14 - Informed actions for better mental health care  pp. 165-177

Informed actions for better mental health care

By Graham Thornicroft and Michele Tansella

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An ambitiously realistic vision for mental health care

In this book we aim to support you in your role, perhaps planning or providing or using mental health services, by providing an overall framework (the matrix model) and by offering a wide range of ideas based upon the best that is currently available in relation to ethics, evidence and experience. What is our longer-term ambition for better mental health care? In a sense our vision is one that provides remedies for the many shortcomings that have been described previously in this book. Here in this concluding chapter we describe a vision for better mental health care that is both ambitious and realistic.

Our proposals start with the recognition (described in Chapter 2) that the difference between the number of people who have mental illnesses and the number who are treated in any way is truly enormous [1]. This ‘treatment gap’ means that even in the best-resourced countries, about a third of people with the most severely disabling conditions such as schizophrenia, and over two-thirds of people with more common mental disorders, such as anxiety and depression, receive no treatment at all [2]. These findings have wide-ranging implications [3]. They mean that most countries simply do not have the capacity, at present, to respond to the full scale of the challenge to offer treatment and care for people with mental illnesses.

Amnesty International. Ethical Codes and Declarations Relevant to the Health Professions. London: Amnesty International; 2000.
Bartlett P, Lewis O and Thorold O. Mental Disability and the European Convention on Human Rights. Leiden: Martinus Nijhoff; 2006.
Becker L, Pickett J and Levine R. Measuring Committment to Health. Global Health Indicators Working Group Report. Washington DC: Centre for Global Development; 2006.
Bero LA, Grilli R, Grimshaw JM, et al. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ 1998; 317(7156): 465–468.
Campbell H, Hotchkiss R, Bradshaw N and Porteous M. Integrated care pathways. BMJ 1998; 316(7125): 133–137.
Chamberlin J. User/consumer involvement in mental health service delivery. Epidemiol. Psichiatr. Soc. 2005; 14(1): 10–14.
Chisholm D, Flisher AJ, Lund C, et al. Scale up services for mental disorders: a call for action. Lancet 2007; 370(9594): 1241–1252.
Cohen A and Gureje O. Making sense of evidence. Int. Rev. Psychiatry 2007; 19(5): 583–591.
Corrigan PW, Watson AC, Gracia G, et al. Newspaper stories as measures of structural stigma. Psychiatr. Serv. 2005; 56(5): 551–556.
Crisp A, Gelder MG, Goddard E and Meltzer H. Stigmatization of people with mental illnesses: a follow-up study within the Changing Minds campaign of the Royal College of Psychiatrists. World Psychiatry 2005; 4: 106–113.
Dear M and Wolch J. Landscapes of Despair. Princeton: Princeton University Press; 1992.
Desjarlais R, Eisenberg L, Good B and Kleinman A. World Mental Health. Problems and Priorities in Low Income Countries. Oxford: Oxford University Press; 1995.
Disability Rights Commission. Equal Treatment: Closing the Gap. A Formal Investigation into Physical Health Inequalities Experienced by People With Learning Disabilities and/or Mental Health Problems. London: Disability Rights Commission; 2006.
Druss BG. Mental health parity, access, and quality of care. Med. Care 2006; 44(6): 497–498.
Dunion L and Gordon L. Tackling the attitude problem. The achievements to date of Scotland's ‘see me’ anti-stigma campaign. Ment. Health Today 2005; 22–25.
Dy SM, Garg P, Nyberg D, et al. Critical pathway effectiveness: assessing the impact of patient, hospital care, and pathway characteristics using qualitative comparative analysis. Health Serv. Res. 2005; 40(2): 499–516.
Emmerson B, Frost A, Fawcett L, et al. Do clinical pathways really improve clinical performance in mental health settings? Australas Psychiatry 2006; 14(4): 395–398.
Estroff S. Making it Crazy: Ethnography of Psychiatric Clients in an American Community. Berkeley: University of California Press; 1981.
Evans-Lacko S, Jarrett M, McCrone P and Thornicroft G. Clinical pathways in psychiatry. In submission 2008.
Frank RG, Goldman HH and McGuire T G. Will parity in coverage result in better mental health care? N. Engl. J. Med. 2001; 345(23): 1701–1704.
Grol R and Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care. Lancet 2003; 362(9391): 1225–1230.
Hanson KW. Public opinion and the mental health parity debate: lessons from the survey literature. Psychiatr. Serv. 1998; 49(8): 1059–1066.
Hinshaw SP and Cicchetti D. Stigma and mental disorder: conceptions of illness, public attitudes, personal disclosure, and social policy. Dev. Psychopathol. 2000; 12(4): 555–598.
Kessler RC, Demler O, Frank RG, et al. Prevalence and treatment of mental disorders, 1990 to 2003. N. Engl. J. Med. 2005; 352(24): 2515–2523.
Kingdon D, Jones R and Lonnqvist J. Protecting the human rights of people with mental disorder: new recommendations emerging from the Council of Europe. Br. J. Psychiatry 2004; 185: 277–279.
Kohn R, Saxena S, Levav I and Saraceno B. The treatment gap in mental health care. Bull. World Health Organ. 2004; 82(11): 858–866.
Leucht S, Burkard T, Henderson J, Maj M and Sartorius N. Physical illness and schizophrenia: a review of the literature. Acta Psychiatr. Scand. 2007; 116(5): 317–333.
Mental Disability Advocacy Centre. Cage Beds. Budapest: Mental Disability Advocacy Centre; 2003.
Mercer S, Dieppe P, Chambers R and MacDonald R. Equality for people with disabilities in medicine. BMJ 2003; 327(7420): 882–883.
Patel V, Saraceno B and Kleinman A. Beyond evidence: the moral case for international mental health. Am. J. Psychiatry 2006; 163(8): 1312–1315.
Porter R. Can the stigma of mental illness be changed? Lancet 1998; 352(9133): 1049–1050.
Prince M, Patel V, Saxena S, et al. No health without mental health. Lancet 2007; 370(9590): 859–877.
Rose D. Users' Voices, The Perspectives of Mental Health Service Users on Community and Hospital Care. London: The Sainsbury Centre; 2001.
Sachs JD and McArthur JW. The Millennium Project: a plan for meeting the Millennium Development Goals. Lancet 2005; 365(9456): 347–353.
Saraceno B, Van OM, Batniji R, et al. Barriers to improvement of mental health services in low-income and middle-income countries. Lancet 2007; 370(9593): 1164–1174.
Sartorius N and Schulze H. Reducing the Stigma of Mental Illness. A Report from a Global Programme of the World Psychiatric Association. Cambridge: Cambridge University Press; 2005.
Sayce L and Curran C. Tackling social exclusion across Europe. In Knapp M, McDaid D, Mossialos E and Thornicroft G (Eds.). Mental Health Policy and Practice Across Europe. The Future Direction of Mental Health Care. Milton Keynes: Open University Press; 2006.
Shorter E. A History of Psychiatry. New York: John Wiley & Sons, Inc.; 1997.
Slade M and Hayward M. Recovery, psychosis and psychiatry: research is better than rhetoric. Acta Psychiatr. Scand. 2007; 116(2): 81–83.
Soanes C and Stevenson A. Concise Oxford English Dictionary, 11th edn. Oxford: Oxford University Press; 2003.
Social Exclusion Unit. Mental Health and Social Exclusion. London: Office of the Deputy Prime Minister; 2004.
Thornicroft G and Rose D. Mental health in Europe. BMJ 2005; 330(7492): 613–614.
Thornicroft G. Shunned: Discrimination against People with Mental Illness. Oxford: Oxford University Press; 2006.
Tugwell P, Robinson V, Grimshaw J and Santesso N. Systematic reviews and knowledge translation. Bull. World Health Organ. 2006; 84(8): 643–651.
United Nations. International Covenant on Civil and Political Rights. Adopted by the UN General Assembly Resolution 2200A (XXI) of 16 December 1966. New York: United Nations (http://www.ohchr.org/english/countries/ratification/4.htm); 1966.
United Nations. International Covenant on Economic, Social and Cultural Rights. Adopted by UN General Assembly Resolution 2200A (XXI) of 16 December 1966. New York: United Nations; 1966.
United Nations. Persons with Disabilities. General Comments Number 5 (Eleventh Session 1994). UN Doc E/C 12/1994/13. UN Committee on Economic, Social and Cultural Rights. New York: United Nations; 1994.
United Nations. UN Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care. Adopted by UN General Assembly Resolution 46/119 of 18 February 1992. New York: United Nations; 1992.
United Nations. Universal Declaration of Human Rights. Adopted and Proclaimed by the UN General Assembly Resolution 217A (III) of 10 December 1948. New York: United Nations; 1948.
Vale L, Thomas R, MacLennan G and Grimshaw J. Systematic review of economic evaluations and cost analyses of guideline implementation strategies. Eur. J. Health Econ. 2007; 8(2): 111–121.
Van Herten LM and Gunning-Schepers LJ. Targets as a tool in health policy. Part I: Lessons learned. Health Policy 2000; 53(1): 1–11.
Van Herten LM and Gunning-Shepers LJ. Targets as a tool in health policy. Part II: Guidelines for application. Health Policy 2000; 53(1): 13–23.
Wang PS, Aguilar-Gaxiola S, Alonso J, et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 2007; 370(9590): 841–850.
Whittle C. Introduction to ICPs (Integrated Care Pathways). http://www.library.nhs.uk/pathways/ViewResource.aspx?resID=259106&tabID=290&catID=12584. London: National Health Service Protocols and Care Pathways Specialist Library; 2007.
Woolf SH, Grol R, Hutchinson A, Eccles M and Grimshaw J. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ 1999; 318(7182): 527–530.
World Health Organisation. WHO Resource Book on Mental Health, Human Rights and Legislation. Geneva: World Health Organisation; 2005.