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Andary S, Bassani J, Burrell G, Cole E, Evans R, Redman E, Kumar S. Barriers and enablers to access and utilization of mental health care services across Southeast Asia: A preliminary scoping review. Asia Pac Psychiatry 2023; 15:e12549. [PMID: 37735090 DOI: 10.1111/appy.12549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 08/29/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
While the importance of mental health and its impact on overall health and well-being has been widely recognized, there continue to be ongoing barriers to accessing mental health services. This is particularly poignant in countries in Southeast Asia (SEA) where there may be further stigma in accessing mental health services. As no reviews have been undertaken on this topic, this review aims to outline the barriers and enablers to access and utilization of mental health care services in SEA. Searches were undertaken in commercially produced and gray literature sources. Two independent reviewers screened the results. The data were then independently extracted, which was then collated and synthesized, using the Health Belief Model (HMB) as a framework. Twelve studies were included in the review. Under the HBM, barriers were grouped into: stigma, poor health literacy, internalized reasons, cultural beliefs, lack of training of health professionals, quality of service, and poor distribution of resources. Enablers included: social support, outreach services, structural stigma, self-awareness, resources and information, accessibility and affordability, and positive attitudes and beliefs about health professionals. Those accessing mental health care in SEA are confronted by complex barriers and few enablers. Ongoing stigma and a distinct lack of resources pose the greatest challenges, which are even more amplified for those in rural areas and minority groups. A multifaceted strategy that improves the structures, processes, and outcomes of mental health is required within these communities.
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Affiliation(s)
- Sleiman Andary
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Jason Bassani
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Gus Burrell
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Eliza Cole
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Rhiannon Evans
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Emily Redman
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Saravana Kumar
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Okoroafor SC, Dela Christmals C. Health Professions Education Strategies for Enhancing Capacity for Task-Shifting and Task-Sharing Implementation in Africa: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00082. [PMID: 37341562 DOI: 10.1097/ceh.0000000000000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
INTRODUCTION To compensate for the shortage of health workers and effectively use the available health workforce to provide access to health services at various levels of the health system, several countries are implementing task-shifting and task-sharing (TSTS). This scoping review was conducted to synthesize evidence on health professions education (HPE) strategies applied to enhance capacities for TSTS implementation in Africa. METHODS This scoping review was conducted using the enhanced Arksey and O'Malley's framework for scoping reviews. The sources of evidence included CINAHL, PubMed, and Scopus. RESULTS Thirty-eight studies conducted in 23 countries provided insights on the strategies implemented in various health services contexts including general health, cancer screenings, reproductive, maternal, newborn, child and adolescent health, HIV/AIDS, emergency care, hypertension, tuberculosis, eye care, diabetes, mental health, and medicines. The HPE strategies applied were in-service training, onsite clinical supervision and mentoring, periodic supportive supervision, provision of job aides, and preservice education. DISCUSSION Scaling up HPE based on the evidence from this study will contribute immensely to enhancing the capacity of health workers in contexts where TSTS are being implemented or planned to provide quality health services based on the population's health needs.
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Affiliation(s)
- Sunny C Okoroafor
- Dr. Okoroafor: Technical Officer, Health Systems Strengthening, Universal Health Coverage-Life Course Cluster, World Health Organization Country Office for Uganda, Kampala, Uganda. Dr. Dela Christmals: Associate Professor, Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Potchefstroom, South Africa
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Mirbahaeddin E, Chreim S. A Narrative Review of Factors Influencing Peer Support Role Implementation in Mental Health Systems: Implications for Research, Policy and Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:596-612. [PMID: 35018509 PMCID: PMC8751663 DOI: 10.1007/s10488-021-01186-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 01/22/2023]
Abstract
With increasing calls to incorporate recovery principles into conventional mental health care, the importance of peer support worker (PSW) services has gained attention. However, studies consistently show that PSWs remain underutilized. Although research addresses several factors that influence formal implementation of their role, there is lack of a comprehensive framework that synthesizes the factors and addresses their interlevel interactions. This paper provides a narrative review and synthesis of literature on multilevel factors that influence formal PSW role implementation in mental health systems. We conducted a search of literature and reviewed 38 articles that met inclusion criteria. Our thematic analysis involved identifying first and second order categories that applied across studies, and developing third order interpretations through iterations. We synthesized the findings in a multilevel framework consisting of macro, meso and micro level influences. Influencing factors at the macro level include broader socio-cultural factors (medical model, recovery values, professional power dynamics, training and certification), regulatory and political factors (policy mandates, political commitment), and economic and financial factors (funding, affordability of services). Factors at the meso level include organizational culture, organizational leadership, change management, and human resource management policies. Micro level influences pertain to relationships between PSWs and team members, and PSW wellbeing. Interlevel interactions are also outlined. Limitations and implications for research, policy and practice are addressed.
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Affiliation(s)
- Elmira Mirbahaeddin
- Telfer School of Management, University of Ottawa, 55 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
| | - Samia Chreim
- Telfer School of Management, University of Ottawa, 55 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
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Sampaio ML, Bispo Júnior JP. Towards comprehensive mental health care: experiences and challenges of psychosocial care in Brazil. BMC Public Health 2021; 21:1352. [PMID: 34238266 PMCID: PMC8268580 DOI: 10.1186/s12889-021-11397-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 06/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background Recommendations are in place for mental health (MH) care to be developed into a comprehensive, people-centred perspective and organised primarily through community services. In recent decades, Brazil has promoted psychiatric reform aimed at transforming the hospital-centred model into a psychosocial model of MH. However, current political and economic changes threaten this reform. This article analyses the comprehensive MH care offered by a Psychosocial Care Network (Rede de Atenção Psicossocial – RAPS) in Brazil. Methods The study involved semi-structured in-depth interviews with 33 stakeholders (policymakers, health professionals, and MH service users) and direct observation of MH services members of the RAPS. Data were analysed using framework analysis with the following dimensions: mental health services access, long-term mental health care, comprehensive mental health care, and crisis patient care. Results Results indicated progression towards comprehensive MH care provision. We identified MH care provided primarily by community services, featuring an ‘open door’ policy, development of localised actions and a search for autonomy. Deinstitutionalisation principles and the psychosocial model support a comprehensive view of MH by policy makers, MH professionals, and users. However, difficulties in providing comprehensive care remain, with the main challenges being insufficient services offered and difficulties in user access at all levels of care, fragile integration between services, lack of clear definitions of the responsibilities of each service, discontinuity of care, limitations in family support, and fragility in crisis patient care. Conclusion We highlight the need to increase funding and services of RAPS, qualification of staff professional, family support, and development of strategies for integrating services. Support and expansion of MH care depend on strengthening the Brazilian health system, which is in danger of being dismantled. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11397-1.
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Affiliation(s)
- Mariá Lanzotti Sampaio
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
| | - José Patrício Bispo Júnior
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil.
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Severo PP, Furstenau LB, Sott MK, Cossul D, Bender MS, Bragazzi NL. Thirty Years of Human Rights Study in the Web of Science Database (1990-2020). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2131. [PMID: 33671671 PMCID: PMC7926733 DOI: 10.3390/ijerph18042131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 12/22/2022]
Abstract
The study of human rights (HR) is vital in order to enhance the development of human beings, but this field of study still needs to be better depicted and understood because violations of its core principles still frequently occur worldwide. In this study, our goal was to perform a bibliometric performance and network analysis (BPNA) to investigate the strategic themes, thematic evolution structure, and trends of HR found in the Web of Science (WoS) database from 1990 to June 2020. To do this, we included 25,542 articles in the SciMAT software for bibliometric analysis. The strategic diagram produced shows 23 themes, 12 of which are motor themes, the most important of which are discussed in this article. The thematic evolution structure presented the 21 most relevant themes of the 2011-2020 period. Our findings show that HR research is directly related to health issues, such as mental health, HIV, and reproductive health. We believe that the presented results and HR panorama presented have the potential to be used as a basis on which researchers in future works may enhance their decision making related to this field of study.
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Affiliation(s)
- Priscilla Paola Severo
- Graduate Program in Law, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Leonardo B. Furstenau
- Graduate Program of Industrial Systems and Processes, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Michele Kremer Sott
- Graduate Program of Industrial Systems and Processes, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Danielli Cossul
- Department of Psychology, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Mariluza Sott Bender
- Multiprofessional Residency Program in Urgency and Emergency, Santa Cruz Hospital, Santa Cruz do Sul 96810-072, Brazil;
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
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Factors that facilitate patient activation in the self-management of diabetes and depression among participants enrolled in an integrated chronic care model in India. Soc Sci Med 2021; 270:113646. [PMID: 33486424 DOI: 10.1016/j.socscimed.2020.113646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this study was to identify factors that influence patients' motivation and ability to self-manage their diabetes and depressive symptoms. METHODS From 2016 to 17, in-depth interviews were conducted with 62 patients receiving the INDEPENDENT care model across two clinics in India. Using a realist evaluation approach, a hypothesized program theory for patient activation was tested and refined. FINDINGS The refined theory demonstrates that motivation, education, and engagement cumulatively contribute to patient activation. CONCLUSION The results indicate that positive and sustained patient-provider relationships drive patient motivation and enhance implementation of the care model.
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Kermode M, Choudhurimayum RS, Rajkumar LS, Haregu T, Armstrong G. Retention and outcomes for clients attending a methadone clinic in a resource-constrained setting: a mixed methods prospective cohort study in Imphal, Northeast India. Harm Reduct J 2020; 17:68. [PMID: 32993646 PMCID: PMC7523306 DOI: 10.1186/s12954-020-00413-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 09/10/2020] [Indexed: 11/22/2022] Open
Abstract
Background Opioid substitution therapy (OST) with buprenorphine has been widely available in India since 2007, but the introduction of methadone occurred much later in 2012, and availability remains limited. Illicit injecting drug use is a long-standing public health problem in Manipur, a state in Northeast India characterised by major resource constraints and political unrest. We investigated retention and outcomes for clients attending a methadone-based OST program in Manipur with the aim of strengthening the evidence base for development of relevant policies and programs. Methods All clients enrolling in the methadone clinic over a 1 year period were invited to be part of a prospective cohort study, which followed up and surveyed both retained and defaulting clients for 12 months post-enrollment to assess retention as well as social, behavioural and mental health outcomes. Additionally, we conducted semi-structured qualitative interviews to supplement quantitative information and identify factors contributing to retention and drop-out. Results Of the 74 clients enrolled, 21 had dropped out and three had died (all defaulters) by 12 months post-enrollment, leaving 67.6% still in the program. Using an intention-to-treat analysis, meaningful and statistically significant gains were observed for all social, behavioural and mental health variables. Between baseline and 12 months there were reductions in needle sharing, drug use, property crime, anxiety, depression and suicidal thoughts; and improvements in physical health, mental health, quality of family relationships, employment and hopefulness. Factors contributing to retention and drop-out were identified, including the centrality of family, and general lack of awareness of and misunderstanding about methadone. Conclusion Even in parts of India where resources are constrained, methadone is an effective treatment for opioid dependence. Scaling up the availability of methadone elsewhere in Manipur and in other areas of India experiencing problematic opioid dependence is indicated.
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Affiliation(s)
- Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne, Level 5/333 Exhibition St, Melbourne, VIC, 3010, Australia.
| | | | - Lenin Singh Rajkumar
- Department of Psychiatry, Regional Institute of Medical Science, Imphal, Manipur, India
| | - Tilahun Haregu
- Nossal Institute for Global Health, University of Melbourne, Level 5/333 Exhibition St, Melbourne, VIC, 3010, Australia
| | - Greg Armstrong
- Nossal Institute for Global Health, University of Melbourne, Level 5/333 Exhibition St, Melbourne, VIC, 3010, Australia
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Hanson K, Rasanathan K, George A. The State of Health Policy and Systems Research: Reflections From the 2018 5th Global Symposium. Health Policy Plan 2020; 34:ii1-ii3. [PMID: 31723960 DOI: 10.1093/heapol/czz113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Kara Hanson
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
| | | | - Asha George
- Health Systems Global, 0179 Kavsadze str. 3, Office 5, Tbilisi, Georgia.,School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, South Africa
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Hall T, Kakuma R, Palmer L, Minas H, Martins J, Armstrong G. Service user and family participation in mental health policy making in Timor-Leste: a qualitative study with multiple stakeholders. BMC Psychiatry 2020; 20:117. [PMID: 32164633 PMCID: PMC7069011 DOI: 10.1186/s12888-020-02521-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Participation in mental health system strengthening by people with mental health problems and their families is a cornerstone of people-centred mental health care, yet there is a dearth of research about participation from low- and middle-income countries (LMICs), particularly from the Asia Pacific region. Hence, this study aimed to assess the current situation, challenges, enabling factors and future actions for service user and family participation in mental health policy making in Timor-Leste. METHODS In-depth interviews were conducted with 85 adults (≥18 years) who were: (1) mental health service users (n = 20) and their families (n = 10); (2) government decision makers (n = 10); (3) mental health and social service providers (n = 23); (4) civil society (n = 9); and (5) other groups (n = 13). Interview data was analysed using framework analysis. RESULTS There was limited service user, family and community participation in mental health policy making in Timor-Leste. Perceptions that policy making is a technical exercise and that people with mental health problems lack cognitive capacity, and a lack of supportive mechanisms challenged participation. Enabling factors were a strong focus on human rights within the social sector, and existing mechanisms for advocacy and representation of people with disabilities in social policy making. Participants suggested bolstering civil society representation of people with mental health problems, and increasing mental health awareness and literacy, including government competencies to facilitate service user participation. CONCLUSION The findings highlight the need for theoretical and practical focus on the role of family within mental health system development in LMICs. Global mental health research and practice should adopt a critical approach to mental health service user and family participation to ensure that the concept and strategies to achieve this are embedded in LMIC knowledge.
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Affiliation(s)
- Teresa Hall
- Nossal Institute for Global Health, The University of Melbourne, Exhibition Street, Melbourne, 3004, Australia.
| | - Ritsuko Kakuma
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK ,grid.1008.90000 0001 2179 088XCentre for Mental Health, The University of Melbourne, Melbourne, Australia
| | - Lisa Palmer
- grid.1008.90000 0001 2179 088XSchool of Geography, The University of Melbourne, Melbourne, Australia
| | - Harry Minas
- grid.1008.90000 0001 2179 088XCentre for Mental Health, The University of Melbourne, Melbourne, Australia
| | - João Martins
- grid.449369.5Faculty of Medicine and Health Sciences, National University of Timor-Leste, Dili, Timor-Leste
| | - Greg Armstrong
- grid.1008.90000 0001 2179 088XNossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
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Hall T, Kakuma R, Palmer L, Minas H, Martins J, Armstrong G. Intersectoral collaboration for people-centred mental health care in Timor-Leste: a mixed-methods study using qualitative and social network analysis. Int J Ment Health Syst 2019; 13:72. [PMID: 31788024 PMCID: PMC6858633 DOI: 10.1186/s13033-019-0328-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intersectoral collaboration is fundamental to the provision of people-centred mental health care, yet there is a dearth of research about how this strategy operates within mental health systems in low- and middle-income countries. This is problematic given the known attitudinal, structural and resource barriers to intersectoral collaboration in high-income country mental health systems. This study was conducted to investigate intersectoral collaboration for people-centred mental health care in Timor-Leste, a South-East Asian country in the process of strengthening its mental health system. METHODS This study employed a mixed-methods convergent design. Qualitative data elicited from in-depth interviews with 85 key stakeholders and document review were complemented with quantitative social network analysis to assess understandings of, the strength and structure of intersectoral collaboration in the Timorese mental health system. RESULTS There was consensus among stakeholder groups that intersectoral collaboration for mental health is important in Timor-Leste. Despite resource restrictions discussed by participants, interview data and social network analysis revealed evidence of information and resource sharing among organisations working within the health and social (disability and violence support) sectors in Timor-Leste (network density = 0.55 and 0.30 for information and resource sharing, respectively). Contrary to the assumption that mental health services and system strengthening are led by the Ministry of Health, the mixed-methods data sources identified a split in stewardship for mental health between subnetworks in the health and social sectors (network degree centralisation = 0.28 and 0.47 for information and resource sharing, respectively). CONCLUSIONS Overall, the findings suggest that there may be opportunities for intersectoral collaborations in mental health systems in LMICs which do not exist in settings with more formalised mental health systems such as HICs. Holistic understandings of health and wellbeing, and a commitment to working together in the face of resource restrictions suggest that intersectoral collaboration can be employed to achieve people-centred mental health care in Timor-Leste.
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Affiliation(s)
- Teresa Hall
- Nossal Institute for Global Health, University of Melbourne, 333 Exhibition St, Melbourne, VIC 3004 Australia
| | - Ritsuko Kakuma
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Mental Health, University of Melbourne, Melbourne, Australia
| | - Lisa Palmer
- School of Geography, University of Melbourne, Melbourne, Australia
| | - Harry Minas
- Centre for Mental Health, University of Melbourne, Melbourne, Australia
| | - João Martins
- Faculty of Medicine and Health Sciences, National University of Timor-Leste, Dili, Timor-Leste
| | - Greg Armstrong
- Nossal Institute for Global Health, University of Melbourne, 333 Exhibition St, Melbourne, VIC 3004 Australia
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Hall T, Kakuma R, Palmer L, Minas H, Martins J, Kermode M. Social inclusion and exclusion of people with mental illness in Timor-Leste: a qualitative investigation with multiple stakeholders. BMC Public Health 2019; 19:702. [PMID: 31174504 PMCID: PMC6554932 DOI: 10.1186/s12889-019-7042-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social inclusion is a human right for all people, including people with mental illness. It is also an important part of recovery from mental illness. In Timor-Leste, no research has investigated the social experiences of people with mental illness and their families. To fill this knowledge gap and inform ongoing mental health system strengthening, we investigated the experiences of social inclusion and exclusion of people with mental illness and their families in Timor-Leste. METHODS Eighty-five participants from the following stakeholder groups across multiple locations in Timor-Leste were interviewed: (1) people with mental illness and their families; (2) mental health and social service providers; (3) government decision makers; (4) civil society members; and (5) other community members. Framework analysis was used to analyse interview transcripts. RESULTS People with mental illness in Timor-Leste were found to face widespread, multi-faceted sociocultural, economic and political exclusion. People with mental illness were stigmatised as a consequence of beliefs that they were dangerous and lacked capacity, and experienced instances of bullying, physical and sexual violence, and confinement. Several barriers to formal employment, educational, social protection and legal systems were identified. Experiences of social inclusion for people with mental illness were also described at family and community levels. People with mental illness were included through family and community structures that promoted unity and acceptance. They also had opportunities to participate in activities surrounding family life and livelihoods that contributed to intergenerational well-being. Some, but not all, Timorese people with mental illness benefited from disability-inclusive programming and policies, including the disability pension, training programs and peer support. CONCLUSIONS These findings highlight the need to combat social exclusion of people with mental illness and their families by harnessing local Timorese sociocultural strengths. Such an approach could centre around people with mental illness and their families to: increase population mental health awareness; bolster rights-based and culturally-grounded mental health services; and promote inclusive and accessible services and systems across sectors.
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Affiliation(s)
- Teresa Hall
- Nossal Institute for Global Health, University of Melbourne, 333 Exhibition St, Melbourne, Victoria, 3004, Australia.
| | - Ritsuko Kakuma
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Mental Health, University of Melbourne, Melbourne, Australia
| | - Lisa Palmer
- School of Geography, University of Melbourne, Melbourne, Australia
| | - Harry Minas
- Centre for Mental Health, University of Melbourne, Melbourne, Australia
| | - João Martins
- Faculty of Medicine and Health Sciences, National University of Timor-Leste, Díli, Timor-Leste
| | - Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne, 333 Exhibition St, Melbourne, Victoria, 3004, Australia
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