This article examines the status of a national mental health policy for children in need of mental health services. The need for systems planning and services integration involving multiple agencies is presented. The different programs of the major governmental agencies involved in the delivery of services to children are reviewed, as are the range of services provided. This article demonstrates the fragmentation and duplication that is endemic in all aspects of mental health, and that consequently makes policy implementation exceedingly difficult.
Part of a symposium on "Studies in Mental Health Policy" (see related abstracts in SOPODA 17:2). The need for systems planning & services integration involving the education, mental health, & child welfare systems is presented. Significant federal programs in these systems, as well as the income support program, Supplemental Security Income, are reviewed, revealing a lack of policy for dealing with emotionally disturbed children. It is demonstrated that fragmentation & duplication are endemic in all aspects of mental health; consequently, policy implementation is exceedingly difficult. 20 References. Adapted from the source document.
The personal trip survey plays a vital role in global, multi-modal transportation planning. The four-step method for estimating travel demand based on data from the personal trip survey has been systematized during the course of long-term studies and practical applications. This method therefore has been widely used in various aspects of transportation planning. However, it is usually concerned with travel demand and very useful in periods of economic expansion. Now that emphasis is being placed on quality because the economy has taken a downturn, the conventional method should be reconsidered in terms of a qualitative, political approach. The present study deals with a new methodology for establishing a qualitative, long-term view of regional requirements. In other words, the purpose of this study is to create a socio-economic vision of the future for proper transportation planning for a target region. This study calls it 'future vision', which consists of several future images when considering the changing characteristics of the region and relationship with surrounding areas. These future images can cover all transportation-related topics, from global problems to local issues. Each future image is composed of scenarios that reflect the future direction and role of transportation planning, which fully describes infrastructures as well as management. Transportation planning experts employed brainstorming to create an initial version of the future vision. The brainstorming brought many important keywords related to the future images. The planners assembled keywords and added sentences to set up scenarios. This version was revised by using the Delphi questionnaire method in order to eliminate obvious errors and improper perspectives, while incorporating missing information. The Delphi method was conducted on researchers, engineers, planners, and administrators that are well versed in transportation planning. A procedure was also developed to update almost automatically according to the results of the questionnaire. The revised version of the future vision was again checked and revised similarly by the Delphi method and the updating procedure. Actually, the future vision was refined twice, which led to the final version of the future vision having a high degree of accuracy and feasibility. The future vision is qualitative and policy-oriented, while the conventional four-step method is quantitative and demand-oriented. Two different approaches should work together for the comprehensive transportation planning. This study finally introduced a hybrid method between the two approaches by discussing a way of linking the future vision with the conventional personal trip survey system. The proposed linkage produced (1) hearing recommendations of various people in many positions, (2) enhancement of the transportation planning by sharing and solving anticipated problems, and (3) incorporation of more policy-oriented planning elements.
Background: Data on the clinical and functional significance of comorbid depression in physical multimorbidity in middle-aged and older adults and from low- and middle-income countries (LMICs) are lacking. Aims: This study aims to determine the association of comorbid depression in physical multimorbidity with health outcomes and quality of life among adults aged ⩾50 years from six LMICs. Methods: Cross-sectional, nationally representative data from the Study on Global Ageing and Adult Health were analyzed. DSM-IV Depression was based on past 12-month symptoms. Eleven chronic physical conditions were assessed. Health status was based on scales ranging from 0 (best) to 100 (worse). The quality of life (8-item WHO Quality of Life) scale ranged from 0 (worse) to 100 (best). Multivariable linear regression analyses were conducted. Results: Data on 34,129 individuals aged ⩾50 years [mean (SD) age 62.4 (16.0) years; 52.1% females] were analyzed. Among people with physical multimorbidity, having comorbid depression was associated with significantly worse health status in terms of sleep/energy (β = 14.71: 95% CI [12.23, 17.20]), self-care (13.23: [8.66, 17.82]), pain/discomfort (13.03: [9.59, 16.47]), mobility (11.06: [6.91, 15.21]), cognition (10.41: [7.31, 13.50]), perceived stress (8.35: [4.71, 11.99]), interpersonal activities (7.81: [3.71, 11.91]), and lower quality of life (−8.81: [−10.74, −6.88]). Conclusions: Comorbid depression in physical multimorbidity was associated with lower quality of life and poorer scores in multiple domains of health status. Treatment of depression in people with physical multimorbidity may potentially lead to better clinical outcomes, but future studies are needed to determine the most effective intervention to address this comorbidity in LMICs.
