Mainstreaming Mental Health Care in 42 Countries

Abstract

Global consensus and national policies have emphasized deinstitutionalization, or a shift in providing mental health care from institutional to community settings. Yet, psychiatric hospitals and asylums receive the majority of mental health funding in many countries, at odds with research evidence that suggests that services should be delivered in the community. Our aim is to investigate the norms, actors, and strategies that influence the uptake of deinstitutionalization internationally. Our study is informed by prior literature on management and implementation science. The success and failure of mental health care operations depend on identifying and overcoming challenges related to implementing innovations within national contexts. We surveyed 78 experts spanning 42 countries on their knowledge and experiences in expanding community-based mental health care and/or downsizing institutionbased care. We also asked them about the contexts in which said methods were implemented in a country. We found that mental health care, whether it is provided in institutions or in the community, does not seem to be standardized across countries. Our analysis also showed that moving deinstitutionalization forward requires meaningful engagement of three types of actors: government officials, health care professionals, and local experts. Progress toward deinstitutionalization depends on the partnerships formed among these actors and with diverse stakeholders, which have the potential to garner resources and to scale-up pilot projects. In conclusion, different countries have adapted deinstitutionalization in ways to meet idiosyncratic situations and population needs. More attention should be given to the management and implementation strategies that are used to augment treatment and preventive services.

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care

“…In most countries, the motivations for this change included breakthroughs in pharmaceutical treatments (86) combined with an emphasis on human rights and social inclusion of persons with mental illness (87), and the expectation of better outcomes in the community (88). However, legal concerns and fiscal decisions aimed at reducing health care expenditures (85,89) were also important drivers. Globally, there is considerable variability in rates of deinstitutionalization (90,91) despite broad based philosophical support (92,93).…”

Improving Care for Deinstitutionalized People With Mental Disorders: Experiences of the Use of Knowledge Translation Tools

“…Although the staff composition of health professionals varies by setting, population needs, the type of health system and the availability of financial resources, the shortage of appropriate human resources for mental health, particularly in low-middleincome countries, is recognized as a global concern (36,37).…”

“…Low political priority, insufficiency resource, knowledgeaction gap in policy implementation and lack of partnership formation with other sectors are important obstacles that needs to be overcome (33,37,39).…”

“…Cooperation from all levels of government to implement and review mental health policy, configuration of proactive partnerships and the adoption of scientific implementation frameworks are facilitators to improve the care practice (11,33,37).…”

Calcium Chloride (CaCl2) : Characteristics and Molecular Interaction in Solution

“…Ketika viskositas meningkat, kecendrungan mengalir menurun. Viskositas kalsium klorida berbanding terbalik dengan suhu (148) konstan (149) konsentrasi, dan meningkat dengan meningkatnya konsentrasi (150)(151)(152) . Tabel dibawah ini menunjukkan viskositas kalsium klorida di berbagai suhu (153).…”