Suchergebnisse

Background: Implementing recovery-oriented mental health services is a policy priority in many countries. In addition, some governments have prioritised new forms of organising, financing and governing the provision of mental health services with a stronger focus on co-delivery and involving communities. Most research in the recovery field has focused on interventions. There is limited knowledge about the role of organisational characteristics and environments in which people experience recovery. Aim: To understand the organisational characteristics of initiatives that implement recovery-oriented practice at the interface between mental health services and communities, as well as the mechanisms they employ to alter the conditions in which they operate. Method: Semi-structured interviews and a focus group workshop with managers of five initiatives in England that implemented recovery-oriented practice at the interface between mental health services and communities. Results: Our cross-sector initiatives shared a range of characteristics and employed mechanisms that created favourable conditions for recovery-oriented practice: strong social value and process (rather than performance) orientation; participatory approaches and shared decision-making; flat hierarchies; creating and seizing business opportunities; utilising networking and (social) marketing opportunities; risk-taking; valuing and supporting all members of their organisations; entrepreneurial and value-driven leadership. Conclusion: Recovery-oriented practice takes place in certain organisational environments that importantly influence an individual's recovery. Our research highlights the need to consider organisational characteristics when evaluating recovery interventions as well as a broader shift of research towards understanding the environments in which people experience recovery as members of society, and how those can be altered.

Background Prescribing of antidepressants varies widely between European countries despite no evidence of difference in the prevalence of affective disorders. Aims To investigate associations between the use of antidepressants, country-level spending on healthcare and country-level attitudes towards mental health problems. Method We used Eurobarometer 2010, a large general population survey from 27 European countries, to measure antidepressant use and regularity of use. We then analysed the associations with country-level spending on healthcare and country-level attitudes towards mental health problems. Results Higher country spending on healthcare was strongly associated with regular use of antidepressants. Beliefs that mentally ill people are 'dangerous' were associated with higher use, and beliefs that they 'never recover' or 'have themselves to blame' were associated with lower and less regular use of antidepressants. Conclusions Contextual factors, such as healthcare spending and public attitudes towards mental illness, may partly explain variations in antidepressant use and regular use of these medications.

AbstractStigma and discrimination in relation to dementia has a range of implications for people living with dementia and their families worldwide, including help-seeking, quality of life, social rejection and isolation. Few studies consider the perceptions and stigma towards dementia from multiple perspectives, such as people living with dementia, carers, general public and health-care workers. South Africa has limited evidence on the stigmatisation of people living with dementia, with responses to people living with dementia being driven by poor understanding of the condition, cultural beliefs about causes and social interaction problems associated with memory and cognitive impairment. This study explored the experiences of stigma among people living with dementia and their carers through understanding their own knowledge, attitudes and beliefs as well as those of the public and health-care workers. Qualitative data (N = 52) were collected across two provinces and in four languages (English, Afrikaans, Sesotho and isiZulu), with semi-structured interviews and focus groups with the following stakeholder groups: people living with dementia and their carers, the general public and health-care workers. Inductive thematic analysis generated themes across stakeholder groups. The study shows that people living with dementia and carers experienced high levels of internalised stigma, related to negative public attitudes, which were associated with high levels of isolation, health system unpreparedness and limited access to support. The study contributes to the evidence base needed in South Africa but also extends its relevance by contributing to a growing global evidence base on stigma and dementia in low- and middle-income contexts.

Background: Existing knowledge about the cultural beliefs of black and minority ethnic (BME) communities in the UK regarding stigma and mental illness is limited. Material: Data were collected in 10 focus groups, five with service users and five with laypersons, from BME communities in London. Discussion: Thematic analysis identified that cultural beliefs regarding mental illness reflect four different voices present within the BME communities. Conclusion: The study revealed that cultural beliefs influencing both relationships with family and, consequently, help-seeking for individuals with mental illness must be considered in the development of anti-stigma interventions and when engaging communities around mental health.

Background: From 2008 on, a severe economic crisis (EC) has characterized the European Union (E.U.). However, changes in substance use behavioral patterns as a result of the economic crisis in Europe, have been poorly reflected upon, and underlying mechanisms remain to be identified; Methods: In this review we explore and systematize the available data on the effect of the 2008 economic crisis on patterns of substance use and related disorders, within the E.U. countries; Results: The results show that effects of the recession need to be differentiated. A number of studies point to reductions in population's overall substance use. In contrast, an increase in harmful use and negative effects is found within specific subgroups within the society. Risk factors include job-loss and long-term unemployment, and pre-existing vulnerabilities. Finally, our findings point to differences between types of substances in their response on economic crisis periods; Conclusions: the effects of the 2008 economic crisis on substance use patterns within countries of the European Union are two-sided. Next to a reduction in a population's overall substance use, a number of vulnerable subgroups experience serious negative effects. These groups are in need of specific attention and support, given that there is a real risk that they will continue to suffer negative health effects long after the economic downfall has formally been ended.

Objectives We aimed to explore the perceptions towards dementia and related care across three stakeholder groups in rural Kenya. Methods A total of 38 key stakeholders (carers of persons with dementia, health care providers and the general public) participated in focus group discussions. Additional five individual interviews were held with carers. Thematic analysis was used to analyse the data. Findings Across the three participant groups, a total of four themes were identified: (i) negative stereotypes of dementia, (ii) limited knowledge about dementia, (iii) diagnostic pathway and (iv) neglect and abuse. Conclusions We found a general lack of knowledge of dementia amongst family carers, healthcare professionals and the general public. The combination of poor awareness and ill-equipped healthcare systems leads to stigma manifested in the form of patchy diagnostic pathways, neglect and abuse. Local governments could take advantage of the existing family- and community-based systems to improve understanding of dementia nationally.

Background: Providing adequate information and involving patients in treatment have become an essential component of mental health care. Despite this, research regarding the extent to which this need has been met in clinical services is still scarce. Aims: To investigate the need for information about psychiatric condition and treatment among outpatients with schizophrenia disorders and how this need is associated with service use, adjusting for sociodemographic and clinical characteristics. Methods: Need for information about condition and treatment, using the corresponding domain in the Camberwell Assessment of Need (CAN), in a representative sample of 401 schizophrenia outpatients in Santos, Brazil was assessed. Hierarchical logistic regression was used to investigate the association of information as a reported need and as an unmet need with service use variables, adjusting for sociodemographic and clinical characteristics. Results: Need for information was reported by 214 (53.4%) patients, being met in 101 (25.2%) and unmet in 113 (28.2%). Hierarchical regression indicated a significant association of a reported need with higher age of onset, family monitoring medication use last year and lower education level, which was only associated with an unmet need. Conclusion: Information was a commonly reported need and which was often unmet, showing no significant association with service use. Greater attention should be given by mental health services to information provision.

Introduction: The recovery approach aims to have users' perspectives at the heart of service development and research; it is a holistic perspective that considers social needs, personal growth and inclusion. In the last decade recovery-oriented research and practice has increased greatly, however, a comprehensive model of recovery considering exclusively the perspectives of people with lived experience has not been devised. Aims: This review aimed to develop a framework and contextualize service users' and informal caregivers' understanding of recovery from severe mental health problems. Methods: We systematically searched 6 databases including key terms related to knowledge, experience and narratives AND mental health AND personal recovery. The search was supplemented with reference sourcing through gray literature, reference tracking and expert consultation. Data analysis consisted of a qualitative meta-synthesis using constant comparative methods. Results: Sixty-two studies were analyzed. A pattern emerged regarding the recovery paradigms that the studies used to frame their findings. The resulting recovery framework included the domains Social recovery; Prosperity (Legal, political, and economic recovery); Individual Recovery; and Clinical Recovery Experience (SPICE). Service users' definitions of recovery tended to prioritize social aspects, particularly being accepted and connecting with others, while caregivers focused instead on clinical definitions of recovery such as symptom remission. Both groups emphasized individual aspects such as becoming self-sufficient and achieving personal goals, which was strongly linked with having economic means for independence. Conclusions: The recovery model provided by this review offers a template for further research in the field and a guide for policy and practice. Predominant definitions of recovery currently reflect understandings of mental health which focus on an individual perspective, while this review found an important emphasis on socio-political aspects. At the same time, only a small number of studies took place in low-income countries, focused on minoritized populations, or included caregivers' perspectives. These are important gaps in the literature that require further attention. Systematic Review Registration: The review protocol was registered on PROSPERO (CRD42017076450); https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=76450.

Introduction: The recovery approach aims to have users' perspectives at the heart of service development and research; it is a holistic perspective that considers social needs, personal growth and inclusion. In the last decade recovery-oriented research and practice has increased greatly, however, a comprehensive model of recovery considering exclusively the perspectives of people with lived experience has not been devised. Aims: This review aimed to develop a framework and contextualize service users' and informal caregivers' understanding of recovery from severe mental health problems. Methods: We systematically searched 6 databases including key terms related to knowledge, experience and narratives AND mental health AND personal recovery. The search was supplemented with reference sourcing through gray literature, reference tracking and expert consultation. Data analysis consisted of a qualitative meta-synthesis using constant comparative methods. Results: Sixty-two studies were analyzed. A pattern emerged regarding the recovery paradigms that the studies used to frame their findings. The resulting recovery framework included the domains Social recovery; Prosperity (Legal, political, and economic recovery); Individual Recovery; and Clinical Recovery Experience (SPICE). Service users' definitions of recovery tended to prioritize social aspects, particularly being accepted and connecting with others, while caregivers focused instead on clinical definitions of recovery such as symptom remission. Both groups emphasized individual aspects such as becoming self-sufficient and achieving personal goals, which was strongly linked with having economic means for independence. Conclusions: The recovery model provided by this review offers a template for further research in the field and a guide for policy and practice. Predominant definitions of recovery currently reflect understandings of mental health which focus on an individual perspective, while this review found an important emphasis on socio-political aspects. At ...

Introduction: The recovery approach aims to have users' perspectives at the heart of service development and research; it is a holistic perspective that considers social needs, personal growth and inclusion. In the last decade recovery-oriented research and practice has increased greatly, however, a comprehensive model of recovery considering exclusively the perspectives of people with lived experience has not been devised. Aims: This review aimed to develop a framework and contextualize service users' and informal caregivers' understanding of recovery from severe mental health problems. Methods: We systematically searched 6 databases including key terms related to knowledge, experience and narratives AND mental health AND personal recovery. The search was supplemented with reference sourcing through gray literature, reference tracking and expert consultation. Data analysis consisted of a qualitative meta-synthesis using constant comparative methods. Results: Sixty-two studies were analyzed. A pattern emerged regarding the recovery paradigms that the studies used to frame their findings. The resulting recovery framework included the domains Social recovery; Prosperity (Legal, political, and economic recovery); Individual Recovery; and Clinical Recovery Experience (SPICE). Service users' definitions of recovery tended to prioritize social aspects, particularly being accepted and connecting with others, while caregivers focused instead on clinical definitions of recovery such as symptom remission. Both groups emphasized individual aspects such as becoming self-sufficient and achieving personal goals, which was strongly linked with having economic means for independence. Conclusions: The recovery model provided by this review offers a template for further research in the field and a guide for policy and practice. Predominant definitions of recovery currently reflect understandings of mental health which focus on an individual perspective, while this review found an important emphasis on socio-political aspects. At the same time, only a small number of studies took place in low-income countries, focused on minoritized populations, or included caregivers' perspectives. These are important gaps in the literature that require further attention. Systematic Review Registration: The review protocol was registered on PROSPERO (CRD42017076450); https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=76450.

Abstract
Purpose
This study examines the association between mental health problems in adolescence and general practice (GP) costs during adulthood up to age 50 in the UK.


Methods
We conducted secondary analyses of three British birth cohorts (individuals born in single weeks in 1946, 1958 and 1970). Data for the three cohorts were analysed separately. All respondents who participated in the cohort studies were included. Adolescent mental health status was assessed in each cohort using the Rutter scale (or, for one cohort, a forerunner of that scale) completed in interviews with parents and teachers when cohort members were aged around 16. Presence and severity of conduct and emotional problems were modelled as independent variables in two-part regression models in which the dependent variable was costs of GP services from data collection sweeps up to mid-adulthood. All analyses were adjusted for covariates (cognitive ability, mother's education, housing tenure, father's social class and childhood physical disability).


Results
Adolescent conduct and emotional problems, particularly when coexisting, were associated with relatively high GP costs in adulthood up to age 50. Associations were generally stronger in females than males.


Conclusion
Associations between adolescent mental health problems and annual GP cost were evident decades later, to age 50, suggesting that there could be significant future savings to healthcare budgets if rates of adolescent conduct and emotional problems could be reduced.

Trial registration
Not applicable.

The objective of this study was to investigate barriers to appropriate mental health care in a sample of Bolivian migrants living in São Paulo and to examine the association between barriers of care and the presence of symptoms of non-psychotic psychiatric disorders in this population. Considering that treatment usually reduces symptoms, it could be hypothesized that individuals reporting more barriers to care also will report more symptoms. The sample comprised 104 individuals born in Bolivia, with Bolivian nationality and living in São Paulo for at least 30 days prior to enrolling in the study, between 18 and 80 years of age and able to read and write in Spanish or Portuguese. The symptoms of mental disorders were assessed using the Self-Reporting Questionnaire (SRQ-20) and barriers to appropriate mental health care were evaluated using the Barriers to Assessing Care Evaluation (BACE). A multiple linear regression analysis was performed to determine the predictive effect of the BACE total score (independent variable) in the SRQ-20 score (dependent variable), including in the model, and the variables that were significantly correlated with the BACE total score or SRQ-20. Our results indicate that more than a half of the sample of Bolivian migrants living in Sao Paulo, Brazil, especially females, presented significant non-psychotic psychopathology. Individuals reporting more barriers to care, especially instrumental and attitudinal barriers, also have a higher risk of psychiatric symptoms, independently of sex, age and family income. Our results suggest that actions to increase availability of mental health services, especially culturally sensitive services, could reduce barriers to care and improve mental health among migrants.

Zusammenfassung. Hintergrund: Stigmatisierung schadet den Betroffenen und verstärkt Suchtprobleme. Sie ist ein Hindernis auf dem Weg zur Hilfe, führt zu schlechterer Behandlung und vergrößert die sozialen und gesundheitlichen Folgen einer Suchtkrankheit. Das gilt sowohl für die individuellen Folgen als auch für die gesellschaftlichen einschließlich der öffentlichen Gesundheitskosten. Zudem ist Stigmatisierung ein ethisches Problem, weil sie eine bestimmte Gruppe benachteiligt und die Menschenwürde der Betroffenen angreift. Ein stigmafreier Umgang mit Suchtkrankheiten ist möglich. Entstigmatisierung bedeutet, bessere Lösungen für Suchtprobleme zu finden und verfügbar zu machen. Nicht Abwertung, Ausgrenzung und Disziplinierung, sondern Wertschätzung und Befähigung (Empowerment) müssen im Zentrum von Prävention, Behandlung sowie dem alltäglichen Umgang mit Suchtkrankheiten stehen.

Despite the high impact of mental disorders in society, European mental health research is at a critical situation with a relatively low level of funding, and few advances been achieved during the last decade. The development of coordinated research policies and integrated research networks in mental health is lagging behind other disciplines in Europe, resulting in lower degree of cooperation and scientific impact. To reduce more efficiently the burden of mental disorders in Europe, a concerted new research agenda is necessary. The ROAMER (Roadmap for Mental Health Research in Europe) project, funded under the European Commission's Seventh Framework Programme, aims to develop a comprehensive and integrated mental health research agenda within the perspective of the European Union (EU) Horizon 2020 programme, with a translational goal, covering basic, clinical and public health research. ROAMER covers six major domains: infrastructures and capacity building, biomedicine, psychological research and treatments, social and economic issues, public health and well-being. Within each of them, state-of-the-art and strength, weakness and gap analyses were conducted before building consensus on future research priorities. The process is inclusive and participatory, incorporating a wide diversity of European expert researchers as well as the views of service users, carers, professionals and policy and funding institutions.