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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.

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.

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.

The Czech Republic suffers many of the problems reported in other Central European and Eastern European countries with respect to the care, treatment and prevention of mental ill health. Most psychiatric care is provided in long‐stay hospitals and the transition to a community‐based service has yet to be made. Mental health services suffer from chronic under‐investment and there is a lack of mental health legislation protecting patients' rights and autonomy. The pressures of transition to a capitalist economy have brought their own problems, in the form of increased rates of addicitions, suicide, and other mental health problems related to social, policitical and economic instability, and there is a pressing need to address the position of mental health within public health services.

Transition from inpatient mental health care to community living can be very difficult, as people are at an increased risk of suicide, self-harm and ultimately readmission into hospital. There is little research conducted exploring peer support workers’ (PSWs) lived experiences that could provide insight into the key transitions of care, particularly the support required after discharge from inpatient mental health care. The purpose of this paper is thus to provide a particular insight into what it feels like being discharged from psychiatric care from a PSW’s perspective, how may support be improved post-discharge and what factors might impact the potential for readmission into inpatient care.

A qualitative, phenomenological approach was adopted to explore and describe PSWs’ lived experiences of transitioning from psychiatric care. Four PSWs who were employed by a UK secure mental health facility were recruited. PSW is a non-clinical role with their main duty to support patients, and they were considered for this type of the study for their experience in negotiating the discharge process to better carry out their job as a PSW.

After being discharged from psychiatric care, PSWs experienced issues that had either a negative impact on their mental wellbeing or even resulted in their readmission back into inpatient psychiatric care. This study identified three inter-related recurrent themes – continuity of support, having options and realisation, all concerning difficulties in adjusting to independent community life following discharge. The findings of the study highlighted the importance of ensuring that service users should be actively involved in their discharge planning, and the use of effective post-discharge planning processes should be used as a crucial step to avoid readmission.

A deeper insight into the factors that impact on readmission to secure care is needed. The active involvement of service users in effective pre- and post-discharge planning is crucial to avoid readmission.

Mental health professionals should consider developing more effective discharge interventions in collaboration with service users; inpatient services should consider creating more effective post-discharge information care and support packages. Their lived experience empowers PSWs to play a key role in guiding patients in the discharge process.

This is the first study, to the best of the authors’ knowledge, to explore what it feels like being discharged from inpatient mental health care by interviewing PSWs employed at a forensic mental health hospital by adopting a phenomenological approach. This paper offers a deeper insight into the transition process and explores in detail what support is needed post discharge to avoid potential readmission from PSWs’ perspectives.

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.