The triple challenge of mental health

Zweifel, Peter

doi:10.1007/s10198-017-0937-z

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…Notwithstanding the widespread myth that characterizes people with mental illness as dangerous, they are also, paradoxically, perceived as vulnerable, particularly in terms of sexual exploitation, conspicuously among females. This perspective aligns with certain theoretical frameworks that portray mental illness as a "triple problem" [56]. Those affected face not only the symptoms of their mental disorder but also grapple with society's stigmatization.…”

Section: Discussionmentioning

confidence: 56%

Vulnerability to risky sexual behavior among patients with severe mental illness in Uganda

Birungi,

Ssebunnya,

Kiwanuka

et al. 2024

Discov Soc Sci Health

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Background The relationship between severe mental illness and risky sexual behaviors, defined as acts associated with a higher risk level is notably significant in sub-Saharan Africa. In Uganda, mental disorders have been substantially correlated with unsafe sexual practices, contributing to the global burden of risky sexual behaviors. The consequential outcomes, such as sexually transmitted diseases, has resulted into a significant challenge in managing severe mental illness and potentially increased risky sexual behaviour. There is an urgent need to identify and understand factors specific to Uganda that amplify the vulnerability of severe mental illness patients to risky sexual behaviors. This study aimed to understand the vulnerability factors to risky sexual behaviour in severe mental illness in central and south-western Uganda, seeking to inform the development of tailored and effective intervention strategies to address this critical issue. Methods This was a qualitative descriptive study that was carried out at Butabika and Masaka hospitals in Uganda, involving a varied group of 32 individuals, comprising 12 persons with diagnosed Severe Mental Illness (Schizophrenia, Bipolar Affective Disorder, or Recurrent Major Depressive Disorder) and to risky sexual behaviors, 8 caregivers (who had patients with severe mental illness and to risky sexual behaviors) and 12 mental health specialists, (who had treated these participants). Purposive sampling was done by intentionally selecting participants based on specific attributes relevant to the research question and the objective of the study which was to explore the factors contributing vulnerability to risky sexual behaviour in severe mental illness in central and south-western Uganda. The interviews were conducted, centered on personal experiences and influences on risky sexual behaviors for the persons with severe mental illness, targeting insights into the nuanced interplay of severe mental illness and sexual behavior. For caregivers and mental health specialists, the interviews were conducted to gain a comprehensive understanding of the unique challenges, perspectives, and experiences they encounter in providing support and treatment respectively. The interviews were tape-recorded and transcribed verbatim. Framework analysis of transcribed interviews, using NVivo11 software that helped to systematically organize and code data within the predetermined and emergent thematic framework, we were able to identify patterns and themes to address the research question and objective. Results The study findings underscored a pervasive pattern of engaging in risky sexual behavior among individuals coping with severe mental illness, a growing concern traditionally associated with sexually transmitted infections like HIV and AIDS, unwanted pregnancies, and sexual encounters with strangers. This problem was largely attributed to factors such as compromised judgment due to underlying morbidity, abnormally high libido, poverty, desperation, and inadequate social support. Additionally, sexual deprivation, often a result of stigma, discrimination, and prolonged periods of hospitalization, was found to contribute to irresponsible and risky sexual acts. Respondents also highlighted certain practices and structural weaknesses within hospital environments, such as stripping patients naked when going to seclusion rooms and inadequate patient monitoring. Conclusions The findings underscore the need for targeted interventions addressing both individual and structural factors to alleviate the risks associated with sexual behavior among individuals with severe mental illness.

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Section: Discussionmentioning

confidence: 56%

Vulnerability to risky sexual behavior among patients with severe mental illness in Uganda

Birungi,

Ssebunnya,

Kiwanuka

et al. 2024

Discov Soc Sci Health

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“…Third, the general level of awareness or stigma around mental health may also contribute to low prioritisation of CYP MH 22. The positive association between spend on adult and CYP mental health found in this paper could be explained by commissioners with increased awareness or knowledge of mental health spending more on mental health services for both CYP and adults 23.…”

Section: Discussionmentioning

confidence: 76%

Variation in spend on young mental health across Clinical Commissioning Groups in England: a cross-sectional observational study

2019

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ObjectivesTo investigate whether the rate of spend on child and adolescent mental health is influenced by demand for other competing services in local commissioning decisions.DesignAnalysis of spend data by Clinical Commissioning Groups (CCG), including other publicly available data to control for variation in need.SettingLocal commissioning decisions in the National Health Service.ParticipantsCommissioning of health services across 209 CCGs.Main outcome measuresAssociation between the rate of child and adolescent mental health spend and demand for child and adolescent mental health services (CAMHS), adult mental health services and physical health services after adjusting for confounding factors.ResultsAn additional percentage point in the proportion of children in care is associated with 4% higher child and young person mental health (CYP MH) spend per person aged 0–18 (ratio of means: 1.04; 95% CI 1.00 to 1.07). Spending £100 more on physical health services was associated with 9% lower spend in CYP MH per person aged 0–18 (ratio of means: 0.91; 95% CI 0.84 to 0.99).ConclusionsHealthcare commissioners in England face a challenge in balancing competing needs. This paper contributes to our understanding of this by quantifying the possible extent of the trade-off between physical health and CYP MH when allocating budgets. Any attempt to explain the variation in CAMHS spend must also take account of demand for other services.

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“…Studies have referred to the significant financial cost of mental illnesses (Global Mental Health Action Network, 2021; Kadakia et al, 2022; Kessler et al, 2008; Rosenthal, 2022; The Sainsbury Centre for Mental Health, 2003; Whiteford et al, 2013), that is far higher than the government budget set aside for mental health services (Mechanic et al, 2014). Although the inherent financial and social benefits of adopting an appropriate approach to dealing with mental illnesses have been highlighted and recommended (Zweifel, 2018, 2020), unfortunately, studies on this topic have not been conducted in Israel so far and the matter should be researched in depth.…”

Section: The Economic and Social Cost Of Mental Illnessmentioning

confidence: 99%

The Israeli law for the rehabilitation in the community of persons with psychiatric disabilities: Achievements and challenges.

Aviram,

Lachman,

Ifergan

2023

Psychiatric Rehabilitation Journal

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Objective: The Community Rehabilitation of Persons with Mental Health Disability Law (2000a) is one of Israel’s most important pieces of social legislation. It grants persons with psychiatric disabilities the right to receive rehabilitation in the community. This article is a case study of the development and implementation of a policy that led to the Rehabilitation Reform and that has become an important component in Israel’s comprehensive mental health reform. The purpose of the study was to review and analyze the law and its elements, examine its implementation during its first two decades of operation, and to identify the issues it faces entering its third decade of application. Method: The study examined the key components of the reform such as intended beneficiaries, financing, workforce, and services provided. It used Israel’s official statistical data and drew upon a series of interviews with officials and experts on rehabilitation, mental health and social services. Results: In 2020, 30,000 persons were receiving community psychiatric rehabilitation services, constituting about one fifth of the estimated eligible population. In addition to the reform’s achievements, this article also identifies a number of issues. Toward the end of the second decade, problems between the psychiatric Rehabilitation Unit and the mental health services became apparent. Conclusions and Implications for Practice: As the Rehabilitation Law enters its third decade, it is recommended to establish an independent committee of experts to examine needed modifications in light of the conclusions drawn about the first two decades of its implementation.

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The triple challenge of mental health

Cited by 4 publications

References 13 publications

Vulnerability to risky sexual behavior among patients with severe mental illness in Uganda

Vulnerability to risky sexual behavior among patients with severe mental illness in Uganda

Variation in spend on young mental health across Clinical Commissioning Groups in England: a cross-sectional observational study

The Israeli law for the rehabilitation in the community of persons with psychiatric disabilities: Achievements and challenges.

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