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It provides clear, concise guidance on policy and practice decisions, learning from what has and has not worked in regions in the world. The book contains many tables documenting the evidence, supported by an essential reference list, and a Key Points summary for each chapter. Etiquetas Thornicroft, G. Global mental health: the context, 3 2. Description of the world regions, 14 3. Overview of mental health policies worldwide, 23 Section 2 Implementation of community mental health services, 37 4. The current provision of community mental health services, 39 5. It is a heterogeneous region with marked cultural, religious, and socioeconomic diversity.

In terms of GDP, the total health expenditure of countries within the region ranges from 1. Increasing qualitative and quantitative health care demands are placing pressures on governments in countries where public-sector health care once dominated private care [25]. Because of varied historical back- grounds and colonial heritages, health care systems diverge even among neighboring countries. References [1] The World Bank. Dec Lancet ; — Barriers to improvement of men- tal health services in low-income and middle-income countries.

National Mental Health Report. Canberra: Com- monwealth of Australia; Wellington, New Zealand; Mary Finlayson, editor.

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Patrick Firkin. Mental Health, editor. Wellington; Ministry of Health. European Health for All Database. Maidenhead: Open University Press; Acta Psychiatrica Scandinavica ;—8. Leading countries in mental health research in Latin America and the Caribbean.

Developments in global mental health - Devpolicy Blog from the Development Policy Centre

Revista Brasileira de Psiquiatria ;— Mental health policy developments in Latin America. Bulletin of the World Health Organization ;78 4 — Mental health and mental health care in Latin America. World Psy- chiatry ;2 1 —6. Census of India. Sri Lanka at a Glance. India at a Glance.

Pakistan at a Glance. Agriculture in South Asia.

Global Hunger Index. Realigning public and private health care in Southeast Asia. World Economic Outlook Database. The World Psychiatric Association Task Force that undertook the preparatory work for this book was not able to gather such information for all countries, so we present here rich and revealing data about many, but not all, countries of the world.

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Europe Mental Health Declaration and Action Plan Europe is one of the regions in which there has been considerable progress over the last decade in the development and reform of mental health policies [1]. The Action Plan proposed 12 action areas for the development of comprehensive mental health services, along with milestones for each of these areas to be implemented. Similarly, all countries in the European region, apart from Andorra, now have mental health legislation see Table 3. However, there are large variations in the content and application of policies and legislation across countries within Europe.

Community mental health services The Mental Health Declaration for Europe [2] included a commitment by health ministers across Europe to develop community-based mental health services as a replacement for large mental institutions. Consequently, with almost one-quarter of countries in Europe having policies, strategies, or plans for the development of community mental health services in place, this is now the area most directly addressed by policies across the region.

Integration of mental health into primary health care The Mental Health Declaration for Europe also committed health minis- ters to the integration of mental health services into primary health care, and emphasized that the successful implementation of community-based mental health services is dependent on this integration [2]. Policies for the integration of mental health into primary care now exist in over two-thirds of countries across the region see Table 3. Year of most recently approved or updated mental health legislation Year of most recent mental health policy Policies, strategies or plans: devel- opment of community mental health services Policies, strategies or plans: downsizing of large mental hospitals Policies, strategies or plans: mental health in primary health care Serbia Has legislation after Yes Yes Yes T.

Note: some countries in Europe—Spain, for instance—have independent regions [5]. Whilst it is acknowledged that these regions may have separate mental health legislation, policies, and service provision in place, any differences within countries are not described further. Rather, it is indicated where policies or legislation exist in any of the regions of a country.

Nonetheless, mental health care has not been regarded as an important priority for most of the countries in the region.

Mental Health for All by Involving All - Vikram Patel - TED Talks

Africa The development of policies and legislation has been much slower in the WHO Africa region [19—22]. At the time of the WHO Mental Health Atlas, only half—23 of the 46—countries in the Africa region had a men- tal health policy in place, with a further six countries being in the process of developing a policy [6].

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Community Mental Health: Putting Policy Into Practice Globally

Twenty of the countries with a mental health policy also had a mental health program. Nine countries had a mental health program in the absence of a policy [23]. Over half of the countries had mental health legislation, although the majority had not been revised recently [24—28]. South Asia Many countries in South Asia also lack mental health policies and infras- tructure [29—31] see Table 3. Mental health policies are present in only a few countries in the region. Furthermore, of the countries that do have mental health legislation in place, with the exception of India which in- troduced a policy in , all were developed during the late s and still lack a comprehensive approach.

Mental health legislation plays an im- portant role in implementing effective mental health services, particularly Table 3. Despite 20 years of effort, China does not yet have a national mental health law, though it has instituted a national mental health plan [32], whilst Hong Kong has a mental health ordinance [33]. In Thailand, mental health legislation came into effect in [34]. Compulsory admission and guardianship Voluntary and compulsory involuntary admissions are regulated by law throughout the region, usually with family involvement.

Involuntary admission with family consent is legalized in Japan and South Korea [35]. Across the region, efforts are being made to ensure that the majority of patients are voluntarily admitted to psychiatric hospitals [37—39]. Community-based mental health care Legislation has been enacted to support community integration in Japan, Malaysia, Mongolia, and South Korea, whilst most of the other coun- tries in the region have some form of policy which refer to the principle In Australia, each of the states and territories has its own plans, which incorporate elements of the national plan and areas for service development relevant to their jurisdiction.

Australia developed its National Mental Health Strategy in It comprised four major documents: the National Mental Health Policy, the National Mental Health Plan, the Mental Health Statement of Rights and Responsibilities, and the Medicare Agreements the latter referring to funding arrangements to support the reform agenda [40]. The First Australian National Mental Health Plan promoted the integra- tion of inpatient and community services into a cohesive mental health program.


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Subsequently, there have been three revisions to the original plan. The Second and Third National Mental Health Plans continued in the direction of the original plan, but expanded the focus of reform to include additional activities such as: promotion and prevention to comple- ment the development of the specialist mental health service system; the development of partnerships in service reform, and especially the rights of consumers and their families; and strengthening quality and service re- sponsiveness, fostering research, innovation, and sustainability [40—42].

It takes a more explicit population health approach heralded in the Third Plan and seeks to implement the National Mental Health Policy revised by the Coalition of Australian Government Ministers in The policy is un- derpinned by eight principles: r respect for the rights and needs of consumers, carers, and families r services delivered with a commitment to a recovery approach r social inclusion r recognition of social, cultural, and geographic diversity and experience r recognition that the focus of care may be different across the lifespan r services delivered to support continuity and coordination of care r service equity across areas, communities, and age groups r consideration of the spectrum of mental health, mental health problems, and mental illness.

The Fourth Plan has eight priority areas with a set of measureable in- dicators, including: social inclusion and recovery; service access, coordi- nation, and continuity of care; prevention and early intervention; quality Each of the plans has had a corresponding report on progress, as a vehicle for accountability [43]. Importantly, it has an explicit combined approach to both mental health and addictions.

Based on a recovery approach, it provided a practical framework for service development. A variety of programs are offered in both countries addressing men- tal health promotion, antidiscrimination and destigmatization, prevention, psychiatric treatment, primary mental health care, recovery, and service integration.


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Despite this, however, considerable unmet needs and contin- uing government efforts are still found in both countries. Policy, planning, and program development in these countries is proceeding in a variety of ways, with different priorities being given to each. Key points in this chapter r Mental health policies and legislation vary widely within and across regions. Promoting mental well-being in the workplace: a European policy perspective. Int Rev Psychiatry Oct;17 5 — Lessons learned in developing commu- nity mental health care 3 : Europe. World Psychiatry; in press.