrativo/estatística & dados numéricos , Adulto , Participação da Comunidade/estatística & dados numéricos , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Pesquisa Qualitativa
19.
Artigo em Inglês | MEDLINE | ID: mdl-31689900

RESUMO

In response to the Air Force Surgeon General, Lieutenant General Mark Ediger's call for medical services to be guided by service members' values, preferences, and experiences within the medical system, we conducted an interpretive phenomenological analysis of transcripts in which service members shared their experiences of military mental health policy and practices after being identified as suicidal. Themes of their experiences underscore nuances as it relates to intersectionality of policy when faced with unique military contextual factors and power differentials; both of which were missing in available research literature. Their experiences also illuminate further the innate "Catch 22" which happens when accessing help. Catch 22 basically means if you know you need help than you are rational; but if you actually seek help, then you are crazy and not trustworthy to do your job. Themes presented center on the lack of confidentiality of Service Members in the Workplace, effects of Unit Members' Surveillance and Command Directed Evaluations, and experiences of Military Mental Health Services. Critical discussions of policy and taken for granted assumptions that often drive narrow responses to suicide, treatment, prevention, and stigma are presented. Particular attention is given to the lived experiences of service members when placed under the demands of circumstances created by policy that may inadvertently lead in some cases to further suffering. The paper closes with recommendations from participants and the authors for policy makers and future directions in research.


Assuntos
Serviços de Saúde Mental , Militares/psicologia , Suicídio/psicologia , Humanos , Serviços de Saúde Mental/legislação & jurisprudência , Política Pública/legislação & jurisprudência , Estigma Social , Suicídio/prevenção & controle
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