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There are significant gaps in the accessibility and quality of mental health services around the globe. A wide range of institutions are addressing the challenges, but there is limited reflection and evaluation on the various approaches, how they compare with each other, and conclusions regarding the most effective approach for particular settings....
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Context 1
... years (2002–12) of joint needs assessments, programme planning, implementation and evaluations across various international jurisdictions served as the basis for the HPIF. Working at the primary, secondary and tertiary levels of the health care system and learning from a trial-by-error approach, the framework emphasizes building horizontal relationships focused on partner needs. The framework concentrates on strengthening capacity in primary health care (PHC), which is assumed to contribute to the overall functioning of the health care system and the delivery of social services connected to mental health (Dooley 1997; Table 2). The next section describes the five pillars that form the basis of the framework (Figure 1). Going beyond the biomedical focus was essential for gaining an in- depth understanding of the current PHC situation, identifying influ- ential factors and recognizing the underlying values of partners living in distinct cultural, political, socioeconomic and historical contexts. The holistic health pillar examines this complexity by exploring the synergies between the individual, interpersonal, organizational, community, policy and superstructural levels of a health system (Sweat and Denison 1995; Scott et al . 2011; Centre for Disease Control and Prevention 2013). In this modified social ecological approach, all levels are inter- linked and necessary for developing and implementing culturally and socioeconomically relevant capacity-building initiatives. This pillar therefore encompasses context-specific social determinants of health at the various levels and embraces the relationship between mental, physical and spiritual health that are paramount to the epis- temologies of many cultures (Bass et al . 2007). The manner in which emotions are perceived and experienced dif- fers significantly across cultures and may lead to an analysis of ‘a radically different way of being a person’ (Kleinman et al . 1985). The HPIF therefore emphasizes that an understanding and knowledge of mental health should come from, rather than be imposed upon, a community of people. This bottom-up approach involves a willingness to critically analyse Western perceptions of ‘mental’ and ‘health’ and has been identified as an essential turnkey in preventing paternalistic attitudes and practices (Bass et al . 2007; Summerfield et al . 2008). It is also critical to incorporate ‘consumers/survivors’, or individuals with mental health and/or addiction issues, as key contributors and stakeholders of mental health policy, planning, legislation, service provision and evaluation processes. Doing so will not only augment the advocacy power of those living with mental illness and addictions but will also enhance local ownership over policies and interventions. This is important, as perceived relevance can both improve the uptake of mental health policies at the political level and increase the likelihood that patients will seek treatment. Hence, acquiring what is often coined as ‘cultural and socioeconomic rele- vance’ in a global health context emerges as a prerequisite to estab- lishing reciprocal partnerships and requires an attitude of respect, openness and humility. Building on the notion of cultural and socioeconomic relevance, the HPIF is grounded in a firm commitment to the principle of reci- procity. Literature shows that reciprocal partnerships, based on trust, respect and co-leadership, are pivotal to effective global health work, including mental health and addiction initiatives (Gaboury 2009). Partnerships are dynamic, requiring constant dialogue and mutual dedication to reconcile differences and embrace similarities in values and culture (Sidle et al . 2006). Every OTGH programme includes a face-to-face workshop component, usually on-site in a partner community, to establish reciprocal relationships and create a foundation for effective communication. The opportunity to exchange knowledge and consult with colleagues from diverse institutions in various countries has consistently been identified by participants as a crucial aspect of a rich learning experience. Group work sessions have also been used to address specific cases, strengthen interdisciplinary skills and develop applied-research projects. Participants are typically given between 2 and 9 months to complete the practical component of their learning, with the support of the OTGH and their respective institutions. Though the process is highly independent, OTGH facilitators provide feedback and support throughout. Table 3 outlines the process for achieving each goal of the partnership and capacity building processes. This pillar emphasizes the need to work collaboratively with partners to identify and assess existing gaps in health-care treatment and policies, as well as existing strengths and opportunities. Identified gaps can then be addressed by building on strengths and opportunities, training professionals and sharing knowledge. Figure 2 highlights the primary teaching methodologies that support the HPIF. Three methodologies are particularly relevant: adult education, action-oriented learning and train-the-trainer techniques. The exam- ined global mental health work uses participatory and mutual learning based on proven adult education methodologies to convey the technical aspects of its interventions through needs assessments, sound relationships, collective learning, reflexivity and accountability (Vella 2002; Freire 2006). Encouraging practitioners to share their own expertise and experiences has resulted in enhanced engagement in the learning process. Action-oriented learning enhances both individual and organizational capacity on a short- and ...
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Background:
A large mental health treatment gap exists among conflict-affected populations, and Syrian refugees specifically. Promising brief psychological interventions for conflict-affected populations exist such as the World Health Organization's Problem Management Plus (PM+) and the Early Adolescent Skills for Emotions (EASE) intervention, how...
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Citations
... Healthcare professionals treat obesity and depression in multiple ways (Stein et al., 2019). This includes promoting a sociological, psychological, and educational mental health model (Khenti et al., 2016). Personality, social, clinical, health, and developmental perspectives could improve diet and exercise interventions (Friel et al., 2007;Lemstra et al., 2016;Mozaffarian et al., 2018). ...
Obesity, body image, and depression are all biopsychosocial phenomena that are frequently misunderstood across cultures. Body dissatisfaction is a psychological aspect of obesity that has been associated with disordered eating, low self-esteem, and depression. Nevertheless, body image dissatisfaction may affect non-obese individuals too. Those with a positive body image are more likely to participate in physical activity than those with a negative body image. Individuals who are satisfied with their body image are more likely to possess high self-esteem, confidence, and healthy eating habits. Obesity prevention among the black population is increasingly important. This study sought to examine the perceptions and experiences of British-born Afro-Caribbean male students at a West Yorkshire University in England regarding obesity, body image, and mental health. Twelve participants took part in 45-minute semi-structured interviews. The data was transcribed verbatim and analyzed using thematic analysis. Results revealed four major themes: "healthy lifestyle monitoring," "body image attitude," "experiences of attempting to maintain weight," and "reasons for weight change." Clinically obese individuals exhibited dissatisfaction with their body image. Depression was found to be strongly related to dissatisfaction with one's body image. Obesity is stigmatized and associated with low self-esteem in many societies in the United Kingdom, which impacts mental health. Future health promotion programs should teach obese individuals who are dissatisfied with their body image to deal with emotions like shame, guilt, and pride. Furthermore, individuals should adopt healthier eating habits and increase their physical activity, which is a broad strategy to reduce the incidence of obesity.
... There was an overall consensus on the benefits of taking a collaborative and integrated approach when delivering mental health care to patients with psychosis. This approach has been recognized as vital to the long-term successful and holistic management of the treatment needs of people with severe mental health conditions in a variety of contexts (28). Within the services included in the study, psychiatrists typically referred individuals in need of psychosocial therapies to psychologists, occupational and rehabilitation therapists, where available, as these staff members could spend more time with patients and their caregivers to resolve social concerns and provide psychoeducation for on-going self-care and management. ...
Background
Globally, a treatment gap exists for individuals with severe mental illness, with 75% of people with psychosis failing to receive appropriate care. This is most pronounced in low and middle-income countries, where there are neither the financial nor human resources to provide high-quality community-based care. Low-cost, evidence-based interventions are urgently needed to address this treatment gap.
Aim
To conduct a situation analysis to (i) describe the provision of psychosocial interventions within the context of existing care in two LMICs-India and Pakistan, and (ii) understand the barriers and facilitators of delivering a new psychosocial intervention.
Method
A situation analysis including a quantitative survey and individual interviews with clinicians, patients and caregivers was conducted. Quantitative survey data was collected from staff members at 11 sites (private and government run hospitals) to assess organizational readiness to implement a new psychosocial intervention. To obtain in-depth information, 24 stakeholders including clinicians and service managers were interviewed about the typical care they provide and/or receive, and their experience of either accessing or delivering psychosocial interventions. This was triangulated by six interviews with carer and patient representatives.
Results and discussion
The results highlight the positive views toward psychosocial interventions within routine care and the enthusiasm for multidisciplinary working. However, barriers to implementation such as clinician time, individual attitudes toward psychosocial interventions and organizational concerns including the lack of space within the facility were highlighted. Such barriers need to be taken into consideration when designing how best to implement and sustain new psychosocial interventions for the community treatment of psychosis within LMICs.
... Over the past two decades, a shift has taken place in the approach to mental health care, moving from an emphasis on the reduction of symptoms, based on pathology and illness, to a more comprehensive and holistic approach (1,2). The definition put forward by Anthony (1993) was a key milestone for this shift, where recovery was described as "a deeply personal, unique process of changing one's attitudes, values, feelings, goals, skills, and/or roles. ...
Introduction: Measuring quality of life (QoL) is essential to understand how clients perceive their care. In practice, many instruments are in place to identify mental health diagnoses and measure treatment outcomes, but there are fewer standardized instruments to routinely collect information about self-reported QoL, especially across different mental health settings. Moreover, existing tools have been criticized for being built from the perspective of care professionals rather than the users' perspective. The 23-item Self-Reported interRAI-QoL Survey for Mental Health and Addictions (interRAI SQoL-MHA) tackles these issues, as it is based on self-reported measures and has proven validity across settings and countries.
Objective: The aim of this study is to assess and compare QoL across settings and explore associations between dimensions of self-reported QoL and some items from the interRAI SQoL-MHA in a multinational sample.
Settings: Inpatient and community mental health services.
Methods: Data were collected from organizations in Belgium, Finland, Russia, Brazil, Rwanda, Canada and Hong Kong. Logistic regression models were constructed using each domain scale of the interRAI SQoL-MHA (relationship, support, hope, activities and relationship with staff) as dependent variables.
Results: A total of 2,474 people (51.2% female, 56.7% of age 45 or older) were included in the study. A benchmark analysis showed the samples that performed above the benchmark line or below. The models yielded significant odds ratios among the domain scales, as well as for the items of the interRAI SQoL-MHA, with positive associations for the items “work and education opportunities” and “satisfied with services”, and inverse associations for the items “financial difficulties” and for the inpatient setting.
Conclusion: The analysis of associations between the determinants offers relevant information to improve mental health care and clients' perceived quality of life. Information about the determinants can help policymakers to design interventions to improve care outcomes, as well as provide more possibilities for integration into the community. The interRAI SQoL-MHA is innovative, as it can be linked to the third generation interRAI MH and Community MH-instruments, to be used in different mental health care settings, combining the objective and subjective QoL domains.
... We used three steps to develop the analysis framework. First, we chose methodological sources that take a comprehensive and people-centred mental health approach [4,6,7,25,28,29]. Second, we identified the main dimensions relating to comprehensive MH care, considering the axes involved in MH care development in primary health care, specialised services, and hospital care. ...
... Current guidelines underlying global MH advocate ensuring the dignity of the person in mental distress, in line with Human Rights Conventions [29]. However, the reality studied by us in Brazil revealed shackling situations, inadequate restraints, and private prisonsunacceptable conditions for the present day. ...
Background
Recommendations are in place for mental health (MH) care to be developed into a comprehensive, people-centred perspective and organised primarily through community services. In recent decades, Brazil has promoted psychiatric reform aimed at transforming the hospital-centred model into a psychosocial model of MH. However, current political and economic changes threaten this reform. This article analyses the comprehensive MH care offered by a Psychosocial Care Network ( Rede de Atenção Psicossocial – RAPS) in Brazil.
Methods
The study involved semi-structured in-depth interviews with 33 stakeholders (policymakers, health professionals, and MH service users) and direct observation of MH services members of the RAPS. Data were analysed using framework analysis with the following dimensions: mental health services access, long-term mental health care, comprehensive mental health care, and crisis patient care.
Results
Results indicated progression towards comprehensive MH care provision. We identified MH care provided primarily by community services, featuring an ‘open door’ policy, development of localised actions and a search for autonomy. Deinstitutionalisation principles and the psychosocial model support a comprehensive view of MH by policy makers, MH professionals, and users. However, difficulties in providing comprehensive care remain, with the main challenges being insufficient services offered and difficulties in user access at all levels of care, fragile integration between services, lack of clear definitions of the responsibilities of each service, discontinuity of care, limitations in family support, and fragility in crisis patient care.
Conclusion
We highlight the need to increase funding and services of RAPS, qualification of staff professional, family support, and development of strategies for integrating services. Support and expansion of MH care depend on strengthening the Brazilian health system, which is in danger of being dismantled.
... Developing strong professional relationships, with emphasis on communication, trust, and respect, is vital for impactful collaborations. Substantive professional relationships built through collaboration buffer the negative effects of challenges and maintains morale during difficulties (Khenti et al., 2016;Hook and Vera, 2020). Critically, collaboration plays a key role in allowing global partners to manage and persevere during the current time. ...
... This information is essential to achieving a successful widespread implementation of the TDM and is an incentive for creating policies in transitional care in mental health settings over diverse regional contexts. The policy guidance is particularly crucial to alleviate potential inadequate policy harmonization, and delays in the application of public mental health interventions to address problems that frontline clinical practice face (Khenti et al., 2016). ...
... There were five main elements in holistic policy: (1) considering the whole individuals and the interactions between the social systems, (2) comprehensive understanding of other risk factors related to health, such as psychology, culture and socioeconomic status, (3) developing community partnerships, creating reciprocal relationships and establishing open communication, (4) increasing collaborative practice for health promotion, and (5) improving sustainability in health systems and healthcare. 9 A previous study investigated the benefits of using holistic health management during the Ebola outbreak in West Africa. They found that health systems should include efforts to incorporate cultural beliefs and practices when determining strategies during an outbreak. ...
... 16 As the COVID-19 response begins and ends at the local level, therefore, in the preparedness phase, comprehensive community planning should focus on improving health systems and services, including communications across all levels: leaders, stakeholders, and wider communities. Six components should be taken before prepar- Njuguna, et al., 21 (2019) Surveillance An integrated surveillance system to help recover from Ebola crisis 5 Arslantas, et al., 31 (2019) Modeling a holistic framework Hazard exposure, vulnerability, poor coping skills, socioeconomic factors increased disease risk 6 Abdulkareem, et al., 32 (2020) Modeling intelligent learning Social learning was affected by social and cultural norms 7 Kinsman, et al., 23 (2018) Case study Preparedness and response plans during an epidemic 8 Afayo, et al., 24 (2019) Cross-sectional study The gap between preparedness and response to the outbreak 9 Craig, et al., 20 (2018) Surveillance ...
The COVID-19 pandemic affects entire communities and causes a huge impact on all life aspects which include biological, psychological, social, and spiritual well-being. Health systems and health policies are promising developments and opportunities to review progress and accelerate interventions in COVID-19 control. Studies devoted to core holistic-comprehensive issues surrounding this pandemic are limited. Therefore, this article aimed to review several best practice studies that reflect holistic-comprehensive approaches to COVID-19. A comprehensive literature review was written based on 15 articles from the data sources which are Google Scholar, Science Direct, ProQuest Health, and Medical Complete, and ProQuest Science Journals from 2010 to 2020, searched terms related to holistic, comprehensive, outbreak, pandemic, epidemics, and COVID-19. There are many evidence-based practices on safe and effective strategies to improve all aspects of well-being before, during, and after the COVID-19 pandemic. Among these promising strategies, a holistic-comprehensive approach could also be considered as a necessary action to improve health policy during the pandemic. A holistic-comprehensive approach involved providing bio-psycho-socio-spiritual care and offered a continuum of healthcare that provides promotive, preventive, curative, and rehabilitative services. A holistic-comprehensive approach to the COVID-19 pandemic requires a sustained commitment from entire communities, stakeholders, and policymakers to achieve better health outcomes for all.
... These findings are not surprising given the existing literature that describes the need for increased capacity to fulfil the requirements of public health roles generally, [7,[19][20][21] as well as across other public health topics including nutrition, [22,23] mental health, [24] and infection prevention [25]. Further, other situational assessments conducted at PHO in public health nutrition and healthy growth and development revealed consistent challenges including the need for increased collaboration, access to evidence and local data, as well as capacity and resource constraints (unpublished). ...
Background:
To effectively impact the significant population burden of injury, we completed a situational assessment of injury prevention practice within a provincial public health system to identify system-wide priorities for capacity-building to advance injury prevention in public health.
Methods:
A descriptive qualitative study was used to collect data on the current practice, challenges and needs of support for injury prevention. Data was collected through semi-structured interviews (n = 20) and focus groups (n = 19). Participants included a cross-section of injury prevention practitioners and leadership from public health units reflecting different population sizes and geographic characteristics, in addition to public health researchers and experts from academia, public health and not-for-profit organizations. Thematic analysis was used to code all of the data by one reviewer, followed by a second independent reviewer who coded a random selection of interview notes. Major codes and sub codes were identified and final themes were decided through iterations of coding comparisons and categorization. Once data were analysed, we confirmed the findings with the field, in addition to participating in a prioritization exercise to surface the top three needs for support.
Results:
Major themes that were identified from the data included: current public health practice challenges; capacity and resource constraints, and; injury as a low priority area. Overall, injury prevention is a broad, complex topic that competes with other areas of public health. Best practices are challenged by system-wide factors related to resources, direction, coordination, collaboration, and emerging injury public health issues. Injury is a reportedly under prioritized and under resourced public health area of practice. Practitioners believe that increasing access to data and evidence, and improving collaboration and networking is required to promote best practice.
Conclusions:
The results of this study suggest that there are several system level needs to support best practice in public health injury prevention in Ontario including reducing research to practice gaps and supporting opportunities for collaboration. Our research contributes to the literature of the complexity of public health practice, and presents several mechanisms of support to increase capacity at a system level to improve injury prevention practice, and eventually lessen the population burden of injury.
... Additionally, while other themes identified by Ng and de Colombani (2015) and Khenti et al. (2015) may have differing terminology, interconnected concepts inherent in these variables are easily identified (e.g., community participation and stakeholder collaboration are building blocks to ensuring relevance and craft partnerships). However, aspects of these best practice recommendations also have varying foci (e.g., Ng and de Colombani's (2015) ethical soundness and replicability domains versus Khenti et al.'s (2015) partnerships and action-based education and learning variables). ...
... Additionally, while other themes identified by Ng and de Colombani (2015) and Khenti et al. (2015) may have differing terminology, interconnected concepts inherent in these variables are easily identified (e.g., community participation and stakeholder collaboration are building blocks to ensuring relevance and craft partnerships). However, aspects of these best practice recommendations also have varying foci (e.g., Ng and de Colombani's (2015) ethical soundness and replicability domains versus Khenti et al.'s (2015) partnerships and action-based education and learning variables). Assessing these variations, while noting commonalities, is a needed task within best practice literature. ...
... The themes which emerged in this study are also aligned with the aims of GMH (e.g., creating partnerships, paying explicit attention to cultural, community, and individual factors that impact mental health). For example, the overarching recommendations related to integrating cultural/contextual variables and collaboration are addressed throughout the extant literature, with varying degrees of specification and detail (e.g., Boutilier et al., 2011;Khenti et al., 2015;Ng & de Colombani;Shah, 2011;Ravitz et al., 2014;Wallcrat et al., 2011), and in many cases, existing literature supports the subthemes found in participants' responses such as reciprocity (e.g., Godoy-Ruiz et al., 2016;Khenti et al., 2015;Khenti et al., 2012;Raviola et al., 2012) andcommunication (e.g., Forti, 2005;Kayingo et al., 2016;Larkan, et al., 2016). However, while considerations related to cultural and contextual competence, as well as collaboration, are replete in the general GMH literature, this study highlights these variables as core components are effective project design, implementation, and evaluation, rather than peripheral issues that are tacked-on to projects. ...
Recommendations for best practice are useful in guiding the ethical and effective practice of psychology. Global mental health, which works to improve mental health treatment and access on a worldwide scale, is a growing field with many opportunities for psychologists, though such best practice recommendations have not been articulated. Using a grounded theory approach, this qualitative study recruited and interviewed psychologists identified as leaders in the field. Findings included broad categories of recommendations related to overarching variables (consideration of cultural/contextual variables and collaboration), program-level characteristics (sustainability, formative and summative evaluation, flexibility, attention to systems, multidisciplinary teams, clinical knowledge and perspective, and attention to spectrum of mental health), and individual-level characteristics (perseverance, ongoing mentorship/supervision, self-awareness, and boundary setting). Future directions include recommendations to recreate this study with a more geographically diverse sample, as well as with community members and service users of global mental health projects. Increased attention to individual-level competencies that impact global mental health projects is warranted. Implications for training are also considered.
... These findings are not surprising given the existing literature that describes the need for increased capacity to fulfil the requirements of public health roles generally, (7,(19)(20)(21) as well as across other public health topics including nutrition, (22,23) mental health, (24) and infection prevention. (25) Further, other situational assessments conducted at Public Health Ontario in public health nutrition and healthy growth and development revealed consistent challenges including the need for increased collaboration, access to evidence and local data, as well as capacity and resource constraints (unpublished). ...
Background: To effectively impact the significant population burden of injury, we completed a situational assessment of injury prevention practice within a provincial public health system to identify system-wide priorities for capacity-building to advance injury prevention in public health.
Methods: A descriptive qualitative study was used to collect data on the current practice, challenges and needs of support for injury prevention. Data was collected through semi-structured interviews (n=20) and focus groups (n=19). Participants included a cross-section of injury prevention practitioners and leadership from public health units reflecting different population sizes and geographic characteristics, in addition to public health researchers and experts from academia, public health and not-for-profit organizations. Thematic analysis was used to code all of the data by one reviewer, followed by a second independent reviewer who coded a random selection of interview notes. Major codes and sub codes were identified and final themes were decided through iterations of coding comparisons and categorization. Once data were analysed, we confirmed the findings with the field, in addition to participating in a prioritization exercise to surface the top three needs for support.
Results: Major themes that were identified from the data included: current public health practice challenges; capacity and resource constraints, and; injury as a low priority area. Overall, injury prevention is a broad, complex topic that competes with other areas of public health. Best practices are challenged by system-wide factors related to resources, direction, coordination, collaboration, and emerging injury public health issues. Injury is a reportedly under prioritized and under resourced public health area of practice. Practitioners believe that increasing access to data and evidence, and improving collaboration and networking is required to promote best practice.
Conclusions: The results of this study suggest that there are several system level needs to support best practice in public health injury prevention in Ontario including reducing research to practice gaps and supporting opportunities for collaboration. Our research contributes to the literature of the complexity of public health practice, and presents several mechanisms of support to increase capacity at a system level to improve injury prevention practice, and eventually lessen the population burden of injury.
