Lessons learned in developing community mental health care in North America

Drake, Robert E.; Latimer, Éric

doi:10.1016/j.wpsyc.2012.01.007

Cited by 74 publications

(49 citation statements)

References 31 publications

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“…This is in accordance with the current mental healthcare developments supported by the World Health Organization (WHO) and other leading healthcare organizations, putting a focus on outpatient, community-based treatment organization for patients with severe mental illnesses [15,16]. The focus in mental healthcare is currently shifting from traditional residential treatment centers to outpatient, community-based settings in which the patient is being treated in an integrative way.…”

Section: Introductionsupporting

confidence: 61%

Treatment for Outpatients with Comorbid Schizophrenia and Substance Use Disorders: A Review

et al. 2013

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Aims: This review provides evidence of which interventions need to be part of effective outpatient integrated treatment for patients with comorbid schizophrenia and substance use disorders. Methods: A total of 14 randomized controlled trials were included. Effect sizes are provided to assess the magnitude of the treatments' efficacy. Results: Despite the studies' heterogeneity, we can conclude that certain programs (e.g. Behavioral Treatment for Substance Abuse in Severe and Persistent Mental Illness ) and specific interventions (e.g. motivational interviewing, family interventions) seem to be effective. Moreover, programs integrating multiple interventions are more likely to be positively related to better outcomes than single interventions. Finally, the lack of difference between effect sizes of assertive community treatment compared to case management suggests that a lower caseload is not necessary for positive treatment outcomes. Conclusion: Integrated treatment seems advantageous, although effect sizes are mostly modest. More homogeneous and qualitative sound studies are needed.

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Section: Introductionsupporting

confidence: 61%

Treatment for Outpatients with Comorbid Schizophrenia and Substance Use Disorders: A Review

et al. 2013

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“…A series of articles in World Psychiatry describe the successes and challenges that regions around the world have faced in integrating community mental health services in primary care [11–13, 22–24]. Many countries have made significant strides in legislating mental health reform and in moving toward de-institutionalization.…”

Section: Integrating Treatment Of Common Mental Disorders In Primary mentioning

confidence: 99%

“…Paradoxically, this gap exists at a time when evidence-based mental health interventions have been found to be effective in limited resource environments [4•, 5]. Trials conducted in low- and middle-income countries (LMICs) have demonstrated the efficacy and effectiveness of both psycho-pharmacological treatment and evidence-based psychotherapies for treating mental disorders [6–13]. Furthermore, studies on the cost-effectiveness of mental health treatments increasingly highlight the economic value of preventing and treating mental disorders in these settings [14••, 15].…”

Section: Introductionmentioning

confidence: 99%

Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective

Wainberg

Scorza

Shultz

et al. 2017

Curr Psychiatry Rep

516

290

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Purpose of Review Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research. Recent Findings Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services. Summary Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions.

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“…Psychiatric outpatient visits are complex, agenda-packed, interpersonal interactions in which time constraints, communication barriers, and lack of access to necessary information create obstacles to optimal care (Torrey and Drake 2010). The work has been made harder by the drastic reductions in funding for community care in recent decades (Drake and Latimer 2012). Psychiatrists working in public sector settings often face tremendous time and productivity pressures and high turnover in the workforce.…”

Section: Introductionmentioning

confidence: 99%

“I Always Viewed this as the Real Psychiatry”: Provider Perspectives on Community Psychiatry as a Career of First Choice

Carpenter‐Song

Torrey

2014

Community Ment Health J

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The US needs engaged and skilled psychiatrists to support the recovery of people with severe mental illnesses and we are currently facing a shortage. This paper examines what attracts providers to community psychiatry and what sustains them in their work. Focus groups and interviews were used to elicit the perspectives of prescribing clinicians in three community mental health clinics in the US. Community psychiatry has inherent challenges, including facing high-risk decisions, encountering intense affects, and occasionally witnessing bad outcomes. Psychiatrists are motivated and sustained in this work by (1) cultivating relationships with patients and colleagues, (2) focusing on the mission of promoting recovery, and (3) engaging with clinical practice as intellectually stimulating work. Administrators support the engagement and morale of psychiatrists by creating workflows that allow psychiatrists to meaningfully apply their expertise to support patients' recovery. These findings hold implications for recruiting and retaining a new generation of physicians.

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Lessons learned in developing community mental health care in North America

Cited by 74 publications

References 31 publications

Treatment for Outpatients with Comorbid Schizophrenia and Substance Use Disorders: A Review

Treatment for Outpatients with Comorbid Schizophrenia and Substance Use Disorders: A Review

Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective

“I Always Viewed this as the Real Psychiatry”: Provider Perspectives on Community Psychiatry as a Career of First Choice

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