- Concluded: Commission on Mental Health Law Reform
- Concluded: Commission on Mental Health Law Reform
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A comprehensive, community-focused model of mental health services has been established in all three districts of Southern Province. This effort has included the following: acute inpatient units in the district general hospitals of Hambantota and Matara in addition to the one in Galle ; intermediate-care facilities at Unawatuna and Ridyagama which previously housed long-stay patients with chronic illness but are being transformed into residential rehabilitation facilities ; community outreach clinics in most divisions in each district to treat patients in the community; a national toll-free telephone service for mental health advice and counseling; a basic mental health information system in each district; and functioning procedures for intersectoral coordination, including health, social affairs, justice, education, and the police.
The challenges of working in the poorest district in the country and in the context of a continuing civil war were substantial. A number of lessons were learned in the process. The most important were that leadership matters most and that effective mental health system development is possible even in unusually difficult environments. The International Mental Health System Development Conference 64 focused on mental health development needs in the Northern and Eastern Provinces, which had been devastated by the final phase of the civil war.
The purpose of the meeting was to review the mental health situation in the Northern and Eastern Provinces and to develop a consensus about how to develop community mental health services. This project will enable key mental health professionals from Northern and Eastern Provinces to participate in the International Mental Health Leadership Program and to carry out mental health system research and development projects with supervision and mentoring by iMHLP faculty and the Sri Lankan members of the H4S Project.
World Vision Australia's REMIND project and the CIMH project described immediately above are complementary in their objectives, with the first focusing on infrastructure for mental health services and the second focusing on skills and capabilities of key people. Both will be informed by the lessons learned from the H4S Project and will contribute to the development of mental health services both nationally and in the north and east.
I have attempted in this article to give an overview of the CIMH approach to mental health system development.go to site
Concluded: Commission on Mental Health Law Reform
The program architecture no doubt betrays the fact that it has been developed in the context of persistently inadequate resources, shifting and unpredictable opportunities, and grants from various agencies, each with its own objectives and expectations—and few with the flexibility and duration required for system development. The consistent thread that runs through CIMH's work is the conviction that leadership matters most.
Without skilled, sustained leadership at multiple levels—most importantly, from national and local governments—efforts to develop or strengthen mental health systems will fail. And yet, even in what would appear to be the most unpromising of settings, mental health system development has been shown to be possible, even with very modest investment. In order for such development to succeed, it is necessary to build partnerships that can be sustained over the long haul. The quality of the relationships will be much more important than the specific details of project design.
These relationships, like any others, need to be based on such things as honesty, mutual respect, and trust, supplemented by a joint commitment to equity and to protecting the rights of people with mental illness. It is also helpful and even important to enjoy each other's company—which makes it easier to continue working collaboratively when things might not be going so well. Despite the significant gains that have been made in recent years in putting mental health system development on the general development agenda, there is still a very long way to go.
Governments, bilateral and other development agencies, and the large philanthropic organizations are starting to appreciate the importance of population mental health. When the necessary funds begin to flow at a scale that is needed, we need to be ready and to be able to scale up our system-development efforts rapidly and with confidence.
The approach that has been presented here has all of the necessary elements and is rapidly scalable. The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article. National Center for Biotechnology Information , U.
Concluded: Commission on Mental Health Law Reform
Harvard Review of Psychiatry. Harv Rev Psychiatry. Published online Feb Author information Article notes Copyright and License information Disclaimer. Correspondence: Dr. Email: ua. This is an open access article distributed under the Supplemental Terms and Conditions for iOpenAccess articles published in Informa Healthcare journals , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC.
- New Labour and Secondary Education, 1994-2010 (Secondary Education in a Changing World).
- Mental Health Law Online: Annual Review by Jonathan Wilson;
- Kodiak: A Picture Book about the Amazing Kodiak Bear.
Abstract Although mental disorders are a major public health problem, the development of mental health services has been a low priority everywhere, particularly in low- and middle-income countries. Keywords: development, leadership, mental health systems, scaling up. Open in a separate window.
- Developmental Disabilities: A Handbook for Occupational Therapists (Occupational Therapy in Health Care Series, Vol 6, No. 2 &3).
- The Centre for International Mental Health Approach to Mental Health System Development.
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In his statement of support for the WHO publication Mental Health and Development , the former Australian minister for international development noted that Australia is committed to reducing poverty and achieving sustainable development in developing countries, and improving responses to people with mental illness is an important building block towards achieving this … Unless the needs of people with disability, including those with mental illness, are met, it will not be possible to achieve the targets of the Millennium Development Goals by Figure 1.
Structure of the CIMH mental health system development program. As the then director of the WHO Department of Mental Health and Substance Abuse noted: It is very important to have good, randomized, clinical trials providing evidence about the efficacy of new treatments but it is equally important to have research providing evidence that a mental health system in a given country, region or district is working better than another. The networks should be across different institutions and teams, across different parts of the research system e.
Strategic leadership, training, and skills development Within countries the IOMHS collaborating groups will contribute to strategic leadership and to shaping the national mental health systems research agenda. User-researcher interaction It is essential that the users of the research results are engaged as early as possible in the research process.
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IOMHS collaborating groups have established links with key research users, particularly ministries of health and civil society and consumer and carer organizations. Research career development The establishment of mental health systems research, education, and development groups in key academic departments will open up career pathways that currently do not exist for mental health systems researchers, and will improve ability to compete for scarce research funds. Training will contribute to building careers in mental health systems research. Ensuring political independence The establishment of IOMHS collaborating groups in influential academic institutions—which everywhere jealously guard their independence—will contribute to ensuring political independence.
However, political independence does not mean political isolation. Cultural change A key component of necessary cultural change is the creation of a culture in which the production, dissemination, and use of high-quality research is valued as an integral part of the health system. Knowledge should be publicly owned, widely disseminated, and shared, and should be used for public benefit. Building an open research culture is an essential and long-term objective. The journal is intended as the place to which mental health system researchers, Health Ministers' advisers, policy makers, mental health consultants advising countries on mental health system development, teachers in psychiatry, nursing, psychology, social work and public health courses, clinicians involved in mental health system reform, and others will turn for the latest research and policy information on how to build equitable, accessible, efficient, high quality mental health systems.
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