The development of mental health care in Guangzhou, China

As an upper-middle-income country, China has a vast territory, a large population and substantial variations in the nature of mental health service provision. Guangzhou, one of the five biggest cities in China, is considered as indicative of the current development of mental health services in a more economically developed part of China. In this paper, we first introduce mental health services in Guangzhou and their historical development: from the rising development of mental health care (1949 to the mid-1960s), the stagnant development period of the psychiatric hospitals (1966-1976), the rapid development period of the psychiatric hospitals (1978 to the 1990s), to the integrated development period of community mental health care (2000-2020). This historical trajectory partly reflects the development of mental health services across China. Second, from the public health perspective, we introduce the current mental health care delivery system and resources in Guangzhou, including the psychiatric specialist hospitals, psychiatric units of general hospitals, and community mental health care. Third, based on the current mental health service system, we highlight community mental health care in Guangzhou. We will describe these elements of the mental health system under the following headings: organizational setup, management, and services. We also explore the design of community mental health service models and the challenges in the post-covid-19 era. Finally, we provide considerations and recommendations for mental health service delivery in Guangzhou in the future.Copyright © 2023 The Authors

Indirect social contact interventions to reduce mental health-related stigma in low- and middle-income countries: systematic review.

AIMS: Mental health-related stigma and discrimination are a complex and widespread issue with negative effects on numerous aspects of life of people with lived experience of mental health conditions. Research shows that social contact is the best evidence-based intervention to reduce stigma. Within the context of a rapid development of remote technology, and COVID-19-related restrictions for face-to-face contact, the aim of this paper is to categorise, compare and define indirect social contact (ISC) interventions to reduce stigma and discrimination in mental health in low- and middle-income countries (LMICs). METHODS: MEDLINE, Global Health, EMBASE, PsychINFO, Cochrane Central Register of Control Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using a strategy including terms related to 'stigma and discrimination', 'intervention', 'indirect social contact', 'mental health' and 'low- and middle-income countries'. Relevant information on ISC interventions was extracted from the included articles, and a quality assessment was conducted. Emerging themes were coded using a thematic synthesis method, and a narrative synthesis was undertaken to present the results. RESULTS: Nine studies were included in the review overall. One study was ineffective; this was not considered for the categorisation of interventions, and it was considered separately for the comparison of interventions. Of the eight effective studies included in synthesis, interventions were categorised by content, combination of stigma-reducing strategies, medium of delivery, delivery agents, target condition and population, as well as by active or passive interaction and follow-up. Most of the interventions used education and ISC. Recovery and personal experience were important content components as all studies included either one or both. Cultural adaptation and local relevance were also important considerations. CONCLUSIONS: ISC interventions were effective in overall terms for both the general public and healthcare providers, including medical students. A new definition of ISC interventions in LMICs is proposed. More research and better reporting of intervention details are needed to explore the effectiveness of ISC strategies in LMICs, especially in regions where little relevant research has been conducted.

Mental Health of Healthcare Workers during COVID-19 Pandemic in Ukraine

Introduction. Health care professionals experience severe occupational and psycho-emotional stress during the COVID-19 pandemic, which put them at high risk of mental disorders. The aim of the study was to examine the mental health of healthcare workers who provided treatment and support to patients with COVID-19. Materials and methods. A set of standardized psycho-diagnostic scales to assess the symptoms of depression (PHQ-9), anxiety (GAD-7), insomnia (ISI) and the impact of traumatic events on psycho-emotional state (IES-R) was used for an online survey of healthcare professionals from all regions of Ukraine during 04/04/2021 to 05/29/2021. A comparative study was conducted comparing two groups of specialists who provided (n = 441) or who did not support (n = 40) patients with COVID-19 on socio-demographic characteristics and indicators of psycho-diagnostic scales. Results. In total 500 staff were invited to take part in this survey. A significant number of health workers in both groups experienced symptoms of mental disorders, indicating the negative impact of the COVID-19 pandemic on their mental health. However, in the group of medical professionals who provided care to patients with COVID-19, there were more pronounced symptoms of depression (p = 0.010), anxiety (p = 0.010), sleep disturbances (p = 0.018) compared with the group of specialists who did not provide direct care to COVID-19 patients. Statistically significant differences were also obtained on the IES-R scale: subscales “avoidance” (p = 0.048), “intrusion” (p = 0.021), “hyperarousal” (p = 0.035). Conclusions. Healthcare professionals who care for COVID-19 patients have a significantly increased risk of mental health problems and require particular attention and the development of special programs of psychological support and psychiatric care. © Vitaliy Pishel, Marina Polyvianaia, Irina Pinchuk, Olha Myshakivska, Graham Thornicroft, Charlotte Hanlon, 2022

Reducing stigma and discrimination associated with COVID-19: early stage pandemic rapid review and practical recommendations.

AIMS: To develop recommendations for strategies and interventions to reduce stigma and discrimination related to coronavirus disease 2019 (COVID-19), through reviewing and synthesising evidence in relation to COVID-19 and other disease outbreaks and infectious/stigmatised conditions from systematic reviews and primary studies and recommendations from additional materials. METHODS: Rapid review, drawing on the World Health Organization's (WHO) methodology for developing interim guidelines during health emergencies. PubMed/MEDLINE, PsycINFO, Cochrane Central and Campbell Collaboration searched up to mid-April 2020. Searches were supplemented by reference-searching and expert recommendations. Searches were designed to identify: (1) systematic reviews (<10 years), or (2) primary intervention studies (no date limit) reporting evidence on anti-stigma interventions (in relation to COVID-19 or other infectious/stigmatised conditions) or (3) additional relevant materials. Data were extracted on population, intervention, outcome and results. These data were compiled into evidence summary tables and narrative overviews. Recommendations on strategies for COVID-19 stigma-reduction were developed using the WHO 'Evidence to Decision' framework approach. The review protocol was registered with PROSPERO (registration ID: CRD42020177677). RESULTS: The searches identified a total of 4150 potentially relevant records, from which 12 systematic reviews and 29 additional articles were included. Overarching considerations and specific recommendations focus on: (1) language/words used in relation to COVID-19 and affected people; (2) media/journalistic practices; (3) public health interventions; (4) targeted public health interventions for key groups and (5) involving communities and key stakeholders. CONCLUSIONS: These recommendations represent the first consolidated evidence-based guidance on stigma and discrimination reduction in relation to COVID-19. Mitigating the impact of stigma is critical in reducing distress and negative experiences, and strengthening communities' resolve to work together during exceptional circumstances. Ultimately, reducing stigma helps addressing structural inequalities that drive marginalisation and exacerbate both health risks and the impact of stigma. Administrations and decision makers are urged to consider integrating these recommendations into the ongoing COVID-19 response.