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 saúde mental e das associações de prestadores de cuidados sobre a prestação, o papel e a contribuição de serviços de saúde mental da comunidade tal como foram percebidos por um número de informadores-chave, incluindo os utentes do serviço mentais e os próprios prestadores de cuidados. O caso específico da Sociedade Saúde Mental do Gana (MEHSOG) foi o foco deste estudo. O modelo foi o de um estudo de caso, utilizando discussões de grupo e entrevistas com informadores-chave como instrumentos de recolha de dados. Estas ferramentas de colheita de dados foram complementadas por observações dos participantes e pela revisão de documentos da MEHSOG e dos vários grupos de apoio da comunidade de auto-ajuda que compõem a associação nacional. O estudo revelou que os utentes dos serviços de saúde mental e seus prestadores de cuidados constituem um importante grupo de partes interessadas na prestação de serviços de saúde mental da comunidade e no desenvolvimento de políticas que tenham em conta as necessidades e os direitos das pessoas com doença mental ou epilepsia. O envolvimento da MEHSOG promove a mobilização de membros e famílias relacionadas com a doença mental de beneficiar de serviços de tratamento bem organizados com um impacto significativo na melhoria da saúde e da participação dos utentes dos serviços e seus prestadores de cuidados primários em processos de tomada de decisão da família e na comunidade processos de desenvolvimento. Os utentes dos serviços por beneficiarem de tratamento, e os prestadores de cuidados primários, 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 famílias e das comunidades. A advocacia dos membros da MEHSOG para conseguir que a “Mental Health Bill” se transforme numa Lei foi também um desenvolvimento significativo resultante da participação ativa dos utentes do serviço em chamar a atenção para uma nova e inclusiva legislação de saúde mental para o Gana. Entre os fatores e oportunidades que permitiram aos utentes dos serviços de saúde mental e aos prestadores de cuidados primários de pessoas com doença mental apoiar activamente a prestação de serviços de saúde mental comunitária e o desenvolvimento de políticas conta-se a contribuição da sociedade civil do Gana, particularmente o movimento da deficiência, e os esforços anteriores de ONGs em saúde mental e dos profissionais de saúde mental para ter uma nova lei em saúde mental. Observámos um certo número de desafios e barreiras que actuam de forma a limitar a influência dos utentes dos serviços de saúde mental na provisão da saúde mental comunitária e no desenvolvimento de políticas. Entre elas o estigma social contra a doença mental e pessoas com doença mental ou epilepsia e seus cuidadores primaries é um factor chave. O estigma tem alterado a percepção e as análises do público em geral, especialmente dos profissionais de saúde e das autoridades políticas afetando a priorização dos problemas de saúde mental nas políticas e programas. Outro desafio foi a deficiente infra-estrutura disponível para apoiar serviços de saúde mentais que assegurem aos utentes permanecerem em bom estado de saúde e bem-estar para serem advogados de si próprios. A recomendação do presente estudo é que os movimentos de utentes dos serviços de saúde mental são importantes e que eles precisam de ser apoiados e encorajados a desempenhar o seu papel como pessoas com experiência vivida para contribuir para a organização e prestação de serviços de saúde mental, bem como para a implementação, monitorização e avaliação de políticas 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.

The policy relevance of wear emissions from road transport, now and in the future : an international workshop report and consensus statement

Road transport emissions are a major contributor to ambient particulate matter concentrations and have been associated with adverse health effects. Therefore, these emissions are targeted through increasingly stringent European emission standards. These policies succeed in reducing exhaust emissions, but do not address "nonexhaust" emissions from brake wear, tire wear, road wear, and suspension in air of road dust. Is this a problem? To what extent do nonexhaust emissions contribute to ambient concentrations of PM10 or PM2.5? In the near future, wear emissions may dominate the remaining traffic-related PM10 emissions in Europe, mostly due to the steep decrease in PM exhaust emissions. This underlines the need to determine the relevance of the wear emissions as a contribution to the existing ambient PM concentrations, and the need to assess the health risks related to wear particles, which has not yet received much attention. During a workshop in 2011, available knowledge was reported and evaluated so as to draw conclusions on the relevance of traffic-related wear emissions for air quality policy development. On the basis of available evidence, which is briefly presented in this paper, it was concluded that nonexhaust emissions and in particular suspension in air of road dust are major contributors to exceedances at street locations of the PM10 air quality standards in various European cities. Furthermore, wear-related PM emissions that contain high concentrations of metals may (despite their limited contribution to the mass of nonexhaust emissions) cause significant health risks for the population, especially those living near intensely trafficked locations. To quantify the existing health risks, targeted research is required on wear emissions, their dispersion in urban areas, population exposure, and its effects on health. Such information will be crucial for environmental policymakers as an input for discussions on the need to develop control strategies.

Review of Automated Vehicle Technology: Policy and Implementation Implications; Version 1.0; RB28-015, 2016

This report provides recommendations for the state of Iowa over the next five years in regards to automated vehicle policy development. These administrative, planning, legal, and community strategy recommendations for government agencies include: • Encouraging automation by preparing government agencies, infrastructure, leveraging procurement, and advocating for safety mandates • Adjusting long range planning processes by identifying and incorporating a wide range of new automation scenarios • Beginning to analyze and, as necessary, clarify existing law as it apples to automated driving • Auditing existing law • Enforcing existing laws • Ensuring vehicle owners and operators bear the true cost of driving • Embracing flexibility by giving agencies the statutory authority to achieve regulatory goals through different means, allowing them to make small-scale exemptions to statutory regimes and clarifying their enforcement discretion • Thinking locally and preparing publicly • Sharing the steps being taken to promote (as well as to anticipate and regulate) automated driving • Instituting public education about automated vehicle technologies.

Ethics in Health Policy for Allergy : A Practical Approach for Decision-Makers

Comme à l’approche d’un tsunami, l’incidence grandissante des allergies affecte maintenant plus de 30% de la population des pays développés. Étant la cause de nombreuses morbidités et un risque significatif de mortalité, les allergies nécessitent des dépenses exorbitantes au système de santé et constituent une des plus importantes sources d’invalidité. Cette thèse a pour but de contribuer à faciliter la prise de décision éclairée dans le développement de politiques en santé en lien avec cette maladie immunitaire chronique en utilisant des principes d’éthique comme outils pour guider le développement de politiques en santé. Le premier chapitre démontre le présent déficit d’analyses des enjeux éthiques en allergologie et démontre de quelle façon les réflexions en éthique peuvent guider le développement de politiques et l’élaboration de stratégies appliquées aux allergies. Les chapitres qui suivront présentent des applications spécifiques des principes d’éthiques ciblant des contextes précis comme des méthodes qui fournissent des outils de réflexion et des cadres théoriques qui peuvent être appliqués par les décideurs pour guider des interventions en santé concernant les allergies et les conditions de co-morbidité reliées. Le second chapitre présente un cadre théorique pour l’évaluation et la priorisation d’interventions en santé publique par la diminution des allergènes présents dans l’environnement basées sur des théories de justice sociale. Les critères entourant les politiques d’évaluation se concentrent sur les enjeux éthiques référant aux populations vulnérables, sur une distribution plus égale des bénéfices pour la santé, et sur le devoir d’éviter la stigmatisation. Le troisième chapitre offre aux administrateurs et au personnel infirmier du réseau scolaire un cadre décisionnel pour guider le développement de politiques efficaces et éthiquement justifiables concernant les allergies alimentaires pour les écoles. Dans ce contexte, les principes de base d’éthique en santé publique et en bioéthique - par exemple, l’empowerment des populations vulnérables dans la prise en charge de leur santé et la protection de la confidentialité du dossier médical - servent d’outils pour évaluer les politiques. Le dernier chapitre emploie les principes de base de recherche en éthique comme méthode pour développer un argumentaire en faveur de la réforme des réglementations entourant la production de médicaments immunothérapeutiques. La nécessité éthique d’éviter les risques de méfait à l’endroit du sujet humain dans la recherche permettra de servir de guide pour structurer de futures politiques en santé publique en égard à la production d’immunothérapeutiques à l’échelle mondiale.

The Masters in Teaching and Learning (MTL): a retrospective, intrinsic case study of the process of policy into practice and its impact on teacher participants

The research reported here is a retrospective case study of the recent (2010) introduction of the Masters in Teaching and Learning (MTL) as a post-graduate level programme of professional development for teachers. It contributes to the debate and research over the past two decades about the impact of post-graduate professional development and appropriate ways of delivering it. The study is located within an extensive body of literature dealing with the importance of the teaching profession with regard to the success of schools and pupils and the impact of professional development on teaching quality and of teaching quality on attainment. A further relevant context is the ongoing tension between the teaching profession and academics on the one hand and government and political actors on the other, in respect of the approaches to professional development and to the control of educational processes. The research questions which inform the study deal with the perspectives of various participants – policy makers, programme directors, coaches and teachers studying for the MTL – on the extent to which the MTL is likely to have an ameliorative effect on teaching and pupil attainment, their experiences of the process of policy development and their experiences as course participants. The study adopts a case study approach which involves elite interviews with those responsible for the development and implementation of the MTL, questionnaires completed by MTL course participants and a comparison group taking a conventional MA and in depth interviews with participants and coaches. The results revealed tensions and difficulties associated with the development of the MTL including uneasy relationships between HE institutions and government agencies, ideas about ‘producer capture’, the relevance of the MBA model and concern over the role of coaches. However, while acknowledging various difficulties and some misconceived expectations they viewed its potential to meet its expressed aims positively, given time. Course participants were positive about their experience of the MTL and felt that it had contributed to many aspects of their professional development. Most saw it as a positive experience despite the variable quality of support from their schools, particularly in the form of the school-based coach the concept of which had been heralded as the bellwether of the MTL. It was striking that the responses of the MTL participants were very similar to those of teachers taking a conventional MA. A finding which would repay further investigation is that while the great majority of course participants felt that the MTL (and the MA) had contributed to their becoming more effective teachers they were much less confident that it had contributed to increased pupil attainment.

Policy instruments to improve energy efficiency in buildings

The newly adopted energy efficiency directive (2012/27/EU) highlights the importance of energy efficiency in reaching the Union’s 2020 targets. The directive commits member states to defining national energy efficiency targets (art. 3), achieving yearly energy savings of 1.5% of the annual energy sales through the energy efficiency obligation scheme (art. 7), and providing a long-term strategy for the building sector that aims at a 3% refurbishment rate for public buildings (art. 4+5). Buildings currently account for 40% of energy use in most countries, putting them among the largest end-use sectors. This report takes a closer look at the best practices for implementing increasing energy efficiency in different regions and countries in Europe. The final aim is to identify some policy tools to be suggested to the region of Dalarna (Dalarna having been chosen as the pilot county in Sweden) as a means of implementing energy efficiency in the building sector. The final objective is to give analysts and decision-makers a better analytical foundation to explore future policy development in the area of buildings to be proposed and tested at the regional level in Dalarna and later at the national level in Sweden.

Immigration as a strategic vector for the socio-economic and institutional development of Brazil

Brazil has demonstrated resilience in relation to the recent economic crises and has an auspicious development potential projected for the coming decades, which, linked to the globalization process, provides important opportunities for our people. Gradually we have established ourselves as one of the leading nations in the world and we have become a reference in questions linked to economic equilibrium, development, energy, agriculture and the environment. This international recognition favors the exchange of experiences with other cultures, governments and organizations, bringing with it the possibility of stimulating a dynamic process of development and innovation.

Digital review 2007 of Latin America and the Caribbean: progress and challenges policies for development with ICT. Abridged document

Includes bibliography

Exploiting the potential of the Caribbean information society as an enabler of human development in the region

Includes bibliography

A model of factors determining levels of public support for health care policy in the United States

Public preferences for policy are formed in a little-understood process that is not adequately described by traditional economic theory of choice. In this paper I suggest that U.S. aggregate support for health reform can be modeled as tradeoffs among a small number of behavioral values and the stage of policy development. The theory underlying the model is based on Samuelson, et al.'s (1986) work and Wilke's (1991) elaboration of it as the Greed/Efficiency/Fairness (GEF) hypothesis of motivation in the management of resource dilemmas, and behavioral economics informed by Kahneman and Thaler's prospect theory. ^ The model developed in this paper employs ordered probit econometric techniques applied to data derived from U.S. polls taken from 1990 to mid-2003 that measured support for health reform proposals. Outcome data are four-tiered Likert counts; independent variables are dummies representing the presence or absence of operationalizations of each behavioral variable, along with an integer representing policy process stage. Marginal effects of each independent variable predict how support levels change on triggering that variable. Model estimation results indicate a vanishingly small likelihood that all coefficients are zero and all variables have signs expected from model theory. ^ Three hypotheses were tested: support will drain from health reform policy as it becomes increasingly well-articulated and approaches enactment; reforms appealing to fairness through universal health coverage will enjoy a higher degree of support than those targeted more narrowly; health reforms calling for government operation of the health finance system will achieve lower support than those that do not. Model results support the first and last hypotheses. Contrary to expectations, universal health care proposals did not provide incremental support beyond those targeted to “deserving” populations—children, elderly, working families. In addition, loss of autonomy (e.g. restrictions on choice of care giver) is found to be the “third rail” of health reform with significantly-reduced support. When applied to a hypothetical health reform in which an employer-mandated Medical Savings Account policy is the centerpiece, the model predicts support that may be insufficient to enactment. These results indicate that the method developed in the paper may prove valuable to health policy designers. ^

Development strategy in Bihar through revitalizing the agricultural sector : a preliminary analysis

Based mainly on secondary data and partly on primary information obtained through field surveys in selected rural areas in Bihar in 2011, this paper firstly argues the critical importance of agricultural growth for overall economic development, and then reviews the sluggish growth of agriculture in Bihar in the past and examines the major reasons for this. The long-term negligence of agricultural research (especially development and diffusion endeavors for improved rice varieties suitable to the local conditions of Bihar) by the state government and some sort of ‘backwardness’ in tube-well irrigation technology can be pointed out as important constraints. There is, in particular, the ‘paradox’ in Bihar agriculture of why rice and wheat yields have remained so low in spite of the relatively well-developed irrigation by tube-wells. Finally, by showing the process of a rapid increase in autumn and winter rice yields during the 1990s in West Bengal, it is suggested that Bihar farmers and policy-makers should learn from the experience of West Bengal in order to get some hints for the development of the rice sector in Bihar.

Antitrust, regulatory capture and economic integration. Bruegel Policy Contribution ISSUE 2015/11, JULY 2015

There is growing worldwide concern about bias in the enforcement of competition law in favour of domestic firms. Even seemingly neutral antitrust laws can lead discrimination if they are enforced selectively. - Authors investigate the distortions that national competition authorities generate when they pursue non-competition goals in favour of domestic firms, and discuss ways to address this negative policy development in a globalised world. - The distortions identified in the paper would dissipate if governments agreed that the sole objective of competition law ought to be the protection of consumer welfare that competition-law institutions ought to be protected against capture. - A realistic and effective way to prompt international convergence towards independent enforcement of competition laws is through the inclusion of competition clauses in bilateral trade agreements and the development of dispute-resolution mechanisms.