Contribution of Mental Health Service User Groups to Mental Health Services and Policy in Ghana : The Case of Mental Health Society of Ghana

RESUMO: Este estudo procurou documentar a perspectiva (s) dos utentes de sa��de mental e das associa����es de prestadores de cuidados sobre a presta����o, o papel e a contribui����o de servi��os de sa��de mental da comunidade tal como foram percebidos por um n��mero de informadores-chave, incluindo os utentes do servi��o mentais e os pr��prios prestadores de cuidados. O caso espec��fico da Sociedade Sa��de Mental do Gana (MEHSOG) foi o foco deste estudo. O modelo foi o de um estudo de caso, utilizando discuss��es de grupo e entrevistas com informadores-chave como instrumentos de recolha de dados. Estas ferramentas de colheita de dados foram complementadas por observa����es dos participantes e pela revis��o de documentos da MEHSOG e dos v��rios grupos de apoio da comunidade de auto-ajuda que comp��em a associa����o nacional. O estudo revelou que os utentes dos servi��os de sa��de mental e seus prestadores de cuidados constituem um importante grupo de partes interessadas na presta����o de servi��os de sa��de mental da comunidade e no desenvolvimento de pol��ticas que tenham em conta as necessidades e os direitos das pessoas com doen��a mental ou epilepsia. O envolvimento da MEHSOG promove a mobiliza����o de membros e fam��lias relacionadas com a doen��a mental de beneficiar de servi��os de tratamento bem organizados com um impacto significativo na melhoria da sa��de e da participa����o dos utentes dos servi��os e seus prestadores de cuidados prim��rios em processos de tomada de decis��o da fam��lia e na comunidade processos de desenvolvimento. Os utentes dos servi��os por beneficiarem de tratamento, e os prestadores de cuidados prim��rios, por se tornarem mais livres e menos sobrecarregados com a responsabilidade de cuidar, podem passar a envolver-se mais em atividades que melhoramo seu estado, o de suas fam��lias e das comunidades. A advocacia dos membros da MEHSOG para conseguir que a ���Mental Health Bill��� se transforme numa Lei foi tamb��m um desenvolvimento significativo resultante da participa����o ativa dos utentes do servi��o em chamar a aten����o para uma nova e inclusiva legisla����o de sa��de mental para o Gana. Entre os fatores e oportunidades que permitiram aos utentes dos servi��os de sa��de mental e aos prestadores de cuidados prim��rios de pessoas com doen��a mental apoiar activamente a presta����o de servi��os de sa��de mental comunit��ria e o desenvolvimento de pol��ticas conta-se a contribui����o da sociedade civil do Gana, particularmente o movimento da defici��ncia, e os esfor��os anteriores de ONGs em sa��de mental e dos profissionais de sa��de mental para ter uma nova lei em sa��de mental. Observ��mos um certo n��mero de desafios e barreiras que actuam de forma a limitar a influ��ncia dos utentes dos servi��os de sa��de mental na provis��o da sa��de mental comunit��ria e no desenvolvimento de pol��ticas. Entre elas o estigma social contra a doen��a mental e pessoas com doen��a mental ou epilepsia e seus cuidadores primaries �� um factor chave. O estigma tem alterado a percep����o e as an��lises do p��blico em geral, especialmente dos profissionais de sa��de e das autoridades pol��ticas afetando a prioriza����o dos problemas de sa��de mental nas pol��ticas e programas. Outro desafio foi a deficiente infra-estrutura dispon��vel para apoiar servi��os de sa��de mentais que assegurem aos utentes permanecerem em bom estado de sa��de e bem-estar para serem advogados de si pr��prios. A recomenda����o do presente estudo �� que os movimentos de utentes dos servi��os de sa��de mental s��o importantes e que eles precisam de ser apoiados e encorajados a desempenhar o seu papel como pessoas com experi��ncia vivida para contribuir para a organiza����o e presta����o de servi��os de sa��de mental, bem como para a implementa����o, monitoriza����o e avalia����o de pol��ticas e programas. ------------------------------------ ABSTRACT: This study sought to document the perspective(s) of mental health users and care-givers associations in community mental health service provision and their role and contribution as it was perceived by a number of key informants including the mental service users and care-givers themselves. The specific case of the Mental Health Society of Ghana (MEHSOG) was the focus of this study. A case study approach was used to with Focus Group Discussions and Key Informants Interviews being the data collection tools that were used. These data collection tools were complemented by participant observations and review of documents of the MEHSOG and the various community self-help peer support groups that make up the national association. The study revealed that mental health service users and their care-givers constitute an important stakeholder group in community mental health service provision and development of policies that factor in the needs and rights of persons with mental illness or epilepsy. MEHSOG���s involvement in mobilising members and education families to come forward with the relations with mental illness to benefit from treatment services were well made a significant impact in improving the health and participation of service users and their primary carers in family decision-making processes and in community development processes. Service users, on benefiting from treatment, and primary care-givers, on becoming freer and less burdened with the responsibility of care, move on to engage in secure livelihoods activities, which enhanced their status in their families and communities. The advocacy MEHSOG members undertook in getting the mental health Bill become Law was also noted as significant development that was realised as a result of active involvement of service users in calling for a new and inclusive mental health legislation for Ghana. Enabling factors and opportunities that enabled mental health service users and primary care-givers of people with mental illness to actively support community mental health service provision and policy development is with the vibrant civil society presence in Ghana, particularly the disability movement, and earlier efforts by NGOs in mental health in Ghana long-side mental health professionals to have a new law in mental health. A number of challenges were also noted which were found to limit the extent to which mental health service users can be influential in community mental health service provision and policy development. Key among them was the social stigma against mental illness and people with mental illness or epilepsy and their primary carers. Stigma has affected perceptions, analyses of the general public, especially health practitioners and policy authorities that it has affected their prioritisation of mental health issues in policies and programmes. Another challenge was the poor infrastructure available to support enhanced mental health care services that ensure mental health service users remain in a good state of health and wellbeing to advocate for themselves. The recommendation from the study is that mental health service user movements are important and need to be supported and encouraged to play their role as persons with lived experience to inform organisation and provision of mental health services as well as design and implementation, monitoring and evaluation of policies and programes.

Reinvigorating and redesigning early intervention in psychosis services for young people in Auckland

RESUMO: Auckland tem sido pioneira na implementa����o de modelos de Interven����o Precoce em Psicose. No entanto, esta organiza����o do servi��o n��o mudou nos ��ltimos 19 anos. Segundo os dados obtidos da utiliza����o do servi��o, no per��odo de 1996 -2012 foram atendidos 997 doentes, que tinham um n��mero m��dio de 89 contactos (IQR: 36-184), com uma dura����o m��dia de 62 horas de contactos (IQR: 24-136). Estes doentes passaram um n��mero m��dio de 338 dias (IQR: 93-757) em contacto com o programa. 517 doentes (52%) n��o necessitaram de internamento no hospital, e os que foram internados, ficaram uma mediana de 124 dias no hospital (IQR: 40-380). Os doentes asi��ticos tiveram um aumento de 50% de probabilidade de serem internados no hospital. Este relat��rio inclui 15 recomenda����es para orientar as reformas para o servi��o e, nomeadamente, delinear a import��ncia de uma vis��o organizacional e dos seus componentes-chave. As recomenda����es incluem o refor��o da gest��o e da lideran��a numa estrutura de equipe mais integrada, com recursos dedicados a melhorar a consciencializa����o da comunidade, a educa����o e dete����o precoce, bem como a capacidade de receber referencia����es diretas. Os Indicadores Chave de Desempenho devem ser estabelecidos, mas os Exames de Estado Mental em risco, devem ser removidos. Auckland deve manter a faixa et��ria alvo atual. A dura����o do servi��o deve ser aumentada para um m��nimo de tr��s anos, com a op����o de aument��-la para cinco anos. A propor����o de gestor de cuidados para os doentes deve ser preconizada em 1:15, enquanto o pessoal de apoio n��o-cl��nico deve ser aumentado. Os psiquiatras devem ter uma carga de trabalho de cerca de 80 doentes por equivalente de tempo completo. Um servi��o local de presta����o de cuidados deve ser desenvolvido com, nomeadamente, interven����es culturais para responder ��s necessidades da popula����o multicultural de Auckland. A capacidade de investiga����o deve ser incorporada no Servi��o de Interven����o Precoce em Psicoses. Qualquer altera����o dever�� envolver contacto com todas as partes interessadas, e a Administra����o Regional de Sa��de deve comprometer-se em tempo, recursos humanos e pol��ticos para apoiar e facilitar a mudan��a do sistema, investindo de forma significativa para melhor servir a comunidade Auckland.----------------------------------- ABSTRACT: Auckland has been pioneering in the adoption of Early Intervention in Psychosis models but the design of the service has not changed in 19 years. In service utilisation data from 997 patients seen from 1996 -2012, patients had a median number of 89 contacts (IQR: 36-184), with a median duration of 62 hours of contact (IQR: 24-136). Patients spent a median number of 338 days (IQR: 93-757) in contact with the program. 517 patients (52%) did not require admission to hospital, and those who did spent a median of 124 days in hospital (IQR: 40-380). Asian patients had a 50% increased chance of being admitted to hospital. This report includes 15 recommendations to guide reforms to the service, including outlining the importance of vision and key components. It recommends strengthened managerial leadership and a more integrated team structure with dedicated resources for improved community awareness, education and early detection as well as the capacity to take direct referrals. Key Performance Indicators (KPIs) should be established but At Risk Mental States should be excluded. Auckland should maintain the current target age range. The duration of service should be increased to a minimum of three years, with the option to extend this to five years. The ratio of care co-ordinator to patients should be capped at 1:15 whilst non-clinical supporting staff should be increased. Psychiatrists should have a caseload of about 80 per FTE. A local Service Delivery framework should be developed, as should cultural interventions to meet the needs of the multicultural population of Auckland. Research capacity should be incorporated into the fabric of Early Intervention in Psychosis Services. Any changes should involve consultation with all stakeholders, and the DHB should commit to investing time, human and political resources to support and facilitate meaningful system change to best serve the Auckland community.

Definition, implementation and management of m.commerce apps and services

This report aims to analyse the Definition, Implementation and Management of Vodafone Portugal���s Apps and Services, so that possible ways of improvement can be suggested. To do so, Vodafone���s strategy regarding the development/ implementation of specific Apps and Services, as well as the strategy of its competitors are going to be analysed. This analysis is going to be complemented with insights from some key-persons of Vodafone���s Consumer Business Unit team in Portugal. Findings suggest that Vodafone is ahead of its competitors when it comes to developing the most innovative Apps and Services, but there is always room for improvements, especially when it comes to communication.

Ideation at Canon business services

Digitalisation, globalisation, and evolving customer demands are only a few of the factors that are bound to transform the business process services industry for CBS. By investigating new ways to address these imminent challenges, this thesis explores the feasibility of implementing a formal approach to ideation to complement CBS��� service innovation practice. Two workshops were therefore conducted to put theory into action by generating new service ideas in a multifunctional team. Applying both divergent and convergent ideation techniques revealed that the latter improved an idea���s novelty and creativity as opposed to the expected increase in workability and relevance. Additionally, further analysis sheds light into the potential influence of individual characteristics and group dynamics on creativity. The thesis concludes with a discussion on the organisational implications of the findings and recommendations for future research.

Community indentification in peer-t-peer collaborative consumption services

Even though collaborative consumption (CC) is gaining economic importance, research in CC is still in its infancy. Consumers��� reasons for participating have already been investigated but little research on consequences of participation has been conducted. This article examines whether interactions between customers in peer-to-peer CC services influence the willingness to coproduce service outcomes. Drawing on social exchange theory, it is proposed that this effect is mediated by consumers��� identification with the brand community. Furthermore, continuance intention in CC is introduced as a second stage moderator. In a cross-sectional study, customers of peer-to-peer accommodation sharing are surveyed. While customer-to-customer interactions were found to have a positive effect on brand community identification, brand community identification did not positively affect co-production intention. Surprisingly, the effect of brand community identification on co-production intention was negative. Moreover, continuance intention of customers did not moderate this relationship. Bearing in mind current challenges for researchers and companies, theoretical and managerial implications are discussed.