Prisons: mental health institutions of the 21st century?
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Australia↗
Biomedical subjects
Harvey Whiteford
Publications and source records attributed to Harvey Whiteford.
A comparison of Australian men with psychotic disorders remanded for criminal offences and a community group of psychotic men who have not offended.
BACKGROUND: People remanded into custody by the courts have a substantially higher rate of severe mental disorder than other prisoners and the general population. Knowledge of their prevalence, needs and characteristics and an analysis of pathways to care may be necessary to provide mental health care effectively and efficiently. Previous prison studies focusing on psychotic offenders have suffered from the use of instruments not validated in a forensic setting and lack of a relevant comparison group. METHOD: The Diagnostic Interview for Psychosis (DP) is a composite semi-structured standardized interview schedule. It combines social and demographic descriptors with measures of functioning adapted from the World Health Organisation Disability Assessment Schedule (DAS). The remand centre surveyed had 466 cells and is the main remand and reception centre for males for the southern region of the state of Queensland, Australia. Of the 621 men screened, 65 answered yes to at least one question in the DP and were interviewed. RESULTS: Six hundred and twenty-one remandees were screened and of these 61 were interviewed as screened positive for psychotic disorder. Thirty-five per cent had been homeless for an average of 32 weeks during the previous year. Most had had little contact with families or close friends. Eighty-one per cent were receiving no treatment at the time of offence. Seventy-eight per cent were unemployed and in receipt of a pension. Eighty per cent were dependent on alcohol, cannabis or amphetamines. Statistical issues of power are detailed in the text. CONCLUSIONS: The simplistic 'prison, hospital or community treatment' debate is misleading. Instead, the development of flexible preventative, management and accommodation services for people with severe mental disorder who have committed offences is a priority.
Adult↗
Suicide in developing countries (1): frequency, distribution, and association with socioeconomic indicators.
OBJECTIVE: Suicide is a global public health problem, but relatively little epidemiological investigation of the phenomenon has occurred in developing countries. This paper aims to (1) examine the availability of rate data in developing countries, (2) provide a description of the frequency and distribution of suicide in those countries for which data are available, and (3) explore the relationship between country-level socioeconomic factors and suicide rates. It is accompanied by two companion papers that consider risk factors and preventive efforts associated with suicide in developing countries, respectively. METHOD: Using World Health Organization data, we calculated the average annual male, female, and total suicide rates during the 1990s for individual countries and regions (classified according to the Human Development Index [HDI]), and examined the association between a range of socioeconomic indicators and suicide rates. RESULTS: For reasons of data availability, we concentrated on medium HDI countries. Suicide rates in these countries were variable. They were generally comparable with those in high HDI countries from the same region, with some exceptions. High education levels, high telephone density, and high per capita levels of cigarette consumption were associated with high suicide rates; high levels of inequality were associated with low suicide rates. CONCLUSION: Epidemiological investigations of this kind have the potential to inform suicide prevention efforts in developing countries, and should be encouraged.
Cause of Death↗
Suicide in developing countries (2): risk factors.
The majority of studies on risk factors for suicide have been conducted in developed countries, and less work has been done to systematically profile risk factors in developing countries. The current paper presents a selective review of sociodemographic, clinical, and environmental/situational risk factors in developing countries. Taken together, the evidence suggests that the profiles of risk factors in developing countries demonstrate some differences from those in developed countries. In some developing countries, at least, being female, living in a rural area, and holding religious beliefs that sanction suicide may be of more relevance to suicide risk than these factors are in developed countries. Conversely, being single or having a history of mental illness may be of less relevance. Risk factors that appear to be universal include youth or old age, low socioeconomic standing, substance use, and previous suicide attempts. Recent stressful life events play a role in both developing and developed countries, although their nature may differ (e.g., social change may have more of an influence in the former). Likewise, access to means heightens risk in both, but the specific means may vary (e.g., access to pesticides is of more relevance in developing countries). These findings have clear implications for suicide prevention, suggesting that preventive efforts that have shown promise in developed countries may need to be tailored differently to address the risk factor profile of developing countries.
Adolescent↗
Suicide in developing countries (3): prevention efforts.
Until now, suicide prevention efforts have been limited in developing countries, although there are pockets of excellent achievement. Various universal, selective, and indicated interventions have been implemented, many of which target a different pattern of risk factors to those in developed countries. In the absence of sufficient mental health services, developing countries rely heavily on nongovernment organizations (NGOs) to provide crisis interventions for suicidal individuals, as well as proactive interventions aimed at raising community awareness and building resilience. Often these NGOs work within a social and public health framework, collaborating with others to provide nested suicide prevention programs that are responsive to local community needs. There is a clear need to develop appropriate, relevant and effective national suicide prevention plans in developing countries, since, to date, only Sri Lanka has done so. These plans should focus on a range of priority areas, specify the actions necessary to achieve positive change in these priority areas, consider the range of collaborators required to implement these actions, and structure their efforts at national, regional, and local levels. The plans should also promote the collection of accurate data on completed and attempted suicide, and should foster evaluation efforts.
Crisis Intervention↗
Queensland Centre for Mental Health Research: the first 17 years.
OBJECTIVE: To reflect on the establishment and evolution of the Queensland Centre for Mental Health Research. METHOD: Narrative historical review. RESULTS: First established as an inpatient research unit in December 1987, the focus of the Centre evolved in concert with the skills of the staff. After the structure was revised in 1996 and 1999, the Centre has evolved into a group with four main research streams--epidemiology, developmental neurobiology, genetics and policy and economics. Although the group maintains a strong focus on serious mental disorders such as schizophrenia, our policy and economic work has a wider perspective. The Queensland Centre for Mental Health Research is based in an historic mental health service, with laboratories in collaborating universities and institutes. Key lessons learnt by the group along the way relate to the importance of focusing on a restricted range of research topics in order to build a critical mass. CONCLUSIONS: Given a facilitating environment, hospital-based research groups can prosper. Over the last 17 years, a cost-efficient, focused and productive research group has evolved that has made contributions to international research.
Academic Medical Centers↗
Leadership in mental health policy: the national context.
OBJECTIVE: To describe how mental health policy is developed and implemented. METHODS: A review of the literature on public policy analysis and the experience of the author in the development and implementation of national mental health policy. RESULTS: A five-step process of problem identification, policy development, political decision, policy implementation and evaluation provides a framework for understanding the policy cycle. CONCLUSION: An understanding of this process is essential for psychiatrists and other mental health professionals in order to influence the process and content of mental health policy.
Australia↗
Mental health policy development: case study of Cambodia.
OBJECTIVE: To identify key issues in the mental health policy development process in Cambodia that will contribute to an increased understanding of how mental health policy gets on the public policy agenda, how it stays there and why policy implementation fails or succeeds. The research was formative because mental health policy analysis is a young and newly emerging discipline. METHOD: A retrospective case study methodology was used to research the development of the draft Cambodian Mental Health Plan 2003-2022. Ten key informants involved in the policy development process were interviewed using a semistructured questionnaire designed to collect qualitative data about the policy formation process, stakeholders and context. RESULTS: The research identified key issues influencing mental health policy development. These are the need to include the Ministry of Health (MoH) in the development of mental health plans; the significance of timing; the usefulness of mental health plans; the impact of the post-conflict context on policy development; and the evolution of stakeholder groups and their need to learn how to debate the merits of mental health reform. CONCLUSIONS: The findings are formative given methodology limitations. However, important insight is provided into the dynamics of the policy development processes that occurred in Cambodia. This allows the generation of important hypotheses for future mental health policy process research in both Cambodia and other post-conflict developing countries.
Cambodia↗
Correlates of victimisation amongst people with psychosis.
BACKGROUND: While much attention has been given to the prediction of violent offending behaviour amongst people with psychotic disorders, less attention has been given to the fact that these same individuals are often the victims of violence. In this paper, we examine victimisation amongst participants in a prevalence study of psychosis, and describe demographic and clinical correlates of victimisation. METHOD The study was based on the Australian National Survey of Mental Health and Wellbeing--Low Prevalence (Psychotic) Disorders. The participants were asked if they had been a victim of violence in the previous year. The association between selected demographic and clinical variables and being a victim of violence was examined using logistic regression. RESULTS: Of the 962 individuals with psychosis, 172 reported being a victim of violence in the past 12 months (17.9 %). The odds of being a victim were increased in those who: (a) were female, (b) were homeless, (c) had a lifetime history of substance abuse, (d) had been arrested in the previous 12 months, (e) had poorer social and occupational function, and (f) had higher scores on the disorganisation summary score. CONCLUSIONS: Clinicians should remain mindful that one out of every six individuals with a psychotic disorder reports being a victim of violence in the previous year. Models of care that address issues related to symptom relief, accommodation, and exposure to high-crime areas may reduce the rates of victimisation amongst those with psychotic disorders.
Adult↗
Social capital and mental health.
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Health Policy↗
Australia's National Mental Health Strategy.
BACKGROUND: Australia commenced a 5-year reform of mental health services in 1993. AIMS: To report on the changes to mental health services achieved by 1998. METHOD: Analysis of data from the Australian National Mental Health Report 2000 and an independent evaluation of the National Mental Health Strategy. RESULTS: Mental health expenditure increased 30% in real terms, with an 87% growth in community expenditures, a 38% increase in general hospitals and a 29% decrease in psychiatric hospitals. The growth in private psychiatry, averaging 6% annually prior to 1992, was reversed. Consumer and carer involvement in services increased. CONCLUSIONS: Major structural reform was achieved but there was limited evidence that these changes had been accompanied by improved service quality. The National Mental Health Strategy was renewed for another 5 years.
Australia↗
The International Consortium on Mental Health Policy and Services: objectives, design and project implementation.
The concept of the burden of disease, introduced and estimated for a broad range of diseases in the World Bank report of 1993 illustrated that mental and neurological disorders not only entail a higher burden than cancer, but are responsible, in developed and developing countries, for more than 15% of the total burden of all diseases. As a consequence, over the past decade, mental disorders have ranked increasingly highly on the international agenda for health. However, the fact that mental health and nervous system disorders are now high on the international health agenda is by no means a guarantee that the fate of patients suffering from these disorders in developing countries will improve. In most developing countries the treatment gap for mental and neurological disorders is still unacceptably high. To address this problem, an international network of collaborating institutions in low-income countries has been set up. The establishment and the achievements of this network--the International Consortium on Mental Health Policy and Services--are reported. Sixteen institutions in developing countries collaborate (supported by a small number of scientific resource centres in industrialized nations) in projects on applied mental health systems research. Over a two-year period, the network produced the key elements of a national mental health policy; provided tools and methods for assessing a country's current mental health status (context, needs and demands, programmes, services and care and outcomes); established a global network of expertise, i.e., institutions and experts, for use by countries wishing to reform their mental health policy, services and care; and generated guidelines and examples for upgrading mental health policy with due regard to the existing mental health delivery system and demographic, cultural and economic factors.
Consensus↗
The mental health policy template: domains and elements for mental health policy formulation.
Mental disorders are a major and rising cause of disease burden in all countries. Even when resources are available, many countries do not have the policy and planning frameworks in place to identify and deliver effective interventions. The World Health Organization (WHO) and the World Bank have emphasized the need for ready access to the basic tools for mental health policy formulation, implementation and sustained development. The Analytical Studies on Mental Health Policy and Service Project, undertaken in 1999-2001 by the International Consortium for Mental Health Services and funded by the Global Forum for Health Research aims to address this need through the development of a template for mental health policy formulation. A mental health policy template has been developed based on an inventory of the key elements of a successful mental health policy. These elements have been validated against a review of international literature, a study of existing mental health policies and the results of extensive consultations with experts in the six WHO regions of the world. The Mental Health Policy Template has been revised and its applicability will be tested in a number of developing countries during 2001-2002. The Mental Health Policy Template and the work of the Consortium for Mental Health Services will be presented and the future role of the template in mental health policy development and reform in developing countries will be discussed.
Developed Countries↗
The appropriateness and use of focus group methodology across international mental health communities.
The ability to interpret collected data across international mental health communities often proves to be difficult. The following paper reports on the use and appropriateness of focus group methodology in helping to clarify issues that could help substantiate data collection and comparison across different cultures and regions. Field tests of the focus group methodology were undertaken in different regions and this paper describes an overview of the final field test in Sofia, Bulgaria. The findings and experiences with utilizing this methodology were incorporated in subsequent data collections.
Attitude to Health↗
The mental health country profile: background, design and use of a systematic method of appraisal.
This article describes the construction and use of a systematic structured method of mental health country situation appraisal, in order to help meet the need for conceptual tools to assist planners and policy makers develop and audit policy and implementation strategies. The tool encompasses the key domains of context, needs, resources, provisions and outcomes, and provides a framework for synthesizing key qualitative and quantitative information, flagging up gaps in knowledge, and for reviewing existing policies. It serves as an enabling tool to alert and inform policy makers, professionals and other key stakeholders about important issues which need to be considered in mental health policy development. It provides detailed country specific information in a systematic format, to facilitate global sharing of experiences of mental health reform and strategies between policy makers and other stakeholders. Lastly, it is designed to be a capacity building tool for local stakeholders to enhance situation appraisal, and multisectorial policy development and implementation.
Africa↗
Do nations' mental health policies, programs and legislation influence their suicide rates? An ecological study of 100 countries.
OBJECTIVE: To test the hypothesis that the presence of national mental health policies, programs and legislation would be associated with lower national suicide rates. METHOD: Suicide rates from 100 countries were regressed on mental health policy, program and legislation indicators. RESULTS: Contrary to the hypothesized relationship, the study found that after introducing mental health initiatives (with the exception of substance abuse policies), countries' suicide rates rose. CONCLUSION: It is of concern that most mental health initiatives are associated with an increase in suicide rates. However, there may be acceptable reasons for the observed findings, for example initiatives may have been introduced in areas of increasing need, or a case-finding effect may be operating. Data limitations must also be considered.
Developed Countries↗
Disability, employment and work performance among people with ICD-10 anxiety disorders.
OBJECTIVE: To ascertain at a population level, patterns of disability, labour force participation, employment and work performance among people with ICD-10 anxiety disorders in comparison to people without disability or long-term health conditions. METHOD: A secondary analysis was conducted of a probability sample of 42 664 individuals collected in an Australian Bureau of Statistics (ABS) national survey in 1998. Trained lay interviewers using ICD-10 computer-assisted interviews identified household residents with anxiety disorders. RESULTS: Anxiety disorders were associated with: reduced labour force participation, degraded employment trajectories and impaired work performance compared to people without disabilities or long-term health conditions. CONCLUSION: People with anxiety disorders may need more effective treatments and assistance with completing education and training, joining and rejoining the workforce, developing career pathways, remaining in the workforce and sustaining work performance. A whole-of-government approach appears needed to reduce the burden of disease and increase community labour resources. Implications for clinicians, vocational professionals and policy makers are discussed.
Adolescent↗