Search results

The U.S. mental health service delivery system consists of a broad array of inpatient and ambulatory services operated under governmental, corporate, nonprofit, and entrepreneurial auspices. Granted this complex mixture of control patterns, a primary question to be addressed by this paper is the degree to which this set of services can be conceptualized as a system at any level of social organization beyond a single control point for a subset of services. This paper will also explore the utility of systems formulations, including cybernetic processes, for addressing the question of whether mental health services can be controlled and directed to such a degree that they act in concert across different control points. Reference will be made to exogenous systems, such as public and private reimbursement programs, that may influence control processes. Some directions for future research will also be explored.

In the last decade we have witnessed much debate and activity around the provision of mental health services for people with learning disabilities in England. This article looks not only at current initiatives to improve mental health care from around England, but also places them within a policy context. Unfortunately there are areas that still fail to provide a basic care standard, some of which has been reported throughout the media from recent investigations. Where this is the case, we outline the responses and actions that have been put in place to address these issues.To maintain a momentum for positive change for the mental health care of people with learning disabilities, there now needs to be cooperation between services that traditionally have not worked together for the benefit of this client group. Before an equality of mental health service provision, in line with national standards, can be realised the traditional views and values of service providers and commissioners will need to be challenged and tuned to the needs of this group of people.

The mental health field is viewed by some as reluctant to tackle the problem of abuse. While ‘adult protection’ offers one way forward, the authors of this paper caution against over‐enthusiastic borrowing from this paradigm. Instead they argue that mental health services will only become intolerant of abuse when there is widespread acceptance of the role of power abuse in psychological distress and disturbance.

An urban mental health service undertook a quality improvement programme to involve staff in the identification and resolution of cross‐cultural issues. The programme involved clinical file audits, staff survey and workshops, and a focus group for consumers and their carers. It was found that non‐English speaking patients received a different spectrum of services from English speaking patients. Non‐English speaking patients were found to receive more pharmacological treatments and less cognitive behavioural therapy. In seeking to address these issues and improve their service delivery to all patients, the mental health service is now in the process of developing cross‐cultural training; revising policies and procedures; and engaging bilingual mental health counsellors in a revision of their roles, particularly to increase their availability to staff as cultural consultants.

Green Light was developed to enable service providers to implement the National Service Framework for Mental Health (NSF MH), and asks how good your mental health services are for people with a learning disability. A multi‐agency user and carer project in Hampshire has evaluated and improved the quality of existing service provision for adults with learning disabilities who also have a mental health problem.

It is nearly eight years since the National Service Framework for Mental Health was published, setting ambitious 10‐year targets. This article draws on findings presented in a recent Sainsbury Centre for Mental Health report on progress to date. It concludes that although the framework confirmed the status of mental health as a health priority for the government, a likely shortfall in funding means that goals will not be met in full. The authors stress that this is not a criticism of policy; rather it reflects the ambitious nature of the government's mental health agenda.

The purpose of this case study is to describe the experiences of a development organization operating in Africa to make mental health services accessible to communities in Kenya and Uganda through partnerships. The lessons that can be learnt from this work are also considered.

The paper is a case study that builds on operations research gathered over five to seven years by the authors who have managed the country mental health programmes in Uganda and Kenya. The case study describes the problem of mental illness and its magnitude in Kenya and Uganda, and why it is important that this is addressed. Existing mechanisms in place and gaps in current service provision are also discussed.

Methods used to address gaps in current service provision include capacitating different service providers, their roles and their contribution to community mental health. The inclusion and training of non‐psychiatrists can contribute to the management, treatment and recovery of people with mental health problems in African communities.

The case study is limited in its applicability in full to other low to middle income countries (LMICs). Causality cannot be established between improvement in access and training of the different health service providers.

The case study gives practical experiences that practitioners in LMICs can further test in improving access to community‐based mental health services. These experiences can help to form a promising practice in how LMICs can reduce health workforce gaps in mental health and planners can consider using this to reduce such gaps.

The case study shows how the participation of service users and other stakeholders and using family resources can bring ownership and sustainability of mental health care at the community level.

The case study adds value to practice and social development theories and models of care.

Young homeless people have mental health needs. Research and national policies have highlighted that accommodation providers need to offer holistic interventions to encourage this vulnerable group to break the cycle of homelessness. Currently no research literature documents how homeless shelters respond to mental health needs. This research was intended to address this research question.A postal questionnaire was sent to 132 managers of homeless shelters, achieving a response rate of 64.4%. Frequencies and descriptive statistics were calculated, and written data was analysed using content analysis. Mental health problems were highly prevalent, and homeless shelters responded in a variety of ways (use of GP services, internal services, referring to external services, in‐house outreach services, no service provision, etc). Only 27.1% of managers of homeless shelters reported that their services were sufficient to meet their young people's needs. These findings reflect the need for inclusion of mental health in homeless shelters' strategic objectives, and development of commissioning of local partnerships with health agencies.

The National Service Framework for Mental Health was published in late 1999, setting ambitious 10‐year targets. This article draws on findings presented in a recent Sainsbury Centre for Mental Health report on progress to date. It concludes that although the framework confirmed the status of mental health as a health priority for the government, a likely shortfall in funding means that goals will not be met in full. The authors stress that this is not a criticism of policy; rather it reflects the ambitious nature of the government's mental health agenda.