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Biomedical subjects

Shekhar Saxena

Publications and source records attributed to Shekhar Saxena.

At least 37 records · Page 2Linked to original sources
PubMed2004

Opportunities for an improved role for nurses in psychoactive substance use: review of the literature.

Nurses form a core component of many health care systems so their role in responding to problems related to psychoactive substance use is crucial. They are often under-utilized, mainly because of anxieties concerning role adequacy, legitimacy, lack of support and failure to implement interventions in a variety of settings. Nurses have unique opportunities through interactions they have with young people, families and significant others. Training and career preparation should encompass development of innovative strategies, taking a leading role in management of substance use patients, involvement in the treatment of the homeless mentally ill, HIV-infected individuals and persons with dual disorders of mental health and substance use. Future directions should focus on developing skills for critical thinking, preventive and therapeutic interventions, clinical judgement, effective organizational capacity and team work. Barriers such as scope of practice, authority, ethical and legal issues surrounding health care for substance use need to be addressed.

Clinical Competence↗
PubMed2004

Reducing the global burden of depression: population-level analysis of intervention cost-effectiveness in 14 world regions.

BACKGROUND: International evidence on the cost and effects of interventions for reducing the global burden of depression remain scarce. Aims To estimate the population-level cost-effectiveness of evidence-based depression interventions and their contribution towards reducing current burden. METHOD: Primary-care-based depression interventions were modelled at the level of whole populations in 14 epidemiological subregions of the world. Total population-level costs (in international dollars or I$) and effectiveness (disability adjusted life years (DALYs) averted) were combined to form average and incremental cost-effectiveness ratios. RESULTS: Evaluated interventions have the potential to reduce the current burden of depression by 10-30%. Pharmacotherapy with older antidepressant drugs, with or without proactive collaborative care, are currently more cost-effective strategies than those using newer antidepressants, particularly in lower-income subregions. CONCLUSIONS: Even in resource-poor regions, each DALYaverted by efficient depression treatments in primary care costs less than 1 year of average per capita income, making such interventions a cost-effective use of health resources. However, current levels of burden can only be reduced significantly if there is a substantial increase substantial increase in treatment coverage.

Adolescent↗
PubMed2004

Brief report - mental health research on low- and middle-income countries in indexed journals: a preliminary assessment.

BACKGROUND: Mental health research focused on low- and middle-income (LAMI) countries is needed in view of the burden of neuropsychiatric diseases and the deficiency of mental health resources in these countries. AIMS OF THE STUDY: To examine whether mental health research publications on LAMI countries address issues that are likely to influence public mental health. METHOD: Four databases were searched for years 2000 and 2001 with subject headings related to mental disorders, mental health services, somatic therapies and psychotherapy. Countries were categorized into income groups according to World Bank (2000) criteria. The title, index words and abstracts were reviewed. RESULTS: Almost 55% of publications related to ten LAMI countries. One sixth of research publications related to services/policies, but less than 1% were devoted to economic evaluation. Affective disorders, self-inflicted injuries and mental retardation were under-researched. DISCUSSION: The geographic spread of internationally accessible mental health research publications is limited. Moreover, publications from LAMI countries often do not address public mental health issues. Use of a single rater might have led to some arbitrariness in classification of articles and some relevant articles would have been missed because of our inability to include all relevant databases. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Sustained support by various stakeholders is needed for research that can inform mental health care provision and use in LAMI countries. IMPLICATIONS FOR HEALTH POLICIES: Scientific research can inform mechanisms that influence policy and public health if adequate attention is paid to dissemination of findings to end users. IMPLICATIONS FOR FURTHER RESEARCH: There is a need to focus research in LAMI countries on mental health conditions causing high burden that are currently under-researched (e.g. depression, mental retardation, self-inflicted injuries), policy and service issues, and mental health economics.

Abstracting and Indexing↗
PubMed2004

Research for Change: the role of scientific journals publishing mental health research.

There is an enormous gap between the burden of mental disorders and mental health resources in low- and middle-income countries. The Mental Health: Global Action Programme of the World Health Organization (WHO) envisions an active role for research in the multidimensional efforts required to change the current mental health situation in these countries (Research for Change). WHO's strategies to achieve this include developing a research policy and a priority agenda at country level with active collaboration from all stakeholders, building research capacity and infrastructure and involving scientific journals to stimulate and disseminate public health oriented research. A recently agreed joint statement by editors of prominent journals publishing mental health research and WHO sets major objectives and some possible strategies for achieving this. WHO is committed to making Research for Change a reality by working with partners who share this aim.

Journal Article↗
PubMed2003

Budget and financing of mental health services: baseline information on 89 countries from WHO's project atlas.

BACKGROUND: Very little information is available on budget and financing of mental health services in the world. AIMS OF THE STUDY: During year 2001, WHO collected information from all countries on resources available for mental health care as a part of Project Atlas. The present report seeks to describe the situation regarding federal budgets and financing of mental health care at the country level. It also examines the association between relative allocation of health budget to mental health and mental health policy, programme and resource indicators in 89 countries. METHOD: The information was collected through a questionnaire (with an accompanying glossary) that was sent to the mental health focal point in the Ministry of Health of each country. Eighty nine countries provided information on their mental health budget as a proportion of health budget. In addition, information was obtained on policy, programme and mental health resource indicators (beds, personnel, services to special population and availability of drugs). RESULTS: The results showed that 32% of 191 countries did not have a specified budget for mental health. Of the 89 countries that supplied the requisite information 36% spent less than 1% of their total health budget on mental health. Many countries from Africa (79%) and the South East Asia (63%) were in this subgroup. Comparison with the Global Burden of Disease data showed a marked disparity between burden and resources. Lower income countries allocated a lesser proportion of their health budget on mental health in comparison to higher income countries. The primary method of financing mental health care in most countries was tax-based (60.2%), but many low-income countries depended on out-of-pocket expenditure (16.4%). The presence of mental health policies and programmes in general was not associated with the proportion of health budget allocated to mental health. Counties categorized based on the proportion of mental health budget to health budget, differed significantly in terms of policy on disability benefits and mental health resource indicators (beds, personnel, services for special populations and availability of drugs). DISCUSSION AND LIMITATIONS: Federal allocation for mental health care in most countries is low compared to the burden of these disorders. There is also a large disparity among countries and regions. Limitations of the study were, an exclusive reliance on government sources and the difficulty some governments faced in providing accurate information on federal mental health budget as it was not identified separately. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: To use resources more efficiently and judiciously, countries should support integration of services, reallocation of mental health beds, training in mental health to providers and services for special populations. IMPLICATIONS FOR HEALTH POLICIES: Most countries need to increase their mental health budgets in order to provide necessary services. Countries with out-of-pocket payment as the primary method of mental health financing should seek to establish social insurance mechanisms. IMPLICATIONS FOR FURTHER RESEARCH: More research needs to be conducted to gather specific information on mental health financing in relation to policy and service planning.

Budgets↗
PubMedDate not supplied

Mental health services in Central and Eastern Europe: current state and continuing concerns.

AIMS: This paper attempts to examine the current state of mental health services in Central and Eastern Europe. METHODS: Selected review of available literature has been done with emphasis on information complied by World Health Organization (WHO). RESULTS: The magnitude and burden of mental disorders is high in Europe, the mental health services are inadequate in most Central and Eastern European countries and human rights situation is unsatisfactory. However, there are some positive recent developments worth noting. These include increased attention to human rights, cooperation and collaboration at sub-regional level and emergence of family and consumer associations. CONCLUSIONS: A concerted and systematic attempt needs to be made to respond to the challenge of providing adequate and human rights-based mental health services in Central and Eastern European countries. The framework developed by WHO can assist the countries in their initiatives aimed at improving mental health systems.

Attitude to Health↗
PubMedDate not supplied

Mental health system and services in Albania.

AIMS: To describe the mental health system in Albania. METHODS: Data were gathered in 2003 and in 2004 using a new WHO instrument, World Health Organization Assessment Instrument for Mental health Systems (WHO-AIMS), designed for collecting essential information on the mental health system of low and middle income countries. It consists of 6 domains, 28 facets and 156 items. RESULTS: The information collected through WHO AIMS covered the key aspects of mental health system in Albania: the mental health policy and the legislative framework, the network of mental health services and the characteristics of the users, the role of the primary health care, the human resources, the public education and the links with other governmental sectors, monitoring and research. CONCLUSIONS: The data collection through WHO AIMS represented a needed step for a better in-depth knowledge of the system and for implementing actions to strengthen the system. Examples of planned actions were the improvement of the mental health component in primary care, a clear shift of resources from mental hospitals to community facilities, an increase of the outpatient care and an expansion of the mental health information system.

Albania↗
PubMedDate not supplied

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↗
PubMedDate not supplied

Alcohol consumption among middle-aged and elderly men: a community study from western India.

AIMS: To assess the prevalence and pattern of alcohol use in a middle-aged and elderly population in Mumbai, India. METHODS: 50 220 men aged >/=45 years from the lower and lower-middle section of the general population were interviewed. RESULTS: 18.8% were currently consuming alcoholic beverages, of whom 32.8% drank on at least 6 days per week. The most popular beverage was locally distilled products of fruits and grain (country liquor). Seventy-five per cent of the consumers of country liquor would consume over 53 g of ethanol on a day when they drank, with 46.6% of these doing so on at least 6 days per week. CONCLUSIONS: Abstinence, and also heavy and frequent use of alcohol, are common in this population and the latter is likely to have significant public health implications.

Aged↗