Mental health promotion during pregnancy and early childhood : an action- research project in primary health care

ABSTRACT ��� Background: Primary Health Care (PHC) is usually the first contact with the health system, and health professionals are key mediators for enabling citizens to take care of their health. In Portugal, great improvements have been achieved in the biometric indicators of maternal and child health during the last decades. Nevertheless, scant attention has been paid to the mental health dimension, in spite of the recognition of its importance, being pregnancy and early childhood crucial opportunities in the lifecycle for mental health promotion, especially in the early years of life, with a strong impact in the health of the child. The impact of early attachment between mother and baby on maternal and child health has long been recognized. This attachment can be influenced by some factors, as the mother���s emotional adjustment. Attention to these factors may facilitate implementation of both positive conditions and preventative measures. Family support during the transition to parenthood has been highlighted as an effective measure and PHC professionals are in a privileged position as information sources as well as mediators. Aims: The project we present describes an action-research process developed together among academic researchers and health professionals to embrace these issues. We intend to enable health professionals to support families in the transition to parenthood thereby promoting children���s mental health. Approach: The project is driven by a participatory approach intended to lead to reorganization of health care during pregnancy and early childhood. Effective change happens when those involved are interested and motivated, what makes their participation so important. Reflection about current practices and needs, and knowledge about evidence-based interventions have been guiding the selection of changes to introduce in clinical practice for family support and development of parenthood skills and self-confidence. Development: We summarize the main steps in development: the initial assessment and the picture taken from the community under study; the decision making process; the training programme of PHC professionals in action; the review of the protocols of maternal consultation, home visits and antenatal education; the implementation planning; the plan for evaluation the effectiveness of the changes introduced in the delivery of maternal and child health care units. The already developed work has shown that motivation, leadership and organizational issues are decisive for process development.-------------------------- RESUMO - Os Cuidados de Sa��de Prim��rios s��o habitualmente o primeiro contacto com o sistema de sa��de e os profissionais de sa��de s��o mediadores chave na capacita����o dos cidad��os para cuidarem da sua sa��de. Em Portugal, nas ��ltimas d��cadas, t��m-se alcan��ado grandes melhorias nos indicadores biom��tricos de sa��de materno-infantil. Contudo, tem-se dedicado pouca aten����o �� dimens��o de sa��de mental, apesar do reconhecimento da sua import��ncia. A gravidez e primeira inf��ncia t��m sido apontadas como uma oportunidade crucial no ciclo de vida para a promo����o da sa��de mental. �� dado especial enfoque aos primeiros tempos de vida, dado o forte impacto na sa��de da crian��a. O impacte da vincula����o precoce entre a m��e e o beb�� na sa��de da m��e e da crian��a h�� muito que �� reconhecido. Esta vincula����o pode ser influenciada por v��rios factores, nomeadamente pelo ajustamento emocional da m��e. A focaliza����o nestes aspectos pode facilitar a cria����o de condi����es favor��veis e a implementa����o de medidas preventivas. O suporte familiar durante o per��odo de transi����o para a parentalidade tem sido enfatizado como uma medida eficaz e os Cuidados de Sa��de Prim��rios est��o numa posi����o privilegiada como fontes de informa����o e como mediadores. O projecto que apresentamos descreve um processo de investiga����o- ac����o desenvolvido em parceria entre investigadores acad��micos e profissionais de sa��de para abordar os aspectos referidos. Pretende-se capacitar os profissionais de sa��de para apoiarem as fam��lias na transi����o para a parentalidade, promovendo assim a sa��de mental das crian��as. O projecto baseia-se numa abordagem participativa, direccionada para a reorganiza����o dos cuidados durante a gravidez e primeiros tempos de vida. A mudan��a efectiva acontece quando os envolvidos est��o interessados e motivados, o que torna a sua participa����o t��o importante. A reflex��o acerca das pr��ticas e necessidades actuais e o conhecimento acerca de interven����es baseadas na evid��ncia t��m guiado a selec����o das altera����es a introduzir na pr��tica cl��nica, no sentido de promover o suporte familiar e o desenvolvimento de compet��ncias parentais e auto-confian��a. Neste artigo, apresentamos as etapas principais do desenvolvimento do projecto: avalia����o inicial da comunidade em estudo; processo de tomada de decis��o; programa de forma����o dos profissionais dos Cuidados de Sa��de Prim��rios; revis��o dos protocolos da consulta de sa��de materna, visita domicili��ria e educa����o pr��-natal; planeamento da implementa����o; plano de avalia����o da efectividade das altera����es introduzidas na presta����o de cuidados. O trabalho j�� desenvolvido tem mostrado que a motiva����o, lideran��a e aspectos

Effects of a mental health training program on health care worker's knowledge and attitude and practice in Belize��

ABSTRACT This study was conducted to assess mental health knowledge, attitude and practices among health care workers in Belize before and immediately after a competency based training program in mental health. A baseline Knowledge, Attitudes and Practices (KAP) survey was given to health personnel, mainly nurses, working primary and secondary care. The intervention was a 13-week face-to-face training course for health care professionals with the objective of increasing their competency in mental health and reducing stigma. After the training a post intervention KAP survey was conducted among the original respondents. 88 health care workers completed the baseline survey and 61 of those respondents completed the post-intervention questionnaire. The results showed that the level of knowledge of the participants had improved by the training intervention and that in general, the intervention was effective in correcting some misconceptions about mental illness and reducing stigmatizing attitudes among the participants.

Analysis of the pathway of developing a national mental health plan for Suriname

ABSTRACT: The aim of this analysis was to analyze and describe the steps that have been taken in the development of the mental health policy in Suriname after the WHO AIMS. The objectives are: 1.To review the steps to be taken in developing a mental health policy and plan for a country 2.To gather information and data concerning mental health policy and plan development in Suriname 3.To draw conclusion from the experience gained that can be applied to other countries. In general, the information that was gathered from the four countries Guyana, Barbados, Trinidad & Tobago and Suriname, was compared with the WHO steps for developing a mental health policy and plan. Were these steps taken into consideration, when developing their mental health policy and plan? If not, what were the reasons why it did not happen? The checklist for evaluating a mental health plan was used in Suriname. This checklist assisted to see if the results of the recommendations given by the WHO AIMS to develop a effective and balanced mental health plan were taken into consideration. The mayor findings of the analysis are that Suriname as well as Guyana used the steps in developing their mental health policy and plan. Barbados and Trinidad & Tobago did not develop a mental health policy and plan. Suriname and Guyana have a mental health coordinating body at the Ministry of Health. Trinidad & Tobago as well as Barbados have a mental health focal person at the Ministry of Health of the respective countries. It can be concluded that successfully improving of health systems and services for mental health is combining theoretical concepts, expert knowledge and cooperation of many stakeholders. The appointment of a mental health coordinating unit at the Ministry of Health is crucial for the development of mental health in a country. Furthermore, mental health is everyone���s business and responsibility. Implementing the steps to be taken when developing a mental health policy and plan as recommended by WHO may be a slow process requiring the mobilization of political will. That���s why it is crucial that persons responsible for this process work close with all stakeholders in relevant sectors, taking their needs into consideration and try to translate that in clear objectives. It is common knowledge that improving the quality of mental health must be accompanied by the availability of financial and human resources. Finally, a mental health policy and plan should be one document tackling all aspects of mental health of a community.

Analysis of mental health service financial models with a particular emphasis of Ireland

ABSTRACT: Financing is a critical factor in ensuring the optimal development and delivery of a mental health system. The primary method of financing worldwide is tax-based. However many low income countries depend on out-of-pocket payments. There is a report on Irish Health Care funding but none that deals exclusively with mental health care. This paper analyses the various financial models that exist globally with respect to financing the mental health sector, examines the impact of various models on service users, especially in terms of relative ���financial burden��� and provides a more detailed examination of the current mental health funding situation in Ireland After extensive internet and hardcopy research on the above topics, the findings were analysed and a number of recommendations were reached. Mental health service should be free at the point of delivery to achieve universal coverage. Government tax-based funding or mandatory social insurance with government top-ups, as required, appears the optimal option, although there is no one funding system applicable everywhere. Out-of-pocket funding can create a crippling financial burden for service users. It is important to employ improved revenue collection systems, eliminate waste, provide equitable resource distribution, ring fence mental health funding and cap the number of visits, where necessary. Political, economic, social and cultural factors play a role in funding decisions and this can be clearly seen in the context of the current economic recession in Ireland. Only 33% of the Irish population has access to free public health care and the number health insurance policy holders has dramatically declined, resulting in increased out-of-pocket payments. This approach risks negatively impacting on the social determinants of health, increasing health inequalities and negatively affecting economic productivity. It is therefore important the Irish government examines other options to provide funding for mental health services.

The impact of Ireland���s current Mental Health Policy on the profile of community mental Health Services

RESUMO: Em 2006, foi aprovada uma nova pol��tica governamental para a sa��de mental intitulada ���Uma Vis��o para a Mudan��a���, a qual est�� neste momento no s��timo ano de implementa����o. A pol��tica descreve um enquadramento para o desenvolvimento e promo����o da sa��de mental positiva para toda a Comunidade e para a presta����o de servi��os acess��veis, baseados na comunidade, servi��os especializados para pessoas com doen��a mental. A implementa����o da pol��tica e o tornar a ���Vision for Change��� uma realidade t��m sido problem��ticos, com cr��ticas consider��veis por parte dos intervenientes, relativas �� lenta e desconexa implementa����o. Este estudo fornece informa����o sobre as caracter��sticas dos servi��os de tr��s importantes tipos de institui����es de sa��de mental comunit��ria a n��vel nacional, nomeadamente Hospitais de Dia, Centros de Dia e resid��ncias comunit��rias operantes 24 horas. A pesquisa analisa objetivos e fun����es, perfis dos pacientes, atividades terap��uticas, a efic��cia das redes de comunica����o e beneficia da perspectiva dos funcion��rios sobre o que mudou no terreno ao longo dos ��ltimos sete anos. As quest��es identificadas a partir das caracter��sticas dos tr��s servi��os dizem respeito a todos. Os participantes indicaram que o ethos da recupera����o parece ter alcan��ado um papel mais central no tratamento do paciente na comunidade mas reconheceram que o desafio de integrar os princ��pios de recupera����o na pr��tica cl��nica se mant��m presente. Parece ser reconhecida a import��ncia da planifica����o do cuidado individual nos servi��os comunit��rios e os entrevistados indicaram que existe um empenho para garantir o envolvimento do usu��rio do servi��o. H�� diferen��as entre os ���pontos de vista do pessoal��� e os ���pontos de vista dos representantes��� sobre uma s��rie de aspetos da presta����o de servi��os. Este �� o primeiro estudo irland��s deste g��nero a examinar a presta����o de servi��os das tr��s principais institui����es comunit��rias de sa��de mental num s�� estudo. Estes servi��os representam um enorme investimento em recursos, quer a n��vel monet��rio, quer humano. O estudo examinou os desafios e as quest��es fundamentais que lhe s��o aplic��veis e que t��m impacto nestes tr��s tipos de presta����o de servi��os. Tamb��m forneceu informa����es sobre os elementos de mudan��a positiva, os quais se come��am a focar lentamente na presta����o do servi��o, assim como na import��ncia da centralidade do utilizador do servi��o e na promo����o de um ethos da recupera����o.----------ABSTRACT: In 2006, a new Government policy for mental health ���A Vision for Change��� was endorsed and is currently in the seventh year of implementation. The policy describes a comprehensive framework for building and fostering positive mental health across the entire community and for providing accessible, community based, specialist services for people with mental illness. The implementation of the policy and turning ���Vision for Change��� into reality has been problematic with considerable criticism from stakeholders concerning slow and disjointed implementation. This study provides information on three key community mental health service settings, namely Day Hospitals, Day Centres and 24 Hour Community Residences at a national level. The research looks at aims and functions, patient profiles, therapeutic activities, effectiveness of key communication networks and gains an insight from staff on what has changed on the ground over the past seven years. Issues identified from the three service settings pertain to all. Participants indicated that the recovery ethos appears to have moved to a more central role in patient care in the community but acknowledged that the challenge of integrating recovery principles in clinical practice remains present. The importance of individual care planning appears to be recognised in community services and respondents indicated that efforts are being made to ensure service user involvement. There were differences between ���staff views��� and ���advocate views��� on a number of aspects of service provision. This is the first Irish study of its kind to examine service provision across the three main community mental health settings in one study. These services represent a huge investment in resources both on a monetary and human level. This study has examined the challenges and key issues which are applicable and impacting on all three types of service provision. It has also provided information on the elements of positive change, which are slowly embedding themselves in service provision such as the importance of the centricity of the service user and the promotion of a recovery ethos.

Mental health care assessed based on structure, process and outcome : a retrospective cohort study

RESUMO: As doen��as mentais s��o comuns, universais e associadas a uma significativa sobrecarga pessoal, familiar, social e econ��mica. Os Servi��os de Sa��de Mental devem abordar de forma adequada as necessidades dos pacientes e familiares tanto ao n��vel cl��nico como tamb��m ao n��vel social. O presente estudo foi realizado num per��odo de grande transforma����o nos sistemas de sa��de prim��rio e de sa��de mental em Portugal, num Departamento de Psiquiatria desenvolvido com base nos princ��pios da OMS. Os objectivos incluem a caracteriza����o: 1) das Unidades Funcionais do Departamento; 2) dos pacientes internados pela primeira vez no internamento de agudos; 3) da utiliza����o dos servi��os nas equipas comunit��rias ap��s a alta; e 4) da avalia����o de alguns dos indicadores de qualidade do departamento, com recurso ao modelo de Donabedian sobre a articula����o entre a Estrutura-Processo-Resultados. Metodologia: Foi escolhido um estudo de coorte retrospectivo. Todos os pacientes internados pela primeira vez entre 2008 e 2010 foram inclu��dos no estudo. Os seus processos cl��nicos e a base de dados do hospital onde s��o registados todos os contactos que estes tiveram com os profissionais de sa��de mental foram revistos de forma a obter dados sociodemogr��ficos e cl��nicos, durante o per��odo do estudo e ap��s a alta. Os instrumentos utilizados foram o WHO-ICMHC (Classifica����o Internacional de Cuidados de Sa��de Mental), para caracterizar o Departamento, o AIESMP (Avalia����o Inicial de Enfermagem em Sa��de Mental e Psiquiatria) para recolha dos dados sociodemogr��ficos, e o VSSS (Escala de Satisfa����o com os Servi��os de Verona) de forma a avaliar a satisfa����o dos pacientes em rela����o aos cuidados recebidos. A an��lise estat��stica incluiu a an��lise descritiva, quantitativa e qualitativa dos dados. Resultados: As Unidades Funcionais do Departamento revelaram n��veis elevados de articula����o e consist��ncia com as necessidades de cuidados psiqui��tricos e reabilita����o psicossocial dos pacientes. Os 543 pacientes admitidos pela primeira vez eram maioritariamente (56.9%) mulheres, caucasianas (81.2%), com diagn��stico de perturba����es do humor (66.3%), internadas voluntariamente (59.7%), e uma idade m��dia de 45.1 anos. Estas eram significativamente mais velhas, mais frequentemente empregadas, casadas/coabitar e tinham uma preval��ncia mais elevada de perturba����es do humor, comparativamente aos homens. O internamento compulsivo era mais significativo nos homens (54.7%). A taxa de abandono no p��s-alta (4.2%) e a taxa de reinternamentos (2.9%) na quinzena ap��s a alta revelaram-se inferiores aos padr��es na literatura internacional. De forma global, a satisfa����o dos pacientes com os cuidados de sa��de mental foi positiva. Conclus��es: Os cuidados prestados mostraram-se eficazes, adaptados e baseados nas necessidades e problemas espec��ficos dos pacientes. A continuidade e a abrang��ncia de cuidados foram difundidos e mantidos ao longo do processo de cuidados. Este Departamento pode ser considerado um exemplo de como proporcionar tratamento digno e eficiente, e uma refer��ncia para futuros servi��os de psiquiatria.-------------- ABSTRACT: Mental health disorders are common, universal, and associated with heavy personal, family, social and economic burden. Mental health services should be aimed at adequately addressing patients��� and families��� needs at clinical and social level. The current study was carried out at a time of great transformation in the health and mental health systems in Portugal, in a Psychiatric Department developed taking in consideration the WHO principles. The objectives included characterizing: 1) the Psychiatric Department���s different units; 2) the patients admitted for the first time to the inpatient unit; 3) their use of community mental health services after discharge; and 4) assessing some of the department���s quality indicators, with resource to Donabedian���s Structure-Process-Outcome model. Methodology: A retrospective cohort design was chosen. All the firstly admitted patients in the period between 2008 and 2010 were included in the study. Their clinical records and the hospital���s database which registers all of the contacts the patients had with the mental health professionals during the study period, were reviewed to retrieve sociodemographic and clinical data and information on follow-up. The instruments used were the WHO International Classification of Mental Health Care (ICMHC) to characterize the department, the Initial Nurses��� Assessment in Mental Health and Psychiatry (AIESMP) for patients��� sociodemographic data, and the Verona Service Satisfaction Scale (VSSS) to assess patients��� satisfaction with care received. Statistical analysis included descriptive, quantitative and qualitative analysis of the data. Results: The Department���s Functional units revealed high levels of articulation, and were consistent with patients��� needs for psychiatric care and psychosocial rehabilitation. The 543 patients firstly admitted were mainly (56.9%) female, Caucasian (81.2%), diagnosed with mood disorders (66.3%), voluntarily admitted (59.7%), and with a mean age of 45.1 years. Female patients were significantly older, more frequently employed, married/cohabiting and had a higher prevalence of mood disorders when compared to males. Involuntary admission was more significant in males (54.7%). Dropout rates during follow-up (4.2%) and readmission rates (2.9%) in the fortnight following discharge were lower than standards in international literature. Overall patients��� satisfaction with mental health care was positive. Conclusions: The care delivered was effective, adapted and based on the patients��� specific needs and problems. Continuity and comprehensiveness of care was endorsed and maintained throughout the care process. This department may be considered an example of both humane and effective treatment, and a reference for future psychiatric care.

Draft for a Mental Health strategy Lebanon

RESUMO: O L��bano �� um pequeno pa��s na costa leste do Mar Mediterr��neo, com uma popula����o de aproximadamente 4.350.000 pessoas, incluindo 1,5 milh��es de refugiados, 400 mil dos quais s��o palestinos atendidos pela UNRWA (Ag��ncia das Na����es Unidas de Socorro aos Refugiados da Palestina) (UNHCR, 2013; OMS, 2010a). Desde 2012, um excedente de 1.000.000 refugiados s��rios cruzaram a fronteira com o L��bano, representando um aumento populacional de aproximadamente 25%. Al��m disso, entre 1975 e 1990, a violenta guerra civil pela qual o L��bano passou, destruiu grande parte da infra-estrutura do pa��s, incluindo os servi��os de sa��de. O sector da sa��de, mais especificamente os servi��os de sa��de mental, �� majoritariamente privado. Servi��os especializados em Sa��de Mental est��o dispon��veis em tr��s hospitais psiqui��tricos privados, e em 4 unidades psiqui��tricas de hospitais gerais, que est��o localizados centralmente em torno da capital, Beirute. O L��bano �� um dos dois ��nicos pa��ses da regi��o que n��o tem uma Pol��tica de Sa��de Mental e um dos seis pa��ses que n��o t��m uma Legisla����o em Sa��de Mental. Nos ��ltimos anos, a Sa��de Mental est�� sendo colocada no topo da agenda nacional, apesar das cont��nuas quest��es pol��ticas e de seguran��a. Baseando-se nas informa����es acima, um projecto de estrat��gia em Sa��de Mental, conduzido pelo Minist��rio da Sa��de e apoiado pela OMS, foi escrito para servir como um guia para trabalhar em diferentes aspectos relacionados tanto em sa��de mental quanto em organiza����o dos servi��os, revis��o de legisla����o, financiamento e prote����o dos direitos humanos b��sicos dos usu��rios do servi��o. Esta tese descreve o processo pelo qual o projecto de estrat��gia nacional de Sa��de Mental foi desenvolvido, seus principais componentes, os pr��ximos passos a serem tomados para a sua implementa����o, os desafios e as oportunidades para implement��-lo e prop��e alguns passos iniciais a serem tomados em primeiro lugar.----------ABSTRACT: Lebanon is a small country on the eastern shore of the Mediterranean Sea with a population of approximately 4,350,000 including 1,500,000 refugees, 400,000 of whom are Palestinians served by UNRWA (the United Nations Relief and Works Agency for Palestine Refugees) (UNHCR, 2013; WHO, 2010a). Since 2012 an excess of 1,000,000 Syrian refugees have crossed the border into Lebanon accounting for approximately 25% increase in the population. In addition, from 1975 to 1990 Lebanon underwent a violent civil war that had also destroyed much of the country infrastructure including health services. The health sector, more so the mental health services, is mostly private. Specialized Mental Health services are available at three private mental hospitals, and 4 psychiatric units within general hospitals, which are located centrally around the capital, Beirut. Lebanon is one of only two countries of the region that does not have a Mental Health policy and one out of the six countries that does not have a Mental Health legislation. In recent years, Mental Health is getting placed higher on the national agenda despite the ever continuing political and security issues. Based on the above, A Mental Health strategy draft, lead by the Ministry of Health and supported by WHO, was written to serve as a guide to work on different aspects related to Mental Health from service organization, to the revision of legislation, financing and the protection of the basic human rights of service users. This thesis describes the process through which the national Mental Health draft strategy was developed, its main components, the next steps to be taken for its implementation, the challenges and the opportunities to implementing it and proposes a few initial steps to be taken first.

Assessing the efficacy of the Mental Health Gap Action Programme (mhGAP) training for non-specialized health workers in Ethiopia

RESUMO: A OMS lan��ou em 2008, o Programa de Ac����o do Gap em Sa��de Mental (mhGAP) para suprir a falta de cuidados, especialmente em pa��ses de rendimento baixo e m��dio, para as pessoas que sofrem de perturba����es mentais, neurol��gicas e de uso de subst��ncias (MNS). Um componente crucial do mhGAP �� representado pelo esfor��o no sentido da integra����o da sa��de mental nos cuidados de sa��de prim��rios. Na Eti��pia, o mhGAP foi monitorizado durante 3 anos, gra��as a um projeto de demonstra����o implementado em cl��nicas selecionadas em quatro regi��es do pa��s. A fase de demonstra����o de mhGAP na Eti��pia traduziu-se principalmente na forma����o de profissionais de sa��de n��o especializados, fornecendo-lhes orienta����o e supervis��o apoiada para a utiliza����o de medicamentos psicotr��picos essenciais e na coordena����o com o Minist��rio Et��ope Federal da Sa��de, Hospital Amanuel de Sa��de Mental e as Secretarias Regionais de Sa��de ( RHBs ). O presente trabalho investigou a efic��cia do pacote de forma����o mhGAP atrav��s de uma an��lise das pontua����es dos participantes no pr��- e p��s-testes. A an��lise estat��stica mostrou - com uma exce����o - que a melhoria dos formandos �� estatisticamente significativa, o que sugere que os conhecimentos dos participantes �� melhorada na fase de p��s-teste. A efic��cia do pacote de forma����o mhGAP para profissionais de sa��de n��o especializados �� uma evid��ncia promissora de que os mesmos podem ser treinados com sucesso para realizar um pacote b��sico de interven����es para a presta����o de cuidados e tratamento para pessoas com perturba����es mentais, neurol��gicas e de uso de subst��ncias. Este trabalho destaca, tamb��m, v��rias limita����es n��o apenas inerentes ao pr��prio projecto de investiga����o tais como o n��mero limitado de respostas que foram analisadas e a falta de dados de uma das quatro regi��es onde mhGAP foi testado na Eti��pia. As principais limita����es decorrem de facto da abordagem global limitar as interven����es de sa��de mental ao programa de forma����o e supervis��o dos trabalhadores de cuidados de sa��de prim��rios . Este processo s�� ser�� bem sucedido se, juntamente com outras interven����es - que v��o desde o desenvolvimento de curr��culos para o desenvolvimento de uma legisla����o de sa��de mental -, f��r inclu��do numa estrat��gia mais abrangente para a reforma da sa��de mental e desafiar o status quo.-----------ABSTRACT:In 2008, WHO launched the Mental Health Gap Action Programme (mhGAP) to address the lack of care, especially in low- and middle- income countries, for people living with mental, neurological and substance use (MNS) disorders. A crucial component of mhGAP is represented by the endeavor towards integration of mental health into primary health care. In Ethiopia, mhGAP has been piloted for 3 years thanks to a demonstration project implemented in selected clinics in 4 regions of the country. The demonstration phase of mhGAP in Ethiopia has mainly translated into training of non-specialized health workers, providing them with mentorship and supportive supervision, availing essential psychotropic medications and coordinating with the Ethiopian Federal Ministry of Health, Amanuel Mental Health Hospital and the Regional Health Bureaus (RHBs). The present paper investigated the efficacy of the mhGAP training package through an analysis of the participants��� scores at pre-test and post-test. The statistical analysis showed - with one exception - that the improvement of trainees is statistically significant, therefore suggesting that the knowledge of participants is improved in the post-test phase. The efficacy of the mhGAP training package on non-specialized health workers is promising evidence that non-specialized health-care providers can be successfully trained to deliver a basic package of interventions for providing care and treatment for people with mental, neurological and substance use disorders. However, this paper also highlights several limitations, which are not only inherent to the research itself, such as the limited number of scores that was analyzed, or the lack of data from one of the four regions where mhGAP has been piloted in Ethiopia; major limitations occur in fact in the overall approach of confining mental health interventions to training and supervising primary health care workers. This process will only be successful if coupled with other interventions ��� ranging from curricula development to development of a mental health legislation - and if it is included in a more comprehensive strategy to reform mental health and challenge the status quo.

An assessment of the integration of the mental health component into the care of women affected by intimate partner violence in Peru

RESUMO: A viol��ncia contra as mulheres (VCM) �� um problema de sa��de p��blica e uma viola����o dos direitos humanos. Ele tem uma alta preval��ncia na Am��rica Latina e no Caribe; o Estudo da Viol��ncia Contra as Mulheres da Organiza����o Mundial de Sa��de (OMS) identificou que as mulheres peruanas sofrem o maior ��ndice de viol��ncia. O Per�� �� signat��rio da CEDAW e da Conven����o de Bel��m do Par��, com recomenda����es para resolver este tipo de discrimina����o e descrever o papel do setor da sa��de. A lei peruana define a viol��ncia como um problema de sa��de mental. Objectivos: As tr��s orienta����es cl��nicas do Minist��rio da Sa��de para avaliar a integra����o da componente de sa��de mental no cuidado de mulheres afetadas pela VCM foram revistas. M��todo: A prote����o da sa��de mental foi avaliada nas orienta����es acima mencionadas. A lei peruana relevante para perceber o reconhecimento das consequ��ncias de VCM na sa��de mental e os cuidados prestados neste contexto foram revistos. Usando esses padr��es nacionais e internacionais, foi realizada uma an��lise de conte��do dos guias peruanos para a aten����o da viol��ncia para ver como eles se integram a sa��de mental. Resultados: Estas orienta����es s��o muito extensas e n��o definem claramente a responsabilidade dos profissionais de sa��de. N��o incluem um exame de sa��de mental na avalia����o da v��tima e s��o vagas na descri����o das atividades a serem realizadas pelo prestador dos cuidados de sa��de. As orienta����es recomendam uma triagem universal usando um instrumento com formato antiquado e pesado. Em contrapartida, as orienta����es da OMS n��o recomendam qualquer triagem. Conclus��o: As v��rias orienta����es analisadas n��o fornecem a informa����o necess��ria para o profissional de sa��de avaliar o envolvimento da sa��de mental e, desnecessariamente, tratam as mulheres sobreviventes de VCM como doentes mentais. Recomenda-se que as orienta����es recentes da OMS (Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines, 2013) para os cuidados de VCM sejam usadas como um modelo para o desenvolvimento de um ��nico dispositivo t��cnico que incorpora directrizes com base cient��fica. legisla����o com base no g��nero, sa��de, guias, preven����o e mujeres 6 RESUMO (PORTUGUESE) A viol��ncia contra as mulheres (VCM) �� um problema de sa��de p��blica e uma viola����o dos direitos humanos. Ele tem uma alta preval��ncia na Am��rica Latina e no Caribe; o Estudo da Viol��ncia Contra as Mulheres da Organiza����o Mundial de Sa��de (OMS) identificou que as mulheres peruanas sofrem o maior ��ndice de viol��ncia. O Per�� �� signat��rio da CEDAW e da Conven����o de Bel��m do Par��, com recomenda����es para resolver este tipo de discrimina����o e descrever o papel do setor da sa��de. A lei peruana define a viol��ncia como um problema de sa��de mental. Objectivos: As tr��s orienta����es cl��nicas do Minist��rio da Sa��de para avaliar a integra����o da componente de sa��de mental no cuidado de mulheres afetadas pela VCM foram revistas. M��todo: A prote����o da sa��de mental foi avaliada nas orienta����es acima mencionadas. A lei peruana relevante para perceber o reconhecimento das consequ��ncias de VCM na sa��de mental e os cuidados prestados neste contexto foram revistos. Usando esses padr��es nacionais e internacionais, foi realizada uma an��lise de conte��do dos guias peruanos para a aten����o da viol��ncia para ver como eles se integram a sa��de mental. Resultados: Estas orienta����es s��o muito extensas e n��o definem claramente a responsabilidade dos profissionais de sa��de. N��o incluem um exame de sa��de mental na avalia����o da v��tima e s��o vagas na descri����o das atividades a serem realizadas pelo prestador dos cuidados de sa��de. As orienta����es recomendam uma triagem universal usando um instrumento com formato antiquado e pesado. Em contrapartida, as orienta����es da OMS n��o recomendam qualquer triagem. Conclus��o: As v��rias orienta����es analisadas n��o fornecem a informa����o necess��ria para o profissional de sa��de avaliar o envolvimento da sa��de mental e, desnecessariamente, tratam as mulheres sobreviventes de VCM como doentes mentais. Recomenda-se que as orienta����es recentes da OMS (Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines, 2013) para os cuidados de VCM sejam usadas como um modelo para o desenvolvimento de um ��nico dispositivo t��cnico que incorpora directrizes com base cient��fica.-----------------ABSTRACT: Violence against women (VAW) is a public health problem and a human rights violation. It is highly prevalent in Latin America and the Caribbean; the Multi-country Study on Violence against Women by the World Health Organization identified rural Peruvian women as suffering the highest rates of VAW. The country is party to CEDAW and Belen Do Para Conventions, which set forth recommendations to overcome this form of discrimination and describe the role of the health sector. Peruvian law defines violence as a mental health issue. Objective: The Ministry of Health���s three technical guidelines were reviewed to assess the integration of mental health into the care of women affected by violence Method: The protection of the woman���s mental health was ascertained in the conventions mentioned above. The recognition of the mental health consequences of VAW and the inclusion of its evaluation and care were assessed in pertinent Peruvian legislation. Using these international and national parameters, the three guidelines for the attention of violence were subject to content analysis to see whether they conform to the conventions and integrate mental health care. Outcome: These guidelines are too extensive and do not clearly define the responsibility of health workers. They do not include a mental health exam in the evaluation of the victim and are vague in the description of the actions to be carried out by the health care provider. Guidelines prescribe universal screening using an outdated instrument and moreover, WHO Guidelines do not recommend screening. Conclusion: These multiple guidelines do not provide useful guidance for health care providers, particularly for the assessment of mental health sequelae, and unnecessarily stigmatize survivors of violence as mentally ill. It is recommended that the World Health Organization���s document Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines (2013) be used as a blueprint for only one technical instrument that incorporates evidence -based national policy and guidelines.

Income and mental health

RESUMO: A enorme carga e o sofrimento provocado pelas doen��as mentais no mundo tornam imperioso conhecer melhor os seus determinantes. Combater as desigualdades em saude tornou-���se uma prioridadade de sa��de publica, mas e necess��rio estabelecer as suas vias causais para ser poss��vel implementar interven����es e politicas efetivas. A literatura cientifica tem sugerido a import��ncia dos determinantes sociais na etiologia e evolucao das principais doen��as mentais e do suicidio, com especial enfase no papel da desvantagem social. Ainda assim, o papel dos factores psicossociais na sa��de mental, e especificamente o papel do rendimento e da sua distribui����o n��o tem sido investigado no meu pais, Portugal. No meu projecto de investiga����o proponho���me a estudar se em Portugal existe uma associa����o entre as doen��as mentais e o rendimento absoluto e relativo. Pretendo usar os dados do primeiro inqu��rito epidemiol��gico sobre saude mental realizado em Portugal,um inqu��rito nacional transversal no domicilio que foi conduzido em 2009, integrado no WHO World Mental Health Survey Consortium. Nesta tese de mestrado apresento os resultados da minha revis��o da literatura Sobre a rela����o entre oestatuto socio-economico e a sa��de mental e esbo��o uma proposta de pesquisa para continuar a investigar estetema. A evidencia que apresento mostra que a exposi����o aum vasto leque de riscos psicossociais, como o baixo rendimento, a educa����o limitada e o estatuto ocupacionalbaixo,aumenta a probabilidade de desenvolver problemas de sa��de mental.. As diferencas em sa��de seguem um gradiente social, com piores resultados de sa��de a medida que a posi����o na hierarquia social diminui. Tambem sumarizo a literatura sobre o papel do contexto na produ����o de desigualdades em sa��de para alem das caracter��sticas individuais. Tem especial interesse o potencial efeito na sa��de do rendimento relativo e a import��ncia da distribui����o dos rendimentos como determinante de saude. Finalmente, delineio os poss��veis mecanismos atrav��s dos quais o estatuto socio-economico contribui para as disparidades em sa��de.-------------------ABSTRACT: The enormous burden and suffering from mental disorders worldwide makes it imperative to better understand its determinants. Tackling nhealth inequalities has become a public health priority, but it is necessary to establish their causalpathways in order to implement effective interventions and policies. Scientific literature has suggested the importance of social determinants in the aetiology and course of major mental disorders and suicide, with special emphasis on the role of social disadvantage. Nevertheless, the role of psychosocial factors on mental health, and specifically the role of income and its distribution, has not been researched in my home country, Portugal. In my research project I propose to study whether in Portugal there is an association between mental disorders and absolute and relative income. I intend to use data from the first Portuguese Mental Health Survey, a national cross-sectional household survey that was conducted in 2009, integrated in the WHO World Mental Health Survey Consortium. In this masters thesis I present the results of my literature review on the relation between Socioeconomic status and mental health and outline a research proposal to further nvestigate this topic. The body of evidence that I present shows that exposure to a wide range of psychosocial risks, such as low income, limited education, and low occupational status, increases the likelihood of mental health problems. Differences in health follow a social gradient, with worsening health as the position in the social ladder decreases. I also summarize the literature on the role of context in producing health inequalities beyond individual characteristics. Of special interest is the potential health effect of relative income and the importance of income distribution as a health determinant. Finally, I outline the various possible mechanisms for health disparities associated with socioeconomic status.

Mental health and the crisis: Evidence from share

Mental health constitutes a significant share of the global burden of disease. It is shaped to a great extent by socioeconomic factors and is vulnerable to external shocks. The recent financial crisis brought about stressors prone to trigger and aggravate mental illnesses. This project presents a micro analysis of the effect of the economic crisis on mental health in eleven European countries, through the estimation of individual health production functions accounting for socioeconomic controls and macroeconomic indicators. We find that mental health has deteriorated since 2007, even though the development of depression episodes is unchanged. Additionally, his variation can be partially attributed to economic recession and budgetary cuts in health spending.

Assessing the community needs of mental health residential care service users in Republic of Moldova

RESUMO: Background: Problemas de sa��de mental s��o um grande problema cl��nico e social na Rep��blica da Mold��via, representando uma quota significante de defici��ncia, sendo classificada no top cinco das dez linhas na hierarquia das condi����es. A taxa de incid��ncia tem sido crescente na Rep��blica da Mold��via, atingindo cerca de 15.000 por ano (14,655 em 2011), ou seja, 411,4 por 100 mil habitantes, e uma taxa de preval��ncia de 97.525 pessoas em 2011, ou seja, 2,737.9 por 100 mil habitantes. Sistema de atendimento psiqui��trico fornece servi��os de sa��de mental escassos a n��vel da comunidade, visando principalmente terapia hospitalar, centralizada, atrav��s de uma rede de tr��s hospitais psiqui��tricos, com 1.860 camas e 4 sanat��rios psico- neurol��gicos com 1890 camas, assim alimentando-se a estigmatiza����o do paciente. Objetivos: O objetivo deste estudo foi a avalia����o das necessidades individuais dos benefici��rios e do seu n��vel de autonomia dentro de cuidados residenciais, para o planeamento de reformas de sa��de mental e desinstitucionaliza����o na Rep��blica da Mold��via. Este estudo foi encomendado pelo Minist��rio do Trabalho, Prote����o Social e da Fam��lia e pelo Minist��rio da Sa��de, com o apoio da Organiza����o Mundial da Sa��de, para determinar o cumprimento eficaz do artigo 19 da Conven����o da ONU. O estudo tem os seguintes objetivos: Avaliar o n��vel de autonomia dos residentes nos hospitais psiqui��tricos e sanat��rios psico-neurol��gico, usando uma amostra representativa de 10 por ce nto do n��mero total de pacientes/residentes e compara����o cruzada; Para avaliar quatro sanat��rios psico-neurol��gicos para adultos e tr��s hospitais psiqui��tricos; Para desenvolver recomenda����es para o planeamento da desinstitucionaliza����o das pessoas com problemas de sa��de mental e coloca����o na comunidade com base nos resultados do estudo. Metodologia e resultados: O estudo fez uso de duas ferramentas globais: question��rio para a avalia����o individual dos residentes do estabelecimento de sa��de mental, e question��rio de avalia����o institucional. Todos os entrevistados foram divididos em quatro categorias conforme com o grau de depend��ncia e prepara����o de viver de forma independente na comunidade. Apenas 1,2% dos entrevistados de PNHB eram totalmente dependentes de terceiros ou servi��os especializados, tornando-se a categoria 4, que necessitam de cuidados e apoio cont��nuo. No PH esta categoria de pessoas �� ausente. Conclus��es: A condi����o dos entrevistados foi pior em PNBH que em PH. No entanto, ainda, aqueles que est��o prontos para ser desinstitucionalizados correspondem com a maior parte dos entrevistados. Todos os hospitais tinham o consentimento do utente para admiss��o e tratamento, enquanto n��o houve consentimento qualquer em PNBH. �� bastante ��bvio que tanto os hospitais como tamb��m a sistema de assist��ncia residencial n��o atingem a sua finalidade, o que significa que a maioria dos utentes pode ser desinstitucionalizados, sem qualquer terapia de suporte.------------------ABSTRACT: Background: Mental health problems are a major clinical and social issue in the Republic of Moldova,accounting for a significant share of disability and ranking in top five of the ten lines in the hierarchy of conditions. The incidence rate has been growing in the Republic of Moldova to reach approximately 15 thousand a year (14,655 in 2011), i.e. 411.4 per 100 thousand population, and a prevalence rate of 97,525 thousand people in 2011, i.e. 2,737.9 per 100 thousand population. Psychiatric care system provides for scanty mental health services at community level, aiming mainly at centralized hospital-based therapy through a network of three psychiatric hospitals tallying up 1,860 beds and 4 psycho-neurological boarding houses with 1,890 beds, thus fuelling up patient stigmatization. Objectives: The purpose of this study was to assess the individual needs of beneficiaries and their level of autonomy within residential care for the planning of mental health system reforms and deinstitutionalization in the Republic of Moldova. This study was commissioned by the Ministry of Labour, Social Protection and Family and by the Ministry of Health, with the World Health Organization support, to provide for effective enforcement of article 19 of the UN CRPD. The study pursued the following goals: To evaluate the level of autonomy of the psychiatric hospital and psycho-neurological boarding house residents by using a representative sample of 10 per cent of the total number of patients / residents and cross-comparison; To evaluate four psycho-neurological boarding houses for adults and three psychiatric hospitals; To develop recommendations for planning the deinstitutionalization of people with mental health problems and community placement based on the study findings.Methodology and results: The study made use of two global tools: questionnaire for individual assessment of mental health facility residents, and institutional assessment questionnaire. All interviewees were divided into four categories by one���s degree of dependence and readiness to live independently in the community. Only 1.2% of respondents from PNHB were fully dependent on a third party or specialized services, making up category 4, requiring continuous care and support. In PH this category of people is absent.Conclusions: The condition of respondents was worse in PNBH than in PH. However, yet, those ready to be deinstitutionalized accounted for most of respondents there. All hospitals had the resident���s consent to admission and treatment, whereas there was no consent in PNBH whatsoever. It is quite obvious that both the hospitals and residential care system do not achieve their intended purpose, meaning that the majority of residents may be deinstitutionalized without any support therapy.

Rehabilitation and reintegration needs of female inmates and promotion mental health in Georgian prison

RESUMO: As mulheres presas encontram-se num sistema essencialmente dirigido por e concebido para homens. As mulheres que entram na pris��o geralmente v��m de ambientes marginalizados e desfavorecidos e muitas vezes t��m hist��rias de viol��ncia e abuso f��sico e sexual. As mulheres presas s��o um grupo particularmente vulner��vel, uma vez que dentro do sistema prisional as suas necessidades de sa��de e higiene s��o muitas vezes negligenciadas. O primeiro passo para o desenvolvimento de programas e pr��ticas sens��veis ao g��nero �� compreender as caracter��sticas das mulheres delinquentes e definir fatores de vida espec��ficos que contribuem para a forma����o do comportamento criminoso de mulheres. Em junho de 2012 foi realizada uma investiga����o na ��nica pris��o feminina da Ge��rgia, para estudar as necessidades mentais e psicossociais das mulheres presas. O objetivo da pesquisa foi o desenvolvimento de programas de apoio pertinentes para a reabilita����o, ressocializa����o e reintegra����o, e a elabora����o de recomenda����es pr��ticas para a gest��o das pris��es. Foi desenvolvido um instrumento de pesquisa (inqu��rito) com uma fundamenta����o conceptual baseada em quatro principais teorias: Teoria dos Caminhos (Pathways Theory), teoria do desenvolvimento psicol��gico da mulher (Theory of Women���s Psychological Development), Trauma e Teorias da Depend��ncia (Trauma and Addiction Theories). Foram inquiridas 120 mulheres presas. Os resultados deste estudo mostram que muitas das necessidades das mulheres presas s��o diferentes das dos homens e requerem estrat��gias adaptadas ��s suas caracter��sticas e situa����es psicossociais espec��ficas. A maioria das mulheres encarceradas �� jovem, en��rgica, pode trabalhar, tem profiss��o e fam��lia. As presas sofrem de problemas psicol��gicos e muitas vezes s��o rejeitadas pelas suas fam��lias. Uma parte substancial das mulheres presas tem m��ltiplos problemas de sa��de f��sica e mental. A maioria delas tem filhos e sofre com o facto das crian��as estarem a crescer longe da m��e. Com base nos resultados desta investiga����o �� poss��vel elaborar um contexto promotor do planeamento e desenvolvimento de servi��os com um enfoque de g��nero na pris��o. Na perspetiva de longo prazo, o conhecimento das necessidades b��sicas e a introdu����o de programas e servi��os com necessidades espec��ficas pertinentes ir�� beneficiar as presas e as suas fam��lias, e melhorar a efic��cia do sistema de justi��a criminal.----------ABSTRACT: Female inmates find themselves in a system essentially run by men for men. Women who enter prison usually come from marginalized and disadvantaged backgrounds and are often characterized by histories of violence, physical and sexual abuse. Female prisoners constitute an especially vulnerable group given their specific health and hygienic needs within the system are often neglected. The first step in developing gender-sensitive program and practice is to understand female offenders��� characteristics and the specific life factors that shape women���s patterns of offending. In June 2012 a research was carried out in the Georgian only female prison facility to assess the mental and psychosocial needs of women prisoners, aiming to develop effective support programs for their rehabilitation, re-socialization and reintegration, as well as to elaborate new recommendations concerning prison management. A survey instrument (questionnaire) was developed within a theoretical framework based on four fundamental theories: Pathways Theory, Theory of Women���s Psychological Development and Trauma and Addiction Theories. Sample size was defined to be 120 surveyed persons. The study showed that needs of incarcerated women were different from those of men, thus requiring approaches tailored to their specific psychosocial characteristics and situations. The basic population of imprisoned women consisted of young, energetic, working-age females, most often with a professional qualification. Female prisoners suffered from psychological problems and are were more likely to be rejected by their families. Most of them had children and suffered that the children were growing without mothers. A substantial proportion of women offenders had multiple physical and mental health problems. Based on the study findings a conceptual framework can be elaborated towards planning and developing gender-sensitive services in prison. In the long-term perspective, acknowledgement of baseline needs and introduction of the relevant needs-specific programs and services may benefit women prisoners as well as their families, improving the effectiveness of the criminal justice system.

Barriers preventing the successful integration of mental health services into Primary Health Care in Nigeria : a mixed methods approach

RESUMO: A Nig��ria tem uma popula����o estimada em cerca de 170 milh��es de pessoas. O n��mero de profissionais de sa��de mental �� muito diminuto, contando apenas com 150 psiquiatras o que perfaz aproximadamente um r��cio de psiquiatra: popula����o de mais de 1:1 milh��o de pessoas. O Plano Nacional de Sa��de Mental de 1991 reconheceu esta insufici��ncia e recomendou a integra����o dos servi��os de sa��de mental nos cuidados de sa��de prim��rios (CSP). Depois de mais de duas d��cadas, essa pol��tica n��o foi ainda implementada. Este estudo teve como objetivos mapear a estrutura organizacional dos servi��os de sa��de mental da Nig��ria, e explorar os desafios e barreiras que impedem a integra����o bem-sucedida dos servi��os de sa��de mental nos cuidados de sa��de prim��rios, isto segundo a perspectiva dos profissionais dos cuidados de sa��de prim��rios. Com este objetivo, desenvolveu-se um estudo explorat��rio sequencial e utilizou-se um modelo misto para a recolha de dados. A aplica����o em simult��neo de abordagens qualitativas e quantitativas permitiram compreender os problemas relacionados com a integra����o dos servi��os de sa��de mental nos CSP na Nig��ria. No estudo qualitativo inicial, foram realizadas entrevistas com listagens abertas a 30 profissionais dos CSP, seguidas de dois grupos focais com profissionais dos CSP de duas zonas governamentais do estado de Oyo de forma a obter uma vis��o global das perspectivas destes profissionais locais sobre os desafios e barreiras que impedem uma integra����o bem-sucedida dos servi��os de sa��de mental nos CSP. Subsequentemente, foram realizadas entrevistas com quatro pessoas-chave, especificamente coordenadores e especialistas em sa��de mental. Os resultados do estudo qualitativo foram utilizados para desenvolver um question��rio para an��lise quantitativa das opini��es de uma amostra maior e mais representativa dos profissionais dos CSP do Estado de Oyo, bem como de duas zonas governamentais locais do Estado de Osun. As barreiras mais comummente identificadas a partir deste estudo incluem o estigma e os preconceitos sobre a doen��a mental, a forma����o inadequada dos profissionais dos CPS sobre sa��de mental, a perce����o pela equipa dos CSP de baixa prioridade de a����o do Governo, o medo da agress��o e viol��ncia pela equipa dos CSP, bem como a falta de disponibilidade de f��rmacos. As recomenda����es para superar estes desafios incluem a melhoria sustentada dos esfor��os da advocacia �� sa��de mental que vise uma maior valoriza����o e apoio governamental, a forma����o e treino organizados dos profissionais dos cuidados prim��rios, a cria����o de redes de refer��ncia e de apoio com institui����es terci��rias adjacentes, e o engajamento da comunidade para melhorar o acesso aos servi��os e �� reabilita����o, pelas pessoas com doen��a mental. Estes resultados fornecem indica����es ��teis sobre a perce����o das barreiras para a integra����o bem sucedida dos servi��os de sa��de mental nos CSP, enquanto se recomenda uma abordagem hol��stica e abrangente. Esta informa����o pode orientar as futuras tentativas de implementa����o da integra����o dos servi��os de sa��de mental nos cuidados prim��rios na Nig��ria.------------ABSTRACT: Nigeria has an estimated population of about 170 million people but the number of mental health professionals is very small, with about 150 psychiatrists. This roughly translates to a psychiatrist:population ratio of more than 1:1 million people. The National Mental Health Policy of 1991 recognized this deficiency and recommended the integration of mental health into primary health care (PHC) delivery system. After more than two decades, this policy has yet to be implemented. This study aimed to map out the organizational structure of the mental health systems in Nigeria, and to explore the challenges and barriers preventing the successful integration of mental health into primary health care, from the perspective of the primary health care workers. A mixed methods exploratory sequential study design was employed, which entails the use of sequential timing in the combined methods of data collection. A combination of qualitative and uantitative approaches in sequence, were utilized to understand the problems of mental health services integration into PHC in Nigeria. The initial qualitative phase utilized free listing interviews with 30 PHC workers, followed by two focus group discussions with primary care workers from two Local Government Areas (LGA) of Oyo State to gain useful insight into the local perspectives of PHC workers about the challenges and barriers preventing successful integration of mental health care services into PHC. Subsequently, 4 key informant interviews with PHC co-ordinators and mental health experts were carried out. The findings from the qualitative study were utilized to develop a quantitative study questionnaire to understand the opinions of a larger and more representative sample of PHC staff in two more LGAs of Oyo State, as well as 2 LGAs from Osun State. The common barriers identified from this study include stigma and misconceptions about mental illness, inadequate training of PHC staff about mental health, low government priority, fear of aggression and violence by the PHC staff, as well as non-availability of medications. Recommendations for overcoming these challenges include improved and sustained efforts at mental health advocacy to gain governmental attention and support, organized training and retraining for primary care staff, establishment of referral and supportive networks with neighbouring tertiary facilities and community engagement to improve service utilization and rehabilitation of mentally ill persons. These findings provide useful insight into the barriers to the successful integration of mental health into PHC, while recommending a holistic and comprehensive approach. This information can guide future attempts to implement the integration of mental health into primary care in Nigeria.

Mental health and neuroscience. A perspective from the magazine market

Mental health awareness has been rising worldwide, motivated by its social and economic costs. Despite the investment in research in neuroscience in the recent years, little is known about the underlying mechanisms in the brain that are correlated with psychiatric conditions. This project, through two feature articles suitable to be published in magazines, provides perspectives onto mental health research. First it presents an example where psychiatry joins forces with neuroscience and computer science in an interdisciplinary effort to improve the life of those affected by mental disorders. The second article gathers opinions which claim that mental health research priorities should be set by patients themselves, or even that people with lived experience of mental health issues should have an active role in that research. This project was planned and researched while I was an Erasmus student at Nottingham Trent University, in the United Kingdom.