Search

Background: The Discrimination and Stigma Scale (DISC) is a patient-reported outcome measure which assesses experiences of discrimination among persons with a mental illness globally. Methods: This study evaluated whether the psychometric properties of a short-form version, DISC-Ultra Short (DISCUS) (11-item), could be replicated in a sample of people with a wide range of mental disorders from 21 sites in 15 countries/territories, across six global regions. The frequency of experienced discrimination was reported. Scaling assumptions (confirmatory factor analysis, inter-item and item-total correlations), reliability (internal consistency) and validity (convergent validity, known groups method) were investigated in each region, and by diagnosis group. Results: 1195 people participated. The most frequently reported experiences of discrimination were being shunned or avoided at work (48.7%) and discrimination in making or keeping friends (47.2%). Confirmatory factor analysis supported a unidimensional model across all six regions and five diagnosis groups. Convergent validity was confirmed in the total sample and within all regions [ Internalised Stigma of Mental Illness (ISMI-10): 0.28–0.67, stopping self: 0.54–0.72, stigma consciousness: −0.32–0.57], as was internal consistency reliability (α = 0.74–0.84). Known groups validity was established in the global sample with levels of experienced discrimination significantly higher for those experiencing higher depression [Patient Health Questionnaire (PHQ)-2: p < 0.001], lower mental wellbeing [Warwick-Edinburgh Well-being Scale (WEMWBS): p < 0.001], higher suicidal ideation [Beck Hopelessness Scale (BHS)-4: p < 0.001] and higher risk of suicidal behaviour [Suicidal Ideation Attributes Scale (SIDAS): p < 0.001]. Conclusions: The DISCUS is a reliable and valid unidimensional measure of experienced discrimination for use in global settings with similar properties to the longer DISC. It offers a brief assessment of experienced discrimination for use in clinical and research settings. [ABSTRACT FROM AUTHOR]

Background: The COVID pandemic has been devastating for not only its direct impact on lives, physical health, socio-economic status of individuals, but also for its impact on mental health. Some individuals are affected psychologically more severely and will need additional care. However, the current health system is so fragmented and focused on caring for those infected that management of mental illness has been neglected. An integrated approach is needed to strengthen the health system, service providers and research to not only manage the current mental health problems related to COVID but develop robust strategies to overcome more long-term impact of the pandemic. A series of recommendations are outlined in this paper to help policy makers, service providers and other stakeholders, and research and research funders to strengthen existing mental health systems, develop new ones, and at the same time advance research to mitigate the mental health impact of COVID19. The recommendations refer to low, middle and high resource settings as capabilities vary greatly between countries and within countries. Discussion: The recommendations for policy makers are focused on strengthening leadership and governance, finance mechanisms, and developing programme and policies that especially include the most vulnerable populations. Service provision should focus on accessible and equitable evidence-based community care models commensurate with the existing mental health capacity to deliver care, train existing primary care staff to cater to increased mental health needs, implement prevention and promotion programmes tailored to local needs, and support civil societies and employers to address the increased burden of mental illness. Researchers and research funders should focus on research to develop robust information systems that can be enhanced further by linking with other data sources to run predictive models using artificial intelligence, understand neurobiological mechanisms and community-based interventions to address the pandemic driven mental health problems in an integrated manner and use innovative digital solutions. Conclusion: Urgent action is needed to strengthen mental health system in all settings. The recommendations outlined can be used as a guide to develop these further or identify new ones in relation to local needs. [ABSTRACT FROM AUTHOR]

Background: The Discrimination and Stigma Scale (DISC-12) was specifically developed to measure experienced and anticipated discrimination reported by people with mental health problems. However, the length of the DISC-12 may represent a disadvantage especially in country settings with limited human capacity and infrastructure. The purpose of the study was to develop a short version of DISC-12 (DISCUS) to address these limitations.Methods: Data from 1087 participants with major depressive disorder and 732 patients with schizophrenia were collected as part of two research network studies across 35 countries - Anti Stigma Programme European Network (ASPEN) and International Study of Discrimination and Stigma (INDIGO). We used a Meta Exploratory Factor Analysis (meta-EFA) and a Multiple Causes Multiple Indicators (MIMIC) Model to reduce the number of items in the DISC-12 scale. The validity and reliability of the reduced scale (DISCUS) was tested in 202 people with the full spectrum of mental disorders recruited in a cross-sectional study conducted in South London. Psychometric validation for the reduced scale used confirmatory factor analysis and measures of Cronbach's alpha and Pearson's correlation coefficient.Results: meta-EFA reduced twenty-one items to twelve items. An additional item was discarded with the use of the MIMIC model. The 11-item DISCUS demonstrated excellent reliability (Cronbach's alpha >0.85), good fit (Tucker Lewis Index and Comparative Fit Index value>0.9) and weak to moderate construct validity.Conclusions: The DISCUS scale is a consistent and valid instrument to measure experienced and anticipated discrimination predominantly in personal and social relationships in global settings. [ABSTRACT FROM AUTHOR]

The interrelationship between stigma and help-seeking is under-researched among children and adolescents. This study explored stigma in relation to pathways to care among young people putatively in an early stage of increased risk of developing psychotic disorders. “Pathways to care” was defined as help-seeking and support from informal and formal resources, and increased risk was determined through the presence of persistent psychotic-like experiences and internalizing/externalizing psychopathology. Twenty-nine qualitative interviews were analyzed using thematic analysis. We defined the superordinate theme in these data as “conditional disclosure,” a concept reflecting the rules and prerequisites that influenced how/whether participants sought help. Through parallels between these findings and established stigma theory, we examined how these conditions could be interpreted as influenced by stigma. Our findings demonstrate the influence of stigma on young people’s perceptions of a range of pre-clinical symptoms, and on how they seek support for these symptoms. [ABSTRACT FROM AUTHOR]

Background: Wellbeing of healthcare workers is important for the effective functioning of health systems. The aim of this study was to explore the conceptualisations of wellbeing, stress and burnout among healthcare workers in primary healthcare settings in rural Ethiopia in order to inform the development of contextually appropriate interventions.Methods: A qualitative study was conducted in a rural zone of southern Ethiopia. A total of 52 frontline primary healthcare workers participated in in-depth interviews (n = 18) or Focus Group Discussions (FGDs) (4 groups, total n = 34). There were 35 facility based healthcare professionals and 17 community-based health workers. Data were analysed using thematic analysis.Results: Most participants conceptualised wellbeing as absence of stress rather than as a positive state. Many threats to wellbeing were identified. For facility-based workers, the main stressors were inadequate supplies leading to fears of acquiring infection and concerns about performance evaluation. For community health workers, the main stressor was role ambiguity. Workload and economic self-sufficiency were a concern for both groups. Burnout and its symptoms were recognised and reported by most as a problem of other healthcare workers. Derogatory and stigmatising terms, such as "chronics", were used to refer to those who had served for many years and who appeared to have become drained of all compassion. Most participants viewed burnout as inevitable if they continued to work in their current workplace without career progression. Structural and environmental aspects of work emerged as potential targets to improve wellbeing, combined with tackling stigmatising attitudes towards mental health problems. An unmet need for intervention for healthcare workers who develop burnout or emotional difficulties was identified.Conclusion: Ethiopian primary healthcare workers commonly face job-related stress and experience features of burnout, which may contribute to the high turnover of staff and dissatisfaction of both patients and providers. Recent initiatives to integrate mental healthcare into primary care provide an opportunity to promote the wellbeing of healthcare workers and intervene to address burnout and emotional problems by creating a better understanding of mental health. [ABSTRACT FROM AUTHOR]

Stigma and discrimination in relation to mental illnesses have been described as having worse consequences than the conditions themselves. Most medical literature in this area of research has been descriptive and has focused on attitudes towards people with mental illness rather than on interventions to reduce stigma. In this narrative Review, we summarise what is known globally from published systematic reviews and primary data on effective interventions intended to reduce mental-illness-related stigma or discrimination. The main findings emerging from this narrative overview are that: (1) at the population level there is a fairly consistent pattern of short-term benefits for positive attitude change, and some lesser evidence for knowledge improvement; (2) for people with mental illness, some group-level anti-stigma inventions show promise and merit further assessment; (3) for specific target groups, such as students, social-contact-based interventions usually achieve short-term (but less clearly long-term) attitudinal improvements, and less often produce knowledge gains; (4) this is a heterogeneous field of study with few strong study designs with large sample sizes; (5) research from low-income and middle-income countries is conspicuous by its relative absence; (6) caution needs to be exercised in not overgeneralising lessons from one target group to another; (7) there is a clear need for studies with longer-term follow-up to assess whether initial gains are sustained or attenuated, and whether booster doses of the intervention are needed to maintain progress; (8) few studies in any part of the world have focused on either the service user's perspective of stigma and discrimination or on the behaviour domain of behavioural change, either by people with or without mental illness in the complex processes of stigmatisation. We found that social contact is the most effective type of intervention to improve stigma-related knowledge and attitudes in the short term. However, the evidence for longer-term benefit of such social contact to reduce stigma is weak. In view of the magnitude of challenges that result from mental health stigma and discrimination, a concerted effort is needed to fund methodologically strong research that will provide robust evidence to support decisions on investment in interventions to reduce stigma. [ABSTRACT FROM AUTHOR]

Background: Since the economic recession began in 2008 anecdotal reports suggest that mental health services in England have experienced disinvestment, but published data to test this proposition are few. Method: This paper presents information from a wider range of official, research and grey literature sources aiming to: (1) assess whether governmental investment in publically funded mental health services has declined since the start of the economic recession in 2008; (2) to assess whether relative changes in mental health service investment over this period were or were not similar to trends in national investment in services for people with physical disorders, and (3) to interpret these findings in terms of met and unmet population levels needs for mental health care. Results: The key findings are that: across England social service expenditure reductions have led to a decrease of 48 % in the number of people with mental illness who receive such care, while direct NHS expenditure was reduced in some local areas by up to 32 %. Conclusions: The results of this overview suggest that there have been substantial reductions in the resources dedicated to mental health treatment and care in England since 2008, that such reductions seem not to have been applied to physical health services, and that these findings appear to run counter to the government policy of 'parity of esteem; for mental and physical healthcare. [ABSTRACT FROM AUTHOR]

Mental illness is a significant public health burden in low- and middle-income countries. A wide treatment gap in mental health care exists within the Nigerian health care system and this gap is worsened by the presence of stigma associated with mental illness, which leads to delay in treatment or acts as a barrier to any care. In this study, our aim was to understand the factors that underlie mental illness stigma in order to inform the design of effective stigma-reducing interventions among health care students in Nigeria. We conducted four focus groups among university health care students in March 2019 in Nigeria. The students included nursing, pharmacy, and medical trainees from a university teaching hospital. We used an inductive-driven thematic analysis to identify codes and themes related to mental health stigma and conceptualization of mental health within the study group. Among the 40 participants, we identified how specific interpretations of religious and spiritual beliefs may be associated with stigmatizing behaviors such as social distancing and discrimination. Conceptualization of mental illness as a communicable disease and the attribution of mental illness to a moral failing contributed to stigma mechanisms. Overall, eight themes associated with mental health stigma and mental health-related concepts were found: spirituality, discrimination and devaluation, conceptualization of mental health, attribution theories, methods to reduce stigma, shortage of resources, violence and dangerousness, and maltreatment. We found that the co-existence of spiritual beliefs and biomedical and psychological models of mental health is a key factor to consider in the design of effective stigma-reducing interventions among university health students in Nigeria. [ABSTRACT FROM AUTHOR]

Background: While stigma measurement across cultures has assumed growing importance in psychiatric epidemiology, it is unknown to what extent concepts arising from culture have been incorporated. We utilize a formulation of culture-as the everyday interactions that 'matter most' to individuals within a cultural group-to identify culturally-specific stigma dynamics relevant to measurement.Methods: A systematic literature review from January 1990 to September 2012 was conducted using PsycINFO, Medline and Google Scholar to identify articles studying: (i) mental health stigma-related concepts; (ii) ≥ 1 non-Western European cultural group. From 5292 abstracts, 196 empirical articles were located.Results: The vast majority of studies (77%) utilized adaptations of existing Western-developed stigma measures to new cultural groups. Extremely few studies (2.0%) featured quantitative stigma measures derived within a non-Western European cultural group. A sizeable amount (16.8%) of studies employed qualitative methods to identify culture-specific stigma processes. The 'what matters most' perspective identified cultural ideals of the everyday activities that comprise 'personhood' of 'preserving lineage' among specific Asian groups, 'fighting hard to overcome problems and taking advantage of immigration opportunities' among specific Latino-American groups, and 'establishing trust among religious institutions due to institutional discrimination' among African-American groups. These essential cultural interactions shaped culture-specific stigma manifestations. Mixed method studies (3.6%) corroborated these qualitative results.Conclusion: Quantitatively-derived, culturally-specific stigma measures were lacking. Further, the vast majority of qualitative studies on stigma were conducted without using stigma-specific frameworks. We propose the 'what matters most' approach to address this key issue in future research. [ABSTRACT FROM AUTHOR]

Background: While stigma measurement across cultures has assumed growing importance in psychiatric epidemiology, it is unknown to what extent concepts arising from culture have been incorporated. We utilize a formulation of culture—as the everyday interactions that ‘matter most’ to individuals within a cultural group—to identify culturally-specific stigma dynamics relevant to measurement.Methods: A systematic literature review from January 1990 to September 2012 was conducted using PsycINFO, Medline and Google Scholar to identify articles studying: (i) mental health stigma-related concepts; (ii) ≥1 non-Western European cultural group. From 5292 abstracts, 196 empirical articles were located.Results: The vast majority of studies (77%) utilized adaptations of existing Western-developed stigma measures to new cultural groups. Extremely few studies (2.0%) featured quantitative stigma measures derived within a non-Western European cultural group. A sizeable amount (16.8%) of studies employed qualitative methods to identify culture-specific stigma processes. The ‘what matters most’ perspective identified cultural ideals of the everyday activities that comprise ‘personhood’ of ‘preserving lineage’ among specific Asian groups, ‘fighting hard to overcome problems and taking advantage of immigration opportunities’ among specific Latino-American groups, and ‘establishing trust among religious institutions due to institutional discrimination’ among African-American groups. These essential cultural interactions shaped culture-specific stigma manifestations. Mixed method studies (3.6%) corroborated these qualitative results.Conclusion: Quantitatively-derived, culturally-specific stigma measures were lacking. Further, the vast majority of qualitative studies on stigma were conducted without using stigma-specific frameworks. We propose the ‘what matters most’ approach to address this key issue in future research. [ABSTRACT FROM PUBLISHER]

Background: Global mental health (GMH) advocates for access to and the equitable provision of mental health care. Although the treatment gap is a useful construct to measure access and equitability of care, it fails to communicate the real-life consequences of the treatment gap and the urgent need to address care disparities. Objective: The aim of this article is to present a perspective on the practical application of the principles of GMH to understand the real-life impact of the treatment gap and the approaches taken to improve treatment coverage in Ethiopia. Design: A case study method is used. Results: Multiple international collaborations undertaken in Ethiopia and facilitated by GMH to improve care, capacity, and the evidence base for increased treatment coverage are described briefly. A series of steps taken at the local and national levels to address the treatment gap are highlighted. The stories of two patients are also presented to illustrate the real-life consequences of the treatment gap and the potential transformational impact of addressing the treatment gap on patients, families, and communities. Conclusions: GMH has a key role to play in addressing the treatment gap, which improves the life of people with mental disorders, their families, and their communities. However, national-level policy support and coordination are essential for any realistic improvement in treatment coverage. The reflections offered through the case examples may have utility in similar low-income settings.

Stigma and discrimination against people with mental ill health are global problems and have severe consequences in terms of social exclusion.[1] Such social exclusion is associated with barriers to health care,[[2]] increased unemployment,[4] and premature mortality.[5] Evidence is clear from high-income countries, and is emerging from low-income and middle-income countries (LMICs), that interventions can be effective in reducing such stigma and discrimination.[[6]] We now need a reappraisal of this field and a set of radical and practical recommendations to guide action locally, nationally, and globally to address mental health-related stigma and discrimination. Fourth, we will conduct a literature review on the effectiveness and cost-effectiveness of interventions to reduce stigma and discrimination related to mental illness. [Extracted from the article]

Purpose: The aim of this study was to explore the experience of having a personality disorder diagnosis within the context of forensic secure and community services. Methods: We used an interpretative phenomenological analysis to analyse interviews with 10 service users purposively recruited from services in South London. Results: Participants described two facets of their lived experience: (1) the way they see themselves now, in light of their offending and social background and (2) the pejorative nature of the personality disorder label, its relationship to mental illness and their need to distance themselves from it. Conclusions: Having a forensic identity affects participants' perceptions of their diagnosis and its treatment as well as their views about themselves. [ABSTRACT FROM AUTHOR]

Background The CRIMSON (CRisis plan IMpact: Subjective and Objective coercion and eNgagement) study is an individual level, randomised controlled trial that compared the effectiveness of Joint Crisis Plans (JCPs) with treatment as usual for people with severe mental illness. The ICP is a negotiated statement by a patient of treatment preferences for any future psychiatric emergency, when he or she might be unable to express clear views. We assessed whether the additional use of JCPs improved patient outcomes compared with treatment as usual. Methods Patients were eligible if they had at least one psychiatric admission in the previous 2 years and were on the Enhanced Care Programme Approach register. The study was done with 64 generic and specialist community mental health teams in four English mental health care provider organisations (trusts). Hypotheses tested were that, compared with the control group, the intervention group would experience: fewer compulsory admissions (primary outcome); fewer psychiatric admissions; shorter psychiatric stays; lower perceived coercion; improved therapeutic relationships; and improved engagement. We stratified participants by centre. The research team but not participants nor clinical staff were masked to allocation. This study is registered with ClinicalTrials.gov, number ISRCTN11501328. Findings 569 participants were randomly assigned (285 to the intervention group and 284 to the control group). No significant treatment effect was seen for the primary outcome (56 [20%] sectioned in the control group and 49 [18%] in the JCP group; odds ratio 0.90 [95% CI 0.58-1.39, p=0.63]) or any secondary outcomes, with the exception of an improved secondary outcome of therapeutic relationships (17.3 [7.6] vs 16.0 [7.1]; adjusted difference -1.28 [95% CI -2.56 to -0.01, p=0.049]). Qualitative data supported this finding. Interpretation Our findings are inconsistent with two earlier JCP studies, and show that the JCP is not significantly more effective than treatment as usual. There is evidence to suggest the JCPs were not fully implemented in all study sites, and were combined with routine clinical review meetings which did not actively incorporate patients' preferences. The study therefore raises important questions about implementing new interventions in routine clinical practice. Funding Medical Research Council UK and the National Institute for Health Research. [ABSTRACT FROM AUTHOR]

Research-generated information about mental disorders is crucial in order to establish the health needs in a given setting, to propose culturally apt and cost-effective individual and collective interventions, to investigate their implementation, and to explore the obstacles that prevent recommended strategies from being implemented. Yet the capacity to undertake such research in low- and middle-income countries is extremely limited. This article describes two methods that have proved successful in strengthening, or that have the potential to strengthen, mental health research capacity in low-resource settings. We identify the central challenges to be faced, review current programs offering training and mentorship, and summarize the key lessons learned. A structured approach is proposed for the career development of research staff at every career stage, to be accompanied by performance monitoring and support. A case example from the Mental Health and Poverty Project in sub-Saharan Africa illustrates how this approach can be put into practice-in particular, by focusing upon training in core transferrable research skills. [ABSTRACT FROM AUTHOR]

Background: The use of compulsory treatment under the Mental Health Act (MHA) has continued to rise in the UK and in other countries. The Joint Crisis Plan (JCP) is a statement of service users' wishes for treatment in the event of a future mental health crisis. It is developed with the clinical team and an independent facilitator. A recent pilot RCT showed a reduction in the use of the MHA amongst service users with a JCP. The JCP is the only intervention that has been shown to reduce compulsory treatment in this way. The CRIMSON trial aims to determine if JCPs, compared with treatment as usual, are effective in reducing the use of the MHA in a range of treatment settings across the UK. Methods/Design: This is a 3 centre, individual-level, single-blind, randomised controlled trial of the JCP compared with treatment as usual for people with a history of relapsing psychotic illness in Birmingham, London and Lancashire/Manchester. 540 service users will be recruited across the three sites. Eligible service users will be adults with a diagnosis of a psychotic disorder (including bipolar disorder), treated in the community under the Care Programme Approach with at least one admission to a psychiatric inpatient ward in the previous two years. Current inpatients and those subject to a community treatment order will be excluded to avoid any potential perceived pressure to participate. Research assessments will be conducted at baseline and 18 months. Following the baseline assessment, eligible service users will be randomly allocated to either develop a Joint Crisis Plan or continue with treatment as usual. Outcome will be assessed at 18 months with assessors blind to treatment allocation. The primary outcome is the proportion of service users treated or otherwise detained under an order of the Mental Health Act (MHA) during the follow-up period, compared across randomisation groups. Secondary outcomes include overall costs, service user engagement, perceived coercion and therapeutic relationships. Sub-analyses will explore the effectiveness of the JCP in reducing use of the MHA specifically for Black Caribbean and Black African service users (combined). Qualitative investigations with staff and service users will explore the acceptability of the JCPs. Discussion: JCPs offer a potential solution to the rise of compulsory treatment for individuals with psychotic disorders and, if shown to be effective in this trial, they are likely to be of interest to mental health service providers worldwide. Trial registration: Current Controlled Trials ISRCTN11501328 [ABSTRACT FROM AUTHOR]

To investigate whether people with long term conditions, whatever their specific nature, need to be assessed and treated for the full range of mental, physical and social problems. Main question investigated: that rheumatoid arthritis and schizophrenia will be associated with significantly greater impairment across the subscores of the SF36 scale than in reference general population samples. Specific hypothesis tested: while rheumatoid arthritis and schizophrenia will impair both physical and mental functioning, when comparing the two groups there will be a greater difference between the physical component scores than there will be between the mental/emotional component scores of the short form health survey (SF-36). Cross sectional comparison of SF-36 subscore profiles of cohorts of: (1) people with rheumatoid arthritis attending specialist Rheumatology outpatient clinics in five London hospitals ( n = 446), and (2) people with schizophrenia treated by community psychiatric teams in four sites in Europe ( n = 409). Both groups had greater impairments across the whole spectrum of mental and physical problems assessed by the SF-36 than age specific normative data for the general population. The results also support our hypothesis that, comparing the people with rheumatoid arthritis and schizophrenia, we did find that there is a greater discrepancy between the physical scales than there is between the mental/emotional scales of the SF-36. These findings show that whether the primary long-term condition is presenting as physical or as mental disorder, the practitioner should ensure that the full range of physical, mental and social problems is assessed and treated. [ABSTRACT FROM AUTHOR]

The article presents a research study which examined the nature, direction, and severity of anticipated and experienced discrimination against people with schizophrenia. A cross-sectional survey was performed using face-to-face interviews of 732 participants with schizophrenia from 27 countries. The discrimination and stigma scale (DISC) was used to measure discrimination. The study found that negative discrimination was experienced by participants in a number of areas including in keeping a job and intimate relationships. Researchers concluded that anticipated and experienced discrimination rates were high across countries among people with mental illness. The authors note the need for interventions to improve self-esteem for people with mental illness.

The article examines the availability of mental health resources around the world, especially in low-income and middle-income countries. The article explains that mental health resources include policy and infrastructure within countries, mental health services, community resources, human resources, and funding. According to the article government spending on mental health in most developed countries is far lower than is actually needed, and the poorest countries in the world spend the lowest percentages of their overall health budgets on mental health. It is reported that the scarcity of available resources, along with inequities in their distribution and inefficiencies in their use pose the three main obstacles to better mental health.

This paper discusses factors associated with low rates of help-seeking and poorer quality of physical healthcare among people with mental illnesses. Evidence is reviewed on the associations between low rates of mental health literacy, negative attitudes towards people with mental illness, and reluctance to seek help by people who consider that they may have a mental disorder. People with mental illness often report encountering negative attitudes among mental health staff about their prognosis, associated in part with 'physician bias'. 'Diagnostic overshadowing' appears to be common in general health care settings, meaning the misattribution of physical illness signs and symptoms to concurrent mental disorders, leading to underdiagnosis and mistreatment of the physical conditions. [ABSTRACT FROM AUTHOR]

Background: The stigma against people with mental illness is a major barrier to help seeking in young people for mental health problems. The objective of this study was to investigate the extent of stigma in relation to treatment avoidance in 14 year-old school students in England in relation to how they refer to people with mental illness. Methods: This is a qualitative, cross-sectional study. The data were gathered as part of the baseline assessment for an intervention study intended to reduce stigma among 14 year old school students. The participating schools were two grammar (selective) schools and three comprehensive (nonselective) schools. At the start of the lesson, the students were asked 'What sorts of words or phrases might you use to describe someone who experiences mental health problems?' Words and terms used to refer to mental illness were enumerated. Using the grounded theory approach, words and terms were grouped in terms of their denotative and connotative meanings. Labels were then derived to capture the key themes attached by the students to the concepts of mental illness. The frequencies of occurrence for each word were also tabulated. Results: 400 of the 472 participating students (85%) provided 250 words and terms to describe a person with mental illness. Five themes were identified from the data. The first theme called 'popular derogatory terms' (116 items) accounted for nearly half of the words examined. The second theme occurred less often and was described as 'negative emotional state' (61 items). The third theme demonstrated the confusion of young people between physical disabilities, learning difficulties and mental health problems (38 items). The use of psychiatric diagnoses (15 items) and terms related to violence (9 items) were unexpectedly uncommon. Conclusion: Our findings suggest the hypothesis that help-seeking by mentally ill young people may be improved by interventions that address both their lack of factual information about mental illness, and those which reduce their strong negative emotional reactions towards people with mental illness. [ABSTRACT FROM AUTHOR]

Wide variations in deprivation exist across England and it is likely that these variations translate into differences in the need for mental health care. Social Services Departments in England account for a substantial proportion of mental health expenditure. It is important that the distribution of expenditure reflects mental health needs. This paper's aims are to (1) describe the development of a new indicator of mental health needs, (2) use the index to explain variations in social services expenditure on mental health, and (3) compare the index with other established measures of need. A principal components analysis of sociodemographic variables considered to be indicators of need was used to produce four distinct factors for 148 Local Authority areas in England. A weighted sum of these factors was used to produce a single index. (Weights were the proportion of variance explained by each factor.) The index was used in a regression model to explain variations in spending on mental health care and was compared with (1) a model containing the four individual factors, (2) the current method of allocating resources, (3) the index used to allocate resources to primary care trusts, (4) the Mental Illness Needs Index (MINI), (5) four indices of deprivation produced by the Office of the Deputy Prime Minister, and (6) the average of the above four indices. The new index could explain 54% of variation, compared with 56% using the current method. The four-factor model could explain 66%, whilst the other models could explain between 37% and 20%. This new index has the advantage that it is not based on previous levels of utilisation or expenditure and yet still explains a comparable amount of variation as the current method. However, a disaggregated model containing individual factors may be preferable. [ABSTRACT FROM AUTHOR]

This paper draws upon a review of the relevant literature and the results of the recent Mental Health Awareness in Action (MHAA) programme in England to discuss the current evidence base on the active ingredients in effective anti-stigma interventions in mental health. The MHAA Programme delivered educational interventions to 109 police officers, 78 adults from different community groups whose working lives involved supporting people with mental health problems but who had received no mental health training and 472 schools students aged 14–15. Each adult target group received two intervention sessions lasting two hours. The two school lessons were 50 minutes each. Knowledge, attitudes and behavioural intent were assessed at baseline and follow-up. In addition focus groups were held with mental health service users to explore the impact of stigma on their lives and facilitators of educational workshops were interviewed to provide expert opinion on ‘what works' to reduce psychiatric stigma. Personal contact was predictive of positive changes in knowledge and attitudes for the school students but not the police officers or community adult group. The key active ingredient identified by all intervention groups and workshop facilitators were the testimonies of service users. The statements of service users (consumers) about their experience of mental health problems and of their contact with a range of services had the greatest and most lasting impact on the target audiences in terms of reducing mental health stigma. [ABSTRACT FROM AUTHOR]

The personal impact of schizophrenia is poorly described in the scientific literature. The European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) study compared representative treated prevalence cohorts of patients with schizophrenia in five European countries, to assess unmet needs, impact on caregivers, quality of life, satisfaction with services, symptoms and disability. Of the 404 patients, 79% undertook no work of any kind, and 65% were single. Low quality of life was associated with: anxiety, depression, psychotic symptoms, more previous psychiatric admissions, alcohol abuse, having no reliable friends nor daily contact with family, being unemployed, and having few leisure activities. The most frequently occurring unmet needs among the patients were: daytime activities, company and intimate relationships, psychotic symptoms, psychological distress, and information. The most common worries of relatives were about the patient''s health, and their own future, safety and financial position. Psychiatric services were therefore largely ineffective in managing the personal impact of schizophrenia, especially upon work, home and family life. Research, clinical practice and disability policy developments need to address a wider range of consequences of the disorder than symptoms alone. [Copyright &y& Elsevier]

The EPSILON project (European Psychiatric Services: Inputs Linked to Outcomes and Needs) is a cross-sectional study of the clinical and social characteristics, needs, satisfaction with services, quality of life, and service utilisation and costs for people with schizophrenia in five European sites (Amsterdam, Copenhagen, London, Santander, and Verona). This study examined five hypotheses: (1) Men will have more total needs and more unmet needs for: ‘accommodation’, ‘substance misuse’, ‘psychotic symptoms’, ‘harm to others’, and ‘sexual expression’, whereas women will have more total needs and more unmet needs in the domains of ‘childcare’ and ‘harm to self’. (2) Caregivers of male patients will show higher rates of psychological distress, and higher scores for ‘supervision’ and ‘urging’ than caregivers of female patients. (3) Male and female patients will show similar levels of satisfaction with services, both in total scores and subscores. (4) Male patients will show lower objective quality of life, but similar subjective quality of life compared with women. (5) Service utilization for men and women will differ, and patterns will vary by site. The results confirmed hypotheses 1 (in part) and 3, but failed to support hypotheses 2, 4 and 5. Graphical models were used to generate hypotheses for future research. The implications for planning separate services for male and female schizophrenic patients are discussed. [Copyright &y& Elsevier]

The purpose of this paper is to describe and explain General Assembly Resolution 46/119 United Nations Principles for the Protection of Persons with Mental Illness and for the Improvement for Mental Health Care and situate them in the current examination of mental health and human rights issues. The paper will provide country examples of human rights standards in mental healthcare, will exemplify some of the failures to use the MI Principles and comment on why this has occurred. The paper will also discuss the 'Principles to Respect': Initiative on Mental Health and Human Rights, a practical strategy to address the human rights standards of persons with mental illness. [ABSTRACT FROM AUTHOR]

This paper summarizes key recent policy and practice developments within general adult mental health services in United Kingdom.The National Service Framework For Mental Health, published in September 1999, provides a national blueprint for mental health services for adults of working age over the next decade.The fundamental principles underlying the framework are outlined, the key stakeholders are identified, and the seven standards are discussed.The standards apply to: mental health promotion, primary-care and access to services, severe mental illness, caring about carers, and preventing suicide. This new national policy is based upon the evidence of cost effective services and treatments. Such services can be described in terms of 5 categories of a Basic Service Profile: outpatient and community services, day services, acute inpatient services, longer-term residential services, and interfaces between services and agencies. [ABSTRACT FROM AUTHOR]

The United Nations' draft Sustainable Development Goals (SDGs) only briefly mention mental health. In the context of a growing burden of disease due to mental disorders and psychosocial disabilities, the inclusion of a clear mental health target and indicators in the SDGs will acknowledge the needs and rights of hundreds of millions of people. It will mobilise international funding and policy development, and support other SDGs; it will also strengthen mental health structures, governance and services in low- and middle-income countries. We argue that for a just, sustainable and inclusive post-2015 development agenda, it is vital that the United Nations includes a clear mental health target and indicators in the SDGs. [ABSTRACT FROM AUTHOR]

Background: Depression is a prevalent mental health condition worldwide but there is limited data on its presentation and associated symptoms in primary care settings in low- and middle-income countries like Nepal. This study aims to assess the prevalence of depression, its hallmark and other associated symptoms that meet the Diagnostic and Statistical Manual (DSM-5) criteria in primary healthcare facilities in Nepal. The collected information will be used to determine the content of a mobile app-based clinical guidelines for better detection and management of depression in primary care. Methods: A total of 1,897 adult patients aged 18–91 (63.1% women) attending ten primary healthcare facilities in Jhapa, a district in eastern Nepal, were recruited for the study between August 2, 2021, and March 25, 2022. Trained research assistants conducted face-to-face interviews in private spaces before the consultation with healthcare providers. Depression symptoms, including hallmark symptoms, was assessed using the validated Nepali version of the Patient Health Questionnaire (PHQ-9). Results: One in seven (14.5%) individuals attending primary health care facilities in Jhapa met the threshold for depression based on a validated cut-off score (> = 10) on the PHQ-9. The most commonly reported depressive symptoms were loss of energy and sleep difficulties. Approximately 25.4% of women and 18.9% of men endorsed at least one of the two hallmark symptoms on the PHQ-9. Using a DSM-5 algorithm (at least one hallmark symptom and five or more total symptoms) to score the PHQ-9, 6.3% of women and 4.3% of men met the criteria for depression. The intra-class correlation coefficient for PHQ-9 total scores by health facility as the unit of clustering was 0.01 (95% confidence interval, 0.00-0.04). Conclusion: Depression symptoms are common among people attending primary healthcare facilities in Nepal. However, the most common symptoms are not the two hallmark criteria. Use of total scores on a screening tool such as the PHQ-9 risks overestimating the prevalence and generating false positive diagnoses. Compared to using cut off scores on screening tools, training health workers to first screen for hallmark criteria may increase the accuracy of identification and lead to better allocation of treatment resources. [ABSTRACT FROM AUTHOR]

Black and minority ethnic group users of mental health services receive, on average, significantly poorer services than their white counterparts in Britain.The evidence indicates that there is a type of progressive filtering effect so that black patients are increasingly over represented in higher levels of secure psychiatric care.This paper summarizes the evidence for this form of social inequality. [ABSTRACT FROM AUTHOR]

Describes the transformation of care management on mental health services in Southwark in England, London. Recognition of the roots of case management; Definition of case management on practice; Implementation of care management.

Reports on a study that compared the risk of compulsory psychiatric admission in mental health facilities among ethnic groups in London, England. Methodology of the study; Setting; Research design; Subjects; Outcome measures; Indications that the risk of compulsory admission is increased in black patients.

The article discusses raising issue of how people with depression and anxiety in Great Britain receive treatment and mention Improving Access to Psychological Therapies (IAPT) programme. Topics discussed include bipolar illness among several patients along with personality disorder, people in World Bank high-income countries receiving treatment, and demand and supply in relation to mental health.

The article focuses on the Time to Change programme introduced in England on January 21, 2009 to reduce stigma and discrimination against people with mental health disorders. The initiative is being run by charities such as Mental Health Media, MIND and Rethink and is funded with £18 million from the Big Lottery Fund and Comic Relief. The programme is said to encourage individuals, communities and stakeholder organisations to take part in events, such as the Mental Health Awareness Week, using coordinated action at national and local levels. It also aims to augment the knowledge of discrimination by employers related to mental health as well as help people take legal action against organisations that have discriminated.

Historically, much of the stigma research has relied on a language of attributes, using survey methodology for assessment, and the consumers' perspectives on stigma are also inadequate, hindering an in-depth understanding of social processes related to stigma. Thus, this study aims to understand the social processes guiding experiences of stigma among adults with serious mental illness. Ethnographic methodology was employed to collect data for this study. Methods included interviews and participant observation. Participants included adults with serious mental illness (n = 18) and mental healthcare providers (n = 16), along with policy stakeholders/experts (n = 7). Data analysis was conducted via open and focused coding along with analytic interpretation. A social process guiding experiences of stigma, termed as the principle of gradient rationality (PoGR), is proposed. Three components to the principle are: 1) categorization via stigma or status symbols, 2) movement within hierarchy via exchange of social capital, and 3) institutionalization of stigma via interactional stigma. Briefly, the principle suggests that, during an interaction, individuals can be placed in a hierarchy of three roles/categories ("unreasonable," "high-functioning," or "normal") based on their measure of non-normative behavior. The lower one's position in the hierarchy, the more likely one is to experience stigma. Findings can help develop stigma measures that are sensitive to the variability of individuals experiencing mental illness and to the variability of stigma experiences on a personal/contextual level. Research in other settings is required to further study the applicability of this principle across contexts. • Understanding stigma through perspectives of consumers, providers, and policymakers. • Social process related to stigma, using lens of interactions and relationships. • Using social capital to avert stigma. • Influence of stigma during interactions on stigma within institutions. [ABSTRACT FROM AUTHOR]

Editorial. Comments on the research priorities of mental health service users. Involvement of mental health service users on research projects; Influence for development of mental health services; Comparison to the research priorities of professionals and funding bodies.

The article presents author's views on improving accessibility to psychological therapies and effective care in England. Topics discussed include Improving Access to Psychological Therapies (IAPT) programme and mental health services; association with practitioner-level factors; and mental conditions

The overlapping COVID-19 crisis and the war starting in 2022 threaten front-line healthcare workers' mental health, well-being and job retention in Ukraine. This paper provides a synopsis of a panel discussion held by the Global Mental Health Humanitarian Coalition in May 2022 and expert consultations with clinicians between December 2022 and February 2023 on these challenges. The crises created new problems and exacerbated many pre-existing difficulties. We found that healthcare workers had needed to mobilise previously untapped strengths, including portable emergency medical documents and bespoke local psychosocial support services, amid the costs and pressures of ongoing healthcare reforms. [ABSTRACT FROM AUTHOR]

Focuses on the elective of students related to contemporary psychiatry in China. Discussions on the historical background; Emphasis on the epidemiology of mental illness; Descriptions on the psychiatric services provided.

Focuses on the legal landmark for community care of former psychiatric patients in England. Accounts on the case of Penny and Richard Lloyds; Apprehension of local residents; Modification of the restrictive covenant to permit the use of the Lloyd's home into a residential care home.

Discusses the importance of job sharing in medicine. Definition of job sharing; Effects of jobsharing to employers; Terms and conditions of employment.

Investigates the risk factors of readmission to hospital for long term psychiatric patients after discharge to the community in London, England. Rate of readmitted patients in the hospitals; Role of staffed group homes in reducing the number of admission beds required; Influence of variations in provision of mental health services on readmission rates.

Focuses on the psychiatric treatment and care services provided to the adults in Great Britain. Presentation of national targets and indicators for mental health; Influence of employment on the psychiatric morbidity; Details on the mental ill health costs.

The university system and students are rapidly growing and changing in low‐ and middle‐income countries (LMICs). This growth can facilitate enhanced national productivity yet it can also bring potential risks to student mental health. The World Mental Health Surveys International College Student (WMH‐ICS) initiative could increase information and support in a relatively low‐cost manner for university students in LMICs—a group that is particularly vulnerable to mental health problems and who live in an environment where few targeted resources may be available. Effective implementation of the WMH‐ICS initiative, however, requires long‐term planning and consideration of the specific challenges present in LMIC settings. Planning as to what types of interventions would be needed and achievable in the next 10 to 15 years and consideration of local issues related to uptake, acceptability, appropriateness, feasibility, fidelity, and sustainability from the very beginning would be needed to ensure that the initiative would be useful in the future. [ABSTRACT FROM AUTHOR]

Background: Mental health remains a neglected issue on the global health policy agenda, particularly in low- and middle-income countries (LMIC), and the translation of research evidence into policy and practice is slow. The new EVITA framework was developed to improve mental health evidence uptake and policy agenda-setting in LMICs. In addition, behavioural science methods may be able to support knowledge translation to policy.Methods: Using a mixed-methods study design, we applied and tested the newly developed EVITA 1.1 framework against three case studies related to South Africa at the district, national and international levels. In-depth interviews with 26 experts were conducted between August and November 2019, transcribed, coded and analysed in NVivo, using iterative categorization. The data were analysed against both the EVITA framework and the MINDSPACE framework for behavioural insights.Results: In our case study comparison, we found that (1) research translation to the policy agenda occurs in a complex, fluid system which includes multiple "research clouds", "policy spheres" and other networks; (2) mental health research policy agenda-setting is based on key individuals and intermediaries and their interrelationships; and (3) key challenges and strategies for successful research to policy agenda impact are known, but are frequently not strategically implemented, such as including all stakeholders to overcome the policy implementation gap. Our data also suggest that behavioural science methods can be strategically applied to support knowledge translation to policy agenda-setting.Conclusion: We found that the EVITA framework is useful for understanding and improving mental health research policy interrelationships to support evidence uptake to the policy agenda, and that behavioural science methods are effective support mechanisms. The revised EVITA 2.0 framework therefore includes behavioural insights, for improved mental health policy agenda-setting in LMICs. More research is needed to understand whether EVITA can be applied to other LMICs and to high-income contexts. [ABSTRACT FROM AUTHOR]

Background: Adolescents are vulnerable to stressors because of the rapid physical and mental changes that they go through during this life period. Young people residing in slum communities experience additional stressors due to living conditions, financial stress, and limited access to healthcare and social support services. The Adolescents' Resilience and Treatment nEeds for Mental Health in Indian Slums (ARTEMIS) study, is testing an intervention intended to improve mental health outcomes for adolescents living in urban slums in India combining an anti-stigma campaign with a digital health intervention to identify and manage depression, self-harm/suicide risk or other significant emotional complaints. Methods: In the formative phase, we developed tools and processes for the ARTEMIS intervention. The two intervention components (anti-stigma and digital health) were implemented in purposively selected slums from the two study sites of New Delhi and Vijayawada. A mixed methods formative evaluation was undertaken to improve the understanding of site-specific context, assess feasibility and acceptability of the two components and identify required improvements to be made in the intervention. In-depth interviews and focus groups with key stakeholders (adolescents, parents, community health workers, doctors, and peer leaders), along with quantitative data from the digital health platform, were analysed. Results: The anti-stigma campaign methods and materials were found to be acceptable and received overall positive feedback from adolescents. A total of 2752 adolescents were screened using the PHQ9 embedded into a digital application, 133 (4.8%) of whom were identified as at high-risk of depression and/or suicide. 57% (n = 75) of those at high risk were diagnosed and treated by primary health care (PHC) doctors, who were guided by an electronic decision support tool based on WHO's mhGAP algorithm, built into the digital health application. Conclusion: The formative evaluation of the intervention strategy led to enhanced understanding of the context, acceptability, and feasibility of the intervention. Feedback from stakeholders helped to identify key areas for improvement in the intervention; strategies to improve implementation included engaging with parents, organising health camps in the sites and formation of peer groups. Trial Registration: The trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries, Reference number: CTRI/2022/02/040307. Registered 18 February 2022. [ABSTRACT FROM AUTHOR]

Introduction: 'Let's Talk About Children' is a brief family focused intervention developed to improve mental health outcomes of children of parents with mental illness (COPMI). This study aims to assess the efficacy of LTC in improving mental health of children of parents with schizophrenia or bipolar disorder in China. Methods: The planned study is a multicentre parallel group randomized wait-list controlled trial. A total of 400 eligible families with children aged 8 to 18 years will be recruited, 200 each for families with parental schizophrenia or bipolar disorder. The intervention group will receive Let's Talk About Children delivered by a trained therapist, while the control group will receive treatment as usual. The primary outcomes are child mental health measured by the strengths and difficulties questionnaire and parent–child communication measured using the parent-adolescent communication scale. Parental mental health and family functioning are secondary outcomes. This study also plans to explore mediating factors for the effect of Let's Talk About Children on child mental health, as well as conduct a cost-effectiveness analysis on using Let's Talk About Children in China. Conclusion: The present study will provide evidence for the efficacy of Let's Talk About Children in families with parental schizophrenia and bipolar disorder in China. In addition, it will evaluate potential mechanisms of action and cost-effectiveness of Let's Talk About Children, providing a basis for future implementation. Trial registration: ChiCTR2300073904. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has had far-reaching effects on the mental health of populations around the world, but there has been limited focus on the impact on people with existing mental health conditions in low-income countries. The aim of this study was to examine impact of the pandemic on mental health care and people with mental health conditions in Ethiopia. Methods: A convergent mixed methods study was conducted. We systematically mapped information from publicly available reports on impacts of the pandemic on mental health care. Monthly service utilisation data were obtained from Amanuel Mental Specialised Hospital, the main psychiatric hospital, and analysed using segmented Poisson regression (2019 vs. 2020). In-depth interviews were conducted with 16 purposively selected key informants. Framework analysis was used for qualitative data. Findings from each data source were integrated. Results: In the early stages of the pandemic, participants indicated a minimal response towards the mental health aspects of COVID-19. Mental health-related stigma and discrimination was evident. Scarce mental health service settings were diverted to become COVID-19 treatment centres. Mental health care became narrowly biomedical with poorer quality of care due to infrequent follow-up. Households of people with pre-existing mental health conditions in the community reported worsening poverty and decreased access to care due to restricted movement, decreased availability and fear. Lack of reliable medication supplies increased relapse and the chance of becoming chained at home, abandoned or homeless. Caregiver burden was exacerbated. Within mental health facilities, prisons and residential units, infection control procedures did not adequately safeguard those with mental health conditions. Meanwhile, the needs of people with mental health conditions in COVID-19 quarantine and treatment facilities were systematically neglected. Only late in the day were integrated services developed to address both physical and mental health needs. Conclusions: The COVID-19 pandemic had substantial negative impacts on the lives of people with mental health conditions in Ethiopia. Future emergency response should prioritise the human rights, health, social and economic needs of people with mental health conditions. Integration of mental and physical health care would both expand access to care and increase resilience of the mental health system. [ABSTRACT FROM AUTHOR]

Background: Building partnerships between mental health services and Black faith communities to co-produce culturally tailored interventions is an essential step towards improving access to services and reducing stigma among the Black population. Given that Black faith organisations are considered a primary source of emotional and psychological support they are well positioned as 'gatekeepers' for services, to overcome barriers to engagement and build trusting relationships with the Black community. The aim of this paper is to pilot a manualised mental health awareness and stigma reduction intervention for Black faith communities in the UK, and to make an initial assessment of feasibility, acceptability and outcomes. Methods: This study employed a mixed methods pre–post-design, based upon the Medical Research Council Framework (MRC) for complex interventions, and the Implementation Science Research Development. Results: The qualitative assessments indicate that the intervention was found overall to be acceptable and feasible to the Black faith community population. This pilot study did not find statistically significant changes for the Mental Health Knowledge schedule (MAKS), Reported and Intended Behaviour Scale (RIBS), intended help-seeking or willingness to disclose (Attitudes to Mental Illness Survey) measures. However, the direction of all the non-significant changes in these measures suggests positive changes in mental health knowledge, a reduction in participants' desire for social distance, and greater willingness to disclose personal experiences of mental health problems. A statistically significant improvement in the Community Attitudes towards Mental Illness (CAMI) scale results indicated a lower level of stigmatising attitudes towards people with lived experience of mental health conditions (PWLE), and an increase in tolerance and support towards PWLE after the intervention. Significant improvement in the willingness to disclose measure suggests increased preparedness to seek help amongst participants, a lesser desire for social distance, and greater willingness to engage with PWLE after the intervention. Three key themes, including 9 subthemes were identified from the qualitative data analysis: (i) initial implementation and intention to adopt; (ii) perceived suitability and usefulness of intervention to address cultural issues relating to mental health in the Black community; and (iii) strengthening the capacity of faith leaders. Conclusions: This ON TRAC pilot study shows that the intervention was feasible and acceptable, and that it has promising positive impacts and next requires larger scale evaluation. These results demonstrate that the intervention was a culturally acceptable way to potentially increase mental health awareness and reduce stigma in Black faith communities. Trial registration: ISRCTN12253092. [ABSTRACT FROM AUTHOR]