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.

An Atlas for the future National Park: Las Cumbres de la Sierra de Guadarrama

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

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

RESUMO: Em 2006, foi aprovada uma nova política governamental para a saúde mental intitulada “Uma Visão para a Mudança”, a qual está neste momento no sétimo ano de implementação. A política descreve um enquadramento para o desenvolvimento e promoção da saúde mental positiva para toda a Comunidade e para a prestação de serviços acessíveis, baseados na comunidade, serviços especializados para pessoas com doença mental. A implementação da política e o tornar a “Vision for Change” uma realidade têm sido problemáticos, com críticas consideráveis por parte dos intervenientes, relativas à lenta e desconexa implementação. Este estudo fornece informação sobre as características dos serviços de três importantes tipos de instituições de saúde mental comunitária a nível nacional, nomeadamente Hospitais de Dia, Centros de Dia e residências comunitárias operantes 24 horas. A pesquisa analisa objetivos e funções, perfis dos pacientes, atividades terapêuticas, a eficácia das redes de comunicação e beneficia da perspectiva dos funcionários sobre o que mudou no terreno ao longo dos últimos sete anos. As questões identificadas a partir das características dos três serviços dizem respeito a todos. Os participantes indicaram que o ethos da recuperação parece ter alcançado um papel mais central no tratamento do paciente na comunidade mas reconheceram que o desafio de integrar os princípios de recuperação na prática clínica se mantém presente. Parece ser reconhecida a importância da planificação do cuidado individual nos serviços comunitários e os entrevistados indicaram que existe um empenho para garantir o envolvimento do usuário do serviço. Há diferenças entre os „pontos de vista do pessoal‟ e os „pontos de vista dos representantes‟ sobre uma série de aspetos da prestação de serviços. Este é o primeiro estudo irlandês deste género a examinar a prestação de serviços das três principais instituições comunitárias de saúde mental num só estudo. Estes serviços representam um enorme investimento em recursos, quer a nível monetário, quer humano. O estudo examinou os desafios e as questões fundamentais que lhe são aplicáveis e que têm impacto nestes três tipos de prestação de serviços. Também forneceu informações sobre os elementos de mudança positiva, os quais se começam a focar lentamente na prestação do serviço, assim como na importância da centralidade do utilizador do serviço e na promoção de um ethos da recuperação.----------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.

The effects of land-use development policies on forest management

This paper develops a model of a forest owner operating in an open-city environment, where the rent for developed land is increasing concave in nearby preserved open space and is rising over time reflecting an upward trend in households’ income. Thus, our model creates the possibility of switching from forestry to residential use at some point in the future. In addition it allows the optimal harvest length to vary over time even if stumpage prices and regeneration costs remain constant. Within this framework we examine how adjacent preserved open space and alternative development constraints affect the private landowner´s decisions. We find that in the presence of rising income, preserved open space hastens regeneration and conversion cuts but leads to lower density development of nearby unzoned parcels due to indirect dynamic effects. We also find that both a binding development moratorium and a binding minimum-lot-size policy can postpone regeneration and conversion cut dates and thus help to protect open space even if only temporarily. However, the policies do not have the same effects on development density of converted forestland. While the former leads to high-density development, the latter encourages low-density development.

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.

"A reserva ecológica nacional e a sua importância para o ordenamento do território"

This work primarily aims to investigate the ambiguity between the right to build and the need to preserve nature through one of its instruments: the National Ecological Reserve. In both national and international political effort, forced by increasing ecological awareness of the society were being created regulations for environmental problemsolving frameworks. This significant increase in provisions, that regulated the environment and spatial territory, are directly related to the objectives of the European community. In a year when the soil policy has changed, it is important to review the priorities of regional planning in the face of environmental policies. REN is a restriction of public utility that, among other things, aims to define and integrate diverse areas of our territory which by their structure are essential to the ecological stability of the environment. Going through a historical study of the various regimes that regulated REN, the present work aims to inform the understanding of the concept REN, exposing its objectives and form of delimitation of integrated areas, in order to answer questions about the nature of this institute. It were related to all regulations governing the ecological reserves and land, namely Scheme for Conservation of Nature and Biodiversity; Natura 2000, the National Agricultural Reserve, the Law of the ownership of water resources and water, and the RJIGT RJUE, checking to its compatibility with REN. Through a literature review regarding the jurisprudence of national courts applying the doctrine, analysis of legal regimes, analysis of maps depicting the REN, we carried out a qualitative assessment of the trend and legal effect of REN in protecting populations and environment. Therefore we will work with this reflect on the existing environment awareness in our society and its problems in the management of natural resources.

Role of Intersectoral Collaboration in Mental Health Policy Formulation And Service Delivery in Saint Lucia

RESUMO: Santa Lúcia pequena ilha de país em desenvolvimento com recursos limitados e é confrontada com uma série de desafios socioeconômicos que exigem soluções criativas e inovadoras. É comprovado que a combinação de recursos entre setores para estabelecer os determinantes social, econômico e ambiental da saúde são uma estratégia útil para melhorar a saúde da população, principalmente a sua saúde mental. Este estudo, o primeiro do seu tipo em Santa Lúcia, procurou examinar até que ponto a disponibilidade de uma política nacional de saúde mental levou a ação intersetorial para o fornecimento de serviços e promoção da saúde mental. Além disso, o estudo examinou o nível de colaboração intersetorial que existe entre as agências que prestam cuidados diretos e serviços de suporte para pessoas com doenças mentais e problemas sérios de saúde mental. O estudo também teve como objetivo identificar os fatores que promovem ou dificultam a colaboração intersectorial e gerar recomendações que possam ser aplicadas para países muito pequenos e com perfis socioeconômicos semelhantes. Os dados gerados a partir de três (3) fontes foram sintetizados para formar uma visão ampla das questões. Uma avaliação da política de saúde mental de 2007, uma avaliação que identifica até que ponto a ação intersetorial atualmente deixa a prestação de serviços de saúde mental e a administração de entrevistas semiestruturadas nas mãos de gestores do programa de diferentes agências em todos os setores. O estudo concluiu que, apesar da disponibilidade de uma política de saúde mental, que articula clara e explicitamente a colaboração intersetorial como área prioritária para ação, quase não existe no sistema de fornecimento atual do serviço. Os provedores de serviços em todos os setores reconhecem que há os benefícios da colaboração intersectorial e com entraves significativos em relação à colaboração intersetorial, que por sua vez, impede uma abordagem nacional para o planejamento e o fornecimento do serviço. A colaboração intersetorial não será possível se os próprios setores dependerem da abordagem direta do setor da saúde ou se a atmosfera geral for ofuscada pela estigmatização das doenças mentais.------------------------------------------------------------------------ABSTRACT: Saint Lucia a small island developing country with limited resources, is faced with a number of socio-economic challenges which require creative and innovative solutions to address. Combining resources across sectors to address the social, economic and environmental determinants of health has proven to be a useful strategy for improving population health in particular mental health. This study, the first of its kind for Saint Lucia sought to examine the extent to which the availability of a national mental health policy led to intersectoral action for mental health promotion and service delivery. In addition the study examined the level of intersectoral collaboration which actually exist between agencies which provide direct care and support services to people with mental illnesses and significant mental health problems. The study also aimed to identify the factors which promote or hinder intersectoral collaboration and generate recommendations which can be applied to extremely small countries with similar socio-economic profiles. Data generated from three (3) sources was synthesized to form a broad picture of the issues. An evaluation of the mental health policy of 2007, an assessment of the extent to which intersectoral action currently exist in mental health service delivery and the administration of semi-structured interviews with program managers from different agencies across sectors to identify implementation issues. The study concluded that despite the availability of a mental health policy which clearly and explicitly articulates intersectoral collaboration as a priority area for action, very little exists in the current service delivery system. Services providers across sectors acknowledge the benefits of intersectoral collaboration and that there are significant barriers to intersectoral collaboration, which in turn hinders a national approach to service planning and delivery. Intersectoral collaboration is not possible if sectors themselves are dependent on a top-down health sector driven and dominated approach, or if the general atmosphere is clouded by stigmatization of mental health illnesses.

Assessment of national parks affected by naturbanization processes in Southern Europe

This paper assesses land-use changes related to naturbanization processes on three biosphere reserves in Southern Europe. A comparative analysis has been done on the National Parks in Peneda-Ger^es in North Portugal, C_evennes in South France and Sierra Nevada in South Spain, using Corine Land Cover data from 1990 until 2006. Results indicate that the process of land-use intensification is taking place in the frame of naturbanization dynamics that could jeopardize the role of Protected Areas. Focusing on the trends faced by National Parks and their surrounding territories, the analysis demonstrates, both in quantitative and spatial terms, the intensification processes of land-use changes and how it is important to know them for coping with increasing threats. The article concludes that in the current context of increasing stresses, a broader focus on nature protection, encompassing the wider countryside, is needed if the initiatives for biodiversity protection are to be effective.

Changes in institutional governance and management of higher education in Laos: National University of Laos

PhD thesis in Educational Sciences (specialization in Politics of Education).

Adult learning and education policies in Germany, Portugal and Sweden: An analysis of national reports to CONFINTEA VI

The chapter presents a theoretical proposal of three analytical models of Adult Learning and Education (ALE) policies. Some analytical categories and the corresponding dimensions are organised according to the ALE rationale which is typical of each social policy model. Historical, cultural and educational features are mentioned in connexion with the different policy models and its interpretative capacity to making sense of policies and practices implemented in Germany, Portugal and Sweden. !e analysis includes the states of the art and the official representations of ALE produced by the respective national authorities through national reports which were presented to CONFINTEA VI (2009).

Cohesion policy in the European Union: a brief critical review

Over the past four decades the EU cohesion policy’s focus, objectives and content have experienced significant changes as a result of successive reforms aiming at adapting it to a Union in constant evolution. In the early stages, cohesion policy had eminently redistributive goals and it assumed an explicit spatial dimension. In the late nineties, the possibility of an extension towards Eastern European countries and the limited willingness of net contributors to increase funding led to a turning point in cohesion policy. The increased importance of economic growth and job creation in the 2000’s, within the cohesion policy’s context, has led to a misrepresentation of its essence and motivations. Cohesion was losing importance towards competitiveness and regional equity towards national efficiency. Today, cohesion policy is for many EU countries the main mean for mobilising investment in a context of budgetary constraints and credit rationing. In light of the available evidence, it is likely that the overall design and priorities of the current cohesion policy have a limited impact in terms of convergence in many EU regions, especially in the less developed regions. This paper’s main objectives are to analyse the evolution of European cohesion policy throughout its history, to present a picture of cohesion policy in the 2014-2020 programming period and to discuss the main problems associated with its design, priorities and programming model.

Interactions between fiscal and monetary policy

Mestrado em Economia Monetária e Financeira

Investigating the long term planning framework for the Galway Bay community from climate change.

This research looked at the scientific evidence available on climate change and in particular, projections on sea level rise which ranged from 0.5m to 2m by the end of the century. These projections were then considered in an Irish context. A review of current policy in Ireland revealed that there was no dedicated Government policy on climate change or coastal zone management. In terms of spatial planning policy, it became apparent that there was little or no guidance on climate change either at a national, regional or local level. Therefore, to determine the likely impacts of sea level rise in Ireland based on current spatial planning practice and policy, a scenario-building exercise was carried out for two case study areas in Galway Bay. The two case study areas were: Oranmore, a densely populated town located to the east of Inner Galway Bay; and Tawin Island, a rural dispersed community, located to the south east of Inner Galway Bay. A ‘best’ and ‘worse’ case scenario was envisaged for both areas in terms of sea level rise. In the absence of specific climate change policies it was projected that in the ‘best’ case scenario of 0.5m sea level rise, Tawin Island would suffer serious and adverse impacts while Oranmore was likely to experience slight to moderate impacts. However, in the ‘worse’ case scenario of a 2m sea level rise, it was likely that Tawin Island would be abandoned while many houses, businesses and infrastructure built within the floodplain of Oranmore Bay would be inundated and permanently flooded. In this regard, it was the author’s opinion that a strategic and integrated climate change policy and adaptation plan is vital for the island of Ireland that recognises the importance of integrated land use and spatial planning in terms of mitigation and adaptation to climate change.

Recent brazilian experience on farmer reaction and crop response to fertilizer use

(1) In the period 1965/77 fertilizer consumption in Brazil increased nearly fifteen foild from circa 200,000 tons of N + P2O5 + K2O to 3 million tons. During the fifteen years extending from 1950 to 1964 usage of the primary macronutrients was raised by a factor of 2 only. (2) Several explanations are given for the remarkable increase, namely: an experimental background which supplied data for recommendations of rates, time and type of application; a convenient governmental policy for minimum prices and rural credit; capacity of the industry to meet the demand of the fertilizer market; an adequate mechanism for the diffusion of the practice of fertilizer use to the farmer. (3) The extension work, which has caused a permanent change in the aptitude towards fertilization, was carried out in the traditional way by salesmen supported by a technical staff, as well as by agronomists of the official services. (4) Two new programs were started and conducted in a rather short time, both putting emphasis on the relatively new technology of fertilizer use. (5) The first program, conducted in the Southern part of the country, extended lab and green house work supplemented by a few field trials to small land owners - the so called "operação tatú" (operation armadillo). (6) The seconde program, covering a larger problem area in the Northeast and in Central Brazil, began directly in field as thousands of demonstrations and simple experiments with the participation of local people whose involvement was essential for the success of the initiative; in this case the official extension services, both foreign and national sources of funds, and universities did participate under the leadership of the Brazilian Association for the Diffusion of Fertilizers (ANDA). (7) It is felt that the Brazilian experience gained thereof could be useful to other countries under similar conditions.

Choice of Contracts in the British National Health Service: An Empirical Study

Following major reforms of the British National Health Service (NHS) in 1990, the roles of purchasing and providing health services were separated, with the relationship between purchasers and providers governed by contracts. Using a mixed multinomial logit analysis, we show how this policy shift led to a selection of contracts that is consistent with the predictions of a simple model, based on contract theory, in which the characteristics of the health services being purchased and of the contracting parties influence the choice of contract form. The paper thus provides evidence in support of the practical relevance of theory in understanding health care market reform.