Mental health and human rights: never waste a serious crisis

A serious health and human rights crisis is unfolding in Indonesia. Media reports in the Jakarta press have highlighted the high death rates in shelters for people with mental illness that are run by the Jakarta Social Affairs Agency. This crisis represents an opportunity to bring about systematic and substantial changes in the Indonesian mental health system. In order to realise this opportunity the necessary elements of an approach are presented and briefly discussed

International observatory on mental health systems: structure and operation

<p>Abstract</p> <p>Introduction</p> <p>Sustained cooperative action is required to improve the mental health of populations, particularly in low and middle-income countries where meagre mental health investment and insufficient human and other resources result in poorly performing mental health systems.</p> <p>The Observatory</p> <p>The International Observatory on Mental Health Systems is a mental health systems research, education and development network that will contribute to the development of high quality mental health systems in low and middle-income countries. The work of the Observatory will be done by mental health systems research, education and development groups that are located in and managed by collaborating organisations. These groups will be supported by the IOMHS Secretariat, the International IOMHS Steering Group and a Technical Reference Group.</p> <p>Summary</p> <p>The International Observatory on Mental Health Systems is: 1) the mental health systems research, education and development groups; 2) the IOMHS Steering Group; 3) the IOMHS Technical Reference Group; and 4) the IOMHS Secretariat. The work of the Observatory will depend on free and open collaboration, sharing of knowledge and skills, and governance arrangements that are inclusive and that put the needs and interests of people with mental illness and their families at the centre of decision-making. We welcome contact from individuals and institutions that wish to contribute to achieving the goals of the Observatory.</p> <p indent="1"><it>Now is the time to make it happen where it matters, by turning scientific knowledge into effective action for people's health</it>. (J.W. Lee, in his acceptance speech on his appointment as the Director-General of the World Health Organization) <abbrgrp><abbr bid="B1">1</abbr></abbrgrp>.</p

Attitudes Towards Youth Suicide: A Comparison Between Italian, Indian and Australian Students

There is a paucity of cross-cultural research on youth suicidal behaviour. An understanding of the cultural aspects of suicidal behaviour is essential for the development of culturally appropriate suicide prevention and intervention strategies. In this study, meanings, cultural representations, attitudes, values and beliefs regarding youth suicide were explored in 700 young Italians, Indians and Australians. Participants were University students (18-24 years old) from Italy, India and Australia. Participants had to be at least second generation, i.e. both they and their parents were born in the countries included in the study. Data collection was through completion of a questionnaire with structured and semi-structured questions (e.g. case vignettes, word associations, attitude scale, open-ended questions) and focus groups. In this proceedings, findings about the attitudes towards suicide focusing on the differences/similarities by country, gender, spiritual beliefs and suicide risk will be presented and the implications of the findings for suicide risk assessment and treatment will be discussed

Why focus on mental health systems?

The global situation for people with mental illness – in developing and developed countries – is dire. Legislative and human rights protections are frequently lacking. Mental health budgets are inadequate. There are insufficient numbers of skilled policy makers, managers and clinicians. Communities are poorly informed about mental health and illness and not well organised for purposes of advocacy. In most of the world, mental health services are inaccessible or of poor quality. Most people who would benefit from psychiatric treatment and rehabilitation do not have affordable access to such services. Leadership – at all levels – for mental health system development needs to be greatly strengthened

Development of the Nursing Relationships Scale: a measure of interpersonal approaches in nursing care

BACKGROUND: There is no comprehensive measure of dimensions describing the nursing relationship that is suitable for use with survey samples and that is focused on nursing particular types of patients. The objective of this study was to develop a measure to investigate significant dimensions of the nurse-patient relationship, the Nursing Relationship Scale (NRS). METHODS: Hypothetical cases (diabetes or mental illness) in vignette format were presented to 132 psychiatric and 76 general nurses. Thirty-four questions about the nurse-patient interaction were asked. Principal component analyses (with oblique rotation) were used to identify underlying dimensionality in the correlations of items, combining ratings from the two case vignettes. Scales were constructed from the final solution and Cronbach's alpha coefficients calculated. Subscale score variations were analysed across nurse type and patient type to examine the discriminant validity of the subscales. RESULTS: Principal components analysis revealed five dimensions accounting for 52 percent of the variation within items. Four 'conceptual' factors were derived. These were labeled Caring/Supportive Approach, Nursing Satisfaction, Authoritarian Stance, and Negativity. Developed as subscales, reliability analysis indicated high internal consistency with respective alpha coefficients for the diabetes case 0.91, 0.75, 0.65, and 0.78 and for the mental illness case of 0.91, 0.75, 0.73, and 0.85. There was significant variation in scale scores according to nurse type (psychiatric versus general) and patient type (diabetes versus mental illness). Nurses endorsed more highly items from the subscales Caring/Supportive Approach and Nursing Satisfaction than items from Authoritarian Stance (with intermediate endorsement) and Negativity (lowest endorsement) subscales. CONCLUSIONS: Psychometric evaluation of the NRS suggests it is a reliable instrument for measuring four key dimensions of the nurse-patient relationship and enables the study of this relationship in large samples

Where there is no evidence: use of expert consensus methods to fill the evidence gap in low-income countries and cultural minorities

<p>Abstract</p> <p>Background</p> <p>In both developing countries and in relation to cultural minorities there have been calls to scale up mental health services and for evidence-informed policy and practice.</p> <p>Evidence based medicine</p> <p>The evidence based medicine movement has had a major influence in improving practice. However, implementation of this approach has some major difficulties. One that has been neglected is the situation where there is no relevant evidence. This situation is more likely to occur for healthcare decisions in developing countries or for cultural minorities within developed countries, because resources do not exist for expensive research studies.</p> <p>Consensus methods</p> <p>Consensus methods, such as the Delphi process, can be useful in providing an evidence base in situations where there is insufficient evidence. They provide a way of systematically tapping the expertise of people working in the area and give evidence that is readily applicable for a particular country and culture. Although consensus methods are often thought of as low in the hierarchy of evidence, consensus is central to the scientific process. We present four examples where the Delphi method was used to assess expert consensus in situations where no other evidence existed: estimating the prevalence of dementia in developing countries, developing mental health first aid guidelines in Asian countries, mental health first aid guidelines for Australian Aboriginal people, and modification of the concept of 'recovery' for Australian immigrant communities.</p> <p>Conclusion</p> <p>Consensus methods can provide a basis for decision-making and considered action when there is no evidence or when there are doubts about the applicability of evidence that has been generated from other populations or health system settings.</p

Aceh Free Pasung: Releasing the mentally ill from physical restraint

<p>Abstract</p> <p>Background</p> <p>Physical restraint and confinement of the mentally ill (called <it>pasung </it>in Indonesia) is common in Aceh. In early 2010, the local government initiated a program called <it>Aceh Free Pasung </it>2010. The main goal of the program is to release the mentally ill in the province from restraint and to provide appropriate medical treatment and care. The aim of the paper is to report the findings of a preliminary investigation of the demographic and clinical characteristics of patients who have been admitted to the Banda Aceh Mental Hospital as part of the <it>Aceh Free Pasung </it>program.</p> <p>Methods</p> <p>This is a cross-sectional descriptive study conducted at the Banda Aceh Mental Hospital, where people who had been restrained or confined in the community are being admitted for psychiatric treatment and, where necessary, physical rehabilitation, as part of the <it>Aceh Free Pasung </it>program.</p> <p>Results</p> <p>Fifty-nine of former ex-<it>pasung </it>patients were examined. The majority (88.1%) of the patients were male, aged 18 to 68 years. The duration of <it>pasung </it>varied from a few days to 20 years, with a mean duration of 4.0 years. The reasons for applying <it>pasung </it>are many, with concerns about dangerousness being most common. The great majority (89.8%) had a diagnosis of schizophrenia.</p> <p>Discussion</p> <p>The development of a community mental health system and the introduction of a health insurance system in Aceh (together with the national health insurance scheme for the poor) has enabled access to free hospital treatment for people with severe mental disorders, including those who have been in <it>pasung</it>. The demographic and clinical characteristics of this group of ex-<it>pasung </it>patients are broadly similar to those reported in previous studies.</p> <p>Conclusions</p> <p>The Aceh Free <it>Pasung </it>program is an important mental health and human rights initiative that can serve to inform similar efforts in other parts of Indonesia and other low and middle-income countries where restraint and confinement of the mentally ill is receiving insufficient attention.</p

A suicide research agenda for people from immigrant and refugee backgrounds

The aim of this study was to establish mental health and suicide research priorities for people from immigrant and refugee background in Australia. This article focuses on the data relevant to the development of the suicide research agenda. This study was conducted using Delphi consensus method with two rounds of online questionnaires. A total of 138 and 86 participants, respectively, completed the first and second rounds of survey. Participants were policy makers, service providers, academics, service users, and carer advocates in Australia with expertise in mental health and/or suicide among people from immigrant and refugee backgrounds. Of the total 268 research questions included in the questionnaires, 70 questions about suicide were ranked as essential by over 50% respondents (i.e., the set level of consensus). In particular, research questions regarded as the greatest priority related to access and engagement with suicide prevention services, suicide protective and risk factors compared to populations not from immigrant and refugee backgrounds, and culturally appropriate assessment of suicide risk

Evaluation of Mental Health First Aid training with members of the Vietnamese community in Melbourne, Australia

<p>Abstract</p> <p>Background</p> <p>The aim of this project was to investigate in members of the Vietnamese community in Melbourne the impact of Mental Health First Aid (MHFA) training on attitudes to people with mental illness and on knowledge about mental disorders. Our hypotheses were that at the end of the training participants would have increased knowledge of mental disorders and their treatments, and decreased negative attitudes towards people with mental disorders.</p> <p>Methods</p> <p>Respondents were 114 participants in two-day MHFA training workshops for the Vietnamese community in Melbourne conducted by two qualified MHFA trainers. Participants completed the research questionnaire prior to the commencement of the training (pre-test) and at its completion (post-test). The questionnaires assessed negative attitudes towards people with mental illness (as described in four vignettes), ability to recognise the mental disorders described in the vignettes, and knowledge about how to assist someone with one of these disorders. Responses to open-ended questions were content analysed and coded. To evaluate the effect of the training, answers to the structured questions and to the coded open-ended questions given at pre- and post-test were compared using McNemar tests for dichotomous values and Wilcoxon tests for other scores.</p> <p>Results</p> <p>Between pre- and post-test there was significant improvement in recognition of mental disorders; more targeted and appropriate mental health first aid responses, and reduction in inappropriate first aid responses; and negative attitudes to the people described in the vignettes declined significantly on many items of the stigma scale.</p> <p>Conclusion</p> <p>A two-day, MHFA training course for general members of the Vietnamese community in Melbourne demonstrated significant reductions in stigmatising attitudes, improved knowledge of mental disorders and improved knowledge about appropriate forms of assistance to give to people in the community with mental disorder. There is sufficient evidence to scale up to a population level program for the Vietnamese community, and a need for longitudinal evaluation of such a scaled up program.</p