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Psychiatry in Society provides an overview of the recent socio-economic and cultural changes affecting mental health and mental health care. These changes include: * The increasing complexity of the economic contexts within which mental health services are funded and delivered * The demand for cost-effectiveness evidence * The rationing of access to new pharmacotherapies and psychotherapies * The emergence of quality of life as an essential criterion in the assessment of health care interventions * The growing awareness of the influence of stigma on shaping the long-term course of severe mental disorders * The enhanced role of advocacy groups in providing information, advice and support to sufferers This book will be of interest to psychiatrists and psychologists, mental health workers, managers and policy makers

The field of mental health, at the present time, has an important potential for rapid development. The reasons for this include important new knowledge that has become available, increased awareness of governments about the size of mental health problems and about the importance of psychosocial factors, and the development of an appropriate technology and a new doctrine of mental health care which allow useful interventions to be made, even when financial resources are extremely scarce.

According to the World Health Organization's World Health Report 2001, one family in four worldwide has at least one member currently suffering from a mental disorder. This disorder often remains undiagnosed and untreated, but the behaviour of the ill person usually has a significant impact on the quality of life of the family and on the mental health of the other members of the family, and generates feelings of shame, guilt, helplessness and despair

The rights of a powerless legion -- Cross-cultural aspects of the stigma of mental illness -- The WPA global programme against stigma and discrimination because of schizophrenia -- 'Fighting stigma and discrimination because of schizophrenia : Open the Doors' : a collaborative review of the experience from the German project centres -- Stigma and health care staff -- Evaluating programmatic needs concerning the stigma of mental illness -- Using the Internet for fighting the stigma of schizophrenia -- Building an evidence base for anti-stigma programming -- Other people stigmatize, but, what about us? : attitudes of mental health professionals towards patients with schizophrenia -- Implementing anti stigma programmes in Boulder, Colorado and Calgary, Alberta -- Stigma measurement approaches : conceptual origins and current applications -- Appendix : inventories to measure the scope and impact of stigma experiences from the perspective of those who are stigmatized : consumer and family versions.

The stigma attached to mental illness is the main obstacle to better mental health care and the better quality of life of people who have the illness, of their families, of their communities and of health service staff that deal with psychiatric disorders. Stigma is pernicious and there are indications that despite advances of psychiatry and medicine it continues to grow and has more and often terrible consequences for patients and families. In 1996, the WPA began an international programme to fight the stigma and discrimination because of schizophrenia. The 'Open the Doors' programme has since been implemented in more than 20 countries and involved roughly 200 different anti-stigma interventions. This book details the results of these efforts internationally and provides recommendations and guidance for those seeking to join this international effort or start similar efforts to dispel stigma and discrimination

Objective: To investigate whether people with schizophrenia experience discrimination when using health care services. Methods: A cross-sectional survey in 27 countries in centres affiliated to the INDIGO Research Network, using face-to-face interviews with 777 participants with schizophrenia (62% male and 38% female). We analysed the data related to health issues, including health care, disrespect of mental health staff, and also personal privacy, safety and security, starting a family, pregnancy and childbirth. Discrimination was measured by the Discrimination and Stigma Scale (DISC), which consists of 36 items comprising three sub-scales: positive experienced discrimination; negative experienced discrimination; and anticipated discrimination. Results: More than 17% of patients experienced discrimination when treated for physical health care problems. More than 38% of participants felt disrespected by mental health staff, with higher ratings in the post-communist countries. Conclusions: Mental health service providers have a key role in decreasing stigma in their provision of health care, and by doing more against stigmatizing and discriminating practices on the therapeutic and organizational level. This will require a change of attitudes and practices among mental and physical health care staff.

Rationale Mental health-related stigma and discrimination not only affect persons living with schizophrenia but also their whole families. Stigma and discrimination reduction is key to respond to the unmet needs of persons with mental illness. The local context is of particular importance in this endeavor, as stigma and its manifestations depend on the specific conditions of the target population and across cultures and settings. Evidence on effective approaches to reduce stigma is sparse and lacking from Central and Eastern Europe, including from the Czech Republic. Objective Our aim was to inform a far-reaching anti-stigma campaign related to a national mental health reform that was being deployed. Methods We conducted a qualitative study based on semi-structured in-depth interviews with relatives of patients diagnosed with schizophrenia in the Czech Republic. Initial respondents were identified through local mental health services and users' organizations with a consecutive chain-referral sampling. Transcribed narratives were thematically analyzed within a pre-developed four-level thematic framework to comprehensively identify experiences of stigma and discrimination in all areas of the respondents' lives. Results Stigma experiences of 25 diverse family members of persons living with schizophrenia spanned four levels of respondents' lives (macro-, meso-, micro-, and intro-level). The overarching issues were: (1) general lack of understanding and misconceptions about mental illness; (2) structural discrimination and paucity of governmental and public support system; (3) burden of "pervasive and unlimited" care and inability of independent living. Conclusions We identified several features of mental health related stigma and the ensuing discrimination in Czech Republic experienced by persons with severe mental illness and their relatives. We developed a set of recommendations for policy-makers aimed at reducing ignorance and prejudice amongst the public and professionals, improving health and social services—including employment, housing and community integration—and the provision of family support.

Just over 25 years have passed since the major sociopolitical changes in central and eastern Europe; our aim was to map and analyse the development of mental health-care practice for people with severe mental illnesses in this region since then. A scoping review was complemented by an expert survey in 24 countries. Mental health-care practice in the region differs greatly across as well as within individual countries. National policies often exist but reforms remain mostly in the realm of aspiration. Services are predominantly based in psychiatric hospitals. Decision making on resource allocation is not transparent, and full economic evaluations of complex interventions and rigorous epidemiological studies are lacking. Stigma seems to be higher than in other European countries, but consideration of human rights and user involvement are increasing. The region has seen respectable development, which happened because of grassroots initiatives supported by international organisations, rather than by systematic implementation of government policies.

Background: Transition from distinct Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS) is beset with multitude of problems affecting continuity of care for young people with mental health needs. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge globally. The overall aim of the Managing the Link and Strengthening Transition from Child to Adult Mental Health Care in Europe (MILESTONE) project (2014-19) is to improve transition from CAMHS to AMHS in diverse healthcare settings across Europe. MILESTONE focuses on current service provision in Europe, new transition-related measures, long term outcomes of young people leaving CAMHS, improving transitional care through 'managed transition', ethics of transitioning and the training of health care professionals. Methods: Data will be collected via systematic literature reviews, pan-European surveys, and focus groups with service providers, users and carers, and members of youth advocacy and mental health advocacy groups. A prospective cohort study will be conducted with a nested cluster randomised controlled trial in eight European Union (EU) countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS users, their carers, and clinicians. Discussion: Improving transitional care can facilitate not only recovery but also mental health promotion and mental illness prevention for young people. MILESTONE will provide evidence of the organisational structures and processes influencing transition at the service interface across differing healthcare models in Europe and longitudinal outcomes for young people leaving CAMHS, solutions for improving transitional care in a cost-effective manner, training modules for clinicians, and commissioning and policy guidelines for service providers and policy makers.

Background. Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care. Methods. The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions. Results. We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures. Conclusions. We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions. ; Peer reviewed

BACKGROUND.: Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care. METHODS.: The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions. RESULTS.: We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures. CONCLUSIONS.: We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.