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The aim of this paper is to review the history of mental health service improvement in Kenya, to discuss current provision of services, challenges to the provision of services and future needs for services.

The paper takes the form of a literature review.

Mental health care in Kenya has been a progressing field, though the momentum of progress has been less than desired. The reasons for this are complex including a lack of evidence of the size of the mental health burden which has undermined the political will to focus scarce resources in this area, lack of human resources, models of prevention, and robust mental health legislation. Traditional healers have a significant place in mental health care, these plus efforts to increase training on mental health, task shifting for other clinicians and also prevention may be important steps in improving access to care.

The review highlights how much remains to be done to improve mental health services in Kenya. It demonstrates the need for good epidemiological and intervention data to support a multi‐level approach, involving government, non‐governmental organizations, communities, families, affected individuals and other stakeholders. Prevention and treatment strategies should be streamlined and emphasis put on stigma reduction as well as provision of accessible, acceptable, sustainable and affordable care.

A review of the literature is useful to highlight what is known but also what information is missing and is needed to go forward.

This is the first system level historical review of the development of mental health services in Kenya. It offers a model for investigation that may be useful for others.

Mental health care in England has been subject to a great deal of scrutiny in recent years for its equality of access, experience and outcome. Five years of the Delivering Race Equality programme produced momentum, learning and improvements. It is clear, though, that efforts need to consider a continuous quality improvement approach and consciously use all new initiatives to further drive more equal services. A current initiative in England is the care clusters model for mental health, along with associated moves to commission services on a payment by results basis. This paper examines these developments and the possible implications for supporting greater equality in mental health care.

The current focus on psychological well‐being and the treatment of people experiencing common mental disorder in primary care is of interest to health professionals and economists alike (Centre for Economic Performance Mental Health Policy Group, 2006). This brings with it an important opportunity to consider how services for people living with long term medical conditions may benefit from developments in widening access to psychological therapies. The National Service Framework for Longterm Conditions (DoH, 2005a) aims to improve the quality of life for people living with chronic medical conditions. Further to this, NICE Guidelines for the Management of Chronic Obstructive Pulmonary Disease (COPD) (NICE, 2004a) specifically focuses attention on quality of life issues for COPD sufferers and the influence of co‐morbid mental disorder on the ability of individuals to optimise selfmanagement of their condition. By examining issues relating to co‐morbidity of common mental disorders within the long‐term condition of COPD this paper concerns itself with how the agenda for widening access to psychological therapies delivered through a stepped model of care and the introduction of new mental health workforce roles such as community matrons, case managers and primary care graduate mental health workers (PCGMHWs) provides an opportunity for primary care services to integrate mental health care into chronic disease management for COPD, which in turn may provide a model for the development of services for other long‐term medical conditions.

The purpose of this paper is twofold. First, to examine the impact on mental health social work of integrated care; and second, to explore the effectiveness of the use of deliberative research, a methodology which is new to mental health social work research.

Developed to enable examination of policy, deliberative research is underpinned by a desire to permit choice and change brought about through an iterative dialogue. This communication is based on informed and respectful equality between policy makers or implementers and those subject to that implementation. In order to achieve this equality, participation in debate by participants is viewed as essential, including as part of the process, participants becoming better informed about the phenomenon in question.

The findings show that effective mental health social work underpins successful integrated care which, in turn, is viewed as relevant. In addition, people who access services identified that mental health social workers are well positioned as facilitators and explainers in integrated care. The issue to be further explored by research, therefore, is not whether services should be delivered separately or in an integrated way, but how to keep improving and developing integrated care and especially the impact of ongoing power differentials.

The use of deliberative research worked reasonably well as an underpinning methodology for this study in that it sought to achieve the opinions of the public, in this instance consumers who provided or accessed mental health social work. The ethical need to ensure no harm came to this particular group meant that their opinions were not debated with the whole. This limitation to iterative dialogue is undoubtedly a consideration when undertaking deliberative research on such populations. This study offered just this, a one-off event, as in reality the commitment from participants to attend more than this one session would have been prohibitive.

The test, practically, comes with the events for data collection. This is not just the debate as to whether these, as one-off events, bring about agreement and not deliberation, but also whether researchers can, with a group that has particular needs, effectively integrate them into the deliberation. Given that it is an ethical priority to ensure that the participants are not harmed, this is not always going to be possible where the “public” includes those who may be vulnerable.

Deliberative research methodology is a new approach in mental health social work research. The influential finding is activism: people who access services recognise and suggest a challenge to the normative power differential in integrated care, as embodied in mental health social workers, and it is this aspect that warrants further investigation.

In light of the growing number of refugees and immigrants in Canada, this paper aims to identify barriers to mental health services for newcomer immigrants and refugees in Quebec and to examine how mental health services can be improved for these populations.

In this qualitative study, semi-structured individual interviews with Farsi-speaking health professionals and focus group interviews with participants from community organizations in Quebec were conducted.

Participants, both health-care professionals and community members, reported that mental health services are not readily accessible to Farsi-speaking immigrants and refugees. Structural barriers, language barriers, cultural safety and stigma were identified as obstacles to accessing care. Recommended strategies for improving access to mental health care are discussed.

Multiple studies have found that language and cultural barriers are associated with health inequalities and under-utilization of mental health services among linguistic and ethnic minorities. However, there are limited data on many groups and contexts, and a need to better understand how language barriers affect health outcomes, service utilization, patient satisfaction or overall costs to the health system or to society. In response to this gap, the present study explores how access to mental health services for Farsi-speaking newcomers may be limited by structural and linguistic barriers and cultural differences and as well as to identify strategies that can reduce the identified barriers.

Compte tenu du nombre croissant de réfugiés et d'immigrants au Canada, cette étude vise à identifier les obstacles aux services de santé mentale pour les nouveaux arrivants immigrants et réfugiés au Québec et à examiner comment les services de santé mentale peuvent être améliorés pour ces populations.

Dans cette étude qualitative, des entretiens individuels semi-structurés avec professionnels de la santé parlant le Farsi et entretiens avec des participants des organisations communautaires au Québec ont été menées.

Les participants, tant des professionnels de la santé que des membres de la communauté, ont déclaré que les services de santé mentale sont inaccessibles aux immigrants et réfugiés parlant le Farsi. Obstacles structurels, les barrières linguistiques, la sécurité culturelle et la stigmatisation ont été identifiées comme des obstacles à l'accès aux soins. Les stratégies recommandées pour améliorer l'accès aux soins de santé mentale sont discutées.

De nombreuses études ont montré que les barrières linguistiques et culturelles sont associées à les inégalités en matière de santé et la sous-utilisation des services de santé mentale chez les minorités linguistiques et ethniques. Cependant, les données sont limitées sur de nombreux groupes et contextes, et il est nécessaire de mieux comprendre comment les barrières linguistiques ont une incidence sur les résultats de santé, l'utilisation des services, la satisfaction des patients ou les coûts globaux pour le système de santé ou à la société. En réponse à cet écarte, la présente étude examine comment l'accès aux services de santé mentale pour les nouveaux arrivants parlant le farsi peuvent être limités par des barrières structurelles et linguistiques et des différences culturelles, ainsi que d'identifier les stratégies de réduire les obstacles identifiés.

This paper provides initial findings from a pilot to introduce graduate mental health workers into primary care, child and adolescent mental health services (CAMHS) across three localities in the north west of England in the UK. The progress of the pilot was monitored by gathering information from students, managers, supervisors and mentors regularly throughout the 12 month period, during which the pilot cohort were being formally trained. The potential of the new role of primary care graduate mental health workers to address problems of volume and access to services, particularly how the role might contribute to developing nonspecialist primary care services, is considered.

Physical health inequalities and mortality rates are higher amongst individuals with severe mental illness (SMI), including among forensic populations, than the general population. This paper aims to explore the experiences of individuals accessing primary health care following discharge from secure services, and the practitioners who support them.

Face-to-face qualitative interviews were conducted with service users (n = 4) and mental health practitioners (n = 4) within a forensic community mental health team in one NHS Trust in England in 2019. Data were analysed using the Interpretative Phenomenological Analysis.

Four super-ordinate themes emerged: perceived importance of physical health, agency, responsibility and relationships. Service users mostly saw themselves as passive recipients of health care and prioritised their mental health over their physical health. Close working relationships meant that mental health practitioners were often the first contact for service users with any health issue and thus felt a sense of responsibility for their physical health care. Service users who did access primary care reported that consistency of professional, feeling understood and listened to without judgement or stigma were important.

Interventions for service users that include practicalities and strategies to facilitate independence in physical health care, and collaborative working between primary care and forensic mental health services, are encouraged.

This study highlights some of the unique challenges in forensics around improving physical health outcomes for individuals with SMI.

Young men of African‐Caribbean origin are over‐represented in mental health services (MHSs), often entering these services by coercive routes, such as under the Mental Health Act or via the criminal justice system. This pilot study focused on patients' narratives of their journey from first contact with primary care services. Our principal aim was to describe and compare early experiences of help‐seeking for serious mental health problems among young men of white and black ethnicity.In‐depth interviews were conducted (using a topic guide) with black and white men aged 18‐30 years old and who were accessing secondary care mental health services for the first time for a psychotic illness. Participants were recruited from the early intervention services serving inner‐city Birmingham. Seven participants were interviewed, and 12 themes were identified from transcripts. Six of these individuals had consulted their GP prior to accessing the early intervention service. Only one attendee received medication at initial consultation, and none were referred to specialist mental health services. Participants described the manner in which family or friends interceded on their behalf to advocate for and secure specialist help ‐ either by accompanying them to see their GP, contacting mental health services directly or taking them to the local accident and emergency department. The latter route was accessed by black but not white participants. Three out of four black participants and one out of three white participants were subsequently admitted to hospital. None of the participants were particularly satisfied with their experience of primary care. Communication was less than ideal, and participants were able to reflect on their own failure to disclose critical information to their doctor. By contrast, all participants confided in family or in their trusted friends that they were becoming aware that they were experiencing mental distress.Our findings confirm the difficulties faced by GPs and those who consult them in the early stages of first onset psychotic episodes, and the importance of having family or friends who are able to advocate on other people's behalf at times of crisis. Despite the advent of universal early intervention services across the UK, those most in need may still not be receiving the help that they need in the timeliest manner.

Care leavers are identified as a vulnerable group within UK society and, unsurprisingly, are more susceptible to mental health problems. Research highlights inadequacies among UK Government provisions combined with poorer outcomes for care leavers. This paper aims to measure the effectiveness of provisions on mental health when transitioning from the care system to adulthood.

A systematic review was conducted to identify and highlight the inadequacies of provisions in place to aid a care leaver’s transition and the effects on their mental health. Of the 211 studies identified from the search, six studies met the eligibility criteria and were deemed eligible by the researcher for further exploration of themes.

The findings identified feeling isolated, training given to care professionals and caregivers, collaboration, lack of preparation and support and access and gaps in provisions as the five key themes. The overarching theme of interconnectedness and interplay between subthemes, mental health and a care leaver’s transition, is strongly presented throughout. Many participants within the individual studies reported negative findings illustrating the weaknesses of provisions and the negative effect on their mental health. Furthermore, the findings emphasise the unique nature of everyone’s experience transitioning out of the care system.

A limitation of the review is the selection of key words, which may have restricted the results produced during the main search, subsequently affecting the amount of relevant data extracted and synthesised. Finally, less emphasis on grey literature and more on empirical studies reduces the probability of discovering null or negative findings, therefore increasing the chances of publication bias (Paez, 2017). A small number of eligible studies increase the risk of not making important comparisons, prompting a wider search to be conducted in the future. An unequal ratio between national and international research in the systematic review restricts fresh perspectives and strategies concerning the mental health of care leavers.

Care leavers are identified as a vulnerable group within society and, unsurprisingly, are more susceptible to mental health problems. The UK Government enforces national and local policies to support young adults leaving the care system and transitioning to independence. However, previous research highlights inadequacies among provisions, combined with poorer mental health outcomes for care leavers.

Following on from gaps in the current findings, an investigation into regional disparities across provisions aimed at assisting care leavers transitioning to independence would produce useful information for the field and policymakers. Although current research addresses the essence of interplay between mental health and transitioning, further research is required to help build a supporting argument for adaptations and improvements in policies and practice.

This study supports the argument for an increase in attention from the UK Government and policymakers to improve the quality and quantity of support for a population often underserved and marginalised, especially in terms of reducing poorer mental health outcomes.

Recent guidelines suggest that cognitive behavioural therapy (CBT) has a pivotal role to play in the treatment of common mental health problems (CMHPs). There is a danger that we simply ask for ‘more of the same’ instead of looking at all the current limitations preventing individuals from accessing appropriate help. Doing this leads us to aim for a more radical and innovative approach to the CMHPs. This paper suggests that progress in primary care mental health has been much more limited than mental health workers and, in particular, researchers often acknowledge. It looks at the major obstacles barring the way to the development of services that could meet the needs of the very large number of people in our communities with CMHPs.