The balanced care model for global mental health

Thornicroft, Graham; Tansella, Michele

doi:10.1017/s0033291712001420

Cited by 123 publications

(100 citation statements)

References 170 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Through shifting tasks, interventions that are originally carried out in specialized services may be carried out in primary or community care instead (van Ginneken et al, 2013). In both high-resource European countries and Syrian neighbouring countries with fewer health care resources, task-shifting is a promising strategy to implement within current stepped care or collaborative care approaches to public health (de Jong, 2011; Thornicroft & Tansella, 2013). The more widespread availability of evidence-based task-shifting interventions for common mental disorders indirectly may also have a positive impact on the treatment gap for severe psychiatric disorders and associated symptoms problems such as psychosis and suicidal behaviours in LMICs.…”

Section: Scaling-up Mental Health Interventions For Refugeesmentioning

confidence: 99%

Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries

Sijbrandij¹,

Acartürk

Bird³

et al. 2017

European Journal of Psychotraumatology

206

202

View full text Add to dashboard Cite

The crisis in Syria has resulted in vast numbers of refugees seeking asylum in Syria’s neighbouring countries as well as in Europe. Refugees are at considerable risk of developing common mental disorders, including depression, anxiety, and posttraumatic stress disorder (PTSD). Most refugees do not have access to mental health services for these problems because of multiple barriers in national and refugee specific health systems, including limited availability of mental health professionals. To counter some of challenges arising from limited mental health system capacity the World Health Organization (WHO) has developed a range of scalable psychological interventions aimed at reducing psychological distress and improving functioning in people living in communities affected by adversity. These interventions, including Problem Management Plus (PM+) and its variants, are intended to be delivered through individual or group face-to-face or smartphone formats by lay, non-professional people who have not received specialized mental health training,We provide an evidence-based rationale for the use of the scalable PM+ oriented programmes being adapted for Syrian refugees and provide information on the newly launched STRENGTHS programme for adapting, testing and scaling up of PM+ in various modalities in both neighbouring and European countries hosting Syrian refugees.

show abstract

Section: Scaling-up Mental Health Interventions For Refugeesmentioning

confidence: 99%

Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries

Sijbrandij¹,

Acartürk

Bird³

et al. 2017

European Journal of Psychotraumatology

206

202

View full text Add to dashboard Cite

show abstract

“…As such, the findings of the present study align with the recommendations made recently by the National Mental Health Commission in its Report of the National Review of Mental Health Programs and Services. 1 According to several international models, [21][22][23] specialised adult mental health services should include the following components: specialised out-patient/ambulatory clinics; assertive community treatment (ACT) teams; alternatives to acute in-patient care; alternative types of long-stay community residential care; and specialised forms of work and occupation. Community-based care and living arrangements are only sustainable if located within a broader system of care that provides short-term expert acute care to manage crisis.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is also important to implement residential alternatives located in the community because these may be less stigmatising and more cost-effective than hospital admission. 22 A recent quasi-experimental study performed in Brisbane (Qld, Australia) demonstrated that 'crisis houses' provide a cost-effective option. 25 These services can also function as 'step-down' transitions from a period of acute psychiatric hospitalisation.…”

Section: Alternatives To Acute In-patient Carementioning

confidence: 99%

“…In Australia, as in other high-income countries, decision makers and/or policy planners take a 'component view' rather than a 'system view' of the whole pattern of care at the local level and how the different components are related. 22 The problem of the component approach is that it results in a highly inefficient use of scarce resources, because investments are made in new services, whereas the core services are absent or not appropriately resourced. This leads to a 'reactive' system rather than a 'proactive' system.…”

Section: Further Findingsmentioning

confidence: 99%

See 1 more Smart Citation

Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations

Fernández

Gillespie

Smith‐Merry

et al. 2017

Aust. Health Review

View full text Add to dashboard Cite

Objective Australian mental health care remains hospital centric and fragmented; it is riddled with gaps and does little to promote recovery. Reform must be built on better knowledge of the shape of existing services. Mental health atlases are an essential part of this knowledge base, enabling comparison with other regions and jurisdictions, but must be based on a rigorous classification of services. The main aim of this study is to create an integrated mental health atlas of the Western Sydney LHD in order to help decision makers to better plan informed by local evidence. Methods The standard classification system, namely the Description and Evaluation of Services and Directories in Europe for Long-term Care model, was used to describe and classify adult mental health services in the Western Sydney Local Health District (LHD). This information provided the foundation for accessibility maps and the analysis of the provision of care for people with a lived experience of mental illness in Western Sydney LHD. All this data was used to create the Integrated Mental Health Atlas of Western Sydney LHD. Results The atlas identified four major gaps in mental health care in Western Sydney LHD: (1) a lack of acute and sub-acute community residential care; (2) an absence of services providing acute day care and non-acute day care; (3) low availability of specific employment services for people with a lived experience of mental ill-health; and (4) a lack of comprehensive data on the availability of supported housing. Conclusions The integrated mental health atlas of the Western Sydney LHD provides a tool for evidence-informed planning and critical analysis of the pattern of adult mental health care. What is known about the topic? Several reports have highlighted that the Australian mental health system is hospital based and fragmented. However, this knowledge has had little effect on actually changing the system. What does this paper add? This paper provides a critical analysis of the pattern of adult mental health care provided within the boundaries of the Western Sydney LHD using a standard, internationally validated tool to describe and classify the services. This provides a good picture of the availability of adult mental health care at the local level that was hitherto lacking. What are the implications for practitioners? The data presented herein provide a better understanding of the context in which mental health practitioners work. Managers and planners of services providing care for people with a lived experience of mental illness can use the information herein for better planning informed by local evidence.

show abstract

“…For example, the 'balanced care' model (WHO 2010;Thornicroft and Tansella, 2013) balances the availability of hospital and community-based mental health services. In resource-poor settings, the model focuses on improving the recognition and treatment of people with mental illnesses within primary health care clinics, alongside the treatment of more complicated cases at specialised centres.…”

Section: Background: a Policy For Primary Mental Health Care In Southmentioning

confidence: 99%

Policy, power, stigma and silence: Exploring the complexities of a primary mental health care model in a rural South African setting

Burgess

2016

Transcult Psychiatry

View full text Add to dashboard Cite

AcknowledgementsThe author would like to thank the Professor Susan Rifkin for her invaluable comments on drafts of this work. AbstractThe movement for global mental health's (MGMH) efforts to scale up the availability of mental health services have been moderately successful. Investigations from resource poor countries like South Africa have pointed towards the value of an integrated primary mental health care model and multidisciplinary collaborations to support mental health needs in underserved and under-resourced communities. However, there remains a need to explore how these policies play out within the daily realities of communities marked by varied environmental and relational complexities. Arguably, the lived realities of mental health policy and service delivery processes are best viewed through ethnographic approaches, which remain underutilised in the field of global mental health. This paper reports on findings from a case study of mental health services for HIV-affected women in a rural South African setting, which employed a motivated ethnography in order to explore the lived realities of primary mental health care model and related policies in South Africa. Findings highlighted the influence of three key symbolic (intangible) factors that impact on the efficacy of the primary mental health care model: power dynamics -which shaped relationships within multi-disciplinary teams, stigma -which limited the efficacy of task-shifting strategies, and a silencing of women's narratives of distress within services. The resultant gap between policy ideals and the reality of practice is discussed. The paper concludes with recommendations for building on existing successes in the delivery of primary mental health care in South Africa.

show abstract

The balanced care model for global mental health

Cited by 123 publications

References 170 publications

Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries

Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries

Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations

Policy, power, stigma and silence: Exploring the complexities of a primary mental health care model in a rural South African setting

Contact Info

Product

Resources

About