Showing papers by "Benedetto Saraceno published in 2007"

WHO's Assessment Instrument for Mental Health Systems: Collecting Essential Information for Policy and Service Delivery

Abstract: Information about mental health systems is essential for mental health planning to reduce the burden of neuropsychiatric disorders. Unfortunately, many low- and middle-income countries lack systematic information on their mental health systems. The objectives, scope, structure, and contents of mental health assessment and monitoring instruments commonly used in high-income countries may not be appropriate for use in middle- and low-income countries. The World Health Organization (WHO) has recently developed the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), a comprehensive assessment tool for mental health systems designed for middle- and low-income countries. WHO-AIMS was developed through an iterative process that included input from in-country and international experts on the clarity, content, validity, and feasibility of the instrument, as well as a pilot trial. The resulting instrument, WHO-AIMS 2.2, consists of six domains: policy and legislative framework, mental health services, mental health in primary care, human resources, public information and links with other sectors, and monitoring and research. These domains address the ten recommendations of the World Health Report 2001 through 28 facets and 155 items. All six domains need to be assessed to form a basic, yet broad, picture of a mental health system, with a focus on health sector activities. WHO-AIMS provides essential information for mental health policy and service delivery. Countries will be able to develop information-based mental health policy and plans with clear baseline information and targets. Moreover, they will be able to monitor progress in implementing reform policies, providing community services, and involving consumers, families, and other stakeholders in mental health promotion, prevention, care and rehabilitation. This article provides an overview of the rationale, development process, and potential uses and benefits of WHO-AIMS.

Children and the Sphere standard on mental and social aspects of health.

Abstract: Most of the world's children live in resource-poor countries where people are at a relatively high risk of exposure to catastrophic situations arising from conflict and natural disasters.(6) Given the potential social, psychological and psychiatric consequences of exposure to disaster, mental health and psychosocial support programmes are increasingly part of humanitarian aid. A minimum standard on mental and social aspects of health is included in the recently revised Humanitarian Charter and Minimum Standards in Disaster Response (Sphere Handbook) (Sphere Project, 2004). Most recommendations for mental health and psychosocial interventions in guidance documents are based on expert opinion rather than research. Consequently, interventions are being implemented without full understanding of their potential benefit or harm. This paper offers a child-focused review of the evidence for each of the interventions described as indicators for the Sphere standard on mental and social aspects of health. It suggests some, but limited, support for each of them. However, the evidence base needs substantial strengthening.

The definitive position of headache among the major public health challenges. An end to the slippery slope of disregard

Abstract: School of Medicine,Sapienza University of Rome,Via Vitorchiano 81, I-00189 Rome, Italye-mail: paolo.martelletti@uniroma1.itTel.: +39-06-3327-4631Fax: +39-06-3327-4632T.J. SteinerDivision of Neuroscience and Mental Health,Imperial College London, London, UKJ.M. Bertolote • T. Dua • B. SaracenoDepartment of Mental Health and Substance Abuse,World Health Organization, Geneva,Switzerland

Global Mental Health 5 Barriers to improvement of mental health services in low-income and middle-income countries

Abstract: Despite the publication of high-profi le reports and promising activities in several countries, progress in mental health service development has been slow in most low-income and middle-income countries. We reviewed barriers to mental health service development through a qualitative survey of international mental health experts and leaders. Barriers include the prevailing public-health priority agenda and its eff ect on funding; the complexity of and resistance to decentralisation of mental health services; challenges to implementation of mental health care in primary-care settings; the low numbers and few types of workers who are trained and supervised in mental health care; and the frequent scarcity of public-health perspectives in mental health leadership. Many of the barriers to progress in improvement of mental health services can be overcome by generation of political will for the organisation of accessible and humane mental health care. Advocates for people with mental disorders will need to clarify and collaborate on their messages. Resistance to decentralisation of resources must be overcome, especially in many mental health professionals and hospital workers. Mental health investments in primary care are important but are unlikely to be sustained unless they are preceded or accompanied by the development of community mental health services, to allow for training, supervision, and continuous support for primary care workers. Mobilisation and recognition of non-formal resources in the community must be stepped up. Community members without formal professional training and people who have mental disorders and their family members, need to partake in advocacy and service delivery. Population-wide progress in access to humane mental health care will depend on substantially more attention to politics, leadership, planning, advocacy, and participation.

Mental health systems research is urgently needed.

Abstract: Recent developments, including experience related to the development of WHO's World Health Report 2001, the WHO Atlas and the DCP Project related to Mental, Neurological, Developmental and Substance Abuse Disorders, indicate why advancing the interests of mental health is now so compelling. In order to deliver a high standard of mental health treatment and care WHO emphasizes the adoption of an integrated system of service delivery to address comprehensively the psychosocial needs of people with mental disorders. Even though the burden is large and increasing, the capacity to reach those in need is poor. This gap cannot be filled just by seeking more funding for mental health, more human resources, or more training. Of course, these aspects are key ingredients but what is often neglected is the need to conceive service delivery rationally. Mental health professionals' attention should be channeled towards mental health systems and service organization which obviously has consequences in their training which should include more public health knowledge. We need to know how to plan and organize services and improve the use of scarce financial and human resources in order to reach out to the mental health needs of the general population and to provide effective and humane services to those who need care.

Redução da estigmatização e da discriminação das pessoas idosas com transtornos mentais: uma declaração técnica de consenso

Abstract: This technical consensus statement is jointly produced by the Old Age Psychiatry section of the World Psychiatric Association and the World Health Organization, with the collaboration of several NGOs and the participation of experts from different regions. It is intended to be a tool for (i) promoting debate at all levels on the stigmatization of older people with mental disorders; (ii) outlining the nature, causes and consequences of this stigmatization; and (iii) promoting and suggesting policies, programs and actions to combat this stigmatization.