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Mental Health is thus the emotional and spiritual resilience, which enables us to enjoy life and to survive pain and disappointment and sadness. It is a positive sense of well-being and an underlying belief on our own and others dignity and worth. Recent transnational and national policies on mental health adopt a broader view than the traditional psychiatric model. This approach is directed at promoting good mental health, preventing mental ill health and ensuring early intervention when mental health problems occur. It involves looking beyond prevention, to the relationship between mental well-being and physical health; behavioural problems; child abuse; violence and drug and alcohol abuse. In promotion and prevention policies such social determinants as living and working conditions; homelessness; poverty, social networks and support, unemployment and risk taking behaviour are included. In effect it means addressing the mental health impact of public policies, programmes and plans like:
Preventing ghettos and marginalisation
Providing safe water, sanitation and shelter
Taking care of families with children and their needs
Enhancing accessible environments
There have been two big changes in mental health services in recent years. The first was the introduction of care in the community. This was meant to enable mental health service users to live in their own homes and neighbourhoods with suitable support instead of going into or staying in hospital. The second is the development of the mental health service survivor’s movement. This has made it possible for service users to speak for themselves, say what they want and to try and improve the way they are treated.
What are the main issues facing this special population, particularly around access, quality, and cost-effective care?
Considerable emphasis was given throughout need to rebalance mental health policy to give a higher priority to promotion and, where possible, prevention. Like public health policy more generally, mental health suffers from the emphasis given to acute, hospital-based care, which continues to receive most of the resources and attention.
The notion of empowerment receives a great deal of lip service, but deep-seated issues of power and professional status are at stake and should not be ignored. Bringing service users and their families into hitherto closed decision-making practices and arenas can be threatening for professionals and disempowering for the users and families. The process should be transparent and designed to benefit everyone concerned.
No single model of care is perfect, although some are clearly more attractive and effective than others. Different countries have different models to offer, and they should embrace diversity as an advantage. Countries should be open to and invest in innovation and change, and search for new ways to tackle familiar problems.
There is a need for better information about developments in the Region and for comparative data on European countries where appropriate. Collecting them may be a task for public health observatories, for which a European movement now exists.
The need for and importance of learning within and more particularly between countries in the Region was stressed. Well-placed and -equipped to undertake the task of education and to help countries transform knowledge into action.
The great bulk of mental disorders are high prevalence disorders such as depression, anxiety, alcohol related disorders and somatiform disorders. These have evidence based treatments.
Developments in services should not be stalled by the fact that there are still many unanswered questions. There are plenty of opportunities for true innovation in the primary care metal health arena.
The general practice workforce has an important role in managing these disorders but cannot do it alone.
Especially in rural areas extra resources need to be spent in provision of accessible services that are evidence based. This needs to encompass the full range of services from specialist psychiatrist services through to support groups, self help manuals and computer based programs.
Further development though Divisions needs to be done in a measured way and needs to engage Divisions and their members and meet their agendas firstly.
2. What are some public policies that would support the needs of this special population?
Both theoretically and methodologically, health research has recently increasingly focussed on cohesion in communities and societies, people’s integrative needs and action models that promote integration. The level of benefits such as income support is low. Because of this it is crucial for mental health service users who are eligible to secure disability benefits. Although these benefits are important to maintain people’s quality of life, they are generally difficult to get and may be difficult to keep. Mental health services are provided by health and social services through care management and the care programme approach. Underfunding and problems of coordination mean that the support service users receive is often inadequate, inappropriate and unreliable.
Unlike most other social care service users, mental health service users/survivors are liable to have their rights restricted and may be subject to legally sanctioned detention, compulsory treatment and control over their lives and opportunities. The government says that care in the community has failed. Present proposals for mental health policy and practice place a special emphasis on the danger and risk from mental health service users and the importance of safeguarding public safety. Provisions for more compulsory treatment, including the extension of compulsion to people living in the community and locking up people labelled as having personality disorder that have not been convicted of any offence, are planned.
Clearly, no one policy or program will be sufficient to meet all the needs of those who choose to parent, but a combination of services that fill in the gaps left by modern-day changes to traditional care giving networks can make a significant difference in the lives of individuals and families and lead to improved public health measures. Home visitation programs, if implemented correctly, can be one effective piece of this pie. Service users have so far had little or no say in the government’s proposed changes. They fear that these will result in their rights being further restricted and being subjected against their will to damaging treatments. They fear that because of this, many service users will try and avoid mental health services at any cost and be denied any support. They fear that government mental health policy will increase rather than reduce social exclusion as it is meant to.
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