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Background: Research on patients with chronic psychotic disorders in rural areas is scarce. Those patients may not receive adequate mental health care. Mental health disparities among rural and urban areas have been recognized. Aims: This review aims to present the most recent research on psychotic disorders in rural areas. Method: We conducted a search in the PubMed and Scopus databases. The search involved articles published over the last decade (2011–2020). All types of research design were included, if studies had used a controlled group of urban patients and reported on the differences among rural/urban residents with psychotic disorders. The focus of the review was on outcome and treatment. Results: A total of 12 studies were included in this review. Most have been conducted in China or India. Reports from Western countries are rare. Outcome studies showed that employment rates are significantly higher in rural patients, as well as rates of marriage in women. It is not clear what is the impact of those outcomes on patients' lives. The finding of lower cost of psychotic disorders in some rural areas, should be viewed with scepticism. Studies on treatment aspects suggested that rural patients were less likely to receive antipsychotics, antipsychotic combination or clozapine. Those results were attributed to limited access to specialized treatment. When rural patients receive specialized community care they seem to have better outcomes than urban patients. Conclusion: There is an ongoing, but still scarce research on patients with chronic psychotic disorders in rural areas. Researchers pointed out the impact of socioeconomic inequalities on outcome and treatment, and stressed the importance of minimizing mental health disparities. These findings may have potential implications for future research; for the introduction of accessible, locally based mental health services in rural areas; and for political initiatives that would address poverty and social inequalities. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the usefulness of Family-Centered Support Conversations (FCSC) offered in community mental health care in Norway to young adults and their families experiencing mental illness. The FCSC is a family nursing intervention based on the Calgary Family Assessment and Intervention Models and the Illness Beliefs Model and is focused on how family members can be supportive to each other, how to identify strengths and resources of the family, and how to share and reflect on the experiences of everyday life together while living with mental illness. Interviews were conducted with young adults and their family members in Norway who had received the FCSC intervention and were analyzed using phenomenography. Two descriptive categories were identified: "Facilitating the sharing of reflections about everyday life" and "Possibility of change in everyday life." The family nursing conversations about family structure and function in the context of mental illness allowed families to find new meanings and possibilities in everyday life. Health care professionals can play an important role in facilitating a safe environment for young adults and their families to talk openly about the experience of living with and managing mental illness. [ABSTRACT FROM AUTHOR]

Background and Aims: The purpose is to highlight the legal and ethical principles that inspired the reform of mental health care in Italy, the only country to have closed its psychiatric hospitals. The article will also try to verify some macro-indicators of the quality of care and discuss the crisis that the mental health care system in Italy is experiencing. Methods: Narrative review. Results: The principal changes in the legislation on mental health care in Italy assumed an important role in the evolution of morals and common sense of the civil society of that country. We describe three critical points: first, the differences in implementation in the different Italian regions; second, the progressive lack of resources that cannot be totally attributed to the economic crisis and which has compromised application of the law; and finally, the scarce attention given to measurement of change with scientific methods. Conclusion: Italy created a revolutionary approach to mental health care in a historical framework in which it produced impressive cultural expressions in many fields. At that time, people were accustomed to 'believing and doing' rather than questioning results and producing research, and this led to underestimating the importance of a scientific approach. With its economic and cultural crisis, Italy has lost creativity as well as interest in mental health, which has been guiltily neglected. Any future humanitarian approach to mental health must take the Italian experience into account, but must not forget that verification is the basis for any transformation in health care culture. [ABSTRACT FROM AUTHOR]

Objective: Presentation to hospital after self-harm is an opportunity to treat underlying mental health problems. We aimed to describe the pattern of mental health contacts following hospital admission focusing on those with and without recent contact with community mental health services (connected and unconnected patients). Methods: We undertook a data linkage study of all individuals admitted as a general or psychiatric inpatient to hospital after self-harm in New South Wales, Australia, between 2005 and 2011. We identified the proportion of admissions where the patient received subsequent in-person community mental health care within 30 days of discharge and the factors associated with receipt of that care. Results: A total of 42,353 individuals were admitted to hospital for self-harm. In 41% of admissions, the patient had contact with a community mental health service after discharge. Patients connected with community mental health services had 5.33 (95% confidence interval = [5.09, 5.59]) times higher odds of follow-up care than unconnected patients. Other factors, such as increasing age and treatment as a psychiatric inpatient, were associated with lower odds of follow-up community care. Conclusion: Our study suggests that full advantage is not being taken of the opportunity to provide comprehensive mental health care for people who self-harm once they have been discharged from the inpatient setting. This is particularly the case for those who have not previously received community mental health care. There appears to be scope for system-level improvement in the way in which those who are treated for self-harm are followed up in the community. [ABSTRACT FROM AUTHOR]

Background: The mental health ‘treatment gap’ is at its widest in low-resource countries where the vast majority of its people have no access to mental health services and where developing effective models of primary mental health care that can expand from research pilot sites to large-scale population-based services is a major research and practice imperative. Aim: The Mental Health in Zomba initiative builds upon an earlier pilot project to establish and sustain a district-wide scale-up of a village-based health workers’ mental health task-sharing intervention in Southern Malawi across a population of more than 600,000 people. Methods: The article describes the development, implementation and structured evaluation of the impact of this task-sharing initiative. Results: Results from an examination of the care for 240 consecutive attendees show how the village-based workers recognised and responded to the needs of people experiencing both common and severe mental health problems and how they facilitated 850 mental health promotion events to more than 40,000 people within their communities. Conclusion: A new and essential district-wide tier of mental health service was established at the crucial intersection between health centre and the community. Within the socio-cultural context of rural Malawi with its diverse explanatory models for psychological distress, the approach of the village-based health worker was found to be both credible and practical in meeting the needs of the population and therefore responding to both the ‘supply’ and ‘demand’ elements of the mental health treatment gap. [ABSTRACT FROM AUTHOR]

Objective: Given increasing numbers of compulsory admissions, it is important to assess patient risk profiles and identify factors that are appropriate for intervention. Methods: A sample of 116 patients who were compulsorily admitted was studied. Socio-demographic and clinical characteristics were recorded. Patients were interviewed twice using the Verona Service Satisfaction Scale and the Birchwood Insight Scale. Changes in insight and satisfaction during 2 years were linked to the incidence of involuntary re-admissions in the next three follow-up years. Results: A higher mean score for patient satisfaction was found (mean=3.77, standard deviation (SD)=0.56; p⩽.001) in the second interview than in the baseline interview (mean=3.26, SD=0.65). There was also an improvement in insight (in the second interview: mean=7.22, SD=2.86 and in the baseline interview: mean=6.34, SD=3.18; p=.027). There was an inverse correlation between increasing satisfaction (in years 1–2) and the incidence of involuntary admission in years 3–5 (odds ratio (OR)=0.445, 95% confidence interval (CI)=0.252–0.793; p=.006). This association proved to be dependent on a history of involuntary admission. Conclusion: Increasing patient satisfaction in the first 2 years was associated with a lower risk of compulsory re-admission in the subsequent follow-up period, but this association proved to be dependent on a history of involuntary admissions in these first two follow-up years. Increase in insight during the same period did not show any effect whatsoever. [ABSTRACT FROM AUTHOR]

Background: Most research on suicide is quantitative, and qualitative research is needed to reveal how individuals subjectively experience and account for suicidal behaviors. Aims: The aim of this study is to learn about the circumstances, motivations and consequences of suicidal behavior among individuals hospitalized for attempted suicide and suicidal ideation during the global economic recession. Methods: In-depth semi-structured interviews were conducted with in-patients hospitalized for suicidal behavior in a state-subsidized public mental hospital and analyzed with framework analysis. Results: Interpersonal conflict in the context of severe economic hardship and inadequate mental health care preceded suicidal behavior, rescue and a subsequent respite from desperate situations. Attempted suicide led to increased attention and concern from loved ones and immediate access to mental health care. Conclusions: Government-subsidized funding for outpatient mental health care should be sustained or increased during economic recessions to protect the most vulnerable from suicidal behavior when it is the only viable path toward immediate psychiatric treatment. [ABSTRACT FROM AUTHOR]

The article presents a study on the risk of compulsory admission and the connection between opinions about prior psychiatric treatment, insight, service engagement and the risk of civil detentions. A random sample was taken from patients who come into contact with Psychiatric Emergency Service Amsterdam and Acute Treatment Unit between September 2004 and September 2006. It was found that the risk of civil detention was reduced remarkably from more satisfaction with prior treatment.

The article focuses on the development of a pilot educational intervention for the enhancement of the role of health surveillance assistants (HSA) in Malawi, Africa. A mental health care training programme for HSAs was designed to overcome the challenge of psychological distress. The knowledge and confidence of HSAs in providing care and analysis of patient records revealed mental health care and health promotion activity.

In accordance with current health care and social reforms designed to enhance service efficiency, the nonprofit and voluntary sector is playing a more prominent role in service delivery. Policy makers would benefit from greater information on ways to enhance coordination between the public health care and social sector and nonprofit organizations. This study has for aim to identify variables associated with the referral process from nonprofit organizations to the public health care and social sector. Data are based on a sample of 168 nonprofit mental health organizations in Quebec, Canada. Five variables were found to influence referrals to the public health care and social sector: (a) proportion of consumers with common mental disorders; (b) number of referrals to other nonprofit organizations; (c) referral rates to intersectorial organizations; (d) formal agreements with hospitals; and (e) participation in a mental health care regional roundtable. Implementing diversified strategies to streamline the referral process and enhance interorganizational collaboration is recommended. [ABSTRACT FROM PUBLISHER]

Background: Little information has become available after psychiatric reforms regarding outcomes of persons with schizophrenia and related disorders cared for in community-based mental health facilities. Aims: The aim of this study was to determine the consequences of psychiatric services in the users of mental health services in Malaga. Method: We describe the cohort and methods involved in the Schizophrenia Case Register (RESMA) in Malaga, Spain. All cases (n = 1,022) were users of public mental health services provided in the catchment area over one year. The majority were male (65%), single (68%), living with their original family (50%), with primary education (41%) and living on disability benefits (52%). Results: Concerning use of services, the majority had out-patient contacts (89%). Results show a substantial overlap in the use of different services during the study period. Conclusion: The Malaga Schizophrenia Case Register provides sociodemographic, clinical and service use information for a large sample of patients with schizophrenia or related disorders. Results obtained from the cohort studied will be instrumental for the follow-up and evaluation of the mental health care reform. [ABSTRACT FROM AUTHOR]

Aims: This study sets out to explore the use flow of mental health services by a cohort of patients with schizophrenia located in Granada (Spain). Methods: All cases (N = 844) included in the analysis were users of the community mental healthcare public service provided in the area. The Markov chain model was used to calculate the probability of transition from one type of contact with mental health services resources to another type of contact in the next month, over a three-year follow-up. Results: For a given one-month period, for each level of service contact, most patients continued to use the same level of care. Conclusions: Our results can be interpreted as a reflection of adequate continuity of mental health care provided by the Andalusian community service. [ABSTRACT FROM AUTHOR]

The authors review the methodology and findings of economic evaluations of 42 community mental health care programs reported in the English-language literature between 1979 and 2003. There were three substantial methodological problems in the literature: costs were often not completely specified, the quality of econometric analysis was often low, and most evaluations failed to integrate cost and health outcome information. Well-conducted research shows that care in the community dominates hospital in-patient care, achieving better outcomes at lower or equal cost. It is less clear what types of community programs are most cost-effective. Future research should focus on identifying which types of community care are most cost effective and at what level of intensity they are most effective. [ABSTRACT FROM AUTHOR]

In the United Kingdom (UK), mental health nurses have worked in the community since the mid-1950s. From modest beginnings, the community mental health nursing workforce has grown dramatically in size, with just under 7,000 community mental health nurses (CMHNs) estimated to have been working in England and Wales in 1996. Mirroring this expansion in numbers, CMHNs over the years have extended the scope of their professional activities, and now work in a variety of settings with a wide range of client groups. For the benefit of a US audience, this paper commences with a review of the origins and development of the CMHN profession in the UK. Prevailing UK National Health Service policies and priorities, along with data from a recent national census of CMHNs,l are then used to provide an analysis of the context and characteristics of contemporary community mental health nursing. [ABSTRACT FROM PUBLISHER]