Global mental health and psychiatric institutions in the 21st century

Cohen, Alex; Minas, Harry

doi:10.1017/s2045796016000652

Cited by 35 publications

(12 citation statements)

References 43 publications

(37 reference statements)

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“…If “returns would be less for a person with schizophrenia than say depression, does this mean that the person with depression should get priority?” Striking a balance, he argues, “with economics as only one of the variables considered, is critical” (p. 505). However, while the asylum is generally acknowledged to be a site of abuse by GMH and all efforts are geared toward community-based care, the asylum’s complicated infrastructures, legacies, and practices of custodial care have received little explicit attention from GMH (Cohen & Minas, 2017).…”

Section: Mental Health Reform As Frontier Of Modernitymentioning

confidence: 99%

Global Mental Health: Interdisciplinary challenges for a field in motion

Bemme

Kirmayer

2020

Transcult Psychiatry

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In recent years, efforts in Global Mental Health (GMH) have evolved alongside critical engagement with the field's claims and interventions. GMH has shifted its agenda and epistemological underpinnings, increased its evidence base, and joined other global policy platforms such as the Sustainable Development Goals. This editorial introduction to a thematic issue traces the recent shifts in the GMH agenda and discusses the changing construct of ''mental health'' as GMH moves away from a categorical biomedical model toward dimensional and transdiagnostic approaches and embraces digital technologies. We highlight persistent and emerging lines of inquiry and advocate for meaningful interdisciplinary engagement. Taken together, the articles in this special issue of Transcultural Psychiatry provide a snapshot of current interdisciplinary work in GMH that considers the socio-cultural and historical dimensions of mental health important and proposes reflexive development of interventions and implementation strategies.

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Section: Mental Health Reform As Frontier Of Modernitymentioning

confidence: 99%

Global Mental Health: Interdisciplinary challenges for a field in motion

Bemme

Kirmayer

2020

Transcult Psychiatry

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“…Psychiatric hospitals remained an area of interest to the scientific community for a large part of the twentieth century; however, the interest sharply declined over the last three decades [ 4 , 5 ]. Further, the emerging field of global mental health prioritized research on community mental health [ 6 ] particularly on common mental disorders and depression while neglecting mental hospitals.…”

Section: Introductionmentioning

confidence: 99%

Psychiatric hospital reform in low- and middle-income countries: a systematic review of literature

Raja

Tuomainen

Madan

et al. 2021

Soc Psychiatry Psychiatr Epidemiol

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Purpose Psychiatric hospitals or mental asylums grew across the world in the colonial era. Despite concerns over quality of care and human rights violations, these hospitals continue to provide the majority of mental health care in most low- and middle-income countries (LMICs). We sought to review the evidence of reform of mental hospitals and associated patient outcomes. Methods We adopted an integrative review methodology by including experimental and non-experimental research. The review protocol was registered on PROSPERO (CRD42019130399). A range of databases and systematic hand searches were conducted by two independent reviewers. Research conducted between 1980 and May 2019, that focused on any aspect of reform in mental hospitals for adults (age 18 and upwards) with severe mental illness and published in English, were considered. Results 16 studies were included in the review. 12 studies met inclusion criteria, and four additional reports emerged from the hand search. Studies covered—India, China, South Africa, Grenada, Georgia, Sri Lanka, Argentina and Brazil. Key findings emphasise the role of judicial intervention as a critical trigger of reform. Structural reform composed of optimisation of resources and renovations of colonial structures to cater to diverse patient needs. Process reforms include changes in medical management, admission processes and a move from closed to open wards. Staff engagement and capacity building have also been used as a modality of reform in mental hospital settings. Conclusion There is some documentation of reform in psychiatric hospitals. However, poor methodological quality and variation in approach and outcomes measured, make it challenging to extrapolate specific findings on process or outcomes of reform. Despite being integral service providers, psychiatric hospitals still do not adopt patient centric, recovery-oriented processes. Hence, there is an urgent need to generate robust evidence on psychiatric reform and its effect on patient outcomes.

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“…In many developing countries, restricted human resources [2], inaccessibility to mental health professionals [3] and inappropriate health-care settings [4] are found to be common challenges. Furthermore, mental health hospitals are notorious for their stigmatization [1] and violation of basic human rights [1,5]. Besides stigma, other important challenges include the following: low ranking as a health system priority, inadequate capacity in management, insufficient training of general practitioners (GPs), the absence of orientation to integrated care, a high turnover of staff, inefficient intersector coordination, poor infrastructure and insufficient budget allocation [4].…”

Section: Introductionmentioning

confidence: 99%

The challenges faced by service providers on satellite mental health-care facilities in Yangon, Myanmar: a qualitative study

Lin¹,

Sun

Sein

2020

JHR

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PurposeMyanmar has an insufficient number of mental health workers with few institutional facilities resulting in a significant treatment gap. Although few mental health services are integrated into primary health care (PHC), the challenges are unknown. This study aimed to assess the challenges perceived by providers in the service delivery of satellite mental health care (SMHC) in two sample townships in Yangon.Design/methodology/approachThe research was based on a case study design by applying a qualitative approach using in-depth interviews (IDIs). In the three types of service providers, a total of six staff participated as interviewees. These consisted of two team leaders, two clinical specialists providing consultations to clients and two mental health nurses.FindingsProviders perceived the following as major challenges in the provision of services: unstable financial resources and management, insufficient human resources and capacity of service providers, restricted outpatient services, the lack of a functional referral system, overcrowding, inadequate individual consultation time, long-waiting hours, finite opening days and hours and poor setting of infrastructure, resulting in lack of privacy.Research limitations/implicationsIn the absence of similar studies in Myanmar, findings could not be placed in the context of the national literature for comparison. Further, the study involved a limited number of respondents, which may have affected the findings.Originality/valueAlthough the challenges revealed were not uncommon in mental health services in developing countries, this study focused on a specific model of mental health care integrated into general healthcare settings in Myanmar. The findings offer a benchmark on efforts to develop decentralized mental health services in Myanmar and provide input for future in-depth studies.

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Global mental health and psychiatric institutions in the 21st century

Cited by 35 publications

References 43 publications

Global Mental Health: Interdisciplinary challenges for a field in motion

Global Mental Health: Interdisciplinary challenges for a field in motion

Psychiatric hospital reform in low- and middle-income countries: a systematic review of literature

The challenges faced by service providers on satellite mental health-care facilities in Yangon, Myanmar: a qualitative study

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