The Ghana Project in Psychiatry: A Systematic Description of the Mental Health Services

Introduction: Mental health is a neglected field within the health care system in Ghana. Studies and public education focusing on mental health remain low, leading to poor knowledge and awareness of mental health among the population. Objective: The overall aim of this study was to provide a systematic description of mental health services in Ghana. Methods: A snowball technique was used to select a total of 42 mental health professionals from six hospitals for interviews. A structured questionnaire was used for data collection. Results: Major findings of this study include inadequate human and material resources;poor knowledge of mental health among the population;weak coordination between general practitioners and mental health professionals;inadequate mental health services in schools and prisons. Additionally, 54.8% of respondents reported limited mental health educational materials, and most schools (54.8%) lacking trained resident mental health professionals. The main interventions for service delivery are taking over activities of daily living by nurses, problem assessment, and psychological interventions which achieved the same results (69%). A tendency to consult faith-based healers and prayer camps;a lack of mental health research capacity, specifically research focusing on policies;and weakness in the organization and decentralization of mental health services in Ghana are among the common challenges to seeking care. Conclusion: Public mental health education on available resources and services is important. Capacity research focusing on dissemination and implementation of mental health policies can serve as the basis for addressing mental health challenges and improving service delivery in Ghana.

Comparing models of mental health service systems between Australia and China： implications for the future development of Chinese mental health service

Mental illness is recognized as a significant social and public health problem in China, with approximately 16 million people affected with mental illness according to a report in 2002.^1 In addition, approximately 30 million children and young adolescents are suffering from mood and/or behavioral disorders. Drug and alcohol problems and other psychosocial disorders affecting women, elders and survivors of disasters are also important problems adding to the overall national mental health burden. Research from both China and abroad indicate that mental and behavioral problems will continue to increase in the future. The World Health Organization （WHO） has warned that the financial burden from mental disorders in China will constitute 1/4 of total burden from various diseases in 2020.^1

The current status of community mental health services in three northern areas of China

Objective:This study investigated and discussed the current status of community mental health service in three northern areas of China(Beijing,Harbin,and Karamay)in an effort to improve the community mental health services in China.Methods:In this study 176 residents from communities of the three northern areas of China were involved and divided into 18 groups.The study was conducted according to a self-prepared structured interview outline.Results:The analysis was conducted based on the following four perspectives:1.commu-nity residents’understanding of the mental health problems and how they treated psychiatric patients;2.community residents’access to and application of mental health information;3.com-munity residents’attitude to accept mental health services and the factors influencing community residents to seek help from mental health services;and 4.community residents’attitude and will-ingness to participate in the activities of community mental health services.Conclusion:Based on the investigation and analysis regarding the current status of the com-munity mental health services in three northern areas of China,it is concluded that the residents do not have s clear and complete understanding of mental health.The characteristics of mental health services had a regional correlation.Currently,the mental health services do not work effectively,and the residents are somewhat passive in obtaining information about mental health.Community mental health services should be offered according to different individual needs of the residents and the actual situations of each region.

Physical restraint in mental health nursing: A concept analysis

Objective: Physical restraint is frequently used in medical services,such as in mental health settings,intensive care units and nursing homes,but its nature varies in different institutions.By reviewing related literature,this study aims to clarify the concept of physical restraint in mental health nursing.Method: Three databases (PubMed,PsyclNFO and CINAHL) were retrieved,and Walker and Avant's concept analysis method was used to analyze the concept of physical restraint in mental health nursing.Results: Physical restraint is a coercive approach that enables the administration of necessary treatment by safely reducing the patient's physical movement.It should be the last option used by qualified personnel.Antecedents of physical restraint are improper behavior (violence and disturbance) of patients,medical assessment prior to implementation and legislation governing clinical usage.Consequences of physical restraint are alleviation of conflict,physical injury,mental trauma and invisible impact on the institution.Discussion: This study defined the characteristics of physical restraint in mental health nursing.The proposed concept analysis provided theoretical foundation for future studies.

Classification,prevalence and integrated care for neurodevelopmental and child mental health disorders:A brief overview for paediatricians

‘Neurodevelopmental disorders’comprise a group of congenital or acquired longterm conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations,including autism spectrum disorder,attention deficit/hyperactivity disorder,tic disorder/Tourette’s syndrome,developmental language disorders and intellectual disability.Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability.Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm.Together these are referred to as neurodevelopmental,emotional,behavioural,and intellectual disorders(NDEBIDs)in this paper.Varying prevalence rates for NDEBID have been reported in developed countries,up to 15%,based on varying methodologies and definitions.NDEBIDs are commonly managed by either child health paediatricians or child/adolescent mental health(CAMH)professionals,working within multidisciplinary teams alongside social care,education,allied healthcare practitioners and voluntary sector.Fragmented services are common problems for children and young people with multi-morbidity,and often complicated by subthreshold diagnoses.Despite repeated reviews,limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research.The recently developed“Mental,Behavioural and Neurodevelopmental disorder”chapter of the International Classification of Diseases-11 offers a way forward.In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID,enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.

No increase in burnout in health care workers during the initial COVID-19 outbreak:Systematic review and meta-analysis

BACKGROUND For decades and before the coronavirus disease 2019(COVID-19)pandemic,for health care workers(HCWs)burnout can be experienced as an upsetting confrontation with their self and the result of a complex a multifactorial process interacting with environmental and personal features.AIM To literature review and meta-analysis was to obtain a comprehensive understanding of burnout and work-related stress in health care workers around the world during the first outbreak of the COVID-19 pandemic.METHODS We performed a database search of Embase,Google Scholar and PubMed from June to October 2020.We analysed burnout risk factors and protective factors in included studies published in peer-reviewed journals as of January 2020,studying a HCW population during the first COVID-19 wave without any geographic restrictions.Furthermore,we performed a meta-analysis to determine overall burnout levels.We studied the main risk factors and protective factors related to burnout and stress at the individual,institutional and regional levels.RESULTS Forty-one studies were included in our final review sample.Most were crosssectional,observational studies with data collection windows during the first wave of the COVID-19 surge.Of those forty-one,twelve studies were included in the meta-analysis.Of the 27907 health care professionals who participated in the reviewed studies,70.4%were women,and two-thirds were either married or living together.The most represented age category was 31-45 years,at 41.5%.Approximately half of the sample comprised nurses(47.6%),and 44.4%were working in COVID-19 wards(intensive care unit,emergency room and dedicated internal medicine wards).Indeed,exposure to the virus was not a leading factor for burnout.Our meta-analytic estimate of burnout prevalence in the HCW population for a sample of 6784 individuals was 30.05%.CONCLUSION There was a significant prevalence of burnout in HCWs during the COVID-19 pandemic,and some of the associated risk factors could be targeted for intervention,both at the individual and organizational levels.Nevertheless,COVID-19 exposure was not a leading factor for burnout,as burnout levels were not notably higher than pre-COVID-19 levels.

上海市精神卫生专科医院心理应急管理现状研究

目的 了解新型冠状病毒肺炎疫情影响下上海市精神卫生专科医院心理应急管理现状及面临的主要问题,为建立健全精神卫生专科医院心理应急管理体系提供对策和建议。方法 采用定量研究和定性研究相结合的方法,面向上海市18家精神卫生中心的心理危机干预管理人员及272名心理危机干预队伍成员开展问卷调查,选取24名心理危机干预相关工作人员进行访谈。结果 (1)管理设置方面,18家医院中仅上海市精神卫生中心设置了独立的心理危机干预办公室,15家(83.3%)已制定心理应急总体干预方案或预案,11家(61.1%)已建立健全心理应急管理相关制度,12家(66.7%)配备心理危机干预工作经费。(2)队伍建设方面,心理危机干预队员以兼职为主(84.9%),年龄主要在35~<45岁(47.8%),96.3%的队员具有大学本科及以上学历,所学专业以精神医学为主(40.4%),85.7%的队员具有心理咨询师资格证书,40.1%的队员具有突发公共卫生事件心理危机干预经验,81.3%的队员能够有效处理创伤后心理问题。(3)心理应急管理过程中存在的主要问题包括队员压力过大、能力水平参差不齐、队伍人手不足和保障机制不完善4个方面。结论 目前,上海市已初步形成心理危机干预体系,但在管理机制和队伍建设方面仍存在不足。建议进一步完善心理危机干预体系管理机制和人才队伍建设。

The nurses’ voice of working in a newly established community based 24-hour support center for people with psychiatric disabilities

This study explores the perceptions of a small group of nurses working at a newly established 24-hour community-based service enter (SC) for users with psychiatric disability using a qualitative approach. Since the mental health reform in Sweden in 1995 where the communities (in Sweden called municipalities) were given the responsibility to establish service and support to people with severe psychiatric disabilities, they have struggled in finding suitable forms of these kinds of areas. In 2010, this led to the creation and development of a new center aiming to provide services and support based on the expressed needs of people with physchiatric disability in a community located in southern Sweden. During 2011, a total of three group interviews were performed to capture the employed nurses’ perceptions of this newly established SC. The interview texts were analyzed by way of qualitative content analysis. A first reading of the interview texts revealed that the nurses’ perceptions of the service center were unwaveringly positive but that their beliefs about who the specific target group were differed. The main finding was summarized by the theme: Making a difference—on an individual, professional, and organizational level. The sub themes were: 24-hour availability, unclear assignment, and preventing mental illness. The findings indicate a need for a community round-the-clock service center in this Swedish community and a more clear definition of the target group.

Efficacy of a Community-Based Trauma Recovery Program after a Fire Disaster

As industries develop,fire disasters and their associated damage are increasing.Investigating the mental health of victims is imperative because this is an essential issue for community recovery after a disaster.This study was conducted to determine the efficacy of a program implemented by a community mental health center based on the investigation of the victims’depression and post-traumatic stress disorder(PTSD)levels immediately after the disaster and at one-year follow-up.As a result,victims’depression and PTSD recovered over time,and more changes were confirmed.In particular,the high-risk group for PTSD showed a high program participation rate,and there was significant recovery over time compared with the group without PTSD.Based on these results,community mental health programs are an effective way to increase community mental health after disasters.In the future,community-based recovery programs after disasters should be expanded,and administrative support for them should be developed.

Rethinking hospital psychiatry in Italy in light of COVID-19 experience

BACKGROUND Italy retains a distinctive organization of mental health services according to a community-based model of care with a multidisciplinary team serving a welldefined catchment area under the coordination of the local department of mental health.The coronavirus disease 2019(COVID-19)pandemic is forcing Italian mental health services to develop new organizational strategies at all levels of care in order to face the associated challenges.AIM To explore factors associated with changes in psychiatric admissions to an inpatient psychiatric unit located in Lombardia Region,Italy.METHODS All hospital admissions(n=44)were recorded to an inpatient psychiatric unit during a three month national lockdown in Italy in 2020 and compared with those occurring over the same time period in 2019(n=71).For each admission,a 20-item checklist was completed to identify factors leading to admission.Statistical analyses were performed using Statistical Package for Social Sciences for Windows,release 11.0.Chi-square test(or Fisher’s exact test)and Mann-Whitney U-test were applied,where appropriate.RESULTS Hospital admissions dropped by 38%during the COVID-19 pandemic.No significant differences were found in demographics,clinical variables associated with hospital admissions and length of stay between 2019 and 2020.Compared with 2019,a significantly greater proportion of hospital admissions in 2020 were related to difficulties in organizing care programs outside the hospital(chi-square=4.91,df 1,one-way P=0.035)and in patients’family contexts(chi-square=3.71,df 1,one-way P=0.049).On the other hand,logistic and communication difficulties pertaining to residential facilities and programs were significantly more common in 2019 than in 2020(chi-square=4.38,df 1,one-way P=0.032).CONCLUSION Admissions to the inpatient psychiatric unit dropped significantly during the COVID-19 pandemic in 2020,with difficulties in organizing care programs outside the hospital and in patients’family contexts occurring more frequently compared with 2019.

The lived experience of a 24-hour support center for persons with psychiatric disabilities: Making me feel almost like an ordinary person

This study illuminates nine psychiatric disabled persons’ lived experience of a newly established community-based service center open around the clock. This new 24-hour support center (SC) was established in 2011 in a Swedish community to better match and facilitate the disabled persons’ needs. In order to illuminate the disabled person’s experiences individual interview was performed. A phenomenological-hermeneutical method inspired by Paul Ricoeur was used to interpret the texts. After a naive reading, a structural analysis revealed two themes: 1), becoming aware of myself as a person, and 2) having a lifeline and belongingness. The comprehensive understanding was interpreted as meaning “Making me feel almost like an ordinary person”, which incorporated the person’s past with their present together with a direction for the future and hope for a more fulfilling life.