Mental Health Policy

Over the last decade state prisons have experienced unprecedented growth and many demographic changes. At the same time, courts are requiring states to provide mental health screening and treatment to prisoners. Findings from recent studies indicate that the prevalence of mental illness is higher in prisons than in the community, and comorbidity is common. Our ability to generalize from these studies is limited, however, because of major shifts in the demographic mix in prisons during the past decade. New studies on the prevalence of mental illness in prisons, which consider these recent changes would help planners allocate funds and staff to more effectively meet the needs of these individuals.

This study examined risk and determinants of rehospitalization of children and adolescents (n = 186) following a first psychiatric hospitalization. It specifically examined the role of postdischarge services. Data were collected for a 30-month follow-up period through structured telephone interviews with caregivers and case record abstractions. 43% of youth experienced readmissions during the follow-up period. Risk of rehospitalization was highest during the first 30 days following discharge and remained elevated for 3 months. 72% of youth received 284 postdischarge services during the follow-up period, which significantly reduced the risk of rehospitalization. Longer first hospitalizations and a higher risk score at admission increased risk.

This study examined the relationship between children's developing theory of mind and their ability to engage in two social behaviors which have, as their cognitive underpinning, the representation that what one knows may not be accessible to others. Children of 3, 4, and 5 years, in a quasi-naturalistic setting, played hide-and-seek and also were required to keep a secret about a surprise. The ability to play hide-and-seek was significantly related to children's ability to refrain from disclosing the secret, and there was a significant relationship between these behaviors and children's social cognition, as measured by theory of mind tasks. The relationship between these social behaviors and tasks measuring executive function was not significant once age was taken into account. With regard to the development of these social behaviors, few 3year-olds, but most 4-year-olds, and almost all 5-year-olds could successfully play hide-and-seek and keep a secret. This study demonstrates the importance of the conceptual understanding of mental states in the young child's social world.

The purpose of the research programme introduced in this article is to provide new knowledge regarding comprehensive multisectoral approaches to breaking the negative cycle of poverty and mental ill-health. The programme undertakes an analysis of existing mental health policies in four African countries (Ghana, South Africa, Uganda, Zambia), and will carry out and evaluate interventions to assist in the development and implementation of mental health policies in those countries, over a five-year period. The four countries in which the programme is being conducted represent a variety of scenarios in mental health policy development and implementation.

Accompanying the rise in the number of mental health agency personnel tasked with quality assurance and improvement (QA/I) responsibilities is an increased need to understand the nature of the work these professionals undertake. Four aspects of the work of quality assurance and improvement (QA/I) professionals in mental health were explored in this qualitative study: their perceived roles, their major activities, their QA/I targets, and their contributions. In-person interviews were conducted with QA/I professionals at 16 mental health agencies. Respondents perceived their roles at varying levels of complexity, focused on different targets, and used different methods to conduct their work. Few targets of QA/I work served as indicators of high quality care. Most QA/I professionals provided concrete descriptions of how they had improved agency services, while others could describe none. Accreditation framed much of agency QA/I work, perhaps to its detriment.

Background: This paper discusses the role of public inquiries as an instrument of public policymaking in New Zealand, using mental health as a case study. The main part of the paper analyses the processes and outcomes of five general inquiries into the state of New Zealand's mental health services that were held between 1858 and 1996. Results: The membership, form, style and processes used by public inquiries have all changed over time in line with constitutional and social trends. So has the extent of public participation. The records of five inquiries provide periodic snapshots of a system bedevilled by long-standing problems such as unacceptable standards, under-resourcing, and poor coordination. Demands for an investigation no less than the reports and recommendations of public inquiries have been the catalyst of some important policy changes, if not immediately, then by creating a climate of opinion that supported later change. Inquiries played a significant role in establishing lunatic asylums, in shaping the structure of mental health legislation, establishing and maintaining a national mental health bureaucracy within the machinery of government, and in paving the way for deinstitutionalisation. Ministers and their departmental advisers have mediated this contribution. Conclusion: Public inquiries have helped shape New Zealand's mental health policy, both directly and indirectly, at different stages of evolution. In both its advisory and investigative forms, the public inquiry remains an important tool of public administration. The inquiry/cause and policy/effect relationship is not necessarily immediate but may facilitate changes in public opinion with corresponding policy outcomes long after any direct causal link could be determined. When considered from that long-term perspective, the five inquiries can be linked to several significant and long-term contributions to mental health policy in New Zealand.

A B S T R A C T : Patients d i s c h a r g e d f r o m state psychiatric hospitals into c o m m u n i t y care h o m e s were followed for four m o n t h s . Both observers a n d the patients themselves r a t e d the h o m e s ' social e n v i r o n m e n t s as well as the patients' needs a n d capabilities. Patients' f u n c t i o n i n g in the c o m m u n i t y was s h o w n to be e n h a n c e d w h e n there was a c o n g r u e n c e between the patient a n d the e n v i r o n m e n t in p a r t i c u l a r areas. Results suggest t h a t patients' p e r c e p t i o n s of c o n g r u e n c e are better predictors of success t h a n are observers' j u d g m e n t s .

Purpose: Although child poverty is recognized as a critical determinant of poor educational achievement in the United States, policy discussions on raising academic achievement rarely include the importance of the effects of poverty on the mental health of adolescents. This article examines the role of adolescent emotional well-being (indicators of depression) as a mediator of the effects of poverty on differences in educational achievement at the national and U.S. state levels. Methods: Differences in standardized adolescent academic achievement across 23 developed countries and 39 U.S. states were analyzed using path analytic techniques to test the hypothesis that indicators of adolescent emotional well-being mediate relations between child poverty rates and academic achievement. Results: Child poverty rates were related to both adolescent emotional well-being and educational achievement across both U.S. states and developed countries. Path analyses showed that the status of a country's or state's adolescent emotional well-being is a strong predictor of its educational achievement and that emotional well-being mediates the relationship between poverty and educational achievement. Conclusion: Policies designed to ameliorate the adverse effects of poverty on mental health are critical as they are likely to improve both average educational achievement and student emotional well-being. Attention to improving mental health care not only has the potential to reduce societal and individual costs directly related to health but also to reduce the indirect costs of poor educational achievement.

This article will provide a brief historical background to mental health law in order to gain a greater sense of the significance of international human rights law to civil commitment legislation today. Historical context will help to identify the purpose and objectives of mental health law, which in turn assist in weighing into the major debates currently underway. The United Nations Convention on the Rights of Persons with Disability (CRPD), in particular, has brought major changes to the way mental health law is understood, including strengthening longstanding critiques, and adding novel critical perspectives. Three 'eras' of mental health law are examined: the pre-modern origins of mental health law and 19th century regulation; the 'medicalising' shift of the 20th century; and deinstitutionalisation and 'rights-based legalism'. These distinct periods of thought will help to critically assess what appears to be a new reform era in which international human rights law will set a new agenda for transforming or even abolishing mental health law as it currently stands.

"Mental disorders are widespread, cause
tremendous individual suffering and have far
reaching economical consequences. Increasing
awareness of these facts has led the European
Commission to publish a Green Paper
“Improving the mental health of the populations
– towards a strategy on mental health for the
European Union”, which stresses the importance
of measures for promoting mental health and
preventing mental disorders.
The Green Paper focuses on mental health
promotion in children and families as well as at
the work place; on the prevention of mental
disorders; on promoting the social inclusion of
mentally ill or disabled people, on the protection
of their fundamental rights and their dignity, and
on the improvement of information and
knowledge on mental health in the EU. It is
stressed that evaluated interventions should have
priority and that exchange of information
between member states is essential.
The provision of health services is not a topic of
the Green Paper, since the European Commission
has no mandate for the organization of health
care. The establishment of a common market and
the harmonization of legalization in the member
states have also contributed to a need for a
common policy on mental health promotion and
mental disorder prevention. The Green Paper
underscores the need for appropriate measures in
all societal sectors, if the status of the mental
health of the population is to be improved. It is
expected that, based on the Green Paper and the
results of the ensuing discussion process, the
European Commission will publish an EU
strategy on mental health in autumn 2007."

Recent years have seen an international move towards home treatment of acute mental health diffi culties. This has been based upon trial data which do little to develop understanding of how or why this approach is as effective as it seems to be. In order to explore this question the study interviewed patients who had recently used the services of a crisis resolution home treatment (CRHT) team in the English East Midlands. Triangulated parallel qualitative analyses of 33 semi-structured interviews conducted by service users trained in research techniques demonstrated that successful CRHT refl ected practitioners' ability to provide clients with a sense of feeling safe, accepted and understood. Unhelpful outcomes followed when participants did not experience such unconditionally supportive relationships. These fi ndings further endorse the primacy of relational factors in mental health practice. They are discussed in relation to the Dodo Bird verdict upon psychological therapies and systemic diffi culties acknowledging an inconvenient truth.

BACKGROUND: Although effective treatment modalities for mental health problems currently exist in Nigeria, they remain irrelevant to the 70% of Nigeria's 120 million people who have no access to modern mental health care services. The nation's Health Ministry has adopted mental health as the 9th component of Primary Health Care (PHC) but ten years later, very little has been done to put this policy into practice. Mental Health is part of the training curriculum of PHC workers, but this appears to be money down the drain. AIMS OF THE STUDY: To review the weaknesses and problems with existing mode of mental health training for PHC workers with a view to developing a cost-effective model for integration. METHODS: A review and analysis of current training methods and their impact on the provision of mental health services in PHC in a rural and an urban local government area in Nigeria were done. An analysis of tested approaches for integrating mental health into PHC was carried ...

The members of the National Association of State Mental Health Program Directors (NASMHPD) believe that seclusion and restraint, including “chemical restraints," are safety interventions of last resort and are not treatment interventions. Seclusion and restraint should never be used for the purposes of discipline, coercion, or staff convenience, or as a replacement for adequate levels of staff or active treatment. The use of seclusion and restraint creates significant risks for people with psychiatric disabilities. These risks include serious injury or death, retraumatization of people who have a history of trauma, and loss of dignity and other psychological harm. In light of these potential serious consequences, seclusion and restraint should be used only when there exists an imminent risk of danger to the individual or others and no other safe and effective intervention is possible. (Endorsed by the State Mental Health Directors, July 13, 1999). (NASMHPD 1999, NASMHPD Position Statement on Seclusion and Restraint. Alexandria, VA: National Technical Assistance Center for State Mental Health Planning.)

Objective: Postpartum depression continues to be under-treated. This project identified state policies that have been enacted regarding peripartum mental health and assessed how effective they might be. Methods: A systematic search strategy was used to detect state-level legislative initiatives. Legislative tracking resources were used to determine which were enacted. Policies were sorted into categories. Related evidence was reviewed to gauge the impact of each category. Results: Thirteen states have enacted one or more state-level peripartum mental health policies. Categories include patient education mandates, depression screening mandates, mandated task force, and public awareness campaigns. Those mandating screening include Illinois, Massachusetts, New Jersey, and West Virginia. Related outcomes evidence suggests a very limited impact. Conclusions: Several states have enacted policies addressing peripartum mental health, but these are probably not influencing clinical outcomes. Home visits with a mental health component are effective for postpartum depression; state policies could support home visits.

This study examined whether the presence of a comorbid substance use disorder increased the risk of criminal recidivism and reincarceration in prison inmates with a severe mental illness. Our analyses of more than 61,000 Texas prison inmates showed that those with a co-occurring psychiatric and substance use disorder exhibited a substantially higher risk of multiple incarcer ations over a 6-year period compared to inmates with psychiatric disorders alone or substance use disorders alone. Further research is needed to identify the factors associated with criminal recidivism among released pris oners with co-occurring disorders.

This report summarises the co-design process that was undertaken in early 2020 towards the formation of a new Service Model for Personality Disorders in Western Australia.
_____
Kelly Clark and Karen Wellington were engaged to facilitate a co-design process to systematically engage people with lived experience, carers and family members and clinicians in the development
of a service model for personality disorders. The purpose of this document is to report back on the co-design process, the findings that emerged and the changes that were suggested for the service
model.

The initial ‘design question’ was to seek development of a state-wide, beyond-clinical model of service for all personality disorders in Western Australia. The assumption of the question was tested,
as all design questions are, through the co-design process. When this had been examined through the co-empathise, co-discover, and the co-define stages, the renewed Problem Definition was:
“How do we make a system work for people with personality disorders - with an emphasis on continuity of philosophy rather than specific treatments?”.
During the co-design process, strengths, weaknesses and possible improvements of the lived experience, carer, clinical and non-clinical professional experience were identified. For lived experience individuals and carers, what current works is: patience, empathy, compassion and
validation from others, an increased understanding of PD, peer support, stable relationships and practical needs being met. What doesn’t work, is the lack of fit with the current array of available treatments. What is needed, is more empathy, compassion, validation and understanding, increased reliability of the system, more personalised and accessible services that give choice and agency, and more support for families and carers. For clinical and non-clinical professionals, what currently
works is professional training, increased understanding and support for reflective practice. What doesn’t work is a lack of knowledge leading to fear and stigma of BPD and burnout. What is needed is more opportunities, time and space for continued training, development and reflective practise, and for all treatments on offer to be evidence-based. For all, what is needed is more personalised and tailored approaches, and a systemic assumption (ie, from clinicians, bosses, peers, and
consumers) that each person is doing the best they can with what they have.

During the co-design process, a ‘prototype’ was created, in the form of a set of Narrative Cards that described potential key principles, features and elements of a future service model. The key principles, features and elements that are described in the Narrative Cards, arose from the
‘empathise’ and ‘discover’ phases of the co-design process. Thus the Narrative Cards developed through this co-design process are the consensus points of hundreds and hundreds of data points
collected throughout the process. The feedback gathered on the cards during Workshop 3 show additional data relating to the iteration of the model presented in the cards. The feedback from the Design Team on the Narrative Cards captures where there are agreements and differences between various stakeholders’ needs, aspirations, visions and ideas and the evidence base for a service model. The Narrative Cards describe points of reference for continuing the design process in
developing a system which works for people with personality disorder in Western Australia.

Based on the Narrative Card set, and the feedback provided, the following elements for a future
service model were most strongly prioritised:
2
● A philosophy of care that is co-developed and used by all services in the State. This philosophy of care enabled each patient/consumer to have services within the system tailored to them, rather than them feeling the need to tailor themselves to the system.
● Improvements to the primary care response
● Clinicians and non-clinical professionals being given time, space and support for self-reflection
For the Project Reference Group, together with the funding and facilitating bodies, to fully and practically answer the question posed in the Problem Definition, an implementation strategy will need to be designed and systematically implemented. It is recommended that the above elements to a future service model be prioritised in the next steps, and the elements within all 30 Narrative Cards be considered. In summary, this will need to be the beginning of a hope filled journey to a
time when everyone in WA is able to receive support in relation to personality disorders.

Note on Scope
During the co-design process the co-design facilitators raised the matter of the enormous scope of the initial co-design question (changes to the state-wide service model for all personality disorders). This report discusses a co-design process that involved predominantly those from the Perth metropolitan area, and predominantly in relation to Borderline Personality Disorder (BPD).

Background: Although most donor and development agency attention is focussed on communicable diseases in Kenya, the importance of non-communicable diseases including mental health and mental illness is increasingly apparent, both in their own right and because of their influence on health, education and social goals. Mental illness is common but the specialist service is extremely sparse and primary care is struggling to cope with major health demands. Non health sectors e.g. education, prisons, police, community development, gender and children, regional administration and local government have significant concerns about mental health, but general health programmes have been surprisingly slow to appreciate the significance of mental health for physical health targets. Despite a people centred post colonial health delivery system, poverty and global social changes have seriously undermined equity. This project sought to meet these challenges, aiming to introduce sustainable mental health policy and implementation across the country, within the context of extremely scarce resources. Methods: A multi-faceted and comprehensive programme which combined situation appraisal to inform planning, sustained intersectoral policy dialogue at national and regional level; establishment of a health sector system for coordination, supervision and training of at each level (national, regional, district and primary care); development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at national, regional, district and local levels; public education; and integration of mental health into health management systems. Results: The programme has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, annual operational plans, mental health policy guidelines to accompany the general health policy, tobacco legislation, adaptation of the WHO primary care guidelines for Kenya, primary care training, construction of a quality system of roles and responsibilities, availability of medicines at primary care level, some strengthening of intersectoral liaison with police, prisons and schools, and public education about mental health.

Very little information is available on budget and financing of mental health services in the world. During year 2001, WHO collected information from all countries on resources available for mental health care as a part of Project Atlas. The present report seeks to describe the situation regarding federal budgets and financing of mental health care at the country level. It also examines the association between relative allocation of health budget to mental health and mental health policy, programme and resource indicators in 89 countries. The information was collected through a questionnaire (with an accompanying glossary) that was sent to the mental health focal point in the Ministry of Health of each country. Eighty nine countries provided information on their mental health budget as a proportion of health budget. In addition, information was obtained on policy, programme and mental health resource indicators (beds, personnel, services to special population and availability of dru...

Suicidal behaviours are one of the most important contributors to the global burden of disease among women, but little is known about prevalence and modifiable risk factors in low and middle income countries. We use data from the WHO multi-country study on women's health and domestic violence against women to examine the prevalence of suicidal thoughts and attempts, and relationships between suicide attempts and mental health status, child sexual abuse, partner violence and other variables. Population representative cross-sectional household surveys were conducted from 2000e2003 in 13 provincial (more rural) and city (urban) sites in Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia, Thailand and Tanzania. 20967 women aged 15e49 years participated. Prevalence of lifetime suicide attempts, lifetime suicidal thoughts, and suicidal thoughts in the past four weeks were calculated, and multivariate logistic regression models were fit to examine factors associated with suicide attempts in each site. Prevalence of lifetime suicide attempts ranged from 0.8% (Tanzania) to 12.0% (Peru city); lifetime thoughts of suicide from 7.2% (Tanzania province) to 29.0% (Peru province), and thoughts in the past four weeks from 1.9% (Serbia) to 13.6% (Peru province). 25e50% of women with suicidal thoughts in the past four weeks had also visited a health worker in that time. The most consistent risk factors for suicide attempts after adjusting for probable common mental health disorders were: intimate partner violence, non-partner physical violence, ever being divorced, separated or widowed, childhood sexual abuse and having a mother who had experienced intimate partner violence. Mental health policies and services must recognise the consistent relationship between violence and suicidality in women in low and middle income countries. Training health sector workers to recognize and respond to the consequences of violence may substantially reduce the health burden associated with suicidal behaviour.

There is a large body of literature examining the determinants of juvenile crime, which highlights economic, family, peer, and educational factors associated with delinquency and recidivism, and the important roles of social service and educational systems. Two factors, substance abuse and mental illness are also potentially important. The observed high correlations between crime, substance abuse and poor mental health suggests that factors which reduce substance abuse and improve mental health may also be effective in reducing criminal activities. The purpose of this paper is to examine the effectiveness of mental health and substance abuse treatment in reducing crimes committed by juveniles. This paper uses detention data in conjunction with substance abuse and mental health treatment data for youth enrolled in the Colorado state foster care program over a three year period. Duration models are used to examine the structural determinants of detention. We analyze the impact of trea...

An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of ''implementation outcomes'' distinct from service system and clinical treatment outcomes. This paper proposes a heuristic, working ''taxonomy'' of eight conceptually distinct implementation outcomes-acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability-along with their nominal definitions. We propose a two-pronged agenda for research on implementation outcomes. Conceptualizing and measuring implementation outcomes will advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies.

Background: Although an abundance of literature exists regarding the attitudes and cultural competency of nurses toward people with mental illness, there is scarcity in the literature on these concepts in relation to Filipino nurses. Thus, this review aims to determine the attitudes and cultural competency of Filipino nurses caring for patients with mental illness. Methods: This scoping review was guided by Arksey and O'Malley's framework. Electronic databases of ProQuest and Ebscohost and the gray literatures were searched from July to August 2018 including the reference lists of eligible articles. Results: Fourteen articles met the inclusion criteria. The information and evidences on Filipino nurses' attitudes (n=11) towards patients with mental illness were limited; mostly extrapolations from the empirical studies and gray literatures on Filipino nurses in other countries and alongside other nurses with different nationalities. Evidences that suggest Filipino nurses are culturally competent (n=3) did not represent that of the nurses caring for patients with mental illness in the Philippines. Conclusion: Given mixed evidences and limited data in the literature, further research is essentially needed to improve quality nursing care and the development of interventions intended to reduce mental illness stigma which can be integrated in the community, school, workplace and other settings in the Philippines.

This article examines deficiencies and innovations in the Tennessee criminal justice system from the point of arrest to the point of release from incarceration.  It focuses on both the moral and financial benefits of adopting policies which better address the significant issues mentally ill criminal offenders face.

Over the last decade state prisons have experienced unprecedented growth and many demographic changes. At the same time, courts are requiring states to provide mental health screening and treatment to prisoners. Findings from recent studies indicate that the prevalence of mental illness is higher in prisons than in the community, and comorbidity is common. Our ability to generalize from these studies is limited, however, because of major shifts in the demographic mix in prisons during the past decade. New studies on the prevalence of mental illness in prisons, which consider these recent changes would help planners allocate funds and staff to more effectively meet the needs of these individuals.

An overview of the history of Asian American psychology is provided by reviewing the context for the development of the field as well as the early founding of the Asian American Psychological Association (AAPA). The presidents of AAPA as well as key events and conferences are noted. The involvement of AAPA leaders in national mental health policies and activities are reviewed. The substantive areas of Asian American psychology and the education and training of Asian American psychologists are also discussed. The article ends with some comments about the future of Asian American psychology.

School based mental health services for children in poverty can capitalize on schools' inherent capacity to support development and bridge home and neighborhood ecologies. We propose an ecological model informed by public health and organizational theories to refocus school based services in poor communities on the core function of schools to promote learning. We describe how coalescing mental health resources around school goals includes a focus on universal programming, mobilizing indigenous school and community resources, and supporting core teaching technologies. We suggest an iterative researchpractice approach to program adaptation and implementation as a means toward advancing science and developing healthy children.

Focusing on Thailand, we give a historical overview of LGBT identities and issues, highlight psychological, psychiatric and nursing research on LGBT mental health and services, and review LGBT-related policy statements of professional associations and state-affiliated instances dealing with mental health. Our review demonstrates that stigma, victimisation and familial rejection in Thailand are linked to stress, depression,
substance use and suicidality among Thai LGBT people. Research has insufficiently covered transgender men, bisexuals and intersex people. Access to mental health services and their appropriateness are impeded by generic factors (e.g. overcrowded services, stigma, and confidentiality concerns) and low practitioner knowledge of LGBT issues, stereotyping of LGBT clients, and anticipation of practitioners not being accepting or understanding LGBT identities. LGBT-related policy statements have been issued by state-affiliated bodies,
but not by professional associations. While sometimes supportive, many policy documents have used stigmatising terminology and perpetuated anti-LGBT prejudice. LGBT-specific counselling and health services have been established, therapeutic strategies have been investigated and information on LGBT issues has been disseminated, but LGBT sensitivity remains to be mainstreamed in Thai health and counselling
services. Providing training on LGBT issues, publicising the Yogyakarta Principles and getting professional associations engaged with LGBT issues are among the ways forward.

An interdisciplinary interrogation of primary evidence linking social capital and mental health sought to establish: (1) 'quality of evidence' (assessed in terms of study design, methods used to address stated questions, rigor of data analysis, and logic and clarity of interpretation of results), and (2) applicability of the evidence to public health policy and practice with respect to mental health. It is found that social capital, a complex and compound construct, can be both an asset and a liability with respect to mental health of those in receipt of and those providing services and other interventions. The most meaningful assessment of social capital or components thereof may examine individual access to rather than possession of social capital, a property of groups, and therefore an ecological variable. Theoretical advances in research on social capital serve to identify mainly two types of social capital: bonding (between individuals in a group) and bridging (between groups). Each type of social capital has cognitive and/or structural component(s) and may operate at micro and/or macro level(s). Effective mental health policy and service provision may build or strengthen bridging social capital and benefit from both bonding and bridging social capital where either or both exist. Established indicators of social capital are amenable to quantitative and qualitative assessment, preferably in tandem. However studies that employ combined research design are rare or non-existent. Interdisciplinary multi-method investigations and analyses are called for in order to unravel mechanisms whereby social capital and mental health might be meaningfully associated. r

What is mental health? Mental health requires the development of cognitive, emotional, and social skills for which educational settings make an ideal context. Mental health may be defined as a state of wellbeing in which every individual realises their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community (WHO). Thus, mental health is not just the absence of illness. Importance of mental health in education Educational settings promote mental health when they provide children and adolescents with a sense of identity and self-respect, direction and meaning in life, mastery, belonging, safety, social support and participation. Good mental health is associated with better educational and behavioural outcomes. A range of effective interventions are available to promote mental health and to prevent and reduce mental illness. However, very few children and adolescents receive such interventions in the school setting. Benefits of incorporating mental health into educational policies Mental health promoting pre-schools and schools have a wide range of positive impacts on children's development, including large impacts on educational outcomes and equity. Incorporating mental health into educational policies contributes to developing, maintaining and protecting society's most potent and least developed resource, the mental health of children. There is solid evidence that the cost-benefit ratio of mental health interventions in educational settings is very favourable. Recommendations • Provide a system of affordable, available and accessible high quality public day-care centres for all children. • Implement evidence based anti-bullying programs and whole-school based interventions to promote mental health and wellbeing, and prevent mental disorders in school. • Routinely assess day-care centres and schools on whether they promote mental health, providing young people with a sense of identity and self-respect, direction and meaning in life, mastery, belonging, safety, social support and participation. • Include children, adolescents and their families in planning school environments which promote mental health and wellbeing. • Collect regularly data on children's and adolescents' mental wellbeing and any problems. • Train school staff to support children's psychosocial development. • Include mental health promotion in national school curriculum. Key messages • The mental health of Europe's children and adolescents is its most potent yet least systematically developed resource. • The mental health and wellbeing of children and adolescents has a value in its own right, and children and adolescents should not only be seen as future adults. • The educational setting is the most important arena outside the family for the development of children's mental health. • Solid evidence is now available to guide day-care centres, pre-schools, and schools in how to promote social-emotional learning and wellbeing, and how to reduce and prevent mental distress, violence, bullying, conflict and aggression. However, few children and adolescents receive such interventions. • Inclusion of mental health in educational policies-nationally, regionally and locally-has a very favourable cost-benefit ratio as it releases large societal resources in terms of wellbeing, cognitive, emotional and social skills (" mental capital "), which again have a broad range of positive impacts, including educational outcomes.

The paper presents an historical critical policy analysis of deinstitutionalisation and the introduction of neoliberal forms of governance in mental health policy. It focuses particularly on a major period of policy reform in the 1980s and 1990s in Victoria, Australia. Many of the particularities of the Victorian experience can be generally observed with deinstitutionalisation throughout the world. In particular, the policy discourse of rights and entitlements, consumer choice and empowerment, at times stood in tension with the service void created by the transition from large, standalone psychiatric institutions, to dispersed forms of service provision outside the hospital. Further, certain policy features could be seen to perpetuate patterns of coercion, abuse and neglect. This article offers a number of potential lessons for mental health law, policy and practice today, which is poised for further advances of neoliberal governance, including through the policy of personalised services, individualised disability funding and human rights-based reform.

The federal Mental Health Parity Act of 1996 requires insurers to offer the same benefits for mental disorders and substance abuse as they would for physical disorders, including any annual or lifetime limitations and restrictions placed upon such coverage. This report examines actuarial studies, the current state of parity legislation across the nation, cost of treatment issues, and the impact on Florida should parity legislation be passed.

Suggested Citation
Bruce Lubotsky Levin, Ardis Hanson, and Richard Coe. "Mental health parity: National and state perspectives 2001: A report to the Florida Legislature" Tampa, FL: The Louis de la Parte Florida Mental Health Institute Jul. 2001.
Available at: http://works.bepress.com/ardis_hanson/77

Albania’s mental health sector is shaped by global mental health reform efforts as well as by the general societal changes taking place in the country during the postsocialist period. An understanding of contextual challenges is crucial to the creation of effective mental health services and the promotion of public mental health in the country. I open this paper with a historical overview of the development of Western and socialist psychiatry in the Albanian context. I continue with an analysis of postsocialist mental health reform, a complex process in which local and international actors seek to transform the Albanian mental health sector from an institutional system characterized by isolation, stigma, and abuse, to one that embraces community-based services, consumer and caregiver empowerment. Finally, I present the impact of these processes on mental health institutions, family and community members, and consumers, drawing on 50 semi-structured interviews and 30+ hours of participant observation conducted in central and southeastern Albania (Elbasan, Korče, and Tirana) during the summer of 2013.

Mental Health in All Policies (MHiAP) is an approach to promote population mental health and wellbeing by initiating and facilitating action within different non-health public policy areas. MHiAP emphasises the impacts of public policies on mental health determinants, strives to reduce mental health inequalities, aims to highlight the opportunities offered by mental health to different policy areas, and reinforces
the accountability of policy-makers for mental health impact. The MHiAP approach can be applied at all administrative levels, ranging from local authorities to the EU level.

The EU Joint Action for Mental Health and Wellbeing set out to map, assess, disseminate and pilot good practices within an MHiAP approach. In this respect, the term mental health incorporates both mental wellbeing and mental disorder. Mental health is perceived as an important resource for the
wellbeing of individuals, families and societies, according to the World Health Organization (WHO) definition of mental health. The Joint Action is underpinned by the notion that mental health is more crucial today than it has ever been. This is due to its broad range of impacts and due to the increase in
mental capacity required by the transition from a society dominated by manual work into an information
society, and by the notion that a range of cost-effective public mental health interventions exists but are not widely implemented.

Mental health has a substantial and broad set of impacts across policy areas. Mental disorders constitute one third of the disease burden in Europe, a figure which is on the increase. Not only do mental disorders cause a significant loss of work days and decrease in European productivity, but also immense
individual and family suffering. Mental disorders also have profound negative effects on academic achievements. A shift in this trend requires coordinated implementation of a range of effective public mental health interventions to promote mental wellbeing and prevent mental disorders.

Many individual, familial and societal determinants of mental health lie in non-health policy domains such as social policy, taxation, education, employment and community design. It is now recognised that the very foundations of mental health are laid down early in life and are later supported by positive
nurturing, high social capital, a good work life and a sense of meaning. Many of these factors can be enhanced through the MHiAP approach in non-health sectors and, therefore, remain important targets for mental health promotion and mental disorder prevention interventions. Examples of effective
interventions to promote population mental health include interventions in local communities, parenting support and home visiting programmes as well as school based programmes.

Lessons learned from the promotion of physical health indicate that the road to improved mental health among populations lies less in the investment in late-coming mental health services, but more in a co-ordinated public mental health programme to implement large-scale promotion and prevention activities.

Globalisation and European integration have strengthened the influence of international actors on health determinants and thus reduced the power and opportunities of national health policies. Increasingly, mental health determinants lie in the areas of EU policy and international agreements. EU legislation and actions in many non-health fields can have a decisive impact on the mental health of EU citizens. This calls for an active civic society to minimise potential negative mental health impacts and to create strong local communities which are conducive to mental health.

ABSTRAK Tingginya angka penolakan pasien rawat inap di Rumah Sakit Jiwa Provinsi Jawa Barat yang mencapai 300-400 pasien per tahun (1.1) tidak sejalan dengan angka kinerja rumah sakit pada tahun 2013. Penelitian bertujuan menggambarkan cetak biru pelayanan pasien dalam mendapatkan pelayanan rawat inap dan menemukan titik potensi perbaikan dengan pengamatan pada lima unit pelayanan yang terlibat. Penelitian ini adalah penelitian kualitatif dengan teknik penelitian operasional. Hasil penelitian yaitu diperolehnya desain cetak biru pelayanan pasien untuk pasien rawat jalan atau pasien gawat darurat yang memerlukan rawat inap, dan penolakan pasien dapat dikurangi dengan menetapkan aturan penggunaan instrumen PANSS-EC (Positive and Negative Syndrome Scale-Excited Component) untuk menilai status pasien. Kata kunci: cetak biru pelayanan, penolakan pasien, rumah sakit jiwa. ABSTRACT The in-patient refusal number in West Java Province Psychiatric Hospital which reach 300-400 patient per year (1) , doesn't go along with the hospital achievement number in 2013. This research is aimed to describe a Service-Blueprints for inpatients services and investigate potential points for improvement by observings five service units that are involved. This is a qualitative research with operational research technique. The results are a set of service-blueprints design for outpatients or emergency patients, who need hospitalization, and establishing the use of Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) instrument as a tool for determining the patient status can significantly lower patient refusal.

Over the past decade, two rapidly evolving areas of criminal justice practice have garnered increasing attention from policy makers, practitioners, and researchers: the management and treatment of justice involved individuals with serious and persistent mental illness, and the challenges of managing the perceived societal risk presented by sex offenders. Yet, whereas each of these issues has independently attracted significant attention, the nexus between them has remained largely unexamined. Matters of concern include the manner in which individuals with serious mental illness may be disproportionately affected by the expanding range of restrictions placed on those with sexual offense histories, the demands for adapting traditional models of sex offender treatment and supervision for those with serious mental illness, and the manner in which public mental health agencies must adapt their systems of inpatient and community-based care to meet the needs of clients with sex offense histories. This article explores the connections between sex offending and serious mental illness, examining the magnitude and nature of the issue, the organizational and programmatic challenges facing both the public mental health and criminal justice systems, and the emergent public policy implications. The article analyzes existing research, identifies relevant gaps in our existing body of knowledge, and concludes by presenting an agenda for policy makers and researchers.

Implementation of evidence-based practices (EBP) in child welfare is a complex process that is often fraught with unanticipated events, conflicts, and resolutions. To some extent, the nature of the process, problems, and solutions may be dependent on the perspectives and experiences of a given stakeholder group. In order to better understand the implementation process in the child-welfare system, we interviewed comprehensive home-based services (CHBS) case managers who were actively engaged in implementing an EBP to reduce child neglect in a state youth services system. Six primary factors were identified as critical determinants of EBP implementation: (1) Acceptability of the EBP to the caseworker and to the family, (2) Suitability of the EBP to the needs of the family, (3) Caseworker motivations for using the EBP, (4) Experiences with being trained in the EBP, (5) Extent of organizational support for EBP implementation, and (6) Impact of EBP on process and outcome of services. These factors reflect two broader themes of attitudes toward or assessments of the EBP itself and experiences with learning and delivering the EBP. Eventual implementation is viewed as the consequence of perseverance, experience, and flexibility.

Like many jurisdictions, mental health policy-making in Ontario, Canada, has a long history of frustrated attempts to move from a hospital and physician-based tradition to a coordinated system with greater emphasis on community-based mental health care. This study examines policy legacies associated with the introduction of psychiatric hospitals in the 1850s and of public health insurance (medicare) in the 1960s in Ontario; and their effect on subsequent mental health reform initiatives using a qualitative case study approach. Following Pierson (1993) we capture the resource/incentive and interpretive effects of prior policies on three groups of actors: government elites, interests, and mass publics. Data are drawn from academic and policy literature, and key informant interviews. The findings suggest that psychiatric hospital policy produced important policy legacies which were reinforced by the establishment of Canadian medicare. These legacies explain the traditional difficulty in achieving mental health reform, but are less helpful in explaining recent promising developments that support community-based care. Current reform of the Ontario health system presents an opportunity to overcome several of these legacies. Analysis of policy legacies in other countries which had an asylum