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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 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.

Individuals suffering from serious mental illness (SMI) face many challenges of navigating a complex and often fragmented health care system and may die significantly earlier from co-morbid physical health conditions. Integrating mental and physical health care for individuals with SMI is an emerging trend addressing the often-neglected physical health care needs of this population to better coordinate care and improve health outcomes.

Population Health Management (PHM) provides a useful framework for designing integrated care programs for individuals with SMI.

This paper examines the structure and evolution of the integrated care program in Missouri in the context of PHM, highlighting particular elements of PHM that facilitate and support development of an integrated mental and physical health care program.

As health care reform provides external motivation to provide integrated care, this study can be useful as other states attempt to address this important issue.

There is evidence that the mental health needs of people with learning disabilities are not adequately met. Primary health care is seen as the way forward to ensure full consideration of psychosocial factors in the promotion of health care. The agenda for action includes improving mental health through general health promotion, surveillance and care. This paper explores how this evidence is being translated through professional and national policy initiatives into innovative mental health of learning disability services that build bridges between primary and specialist services and ensure a comprehensive strategy to meet the mental health needs of people with learning disabilities.

Sociology promotes and describes public health, helping to explain macro-social dynamics of mental health care through studies of organizations, networks, and systems of care.

This chapter summarizes sociological research on mental health care organizations and systems, illustrating a macro-social perspective by examining the problem of transitions in care for young adults. Summary findings from a regional mental health services research project describe a system of care that includes 100 organizations. This system helps young adults with mental health needs.

The scope and management of care involves a focus on modes of treatment supported by research evidence and delivered effectively by people with cultural competencies. Care and continuity of care are delivered through coordinated systems of inter-organizational networks, linking organizations and providers. Active inter-organizational linkages are needed to support mental health for young adults during challenging and sometimes difficult transitions.

This research summarizes original and regional data on mental health care organizations within a regional system of care. Practical implications include support for the importance of coordination, transition planning, and cultural competence within and among organizations. Sociological and original research on organizations and systems should continue to elaborate the needs and values of mental health services for regional planning and public health.

At the heart of health and social care services is the pursuit of safety and dignity. Legislation and organizational policies are the main way in which statutory and independent organizations’ are tasked with enabling adults with mental health services along the road to recovery. Safety is an intrinsic motivator and basic need.

There is increased political recognition that social policy including the Mental Health Act 2007, which is a cornerstone, is in need of reform. A Conservative Manifesto pledge to reform mental health legislation is based upon the need to mitigate discrimination.

The chapter will explore the interrelationship between “poor outcomes” within the black community and safety; consider the opportunities to move from organizational complacency as a result of new policy and legal frameworks; and promote the view that developing a new discourse around safety is an integral part of improving outcomes for service users, particularly those who are poorly served currently.

A literature review plus reference to case studies will form the basis of the chapter ent and modern racism?

In this chapter, I develop an analysis of the institutional logics which have shaped the organizational field of public sector mental health and which provide a framework for understanding the complexities facing policy makers, providers, researchers, and community mental health advocates.

I first assess the current state of public sector mental health care. I then describe institutional theory, which focuses our attention on the wider social values and priorities (i.e., institutional logics) which shape mental health care. In the current post-deinstitutionalization era, there are three competing institutional logics: recovery and community integration, cost containment and commodification, and increased social control over those with severe mental disorders. Each of these logics, and the conflict between them, is explicated and analyzed. I then develop a theoretical framework for understanding how conflicting institutional logics are resolved. In the concluding section of this chapter, I offer some guidance to both researchers and advocates seeking meaningful system level reform.

Researchers studying mental health policy need to understand how competing institutional logics work to shape the political climate, economic priorities, and types of services available.

Advocacy is critical for meaningful reform, and a fourth institutional logic – that of social justice – needs to be developed by which to evaluate policy reforms and service offerings.

This chapter explores how primary care physicians deliver mental health treatment for Medicaid patients in one county in the United States, and how treatment may have changed after HMO enrollment with a mental health carve-out. We utilize Lipsky's theory of street-level bureaucracy to better understand how primary care physicians treat Medicaid patients for depression and what types of insurance arrangements support or inhibit that treatment. Exploratory interviews with 20 physicians revealed that the patient's status as a non-voluntary client, service system barriers and physicians’ commitment to treatment caused them to bear primary responsibility for the majority of depression care. Physicians were willing to act as advocates for their clients and viewed such advocacy as ethical given the lack of mental health parity. In general, primary care physicians were not familiar with new policies dictating mental health carve-outs for Medicaid patients, nor were they concerned with how mental health care was reimbursed for their patients. However, they were willing to provide mental health care even if they were not reimbursed. Physicians rely upon medication management to treat depression, and reimbursement plays a role in the amount of time spent with patients and in the coding used for the visit. Lipsky's (1980) theory of street-level bureaucracy provides a useful framework for understanding how physicians will act as advocates for their clients in the face of structural as well as resource constraints on health care.