choose to not participate in government programs in- cluding social assistance, public health insurance, unem- ployment insurance, pension and old age security pro- grams. In addition, self-reliance remains a basic virtue taught to all OOMs from childhood, despite the existence of a strong mutual aid system . Reluctance among OOMs to utilize broader safety nets may elevate the im- portance of job control to ensure adequate material re- sources and economic stability in meeting ongoing fam- ily needs. Also, farming is the sacred vocation valued above all others by OOMs, thus job control may be seen as the way to preserve their culture identity and family ideals . Therefore, the psychosocial pathway repre- sents another potential mechanism through which job control impacts mentalhealth. With more control comes the ability to vary the pace and focus of the work or to support others, all of which have been linked to better mentalhealth in the workplace . Moreover, control allows OOMs to focus on farming, which they view as “physically exhausting, yet mentally and spiritually ex- hilarating” [47, p. 219]. Links between land, work and pleasure are instrumental in Gemeinschaft cultures ac- cording to Tönnies: the first bond (pillar) is with the land, with those working it receiving a sense of enjoyment that “intensifies the reciprocal relationship between work and pleasure” .
AHW: auxiliary health workers; ANMs: auxiliary nurse midwives; BIP: bipolar dis- order; CCMHS: comprehensive community based mentalhealth services pack- age; CIDT: community informant detection tool; CDO: Community Develop- ment Officer; CoRPs: community resource persons; DHO: district health officer; EPI: epilepsy; FCHVs: female community health volunteers; FGD: focused group discussion; KII: key-informant interview; HA: health assistants; HP: health posts; LMIC: low and middle income countries; MCHW: maternal and child health worker; mhBeF: mentalhealth beyond facilities project; mhGAP: mentalhealth gap action program; MoHP: Ministry of Health and Population; NHSSP: National Health Sector Support Program; NGO: non-government organiza- tion; OPD: out-patient department; PHC: primary Health Care; PHCC: primary health care centers; PSY: psychosis; PWSMD: persons living with severe mental disorders; SHP: sub health posts; SN: Staff Nurse; VDC: village development committee.
From our experience, in Ethiopia, there seems a clear commitment for improving mentalhealth care and increasing coverage at the highest governmental level. Primary health cares are expected for providing ‘essential health care’ which is universally accessible to individuals and families in the community and provide as close as possible to where people live and work. Implementation of the integration of mentalhealth services at primary health care level was started in 2014. In order to make the integration effective, primary care health profession- als were selected to be the key personnel. A study from Nigeria suggests that the major challenges of successful integration of mentalhealth into PHC could be a negative and stigmatizing attitude  but there is very limited information in the context of Ethiopia but understanding of the attitude of these professionals is extremely impor- tant for the delivery and uptake of mentalhealth services in primary care level. This study will offer a formative information the perception of primary health care nurses’ about people with severe mental illness that may be help- ful in designing appropriate training or re-training pro- grams in Ethiopia. The finding will also help to facilitate the integration of mentalhealth service to primary health care level. Thus, we aimed to explore primary health care nurses’ attitude towards people with severe mental disor- ders (Fig. 1).
Mentalhealth integrated into primary care was per- ceived by all respondents to be more responsive and efficient than the existing centralised system of special- ist mentalhealth care. However, there was concern about how integrated care could be achieved in prac- tice unless critical system level barriers were addressed. Chief among the barriers were low demand for mentalhealth care (due to low awareness and stigma), lack of affordability of long-term care and inadequate supervi- sion from mentalhealth specialists. These factors may result in low uptake of care, expiry of medications (com- pounding supply chain obstacles), ineffectiveness of care and, ultimately, a lack of sustainability of services. Rais- ing awareness about mentalhealth conditions and their treatability in the community, combined with training community members to detect and refer possible cases, has been used successfully to increase uptake of mentalhealth care in the PRIME implementation district . This is a potentially scalable approach which could be integrated into health extension worker activities in order to support the national programme of mentalhealth care scale-up. Given the brief nature of mhGAP training for primary care workers, ongoing supervision, mentoring and refresher training is essential for quality of care and to give primary care workers the confidence and impetus to deliver mentalhealth care . The shortage of men- tal health specialists in Ethiopia and their orientation towards hospital-based delivery of clinical care in hos- pitals means that regular supervision of newly trained primary care workers is not currently achievable. There is a need to expand the remit of mentalhealth special- ists to include supervision of primary care workers and to ensure that pre-service training equips specialists with the requisite skills. In the meantime, training the existing pool of non-specialist health worker supervisors in each district to also cover mentalhealth care and combining this with telephone consultation with mentalhealth spe- cialists could help to address this important gap.
Abstract: Mentalhealth promotion needs to be studied more deeply within the context of primary care, because persons with multiple chronic conditions are at risk of developing poor mentalhealth. In order to make progress in the understanding of mentalhealth promotion, the aim of this study was to describe the experiences of health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity – what these seniors believe is important for achieving a dialogue that may promote their mentalhealth. Seven interviews with six women and one man, aged 83–96 years, were analyzed using qualitative content analysis. The results were summarized into nine subcategories and three categories. The underlying meaning of the text was formulated into an overarching theme that embraced every category, “perceived and well-managed as a unique individual”. These seniors with multimorbidity missed someone to talk to about their mentalhealth, and needed partners that were accessible for health dialogues that could promote mentalhealth. The participants missed friends and relatives to talk to and they (crucially) lacked health care or social service providers for health-promoting dialogues that may promote mentalhealth. An optimal level of care can be achieved through involvement, continuity, and by providing a health-promoting dialogue based on seniors’ needs and wishes, with the remembrance that general health promotion also may promote mentalhealth. Implications for clinical practice and further research are discussed.
The present study intended to confirm and expand pre- vious findings by analysing data collected in a community and an outpatient sample. The ability of parent and youth SDQ scales measuring problems and impact were ana- lysed in order to predict mentalhealth problems/disor- ders across several mentalhealth domains (any disorder, emotional disorders, behavioural disorders), as validated against two contrasting indices of validity derived from the Development and Well-Being Assessment, DAWBA (see method section below): One approach used the empirically developed multi-informant DAWBA bands (ordinal measures) based on a computer algorithm to aggregate parent and/or youth information from struc- tured interview questions, while the other approach used ICD-10 diagnosis generated by expert DAWBA raters, i.e., experienced clinicians who rated the presence of an ICD-10 disorders after reviewing the answers to closed and open-ended questions. Because the DAWBA is a well validated multi-informant based instrument [35, 36], the current study may overcome some methodological limi- tations of diagnoses derived from single informants or unstructured clinical evaluations.
As little is known about the establishment and use of Family Rooms, an exploratory descriptive design  with multiple data sources was used. A project advisory group guided the study, comprising consumer, carer, and senior nurse representatives from the Local Health District. Due to a lack of systematic documentation of parental status in mentalhealth settings, data were indi- vidually gathered from each unit on the number of parent consumers over a 12 week period. In order to gain an understanding of the use of Family Rooms, de- scriptive data were gathered via a written log maintained for up to 12 weeks in each room and filled in by staff when the room was used. Log data included when, by whom, for what purpose and for how long the Family Room was used. To ascertain the development and structure of Family Rooms in the four units, a brief, purposefully designed, questionnaire was completed by Nurse Unit Managers, with 7 open-ended questions ask- ing about the process of and impetus for, room develop- ment, any obstacles to development, decision making processes and descriptions of the unit, the room, and its use. Paper questionnaires were distributed to Nurse Unit Managers with information about the study and returned via internal mail to the Primary Investigator. All distributed questionnaires were returned.
This article compares the MHL and some relevant con- cerns regarding involuntary assessment and treatment for people suffering with mental illness in these four countries. While their colonial heritages are similar, their healthcare systems vary considerably [8–10]. Despite this variation in healthcare systems, their goals to develop mentalhealth services and reform their legislation in order to ensure proper care for this vulnerable group are comparable. Notwithstanding geographical, cultural, his- torical and linguistic diversity, commonalties have been identified when laws and some psychiatric clinical prac- tices have been compared across nations [11–14].
In the absence of guidelines as to what to expect from people who are experiencing mental ill-health, employees who have such problems face a difficult dilemma. On the one hand, in order to get the support and understanding of their employer and colleagues which would be helpful – maybe even essential – in allowing them to adopt the necessary adaptive and coping strategies, it is desirable that these difficulties should be shared within the workplace. On the other hand, however, to do so risks stigmatisation, ostracisation and exclusion, due to the very negative connotations of such difficulties. Employees said that they would be very uncomfortable and uncertain how to behave around a work colleague experiencing mental ill-health. And employers, although regretfully, said that if they became aware that a potential employee had such difficulties, they would be unwilling to take them on. Although they claimed that they would try to be as supportive as possible to an existing employee with whom this should arise, it was clear that advancement opportunities would be curtailed.
and above to be 50 for 100,000 and 16 for 100,000 respectively (Heisel, 2005). In a study from South India (Hall, Platt &, Hall, 1999) it was found that the suicide rate in the population above 55 years of age is 189 for 100,000.Around one in five of all successful suicides are committed by individuals above the age of 65 years. Some prognosticators of suicide in old age have been described in studies, such as mentalhealth, personality, physical diseases, social factors (Conwell & Thompson, 2008), psychiatric disorders (Waern, Rubenowitz, Runeson, Skoog, Wilhelmson & Allebeck, 2002) (particularly depression), physical illness, functional impairment, and stressful life events increases the risk for suicide in the elderly (Erlangsen, Jeune, Bille-Brahe & Vaupel, 2004).
Similar alternative models are well employed across the UK, such as intensive home treatments, early intervention services for psychosis, assertive outreach; intensive day ser- vices and outpatient treatment, day hospitals, therapeutic foster care and crisis intervention services . Neverthe- less, a review conducted in 2012 indicated that these alter- native models vary widely in structure, with inconclusive methodological evidence rated as low or very low for their clinical effectiveness . A similar conclusion came from another review, stating that “there is little systematic evi- dence of efficacy” of intensive community services (ICS) as an alternative to inpatient settings . However, ICS may be considered a possible alternative approach with very lim- ited evidence, which according to Kwok et al.  is focused predominantly on data generated from YP with moderate- to-severe levels of mentalhealth needs.
We consider it a strength to use geographical area as a marker of socioeconomic position, and not for example individual education or income. Residential areas are dis- tinct and easy to handle for authorities and politicians, and the majority of health care resources are allocated at area level. That inhabitants in affluent areas are healthier than in less attractive areas, is hardly a surprise, but which are the mechanisms behind the differences? There may be a certain amount of selection: The financial disadvantage of disabled people make it more likely that they live in poorer areas. In our material, far more people of non- western origin lived in east compared to west. As being of non-Western origin showed a strong independent correla- tion with severe muscular pain, this selection contributed significantly to the between area difference observed. A less healthy physical environment, less healthy lifestyle, and the psychological impact of being poorer than other people, are also possible explanatory factors . Some authors have found that geographical variations in self- reported illness persist even after allowing for socio-struc- tural individual characteristics [20,21]. This was not the case in our study, as area of living did not show any inde-
The chi-square test was used, in order to characterize absenteeism. The results suggested that, for the year 2005, it was the younger participants, single and di- vorced, who belonged to the nurse and general services professional category that revealed less absenteeism. It was also found that participants with less ab- sence from work were those who showed greater levels of job motivation/satis- faction. As for the reasons for the absence, the most satisfied participants were those who reported lower rates of physical and mental illness. Similar results were found in the studies by Burke (1969, 1970, in Locke, 1976), Ripon (1987), Robbins (2001), and Herzberg, Mausner, & Snyderman (1959). These results were not corroborated for the year 2006, where older participants who were sa- tisfied with the wage dimension revealed less absence from work. It was also found that participants, who were single and in a de facto union, practiced ro- tating day and night shifts, did not perform duties in other institutions and did not smoke, revealed less absenteeism. As for the reasons behind the absence, it was the married participants, who practiced fixed day shifts, did not perform managerial duties and possessed a better relationship with coworkers that pre- sented higher manifestations of physical disease. Statistically significant associa- tions were also found concerning marital status and working conditions, with participants who were in a de facto union attributing greater absenteeism to poor working conditions.
Another resource challenge that strongly came up in this study was inadequate human resource for mentalhealth. The facility had very few mentalhealth care pro- viders compared to the number of patients being seeing. They had no psychiatrist, but used to borrow one from Muhimbili National Hospital, who was attached there on a temporary basis. The shortage of human resource for mentalhealth was attributed to lack of interest in the program, retirement, and government policy that short- ened diploma and certificate nursing programs leading to exclusion of the mentalhealth package for graduating nurses. This corroborates with findings from other studies which show that inadequate or lack of human resource for mentalhealth is a common problem in low and middle income countries [6, 10, 19, 22, 25, 26]. Known reasons for this shortage from other studies include little time devoted to mentalhealth within professional training programmes, poor working conditions, low status of the profession, which mean that few people enter the mentalhealth professions, and among a few who graduate some are brain drained for greener pasture in other countries with better working conditions [6, 25]. The shortage contributes to having the majority of people with mental disorders not receiving evidence-based care, leading to chronicity, suffering, and increased costs of care . Many strategies have been proposed to address this problem including task shifting and prioritizing organization and ways of delivering community-based mentalhealth services .
China accounts for 17% of the global burden of men- tal, neurological and substance use disorder (MNS) . Within China, the disease burden attributed to MNS is over 10 million disability adjusted life years (DALYs) and is expected to increase by 10% by 2025 due to China’s rapidly aging population . Each year, over 50 million people in China (3.6% of the population) suffer from depressive disorder , one of the most prevalent MNS disorders. Depressive disorder is characterized by the “presence of sad, empty, or irritable mood, accompa- nied by somatic and cognitive changes that significantly affect the individuals’ capacity to function” . Depres- sive disorder is strongly associated with suicide, China’s 8th most frequent cause of death and accounts for 26% of suicides globally . Depressive disorder also exerts an indirect economic burden on China in excess of US$6.3 billion per annum . Despite its far-reaching effects at the community, national and global level, and the avail- ability of cost-effective mental healthcare [6, 7], the vast majority of depression cases in China remain undiag- nosed and untreated .
orientation pose two significant implications. First, the reforms will attempt to curb hospitalized treatments as much as possible by reinforcing admissions reviews. They also serve to promote the human right of the PMI against involuntary hospitalization. Second, the reforms intend to extend the coverage of public support to the major- ity of the population. These reforms can be understood when considering that a community mentalhealth sys- tem should cope with increasing risk factors e.g. high sui- cide or depression rates among the population (e.g. see [3, 4] for the review of suicide and depression issues in Korea). Consequently, the MHA was completely revised and newly came into force in 2017 seeking to improve the mentalhealth of the public and support the PMI. How- ever, most MHWCs as primary bases for community care in mentalhealth have considerable difficulties in meeting the rising level of demand for services, as many past reforms were pushed into practice without essen- tial investments in financial and/or human resources. Given the lack of further public inputs, it is unlikely that the new act will immediately bring about positive shifts toward community-based care.
Longitudinal studies on adults with ASD indicate that 37 to 59% have poor outcomes . The average life- time cost of supporting an individual with ASD is esti- mated to be at least USD$1.4 million in the United States and £0.92 million in the United Kingdom . When a child has concurrent intellectual disability, this cost rises to USD$2.4 million and £1.5 million, respectively . While autism-specific behavioral therapies have strong data supporting outcome improvement, there has not been reliable evidence on the effectiveness of environ- mental modifications including diet, antifungals, fecal microbiota transplants, heavy metal chelation, and vac- cine avoidance. The intention of this review is not to discuss potential ways for intervention through gut microbiome modulation. Rather, it is to take a closer look at whether the plethora of literature published provides consistent evidence on features of gut microbiome altera- tions associated with ASD and to establish the strength of evidence.
In 2001, the Florida Legislature passed a law mandating that all licensed health professionals complete and repeat every three years a 2-hour course on the topic of prevention of medical errors. Several years previous to this decision, the Institute of Medicine (IOM) published a document entitled To Err is Human: Building a Safer Health System . The authors reviewed the prevalence of medical errors in the United States which revealed that somewhere between 44,000 and, quite possibly, upwards of 90,000 deaths attributed to medical errors occurred annually in hospitals. A recently published (2004) HealthGrades report stated that annual deaths attributable to medical errors may be as high as 195,000 . This number compared to other causes of death in 2001
The most noteworthy of the new powers is the ASBO, a civil order which results in criminal sanctions if breached. This has generated significant concern that civil proceedings are being used as a way of evading higher standards of proof and evidentiary burdens associated with the criminal justice process. For instance, the manner in which civil proceedings allow forms of hearsay evidence, not admissible in the criminal court, has been central to securing successful ASBO applications. Furthermore, the ASBO - in the name of effectiveness (Home Office 2005) - permits publicity which in the case of young people has eroded the traditional right to anonymity in civil and criminal proceedings (Cobb 2007). In common with some other new powers – such as dispersal (Crawford 2008) and parenting orders - ASBOs constitute what Simester and von Hirsch (2006) term ‘two-step prohibitions’, whereby the possibility of criminal sanctions arise only in respect of future conduct, not in relation to the conduct that gave rise to the order in the first place. The conditions imposed at the fist step create something tantamount to what the European Commissioner for Human Rights described as ‘personalised penal codes, where noncriminal behaviour becomes criminal for individuals who have incurred the wrath of the community’ (Gil-Robles 2005: 34). The conduct that