Scale up of services for mental health in low-income and middle-income countries.

Mental disorders constitute a huge global burden of disease, and there is a large treatment gap, particularly in low-income and middle-income countries. One response to this issue has been the call to scale up mental health services. We assess progress in scaling up such services worldwide using a systematic review of literature and a survey of key national stakeholders in mental health. The large number of programmes identified suggested that successful strategies can be adopted to overcome barriers to scaling up, such as the low priority accorded to mental health, scarcity of human and financial resources, and difficulties in changing poorly organised services. However, there was a lack of well documented examples of services that had been taken to scale that could guide how to replicate successful scaling up in other settings. Recommendations are made on the basis of available evidence for how to take forward the process of scaling ...

The OECD Mental Health and Work Policy Framework - Integrated services for sustainable growth

Mental health is an important driver of labour market outcomes and thus affects economic growth and future development. If labour markets are to function well, it is important that policy makers address the interplay between mental health and work, as they are slowly coming to recognise that they have long neglected an issue that is critical to people’s well-being and for contributing to sustainable economic growth. This report discusses which aspects of mental health and employment interventions must be addressed to push policy making in the right direction, namely: when to intervene, how to intervene or what to do, and who needs to intervene. It draws on policy examples from nine OECD countries (Australia, Austria, Belgium, Denmark, The Netherlands, Norway, Sweden, Switzerland, UK), discussing why policy must make those changes and how it can achieve them. The examples are rich in nature and, taken together, provide a promising and ...

Quality standards for antenatal and postnatal mental health

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement. This quality standard covers the recognition, assessment, care and treatment of mental health problems in women during pregnancy and the postnatal period (up to 1 year after childbirth). It also includes providing pre-conception support and advice for women with an existing mental health problem who might become pregnant, and the organisation of mental health services needed in pregnancy and the postnatal period. This quality standard is endorse by NHS England, and supported by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists.

Bringing together physical and mental health: A new frontier for integrated care

In March 2016, the King’s Fund published a compelling case for this ‘new frontier’ for integration:physical and mental health. It gives service users’ perspectives on what integrated care would look like and highlights 10 areas that offer some of the biggest opportunities for improving the quality and controlling costs: 

1. Incorporating mental health into public health programmes
2. Promoting health among people with severe mental illnesses
3. Improving management of medically unexplained symptoms in primary care
4. Strengthening primary care for the physical health needs of people with severe mental illnesses
5. Supporting the mental health of people with long-term conditions
6. Supporting the mental health and wellbeing of carers
7. Supporting mental health in acute hospitals
8. Addressing physical health in mental health inpatient facilities
9. Providing integrated support for perinatal mental health
10. Supporting the mental health needs of people in residential homes

The key findings of this report are precisely that the efforts to develop ...

Physical and mental health: a new frontier for integrated care.

Traditionally, integrated care has been focused on closing the gaps between social and health care. Nevertheless, integrating mental and physical care should also be seen as a way to develop integrated care. In this report published by the King’s Fund, this topic is addressed, describing the current situation of mental and physical care and identifying ten areas where this kind of integration would be most needed:

1. Incorporating mental health into public health programmes.

2. Promoting health among people with severe mental illness.

3. Improving management of medically unexplained symptoms in primary care.

4. Strengthening primary care for the physical health needs of people with severe mental illnesses.

5. Supporting the mental health for people with long-term conditions.

6. Supporting the mental health and wellbeing for carers.

7. Supporting mental health in acute hospitals.

8. Addressing physical health in mental health inpatient facilities.

9. Providing integrated support for perinatal mental health.

10. Supporting the mental health needs of people ...

Mapping dementia-friendly communities across Europe

‘Mapping dementia-friendly communities across Europe’ is a study commissioned by EFID (European Foundation's Initiative on Dementia) and undertaken by the Mental Health Foundation in 2014 and 2015.

The research originated from a shared interest, by the foundations engaged in EFID, to conduct an analysis of concepts and practices of what it is commonly referred to as ‘dementia-friendly communities’ (DFCs) and similar initiatives across Europe.

The aim of the report is to provide practical information, guidance and examples to support good practice around sustainable, inclusive and supportive environments for people living with dementia and their carers. The report is accompanied by an online collection of case studies that illustrate the diversity of ‘dementia-friendly community’ activity in Europe.

The executive summary of the study is available here: ‘Mapping dementia-friendly communities across Europe’ 

The full report is available here: “Mapping dementia-friendly communities across Europe: a study commissioned by EFID”. 

Achieving triple integration: The central role of mental health in integrated care

During the 16th International Conference on Integrated Care that was held Barcelona last May,  one of the keynote presentation that was highlighted was "Achieving triple integration: The central role of mental health in integrated care"by Chris Naylor, Senior Fellow and Policy from The King's Fund.

The Spanish version of the video is available here: Achieving triple integration: The central role of mental health in integrated care. 

Achieving triple integration: The central role of mental health in integrated care

During the 16th International Conference on Integrated Care that was held Barcelona last May,  one of the keynote presentation that was highlighted was "Achieving triple integration: The central role of mental health in integrated care"by Chris Naylor, Senior Fellow and Policy from The King's Fund.

The Spanish version of the video is available here: Achieving triple integration: The central role of mental health in integrated care. 

Shifting towards community-oriented mental health care in Belgium

Changes to legislation, policy and care guidelines at the national level guided mental health reform and government funding was made available to promote the implementation of local community mental health projects aligned with the new national vision for mental health; top-down support for bottom-up ideas ensured both the necessary resources and local ownership needed to optimize mental health reform; a supportive legislative framework helped solidify a common vision for mental health reform, providing a unified focus for local efforts to align with; space for experimentation in the delivery of mental health care was allowed for, motivating locally-adapted projects and sparking grassroots innovation; increasing the provision of community- and home-based care supported greater consideration of patients’ environments.  

Integrated primary and acute care systems (PACS) - Describing the care model and the business model

A new framework to help local areas establish a single primary and acute care system (PACS) has been published by NHS England, as well as another for improving the lives of care home residents.

Under a PACS, hospital, primary, community, mental health and social care services align their goals and incentives to improve the health and wellbeing of the population.

The announcement comes following the publication in July of a framework for the multispecialty community provider (MCP) model.

Perceptions of health managers and professionals about mental health and primary care integration in Rio de Janeiro: a mixed methods study

Community-based primary mental health care is recommended in low and middle-income countries. The Brazilian Health System has been restructuring primary care by expanding its Family Health Strategy. Due to mental health problems, psychosocial vulnerability and accessibility, Matrix Support teams are being set up to broaden the professional scope of primary care. This paper aims to analyse the perceptions of health professionals and managers about the integration of primary care and mental health.

Strengthening community-based mental health services in Cyprus

New political commitments to mental health reform led the government to pass the Mental Health Act in 1997 to promote community-based mental health care; a wide variety of community-based mental health services have been made available, with emphasis on services for prevention, early treatment, rehabilitation and home care; advocacy from the health workforce motivated reforms and helped define the vision for care transformations; strategic timing was an important contributing factor in achieving political support for mental health reform; partnerships with NGOs and volunteer organizations helped expand the continuum of mental health care.

The Impact of Integrated Psychological Services in a Safety Net Primary Care Clinic on Medical Utilization

The integration of phychological and behavioral health services into safety net primary care clinics has been viewed as a step toward reducing disparities in mental health treatment and addressing behavioral factors in chronic diseases. Though it is posited that integrated behavioral health (IBI) reduces preventable medical costs, this premise has yet to be tested in a safety net primary care clinic. 

Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal

Mental illnesess are the largest contributors to the global burden of non-communicable diseases. However, there is extremly limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation

Digital Health and Care Congress 2017. Embedding technology in health and social care.

NHS England's Next steps on the five year forward view outlines the plan to harness technology and innovation over the next two years but what's really happening on the ground? Join us at this two-day event to hear the latest policy updates and learn from case studies showcasing best practice from around the country.

Interventions and approaches to integrating HIV and mental health services: a systematic review

• Available literature on interventions integrating HIV and mental health services reveal that there is much diversity in the approaches adopted in combining treatment modalities; ranging from integration within a single facility, to multi-facility integration, and integrated care coordinated by non-physician case managers.

• Existing evidence, although limited, suggest that integrating HIV and mental health services may be linked to improved patient and service delivery outcomes in diverse settings.

• There is a need for higher quality and robustly designed studies to evaluate and compare integration models at different levels of service delivery in terms of long-term impact on patient outcomes and cost-effectiveness, particularly in low- and middle-income countries with high HIV and AIDS burden.

1st Asia Pacific Conference on Integrated Care (APIC1)

Presentations from the conference are available to download here

Videos from the conference are available to watch here

Pictures from the conference are available to view and ...

Coming Problems in Behavioral Health Care

People with serious mental health and substance abuse disorders remain among the most neglected stigmatized in our health and social services systems. Many with profoundi disabilities are impoverished, are unable to work and at risk of homelessness.

Fortunatelly, the  Affordable Care Act (ACA) and expansions and implementation of the Mental Health Parity and Addiction Equity of 2008 provided a significant turning point in addressing these challenges vital to the nation´s health. 

Primary Care Home October 2017

The Primary Care Home programme has gathered huge momentum since its inception in autumn 2015. From 15 original rapid test sites– they now have more than 190 sites across England, covering eight million patients– 14 per cent of the population.

Applications continue to come in – all are very welcome to join what has all the hallmarks of a social movement across integrated care. Its success, they believe, is because it is bringing about the change that clinicians know is right for their patients – something they've always wanted to do. Staff now feel empowered and excited, with the freedom to innovate and drive improvements. It is also about the human scale of the change where people feel they belong, own local challenges and can make a real difference working alongside their patients. Many have started with small changes that have led to early benefits and created a compelling case for ...

Project INTEGRATE: Lessons for Policy, Management and Implementation of Integrated Care in Europe

Project INTEGRATE aims to gain valuable insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term chronic conditions.

This project has already examined four case studies of best practices of integrated care in Europe, in the areas of COPD, Mental Health, Geriatric Conditions and Diabetes, that have had a proven impact in terms of improving patient experiences, generating better care outcomes and providing cost-effectiveness. The key aim of this part of the research was to define what constitutes good quality integrated care provision, and how integrated care systems can most effectively be built. In Phase 2 of the research, the project considered the cross-cutting themes process design, service delivery, skill mix, patient involvement, financial flows, regulatory conditions, and enabling information technologies in order to create connectivity, alignment and collaboration ...

The Western Sydney Integrated Care Program (WSICP): Qualitative Evaluation

The ageing population together with an increasing prevalence of chronic conditions require a systems wide integrated approach to health care. This includes overcoming barriers between primary and secondary care, physical and mental health, and health and social care in order to provide patient centred care. In Australia, the New South Wales Ministry of Health is piloting an innovative Integrated Care Program in Western Sydney, foccussed on care facilitator roles to coordinate patient care between General Practices and hospitals. 

Coordinating Mental and Physical Health Care in Rural Australia: An Integrated Model for Primary Care Settings

The "GP Clinic" providers primary health care to people using community mental health services in a small town in Australia. This article examines the factors that have driven successful integration in this rural location. Integrated physical and mental health service models that focus on building local service provider relationships and are responsive to community needs and outcomes may be more beneficial in rural settings than top down approaches that focus on policies, formal structures, and governance. 

Integrated primary and acute care systems (PACS) - Describing the care model and the business model

A new framework to help local areas establish a single primary and acute care system (PACS) has been published by NHS England. Under a PACS, hospital, primary, community, mental health and social care services align their goals and incentives to improve the health and wellbeing of the population.

The announcement comes following the publication in July of a framework for the multispecialty community provider (MCP) model.

Why integrated care already owns the future

Integrated care has certainly arrived in the primary care clinic. Evidence and momentum began building 20 years ago with the demonstrated effectiveness of collaborative care programs for depression and anxiety disorders in primary care. Since then, various forms of integrated care have been repeatedly proven effective across a range of care settings, patient populations, languages and cultures.

Integrated care models are well adapted to thrive during the Fourth Industrial Revolution in health care. Because integrated care has embraced flexibility and disruption, integrated care models will succeed—or even dominate—in a future that will demand flexibility.

Integrated care workforce development: university-community collaboration

Behavioral health workforce shortages to provide quality care services for children, adolescents, and transitional age youth are well established. This paper highlights the workforce shortage and the need to infuse interprofessional education to engage in integrated care for children, adolescents and transitional age youth with behavioral health needs. 

QualityRights materials for training, guidance and transformation

As part of the QualityRights Initiative, WHO has developed a comprehensive package of training and guidance materials. The materials can be used to build capacity among mental health practitioners, people with psychosocial, intellectual and cognitive disabilities, people using mental health services, families, care partners and other supporters, nongovernmental organizations, organizations of persons with disabilities and others on how to implement a human rights and recovery approach in the area of mental health in line with the UN Convention on the Rights of Persons with Disabilities and other international human rights standards.

The ultimate goal of WHO’s QualityRights is to change mindsets and practices in a sustainable way and empower all stakeholders to promote rights and recovery in order to improve the lives of people with psychosocial, intellectual or cognitive disabilities everywhere.

Innovative Integrated Health And Social Care Programs In Eleven High-Income Countries

High-income countries face the challenge of providing effective and efficient care to the relatively small proportion of their populations with high health and social care needs. Recent reports suggest that integrated health and social care programs target specific high-needs population segments, coordinate health and social care services to meet their clients’ needs, and engage clients and their caregivers. We identified thirty health and social care programs in eleven high-income countries that delivered care in new ways. We used a structured survey to characterize the strategies and activities used by these programs to identify and recruit clients, coordinate care, and engage clients and caregivers. We found that there were some common features in the implementation of these innovations across the eleven countries and some variation related to local context or the clients served by these programs. Researchers could use this structured approach to better characterize the core components of innovative integrated ...

Towards Integrated Youth Care: A Systematic Review of Facilitators and Barriers for Professionals

To overcome fragmentation in support for children and their families with multiple and enduring problems across life domains, professionals increasingly try to organize integrated care. However, it is unclear what facilitators and barriers professionals experience when providing this integrated care. Our systematic review, including 55 studies from a broad variety of settings in Youth Care, showed that integrated care on a professional level is a multi-component entity consisting of several facilitators and barriers. Findings were clustered in seven general themes: 'Child's environment', 'Preconditions', 'Care process', 'Expertise', 'Interprofessional collaboration', 'Information exchange', and 'Professional identity'. The identified facilitators and barriers were generally consistent across studies, indicating broad applicability across settings and professional disciplines. This review clearly shows that when Youth Care professionals address a broad spectrum of problems, a variety of facilitators and barriers should be considered.

What Do Parents Expect in the 21st Century? A Qualitative Analysis of Integrated Youth Care

To provide integrated Youth Care responsive to the needs of families with multiple problems across life domains, it is essential to incorporate parental perspectives into clinical practice. The parental perspectives on integrated Youth Care in this study emphasize that parents have a strong desire for a family-centred approach and active participation in decision making over their own care process. However, since parental expectations regarding these key components of integrated Youth Care are somewhat opposing, professionals should be aware of potential confusion and explicitly discuss mutual expectations during a care process. 

Patient experience of an integrated care model in a family practice clinic and Federally Qualified Health Center (FQHC)

Behavioral health issues are daily challenges in all primary care settings. The integration of programs and strategies translates into better global results, which optimizes the effort of health workers. In this study, user satisfaction is evaluated, through validated surveys, in 727 patients from different centers, family practice clinic and a Federally Qualified Health Center.

Opportunities and challenges to integrating mental health into HIV programs in a lowand middle-income country: insights from the Nigeria implementation science Alliance

In Nigeria, there is an estimated 1.9 million people living with HIV (PLHIV), 53% of whom utilize HIV care and services. With decreasing HIV-related deaths and increasing new infections, HIV with its associated comorbidities continue to be a key public health challenge in Nigeria. Untreated, comorbid mental disorders are a critical but potentially modifiable determinant of optimal HIV treatment outcomes. This study aimed to identify the challenges and opportunities related to integrating mental health care into existing HIV programs in Nigeria.

e-Mental Health International Conference 2020

Delivering person-centred care through new technology

The Priority Research Centre for Brain and Mental Health Research (University of Newcastle, Australia), following their success in organising the e-Mental Health International Conference in 2016 and 2018,  once again brings the conference to you. Because of the COVID-19 pandemic, conference will be held online this year.

The conference will provide a forum focusing on applying information and communication technologies in person-centred strategies of mental health care. It will contribute to generating, verifying and refining theories and practices of employing technologies in person-centred care. Specific objectives are:

• To review initiatives in using information and communication technologies in person-centred care delivery.
• To reinforce the significance of evidence based e-health practice in promoting, maintaining and restoring health.
• To define critically the roles of e-health in attaining excellence in care and explore the issues related to these roles.
• To examine global and regional strategies of enhancing e-health ...

Addressing Common Challenges in the Implementation of Collaborative Care for Mental Health: The Penn Integrated Care Program

The purpose of this article was to develop and implement a new model of collaborative care that includes a triage and referral management system. The authors present initial implementation metrics using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.  

A journey towards integrated person-centred care: a case study of a mental health perspective in the voluntary sector

Integration of mental health counselling into chronic disease services at the primary health care level: Formative research on dedicated versus designated strategies in the Western Cape, South Africa

To explore health care providers’ views on the acceptability and feasibility of two models for integrating facility-based counsellor delivered mental health counselling into chronic disease care, and how such an approach could be improved in South Africa.

Although study participants unanimously agreed that counselling for common mental disorders should be integrated into chronic disease services, they had differing views on the type of model that should be adopted. 

Teamwork: A Multidisciplinary Review

Promoting integrated care initiatives is an important approach to addressing growing gaps in access to mental health. This article presents a multidisciplinary review of essential team elements and how to optimize team performance. Fostering a collaborative team approach can produce more effective and efficient mental health ca

Healthcare team coordination at the Mali Hospital face the psychological difficulties of COVID+ patients

The COVID-19 pandemic crisis has accentuated the problems that fragmented health care systems face to adapt their actions to respond with coordinated services. Public hospitals were brought to the forefront early on in the fight against the pandemic, even though the neoliberal reforms of the last thirty years have largely contributed to undermining their capacity to cope with it. Other factors are challenging the organization of health systems to meet the priority needs of populations, such as the prevalence of hospital-centrism, the requirement that users pay for care when they are sick and visit health services, and the construction of new hospitals in Africa.

Mali Hospital (HDM) received its first patients on March 29, 2020, five days after the first case was identified in the country. The HDM is one of the newest hospitals in the country. Built with the support of Chinese cooperation, it was inaugurated in September 2010 ...

Readiness to deliver person-focused care in a fragile situation: the case of Mental Health Services in Lebanon

Evidence suggests wide variability in the provision of mental healthcare across countries. Countries experiencing fragility related risks suffer from a high burden of mental-ill health and additionally have limited capacity to scale up mental health services given financial and human resource shortages. Integration of mental health services into routine primary care is one potential strategy for enhancing service availability, however little is known about the experiences of currently active health care providers involved in mental health and psychosocial support service (MHPSS) provision at primary care level. This study aims to determine how healthcare providers offering MHPSS services at primary care levels in Lebanon perceive mental health and the health system’s ability to address the rising mental ill-health burden with a view to identify opportunities for strengthening MHPSS service implementation geared towards integrated person focused care model.

Integrated care systems need to be different - but how exactly?

ICSs are intended to be a fundamental departure from previous NHS structures with a different type of leadership based on partnership, in which local partner organisations hold collective responsibility for resource use and outcomes. However, as ICSs take on statutory responsibilities for the first time later this year (assuming the Heath and Care Bill gains parliamentary approval) there is a risk of recreating established ways of working within the new structures. To live up to their promise, what are the things that should be ‘different’ about ICSs?

First, the concept of equal partnership between the NHS, local government, voluntary sector and others needs to be at the core of how these reforms are implemented. ICSs started their lives as informal partnerships operating through soft power and influence. The Health and Care Bill changes this by putting ICSs on a statutory footing, but partnership-working and collective responsibility need to remain at ...

EFPC 2022 Conference Ghent. Integrated Community Care: a new opportunity for Primary Care

The European Forum for Primary Care Association is happy to announce its 2022 annual conference with a focus on Integrated Community Care. 

WHO guide for integration of perinatal mental health in maternal and child health services

Overview

Supporting good mental health can improve health outcomes, and the quality of maternal and child health services for all women can be improved by creating an environment where they feel safe to discuss any difficulties they are experiencing in a respectful and caring environment that is free from stigmatization. 

The guide for integration of perinatal mental health in maternal and child health services outlines an evidence-informed approach describing how program managers, health service administrators and policy-makers responsible of planning and managing maternal and child health services can develop and sustain high-quality, integrated mental health services for women during the perinatal period. It brings together the best available evidence to support maternal and child health providers in promoting good mental health, identifying symptoms of mental health problems and responding in a way that is adapted to their local and cultural context. 

Common procedures of remote measurement-based care in an integrated behavioural health context: protocol for a scoping review

Integrated behavioural health, a model of care that embeds mental health services in primary care, can potentially increase access to mental healthcare. With the increase in health information technologies, remote measurement-based care (RMBC) presents an opportunity to improve support of integrated care. This scoping review will comprehensively examine what common procedures are followed when RMBC for mental health is tested in integrated care settings.

Social workers in integrated care beyond primary care: a scoping review

Social workers are key members of integrated care (IC) teams, yet there is limited research on the presence and roles of social workers on IC teams. Research literature from 2014 to 2021 was identified using the following search engines: Academic Search Complete, PsycINFO, CINAHL Plus, SocINDEX and MEDLINE. An exploratory search was conducted in January 2021 and an updated search was conducted in August 2021. This search resulted in 802 references, 50 of which met criteria for full-text review. Nine articles were identified through supplemental searching. 20 articles were included in the final review. Of the 20 studies included, most were randomized control trials (45%; n = 9). Studies varied across settings including specialty care (40%; n = 8), community-based practices (35%; n = 7), and primary care (25%; n = 5). Social workers engaged in a variety of roles including behavioral interventions, care coordination, and intake assessment. Social workers are engaged in IC ...

Integration of mental health support teams in COVID-19 units within French general hospitals: a qualitative study

This study aimed to explore the lived experience of mental health professionals (mhPs) who had been redeployed on support teams (MHSTs) implemented in general hospital for patients with coronavirus disease 2019 (COVID-19) and their families, in order to scale up mental and physical health care integration in times of epidemic crisis.

Person- and family-centered approach of integrated care (IC) is essential to address fragmentation between mental and physical health care in times of epidemic crisis. Hospital and political leaders should support and draw from bottom-up mental health IC initiatives such as MHSTs, that embody this vision, in order to improve health systems preparedness for future crises.

Developing an integrated model of care for vulnerable populations living with non-communicable diseases in Lebanon: an online theory of change workshop

The Syrian crisis, followed by a financial crisis, port explosion, and COVID-19, have put enormous strain on Lebanon’s health system. Syrian refugees and the vulnerable host population have a high burden of Non-communicable Diseases (NCD) morbidity and unmet mental health, psychosocial and rehabilitation needs. The International Committee of the Red Cross (ICRC) recently introduced integrated NCD services within its package of primary care in Lebanon, which includes NCD primary health care, rehabilitation, and mental health and psychosocial support services. We aimed to identify relevant outcomes for people living with NCDs from refugee and host communities in northern Lebanon, as well as to define the processes needed to achieve them through an integrated model of care. Given the complexity of the health system in which the interventions are delivered, and the limited practical guidance on integration, we considered systems thinking to be the most appropriate methodological approach.

Integrated care and the behavioral health primary care provider

Primary care remains the main setting for delivery of psychiatric care. An integrated approach improves the ability of primary care providers (PCPs) to care for complex patients with behavioral health needs. This article describes integrated care and how physician associates/assistants can gain additional training to become behavioral health specialists.