Situational analysis: preliminary regional review of the Mental Health Atlas 2014.

The WHO comprehensive Mental Health Action Plan 2013-2020 established goals and objectives that Member States have agreed to meet by 2020. To update the Atlas of Mental Health 2011, specific indicators from the Mental Health Action Plan and additional indicators on service coverage were incorporated into the questionnaire for the Atlas 2014. The data will help facilitate improvement in information gathering and focus efforts towards implementation of the Mental Health Action Plan. The questionnaire was completed by the national mental health focal point of each country. This preliminary review seeks to consolidate data from the initial response to the Atlas 2014 questionnaire by Member States in the Eastern Mediterranean Region. Data for this review were analysed for the whole Region, by health systems groupings and by individual countries. Where possible, data are compared with the Mental Health Atlas 2011 to give a longitudinal perspective.

Reorganization of mental health services: from institutional to community-based models of care.

Mental health services in the Eastern Mediterranean Region are predominantly centralized and institutionalized, relying on scarce specialist manpower. This creates a major treatment gap for patients with common and disabling mental disorders and places an unnecessary burden on the individual, their family and society. Six steps for reorganization of mental health services in the Region can be outlined: (1) integrate delivery of interventions for priority mental disorders into primary health care and existing priority programmes; (2) systematically strengthen the capacity of non-specialized health personnel for providing mental health care; (3) scale up community-based services (community outreach teams for defined catchment, supported residential facilities, supported employment and family support); (4) establish mental health services in general hospitals for outpatient and acute inpatient care; (5) progressively reduce the number of long-stay beds in mental hospitals through restricting new admissions; and (6) provide transitional/bridge funding over a period of time to scale up community-based services and downsize mental institutions in parallel.

Mental health surveillance and information systems.

Routine information systems for mental health in many Eastern Mediterranean Region countries are rudimentary or absent, making it difficult to understand the needs of local populations and to plan accordingly. Key components for mental health surveillance and information systems are: national commitment and leadership to ensure that relevant high quality information is collected and reported; a minimum data set of key mental health indicators; intersectoral collaboration with appropriate data sharing; routine data collection supplemented with periodic surveys; quality control and confidentiality; and technology and skills to support data collection, sharing and dissemination. Priority strategic interventions include: (1) periodically assessing and reporting the mental health resources and capacities available using standardized methodologies; (2) routine collection of information and reporting on service availability, coverage and continuity, for priority mental disorders disaggregated by age, sex and diagnosis; and (3) mandatory recording and reporting of suicides at the national level (using relevant ICD codes).

Mental health research: developing priorities and promoting its utilization to inform policies and services.

Investment in research on the prevention and treatment of mental health disorders is disproportionately low in the WHO Eastern Mediterranean Region (EMR) relative to the disease burden. Scaling-up mental health research in the EMR could generate enormous returns in terms of reducing disability, improving outcomes and preventing premature death, through early diagnosis, better management and community-based rehabilitation. EMR countries must therefore work to identify research priorities, mobilize resources, develop human and infrastructure capacities and institutionalize use of research findings to guide development of policies and service delivery models. Several key strategic interventions for EMR Member States are recommended: adopt a prioritized national mental health research agenda; systematically map national and international research funding to identify and secure resources to support the implementation of the agenda; strengthen national capacity to undertake prioritized research; periodically map research output in mental health; and foster dialogue between researchers and policy-makers/programme managers.

Mental health research:developing priorities and promoting its utilization to inform policies and services

Investment in research on the prevention and treatment of mental health disorders is disproportionately low in the WHO Eastern Mediterranean Region [EMR] relative to the disease burden. Scaling-up mental health research in the EMR could generate enormous returns in terms of reducing disability, improving outcomes and preventing premature death,through early diagnosis, better management and community-based rehabilitation. EMR countries must therefore work to identify research priorities, mobilize resources, develop human and infrastructure capacities and institutionalize use of research findings to guide development of policies and service delivery models. Several key strategic interventions for EMR Member States are recommended: adopt a prioritized national mental health research agenda; systematically map national and international research funding to identify and secure resources to support the implementation of the agenda; strengthen national capacity to undertake prioritized research;periodically map research output in mental health; and foster dialogue between researchers and policy-makers/programme managers

L'investissement dans la recherche sur la prévention et le traitement des troubles de santé mentale est disproportionnellement faible dans la Région OMS de la Méditerranée orientale par rapport à la charge de morbidité. L'intensification de la recherche en santé mentale dans la Région de la Méditerranée orientale pourrait générer d'énormes retours en termes de réduction des incapacités,d'amélioration des résultats et de prévention des décès prématurés,au moyen du diagnostic précoce, d'une meilleure prise en charge et de la réadaptation communautaire. Les pays de la Région doivent œuvrer ensemble afin d'identifier les priorités de recherche, de mobiliser des ressources,de renforcer les capacités humaines et matérielles et d'institutionnaliser l'utilisation des résultats de recherche pour orienter l'élaboration de politiques et de modèles de prestation de services. Plusieurs interventions stratégiques clés pour les Etats Membres de la Région de la Méditerranée orientale sont recommandées : l'adoption d'un programme de recherche national en santé mentale ; la cartographie systématique du financement de la recherche national et international pour identifier et sécuriser les ressources à l'appui de la mise en oeuvre du programme d'action ; le renforcement des capacités nationales permettant d'entreprendre une recherche par priorités ; la cartographie périodique des résultats de la recherche en santé mentale ; et la promotion du dialogue entre chercheurs et responsables des politiques/des programmes

Mental health surveillance and information systems

Routine information systems for mental health in many Eastern Mediterranean Region countries are rudimentary or absent, making it difficult to understand the needs of local populations and to plan accordingly. Key components for mental health surveillance and information systems are: national commitment and leadership to ensure that relevant high quality information is collected and reported; a minimum data set of key mental health indicators; intersectoral collaboration with appropriate data sharing; routine data collection supplemented with periodic surveys; quality control and confidentiality; and technology and skills to support data collection, sharing and dissemination. Priority strategic interventions include: [1]periodically assessing and reporting the mental health resources and capacities available using standardized methodologies; [2]routine collection of information and reporting on service availability, coverage and continuity, for priority mental disorders disaggregated by age, sex and diagnosis; and [3]mandatory recording and reporting of suicides at the national level [using relevant ICD codes]

Les systèmes d'information de routine pour la santé mentale dans de nombreux pays de la Région de la Méditerranée orientale sont rudimentaires ou font défaut, ce qui rend difficile la compréhension des besoins des populations locales et la planification correspondante. Les composantes clés des systèmes d'information et de surveillance de la santé mentale sont les suivantes : un engagement et un rôle de premier plan à l'échelle nationale pour garantir que des données pertinentes et de haute qualité sont recueillies et transmises ; un ensemble de données minimales servant d'indicateurs clés pour la santé mentale ; une collaboration intersectorielle permettant le partage approprié des informations ; le recueil de données systématique complété par des enquêtes périodiques ; un contrôle qualité et la confidentialité ; et de la technologie et des compétences pour appuyer le recueil, le partage et la diffusion des données.Parmi les interventions stratégiques prioritaires,on peut citer : 1]l'évaluation périodique des ressources et des capacités en santé mentale disponibles et la notification de ces informations à l'aide de méthodologies normalisées ; 2]le recueil et la notification de données systématiques sur la disponibilité des services, leur couverture et leur pérennité pour les troubles de santé mentale prioritaires,ventilées par âge, sexe et diagnostic ; et 3]l'enregistrement et la notification obligatoires des suicides à l'échelle nationale [à l'aide des codes CIM pertinents]

Reorganization of mental health services:from institutional to community-based models of care

Mental health services in the Eastern Mediterranean Region are predominantly centralized and institutionalized, relying on scarce specialist manpower. This creates a major treatment gap for patients with common and disabling mental disorders and places an unnecessary burden on the individual,their family and society. Six steps for reorganization of mental health services in the Region can be outlined: [1]integrate delivery of interventions for priority mental disorders into primary health care and existing priority programmes; [2]systematically strengthen the capacity of non-specialized health personnel for providing mental health care; [3]scale up community-based services [community outreach teams for defined catchment, supported residential facilities,supported employment and family support]; [4]establish mental health services in general hospitals for outpatient and acute inpatient care;[5]progressively reduce the number of long-stay beds in mental hospitals through restricting new admissions; and [6]provide transitional/bridge funding over a period of time to scale up community-based services and downsize mental institutions in parallel

Les services de santé mentale dans la Région de la Méditerranée orientale sont essentiellement centralisés et institutionnalisés.Ils reposent sur un personnel spécialisé qui est rare. Cette situation crée un large fossé thérapeutique pour les patients atteints de troubles mentaux courants et handicapants, et fait porter une charge inutile pour l'individu,sa famille et la société.Six étapes pour la réorganisation des services de santé mentale dans la Région peuvent être présentées de la manière suivante : 1]intégrer l'offre des interventions pour les troubles de santé mentale prioritaires dans les programmes de soins de santé primaires et les programmes prioritaires existants ; 2]renforcer systématiquement les capacités du personnel de santé non spécialisé à fournir des soins de santé mentale ; 3]intensifier les services communautaires [équipes communautaires de proximité pour une zone de desserte définie,établissements résidentiels bénéficiant d'assistance aide à l'emploi et soutien apporté à la famille]; 4]établir des services de soins de santé mentale dans des hôpitaux généraux pour les soins externes et les soins aigus chez le patient hospitalisé ; 5]réduire progressivement le nombre de lits de long séjour dans les hôpitaux de soins de santé mentale en diminuant le nombre des nouvelles admissions ; 6]fournir un financement de transition/provisoire pendant une certaine durée pour intensifier les services communautaires et parallèlement réduire la taille des institutions de santé mentale

Situational analysis:preliminary regional review of the Mental Health Atlas 2014

The WHO comprehensive Mental Health Action Plan 2013-2020 established goals and objectives that Member States have agreed to meet by 2020. To update the Atlas of Mental Health 2011, specific indicators from the Mental Health Action Plan and additional indicators on service coverage were incorporated into the questionnaire for the Atlas 2014. The data will help facilitate improvement in information gathering and focus efforts towards implementation of the Mental Health Action Plan. The questionnaire was completed by the national mental health focal point of each country. This preliminary review seeks to consolidate data from the initial response to the Atlas 2014 questionnaire by Member States in the Eastern Mediterranean Region. Data for this review were analysed for the whole Region, by health systems groupings and by individual countries. Where possible, data are compared with the Mental Health Atlas 2011 to give a longitudinal perspective

Le Plan d'action exhaustif de l'OMS pour la santé mentale sur la période de 2013-2020 a déterminé des cibles et des objectifs que les Etats Membres ont accepté d'atteindre d'ici 2020. Pour actualiser l'Atlas de la santé mentale de 2011, des indicateurs spécifiques du Plan d'action pour la santé mentale ainsi que des indicateurs supplémentaires concernant la couverture des services ont été intégrés au questionnaire pour l'Atlas 2014.Les données permettront de favoriser l'amélioration du recueil d'informations et de concentrer les efforts sur la mise en application du Plan d'action pour la santé mentale. Le questionnaire a été complété par le point focal national pour la santé mentale dans chaque pays. Cet examen préliminaire visait à consolider les données provenant de la réponse initiale au questionnaire pour l'Atlas 2014 par les Etats Membres dans la Région de la Méditerranée orientale. Les données pour cet examen ont été analysées pour toute la Région, par groupes de systèmes de santé et par pays.Dans la mesure du possible, les données ont été comparées à celles de l'Atlas de la santé mentale de 2011 pour apporter une perspective longitudinale

Determinants of subjective quality of life in patients attending community-based mental health services. The South-Verona Outcome Project 5.

OBJECTIVE: Investigate the relationship of various domains of quality of life (QoL) with socio-demographics, clinical and social characteristics, service use and satisfaction in a representative sample of patients in contact with the South-Verona community mental health service. METHOD: Measures included: Lancashire Quality of Life Profile (LQOLP), demographics, diagnosis and service utilization data from the Case Register, Brief Psychiatric Rating Scale (BPRS), Disability Assessment Schedule (DAS), Global Assessment of Functioning (GAF) and Verona Service Satisfaction Scale (VSSS). Analyses were conducted using a block-stratified multiple regression model. RESULTS: Demographics, diagnosis, psychopathology, disability, functioning and service use together explained different amounts of variance in each LQOLP domain, but always less than 14%. VSSS explained more variance than any other indicator in health (13.1%), social relations (12.1%), leisure/participation (9.1%), and general wellbeing (9.0%). CONCLUSION: Different domains of QoL are predicted by different indicators. In some important domains, self-perceived satisfactory and effective care might have an impact on the QoL of patients.

Mental health: the missing link in primary care? Health for All by the Year 2000 revisited.

The effects on the uptake of services offered in primary health care of a demonstration community mental health project in Pakistan were assessed. A subdistrict with the project was compared with a matched area without the project over 7 years. Routinely collected information on service use was used, including the detection and treatment of mental disorders. Compared with the comparison subdistrict, the index subdistrict showed an increase in use of primary care by men, reduction in pregnancy rate, increased use of antenatal care, reduced maternal mortality, increased immunization coverage, and increased detection and treatment of mental disorders.

Mental health: the missing link in primary care? Health for All by the Year 2000 revisited

The effects on the uptake of services offered in primary health care of a demonstration community mental health project in Pakistan were assessed. A subdistrict with the project was compared with a matched area without the project over 7 years. Routinely collected information on service use was used, including the detection and treatment of mental disorders. Compared with the comparison subdistrict, the index subdistrict showed an increase in use of primary care by men, reduction in pregnancy rate, increased use of antenatal care, reduced maternal mortality, increased immunization coverage, and increased detection and treatment of mental disorders

The prevalence, classification and treatment of mental disorders among attenders of native faith healers in rural Pakistan.

BACKGROUND: Although native faith healers are found in all parts of Pakistan, where they practice in harmony with the cultural value system, their practice is poorly understood. This study investigated the prevalence, classification and treatment of mental disorders among attenders at faith healers. METHOD: The work of faith healers with 139 attenders was observed and recorded. The mental status of attenders was assessed using a two-stage design: screening using the General Health Questionnaire followed by diagnostic interview using the Psychiatric Assessment Schedule. RESULTS: The classification used by faith healers is based on the mystic cause of disorders: saya (27%), jinn possession (16%) or churail (14%). Sixty-one percent of attenders were given a research diagnosis of mental disorder: major depressive episode (24%), generalized anxiety disorder (15%) or epilepsy (9%). There was little agreement between the faith healers' classification and DSM-IIIR diagnosis. Faith healers use powerful techniques of suggestion and cultural psychotherapeutic procedures. CONCLUSIONS: Faith healers are a major source of care for people with mental health problems in Pakistan, particularly for women and those with little education. Further research should assess methods of collaboration that will permit people with mental health problems to access effective and culturally appropriate treatment.

Matching resources to care: the acceptability, validity and inter-rater reliability of a new instrument to assess severe mental illness (MARC-1).

BACKGROUND: Most definitions of severe mental illness (SMI) are categorical and assign the patient to either SMI or not-SMI status. While this is useful for some purposes, it is a rather limited approach. The purpose of the present study is to develop a new method of addressing the issue of 'severity', and to develop a dimensional rather than a categorical approach. The paper reports on the acceptability, reliability and validity of a method developed to collect a standard set of data covering the majority of items specified in the academic and policy literature as characterising SMI. METHOD: A single page form, Matching Resources to Care (MARC-1), containing most of the items used in definitions of SMI was used to collect data from community mental health staff about their current open caseload, in four co-terminous health and social services settings during a census week (n = 2139). In addition to the data from the four pilot sites, we conducted a substudy (n = 91), in which two raters rated the same cases during the same week. RESULTS: The MARC-1 scores were able to distinguish between patients in receipt, and those not in receipt, of specific types of community care (level of care, eligibility for care and statutory aftercare) (P < 0.001). The MARC-1 score was modestly but significantly correlated (r = 0.28) with the Global Assessment Scale (P < 0.001). The mean percentage inter-rater agreement for the MARC-1 score items was 87%. CONCLUSION: It is possible to use a simple census form in both health and social services agencies. The completion rates were good in both services. The levels of reliability were good, and concurrent validity was established with specific types of care in the community.

Developing child mental health services in developing countries.

There is an urgent need to pay attention to the mental health of children in developing countries. Professionals confronted with this task face a number of challenges. Services have to be planned in a rational way, keeping in mind the needs of local populations. These needs will often exceed the available resources, and it will be necessary to set priorities. Feasible and cost-effective models of service delivery then have to be developed to meet these needs. This annotation provides a framework within which mental health needs of children can be assessed, priorities established, and services organised. This is illustrated with examples of relevant activities undertaken in low-income developing countries over the last two decades.

Detection of disabilities by schoolchildren: a pilot study in rural Pakistan.

An important consideration in planning services for disabled children is to establish the need, including the size of the potential beneficiary group. However, surveys are expensive and time consuming (especially surveys of disability, which has a low prevalence within the population), and can raise expectations of service for patients who are often very unsure about how to cope with their disabled child. The World Health Organization (WHO) has produced a series of survey tools which have been used to identify disabled children in settings where a service is planned. Zaman et al, produced the '10 Question Screen', a simple screening tool for use by community health staff to identify disabilities among children in the community. Both the WHO survey tools and the 10 Question Screen rely on trained primary health care (PHC) or community-based rehabilitation (CBR) staff. The small study reported here shows that schoolchildren are effective identifiers of disabled children within their home communities and may be a useful resource when there are no trained CBR or PHC workers to conduct surveys. Furthermore, the children's ability to identify within the five major disability groups was relatively robust when compared with medical diagnosis.

Gender differences in the prevalence of depression: a survey in primary care.

Epidemiological surveys demonstrate that unipolar depression is more common in females than in males. Gender-specific cultural and social factors may contribute to the female preponderance. This study explores this possibility in a cross-cultural sample of general-practice patients systematically recruited in the WHO study "Psychological Problems in Primary Care" conducted in 14 countries with identical sampling and assessment strategies. Although absolute prevalence rates are broadly varying between centers proposing that the gender ratio is nearly constant with 1:2. The cultural context does not contribute substantially to the female preponderance. This study lends some support to previous observations that the magnitude of female preponderance is associated with the number of symptoms associated with depression requested for caseness and inversely related to the degree of social impairment. Matching social role variables (marital status, children, occupational status) between females and males reduces the female excess by about 50% across all centers. Therefore, we conclude that social factors are inducing part of the preponderance of females among depressed cases.