Mental health policy and integrated care: global perspectives

Abstract

Although omitted from the World Health Organization's eight Millennium Development Goals, mental illness ranks fourth of the 10 leading causes of disability in the world and is expected to approach second place by 2020. Scarce resources challenge responses to mental health needs. Effective approaches must consider existing healthcare delivery networks, nurses as care providers, as well as social, cultural, political and historical contexts. This paper reviews policy development and care approaches to address mental health needs around the world. Challenges, successes and further needs are discussed. Selected articles were reviewed to represent varied approaches to address mental health needs in countries with diverse resources and infrastructures. Integrated systems offer one model for addressing mental health needs along with physical health needs within a population. While potentially an efficient strategy, caution is advised to ensure services are integrated and not merely added on top of an already overburdened system. As the largest group of healthcare professionals worldwide, nurses play a key role in the delivery of mental health services. Nurses have an opportunity, if not a responsibility, to collaborate across borders sharing education and innovative approaches to care delivery.

The development of mental health services within primary care in India: learning from oral history

“…It demands a “new perspective which engages an orientation towards the unique mental, physical, social and cultural needs of the individual”, and involves family and community support [61]. India’s NMHP has prioritised mental health literacy of the general population through campaigns but has not re-orientated the primary care provider, either the doctor or the lay health worker, away from a biomedical model to a process of thinking necessary for comprehensive mental and physical care.…”

“…India’s NMHP has prioritised mental health literacy of the general population through campaigns but has not re-orientated the primary care provider, either the doctor or the lay health worker, away from a biomedical model to a process of thinking necessary for comprehensive mental and physical care. India may consider remedying this, as have some of its low- and middle- income counterparts, where this re-orientation of health workers is being attempted for example in South Africa (with primary care nurses and health district management) and in Mozambique (with traditional healers) [61-63]. …”

District nurses meeting with and providing care to people with mental illness in health centers – An interview study

“…Lee and Knight [18] and Meehan and Robertsson [19] conclude that district nurses have an important role in the prevention and management of mental illness. Galon and Graor, [7] Zolnierek [8] and Kauppi et al [9] all find that the attitudes and demeanor of health center nurses are important factors for patients with mental illness.…”

“…Such knowledge can also help identify barriers and facilitators in primary healthcare from a patient perspective. [5][6][7][8][9] However, there are no specific descriptions of the meeting with and provision of care to patients with mental illness in health centers from a district nurse perspective.…”

“…[ [5][6][7][8][9] Nonetheless, there is insufficient research on how district nurses experience their meeting with and care provision to patients with mental illness in health centers. The aim of this study was to explore this particular issue and to provide insights and conclusions that may be of benefit to both district nurses and their patients with mental illness.…”