Policymakers, in particular central government need to provide leadership, direction and the financial resources to initiate and fund high quality research programmes to increase the evidence base for treatments and interventions to improve outcomes for older adults with a SMI. A growing body of evidence highlights the shocking statistics that people with a SMI have a significantly reduced life expectancy compared with the general population. As a society we are failing to address the age related needs of this most vulnerable group of citizens. Recently, in November 2011 Rethink established “The Schizophrenia Commission” an independent commission to review how outcomes for people with schizophrenia and psychosis can be improved. The Commission’s report “The Abandoned Illness” (Rethink, 2012), make several key recommendations for Government, National Bodies (including the Royal Colleges), the NHS Commissioning Board, Mental Health Providers and Research Funding Bodies to address the specific needs of this group. Although it is not explicitly clear, we assume these recommendations are aimed at both working age and older age adults experiencing schizophrenia. Mental health clinicians and service users should be aware there is little in the way of good quality evidence to improve outcomes for older adults with a SMI and Higher Education Institutions have a role to play in offering health and social care programmes that address the needs of all older adults and, specifically, older adults with a SMI. Such programmes have a role to play in raising awareness of this group and can help foster the attitudes and values future healthcare clinicians require to meet older adults’ specific needs.
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Background: Childhood mental illness is a major factor of overall lifespan of children continuing into adulthood. Population based surveys and public health surveillance provide the much needed evidence to understand mental health promotion, prevention, and treatment of mental illness in children in the United States. Objective: To review available current national survey data regarding mental illness in children over the past decade and to review the global implications of childhood mental illness. Results: Altogether, 13% - 20% of children experienced a mental health disorder from 1994 to 2011. The prevalence of depression among children of 3 - 17 years old was 3% and the prevalence of lifetime and past year major depressive episode were 12.8% and 8.1% respectively among adolescents of 12 - 17 years old, with a prevalence of depression in the preceding 2 weeks of 6.7%. 7.1% of children of 12 - 17 years old ever had a diagnosis of depression, 3.5% had current depression and 5.1% had a diagnosis of depression in the past year. Overall, 28.5% of high school students of 14 - 18 years old reported feeling so sad or hopeless every day for two weeks or more in a row that they stopped doing usual activities, higher among girls (35.9%) than boys (21.5%), and greater in Hispanic students (32.6%) than white non-Hispanic (27.2%) or black non-Hispanic students (24.7%). The overall rate of suicide in children in 2010 was 4.5 per 100,000. Conclusions: Mental illness presents serious departures from the expected cognitive, social, and emotional development in children, and an important area for prevention in the U.S. and globally. Mental illness will be managed effectively when there is adequate access to treatment services to reduce its associated morbidity and mortality.
with learning disabilities. Education could certainly address this, but macro communication is also an issue. Jenkins (2009) reminds us that multidisciplinary, interprofessional working should be inclusive of, and reflective of an individual’s needs, as well as including any involved carers or family where appropriate. This is a major concern for the delivery of health care for individuals with a learning disability who may need to utilise mainstream mental health services. In the UK, there is a political imperative for mental health nurses to provide specialist mental health services to people with learning disabilities, but it is perhaps only the interest and motivation of individual lecturing staff that will begin to address this.
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Results: Eighteen studies that met the inclusion criteria were identified. Digital health tech- nologies (DHTs) assessed in the selected studies included mobile applications (apps), digital medicine, digital personal health records, and an electronic pill container. Smartphone apps accounted for the largest share of DHTs. The intended uses of DHTs could be broadly classified as monitoring to gain a better understanding of illness, clinical assessment, and intervention. Overall, studies indicated high usability/feasibility and efficacy/effectiveness, with several reporting validity against established clinical scales. Users were generally engaged with the DHT, and mobile assessments were deemed helpful in monitoring disease symptoms. Conclusion: Rapidly proliferating digital technologies seem to be feasible for short-term use in patients with serious mental illness; nevertheless, long-term effectiveness data from naturalistic studies will help demonstrate their usefulness and facilitate their adoption and integration into the mental health-care system.
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Unemployment defines a section of the population who is not currently at work but has the capacity to, and is actively seeking to work (Collins English Dictionary, 2011). Unemployment has been shown to negatively impact both physical and mental health (Brenner, 1988). The first descriptive studies character- ized mental health related outcomes as “depression, anxiety, poor self-esteem, isolation and strain on the family” (Donovan et al., 1987). Further many cross-sectional studies have demon- strated an association between unemployment and mental ill- ness (Paul & Moser, 2009). Perhaps it is because the impacts of unemployment are so common sense and wide ranging that the topic has attracted limited interest from psychiatry. There has been much work on the mental health impacts of unemploy- ment but very little on its relationship with clinically defined mental illness. Work on unemployment and mental illness has so far looked mainly at rates of employment in people who already have a psychiatric diagnosis (Marwaha et al., 2007), and re-employment as a positive goal in the recovery from dis- ease episodes (Secker et al., 2001). Although work in looking at general impacts of unemployment and mental health has been fruitful, little has focused specifically on unemployment as a prospective risk factor for mental illness.
We tend to use madness rather loosely, especially when we are in love. Most of us claim to be madly in love, because that is what we have learned from literature, folklore and cinema. Love is a source of delight, but its absence is a source of pain. 16 This means love should give us delight and all the emotions that go with it. This is only possible if there is a fair share of delight from either end. This delight can be sustained only if there is great admiration for a person s qualities. These qualities are available to creative human beings.
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Barriers to receiving appropriate and timely healthcare provision are also attributed to the attitudes, training and confidence of health professionals (Lawrence & Kisely, 2010). Several cross-sectional studies have investigated the physical health care knowledge and training of mental health nurses in the UK (Nash, 2005; Howard & Gamble 2011; Robson et al 2013) and Australia (Happell et al 2013) and have identified varying levels of preparation, involvement and confidence. A literature review of nine studies that focused on the role of mental health nurses in providing physical health care for people with SMI identified limitations in support and training in this area together with uncertainties about role and responsibilities (Blythe & White, 2012). Similar findings have been found among primary care professionals, who report a lack of knowledge to care effectively for people with SMI (Lester et al, 2005).
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with lymphedema . This is a decline from the previ- ously quoted figures of WHO when the Global Programme to Eliminate the diseases began in 2000 when 119 million were estimated to be infected in 1996 with 43 million showing clinical symptoms (hydrocele and lymphedema). The DALYs attributable to lymphatic filariasis in the GBD study  were 2.78 million, based on a disability weight of 0.11 and 36 million cases (95 % confidence internal: 34–39 million) in 2010. In our studies to calculate the burden of depressive illness, we used disability weights of 0.159 for mild depression, 0.406 for moderate depression, and 0.655 for severe depression [17, 18]. Using a figure of 50 % that those with clinical illness suffer severely enough to cause depression, the prevalence of depression among patients with lymphatic filariasis was estimated at 18.1 million. This was based on the four studies of the mental illness in filariasis patients in the literature where the prevalence of depressive illness was 97 % in South India; 70 % in Togo; 37 % in Haiti and 8.5 % in Sri Lanka [12–15]. We used a conservative distribution estimate of ten million, seven million and one million for mild, moder- ate and severe depression, respectively. The studies from the above countries did not provide detailed breakdowns for the level of depression reported hence we chose a conservative set of estimates with only one million out of the 18 million sufferes of depression be- ing regarded as having severe depression the majority only suffering mild depression. Clearly a higher figure of severe depression given the higher DW would result in a much higher estimate of burden. We estimated YLD to be 1.59 million, 2.84 million and 655,000 for these levels of depression severity, totalling 5.09 mil- lion DALYs. Because mortality directly attributable to lymphatic filariasis is rare although suicidal ideations have been reported, and because the GBD classified no deaths from depression in 2010, we assumed that YLL is close to zero. As a result, the total DALYs estimated from depression attributed to lymphatic filariasis is es- timated at 5.09 million (Appendix A).
In the literature, it has been shown that attitudes to- wards people with mental illness can be measured using stereotypes such as: ‘people with mental illness are dan- gerous, ’ and ‘people with mental illness do not recover’ [23,24] as well as a desire for social distance because of the aforementioned stereotypes . Stigmatizing atti- tudes can also be measured in the form of emotional reactions towards people with mental illness. Finally, dis- closing that one has a mental illness, because of the dimensions described above, can lead to self stigma and may also be an indicator of mental illness related stigma [24,25]. While it has been shown that self stigma is dif- ferent than holding stigmatizing attitudes towards people with mental illness , we believed it was im- portant to measure in health care providers because, we saw disclosure as a dimension of stigma that would also indicate whether the respondent held stigmatizing atti- tudes towards mental illness. For example, those who would disclose that they had a mental illness may not think that mental illness is something to be ashamed of and may therefore be less stigmatizing. This has been described in the literature where some refuse to be diminished by stigma and becoming more active partici- pants of change in health care . Also, potential users of the instrument, such as professional organizations, are likely to be interested in the issue of disclosure be- cause of a desire to see their members receive appro- priate treatment and support for mental health issues.
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The results of this study indicate that the students’ beliefs about mental illness were interrelated to their attitudes, both of which set the stage for how they interact with people with mental illness as well as how they seek help and support when faced with a psychological problem themselves. The findings of this study were similar and consistent with those found in the general population in Qatar, supporting existing literature that attitudes and beliefs about mental illness are shaped by knowledge and cultural stereotypes. Nevertheless, the sample was small and as such, larger studies from a randomly selected population are needed in order to make more conclusive remarks. Because knowledge and attitudes are fundamental for reducing stigmatization, the study findings are important for determining the need for culturally specific targeted stigma intervention programs at the university level.
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The classification and diagnostic model used in the diagnosis of disease is based on Comte’s philosophy of positivism (1853), which states that everything can be understood by employing the scientific method (Walker, 2006). This overreliance on the positivist model of diagnosis has led to a mechanist view that human beings can be diagnosed and treated like computers (Conrad & Barker, 2010). The power and reliance on positivism in medical diagnosis has also led to a monopoly on “truth” and rather than being value-neutral, positivism actually reflects and reproduces forms of social inequality (Foucault, 1975,1977). The use of social constructionism offers a caveat to the deterministic principally reductionist approach to the diagnoses of mental illness, employed by the bio- medical model (Conrad & Barker, 2010). Social constructionism is engrained in the theoretical dissimilarity between disease (biological components; Schneider & Conrad, 1981) and illness (social experiences of the condition; Eisenberg, 1977). This essay will critically analyse; how the use of a bio-medical model, philosophically rooted in positivism and a diagnostic language that confuses “truth” with diagnostic perspectives has led to an obsession with “compliance” on a global scale and a failure to recognize how medical discourses have negatively influenced how peoples’ illnesses are experienced, depicted and viewed within society, with specific reference to schizophrenia (Walker, 2006; Foucault, 1975, 1977).
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72]. Although there was some level of interest in a variety of activities, walking was, by far, the most popular option. Therefore, a walking program at moderate intensity that takes place outside would likely be an appealing option to many participants. Since participants were receptive to the use of pedometers, it is recommended that the PA intervention incorporate this tool to allow participants to self-monitor their progress over time. Personal assess- ment and monitoring may also serve as a motivational tool to help participants stay active . A walking pro- gram may also be an effective way to build confidence and self-efficacy to consider other forms of PA in the future . Since half of the participants wanted a PA program that was offered specifically to individuals with their diagnosis, a walking program may be a feasible addi- tion for mental health centers and hospitals that see these patients regularly or have an inpatient unit. Furthermore, it is recommended that strength and resistance training also be made available to participants in addition to the walking program as there is high receptivity towards this type of exercise. In fact, a combined aerobic and strength training program has been previously shown to be well received by inpatients at a mental health facility . This type of exercise has also been shown to be effective at improving cognitive, physical and psychiatric symptom- related outcomes among individuals with SMI [76, 77]. These considerations are now informing our own inter- vention work in these populations.
For the sake of highlighting the advantages of the sophisticated medical model of mental illness over that of the strong interpretation of the medical model, let’s imagine an alternative scenario in which Rebecca goes only to see a psychiatrist who upholds the latter model. This psychiatrist assumes that the approach used to diagnose somatic illnesses is equally as effective for diagnosing and treating mental illness (Black 2005). He thus takes Rebecca’s medical history, but does not ask her to go into any specific details about her family history (apart from medical history), recent life experiences or interpersonal relationships. This is because the psychiatrist believes that non-biological causes (e.g., social or psychological causes) are not relevant for diagnosing and treating mental illness. Rather, he is committed to the idea that mental disorders like depression are brain-based and that “an increased understanding of the physiology of the brain will eventually improve the care of patients with mental illness” (Black 2005, 5). Apart from the drug prescription he gives to Rebecca, a brief itemization of its side effects, and the request for a follow-up visit, the psychiatrist suggests no other modes of treatment (e.g., counseling, other life-style changes, etc.).
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to the finding of more than two third of the depressed patients were females who constitute most of the unemployed participants in this study. There was no significant association between depression and family history of mental illness (p = 0.320). This could be explained by earlier findings of Ohaeri and Otote  that family history was significantly more common in psychotic or severe depression meaning that those with family history have more severe illness while consider- ing that only few (5.5%) had severe depression, it was not surprising therefore there were few depressed patients with family history of mental illness. Another reason might be as Sale who worked in Kano for his part II dis- sertation on depression among HIV/AIDS patients reported that concealment of positive family history of men- tal illness was to avoid the disadvantage it confers in marriage and relationships, which might have played a role among these participants . Substance use had no association with depression in this study (p = 0.35). This is contrary to many documented findings like that of Currie et al. who reported that substance use coexists with a high frequency of cases of depressive disorders in Canada . Kelder et al. too reported that the symptoms of depression were strongly and positively related to substance use in non-whites in particular . However, Ai- yelero et al. in ABUTH Zaria found very low history of substance use among depressed patient . This find- ing could be attributed to the fact that the use of alcohol is prohibited in Islam which the religion practices by majority the people who reside in the area where the study was conducted. Depression was found to be common among those with chronic medical conditions (CMC) (such as hypertension, chronic respiratory disease(s), dia- betes mellitus etc) (p = 0.001). One hundred and seventy (42.3%) depressed had one or more chronic medical condition(s). This was as reported by David et al. in a review article on the epidemiology, risk and treatment evidence of depression, anxiety and their relationship with chronic disease that depression is more common in all disease (CMC) groups than the general population .
The Attitudes to Mental Illness questionnaire was developed for the 1993 survey. The statements used originated in local studies based in Toronto and the West Midlands. There have been minor changes to the questionnaire over the course of the surveys, but the core has remained the same. Some new questions were added in 2009 and 2010 to tie in with the evaluation of the ‘Time to Change’ anti-discrimination campaign, by the Institute of Psychiatry. The 2010 questionnaire consisted of:
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In order to achieve equivalence of treatment in line with these recommendations there needs to be a national expansion of local secure psychiatric services, for example psychiatric intensive care units (i.e. acute low-secure psychiatric units) and long-term low-secure psychiatric units. A significant number of mentally disordered prisoners are detained in custody on relatively minor charges where treatment in such a community psychiatric service would be more appropriate, serving both the patients’ best interest and the public at large. Others are still remanded in custody solely for the preparation of a psychiatric court report, an unnecessary and regrettable practice. Under current legislation (Mental Treatment Act 1945) the court cannot make any disposal for such individuals to be assessed and if necessary treated in the mental health system, thereby keeping them out of the criminal justice system. Many examples of such legislative instruments and services can be found in other jurisdictions 58 .
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mental health issues. A pattern of consensus can be found in all these studies regarding the existence of deviant behavior specifically revealing irrelevant talk, inappropriate behavior, and self-talk, self-laughter, and crying as some major behav- iors identified as abnormal. Studies also revealed physical symptoms of body aches and headaches and escaping behav- ior, that is, avoiding or escaping from difficult situations, in addition to the previously discussed symptoms. These find- ings are consistent with the behavioral theories of psychology that reject the traditional belief in unconscious behavior and replace it with the notion that problematic behaviors could be learned behaviors. 43
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In India Kermode and colleagues , found that the main predictors of a variable of social distance from people with mental illness was perceiving the person as dangerous, while the main predictors of reduced social distance was being a volunteer health worker, and seeing the problem as a personal weakness. For depression, believing the cause to be family tension reduced social distance. For psychosis, labelling the illness as a mind/ brain problem, a genetic problem or a lack of control over life increased social distance, and this may be due to the central importance of marriage in Indian culture. These findings suggest that promoting explanations around genetic and other physical causes may not always help stigma.
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Researchers and advocates have jointly developed in- terventions that are effective in diminishing the stigma ex- perienced by people with mental illness or by family mem- bers. These strategies may also be useful for guiding psychiatric trainees away from stigmatizing attitudes to- ward more empowering expectations. Psychiatrists may teach trainees some of the ways to incorporate addressing stigma into treatment plans. Psychiatrists may also incor- porate strategies into treatment plans for family members to deal with stigma. Strategies may include family members developing an awareness of stigma, identifying coping techniques, finding safe and supportive environments to explore experiences with stigma, participating in anti- stigma programs, developing an awareness of the impact of stigma, and providing opportunities to practice coping skills. Moreover, psychiatrists may take an active role in setting up and providing antistigma interventions. These interventions are reviewed in terms of public versus self- stigma.
The seven steps of a meta-synthesis described by Noblit and Hare (1988) are an iterative, rather than discrete, linear process (Pope, Mays, & Popay, 2007). They include ‘getting started’; ‘deciding what is relevant’; ‘reading the studies’; ‘determining how studies are related’; ‘translating studies into one another’; ‘synthesising translations’; and ‘expressing the synthesis’. Steps one and two were achieved through completing a thorough literature search and implementing set inclusion and exclusion criteria (as described above). With repeated reading, the original findings were noted, including key phrases, metaphors, ideas or concepts. By separating the data in this way it became easier to identify relationships,
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