Mental Health and Prevention最新文献

This paper describes how knowledge from life-course research and community intervention studies can be integrated within community coalition models to inform a feasible national plan to measurably prevent and reduce mental and behavioral disorders. In many nations, including Australia, mental and behavioral disorders are increasing in child and youth populations, forewarning of increased future disorders. There is limited evidence that treatment interventions can turn the tide. However, we argue here that universal (whole population) and selective (group targeted) preventative interventions are feasible, effective, and cost-effective for reducing child and adolescent mental and behavioral disorders. Modifiable risk factors (causal or associational predictors) and protective factors (risk modifiers) have been identified across diverse settings (e.g., family, school, and community). As no single factor is solely responsible for the development of child and adolescent mental and behavioral disorders, a multi-factor intervention approach is required. Given communities vary in their profile of child and adolescent mental and behavioral disorders, and local risk and protective influences, tailoring prevention strategies to community conditions is essential. We present here the ‘Communities That Care’ model as a feasible community coalition training approach, scalable to cost-effectively prevent and reduce child and adolescent mental and behavioral disorders across large populations. The Communities That Care model comprises five phases that sequentially prepare and formalize a community coalition, assist a needs assessment, strategically planned implementation, and evaluation. Australian evaluations demonstrate that municipal completion of the model achieves youth-reported improvements in substance use, behavior problems and risk and protective factors. Archival data analyses associate municipal completion with annual reductions of above 8 % per annum in child and adolescent injury hospitalization and in reduced police reports of youth crime (5 % pa) and violence (2 % pa). Despite its excellent credentials, the Communities That Care model is presently under-utilized for the prevention of mental and behavioral disorders. To immediately reduce the crisis of increasing child and adolescent mental and behavioral disorders, we advocate for increased funding for the national implementation and evaluation of community coalition models, with a requirement that alternative models should be evaluated against current best-practice as incorporated in the Communities That Care model.

Background

Child mental health conditions in Australian children continue to be a major concern with high prevalence rates, and amplified by the COVID pandemic. Given a minority of children receive professional help, universal platforms such as primary schools are increasingly recognized as having an important role in supporting children's mental health. International studies suggest that schools are largely ill-equipped to support children's mental health, and little research explores the views of primary school staff.

Purpose

This qualitative study aims to examine the challenges faced by primary school staff in identifying and supporting students with mental health difficulties.

Methods

We carried out interviews and focus groups with 56 school staff, including teachers, well-being officers, leadership staff and departmental psychologists, from 25 primary schools across the state of Victoria, Australia. All interviews were transcribed and analyzed using thematic analysis.

Results

The key theme that emerged was that teachers lack the capacity, skills, confidence and resources to recognize and support children with mental health difficulties. A lack of staff resourcing and onsite support from mental health professionals, together with contributing student family issues, imposes a major challenge in addressing children's mental health needs.

Conclusions

Our findings indicate that teachers, and primary schools more broadly, are struggling to support children with mental health difficulties. There is a pressing need to consider how to build the capacity of primary school teachers and schools to enable them to play an active role in supporting children's mental health and well-being.

The population's mental health - their ability to handle emotions, think rationally, control their behavior, and maintain good relations with others - is a county's most important resource. Failing ability to do so, causes a country's most burdensome illnesses, mental distress and mental disorder, and hinders optimal utilization of other resources. In Norway, prevalence of mental illness is similar to that of other rich countries. Cost of mental illness corresponds to four times the cost of running the armed forces. In working age, loss of health from mental illness is greater than from all somatic non-communicable illness together, and loss of healthy life years is comparable to that of all cancers together. More treatment cannot curb this. Prevention is the only way out. Based on known risk and protecting factors, thirteen strategic principles for an effective prevention plan are presented together with the new Norwegian escalation plan for mental health 2023–2033. Four evidence-based priorities are recommended: universal mental health screening in pregnancy and early motherhood, mandatory guidance of all new day-care center teachers, mental health as a separate subject in school, and employment for all. Finally, with reference to human rights, seven mental health rights are suggested to assure that all organizations become mental health promoting.

Objective

The study objective is to determine the effectiveness of the suicide prevention program (SPP) on knowledge, attitude, and gatekeeper behaviour among teachers of Pre University colleges.

Method

This is a randomized controlled study, divided into two phases with assessments at baseline, one month, three months, and six months. A descriptive cross-sectional survey will be conducted in Phase-I among all teachers of first-year Pre-University courses of Udupi using the Literacy of Suicide Scale (LOSS), Attitude Towards Suicide Prevention (ATSP) scale, and Gatekeeper Behavior Scale (GBS). The participants who score below 75 % in the knowledge domain in Phase I will be recruited into Phase II. Pre-University colleges will be assigned to intervention and control groups by cluster randomization. Based on the types of colleges (Unaided, aided, and government), a proportionate sampling technique will be adopted to recruit 62 participants into each group. A ten-hour workshop on suicide prevention program (SPP) will be conducted for the intervention group. An information booklet on suicide prevention will be provided to the control group after the third follow-up (six months). The data will be analyzed statistically.

Expected results

If the study results demonstrate statistical superiority of the intervention group over the control group in improving the knowledge, attitude, and gatekeeper behaviour on suicide prevention, it could enable the Pre-University teachers to implement the SPP.

Conclusion

The present study results may support the implementation of the SPP.

Trial registration number

CTRI/2022/09/045819.

The global burden of Common Mental Disorders (CMDs), including depressive, anxiety and substance use disorders, is substantial. Since increased treatment has not reduced CMD prevalence, prevention is a logical approach to reduce CMD burden. However, CMD prevention as currently delivered has not reduced prevalence. Seven conditions need to be met to maximize the long-term effectiveness of CMD prevention: 1. Target young persons early in life and families. 2. Modify major CMD risk and protective factors. 3. Embed in social institutions and culture. 4. Implement via synergistic programs of proven effectiveness in multiple community settings (pre-school and kindergarten, elementary and secondary schools, child and health care, social welfare/family support). 5. Secure long-term funding with permanent, structural integration into community organizations. 6. Address socio-economic disadvantage and attendant risk factors. 7. Use the power of policy. We consider how these conditions might be achieved in large populations. A dilemma is that compelling evidence regarding the benefits of CMD prevention may be needed to motivate large, long-term investments, but until society has made and sustained these investments for 10 to 20 years, full benefits of CMD prevention may not be realized. Therefore, we propose regional implementation and evaluation focused initially on proximal benefits for child development. Developmental determinants important to educators, parents and other stakeholders should be evaluated initially to establish short-term pay-offs for educational and behavioral outcomes. Long-term CMD prevention initiatives may not only prevent CMDs, but also develop resourceful, resilient, and well-educated children and adults.

Objective

Virtual reality (VR) relaxation has been implemented in workplaces for staff wellbeing. However, little is known about potential benefits for mental health staff who work in challenging settings who can experience high stress levels and poor wellbeing.

Methods

This study evaluated implementation of a single-session VR relaxation intervention for staff in complex care mental health settings. Pre- and post-VR visual analogue scales (VAS) explored the effect of VR on wellbeing. Post-VR, VAS on helpfulness and immersiveness were recorded, participants planned a behavioural activity to explore the real-world application of VR relaxation, and narrative feedback was collected.

Results

Participants (N = 22) were mostly of Black ethnicity, in their early forties, and just over half were female. There was an even mix of outpatient and inpatient staff from various professions. Most were nurses, occupational therapists, or doctors. Post-VR, for the total sample, there were significant increases in relaxation, happiness, connectedness to nature (all d>1.00 and p<0.00); and decreases in stress, anxiety (both d>1.00 and p<0.00) and sadness (d = 0.53, p = 0.02). There was no significant effect of sadness for outpatient staff, whereas inpatient staff experienced a significant decrease post-VR (d = 68, p = 0.03). Mean helpfulness and immersiveness ratings were high. All participants planned a behavioural activity, and 15 participants (68 %) carried it out. Participants found the VR intervention to be relaxing, soothing, exciting and an immersive respite from work.

Conclusion

The positive findings indicate potential for wider implementation of VR-based wellbeing interventions in mental health settings and other workplaces where staff experience high stress levels.

The global burden of mental disorders is increasing, in line with the shift from communicable to chronic non-communicable diseases. Mental disorders affect the functioning of individuals, resulting not only in enormous emotional suffering and diminished quality of life, but also in stigma and discrimination. This burden extends to the community and society, with far-reaching economic and social consequences. Even under optimal conditions, treatment alone will never be sufficient to reduce the global burden of mental disorders, so a shift in focus from treatment to prevention of mental disorders should be promoted at the central level in the form of legislation, policy formulation and resource allocation. Universal and selective prevention programs should be prioritized nationally, as they aim to change the risk profile of the entire population and specifically target populations at risk for mental disorders, respectively. In this article, we review the key risk factors for mental disorders and the measures that can be taken at the national level to prevent them, taking into due consideration that prevention efforts can vary based on the audience they are addressing, level of intensity they are providing, and the life phase they target. By adopting a human rights perspective and placing the social determinants of health at the center of our narrative, we maintain that improving mental health cannot be achieved by strengthening health services alone. Coordination across government departments is needed to implement multi-level public health interventions across a wide range of settings, programs, and policies. Focusing on children's mental health and addressing poverty, gender inequality and social discrimination should be absolute priorities for national mental health policies and plans.

Background

Male engagement with public health programming, especially around stigmatised issues, is often low, which may have adverse health outcomes. Eyethu, a behavioural intervention delivered using soccer to reduce multiple risks associated with HIV and substance use among young men, was shown in a randomised trial to be ineffective. This study explored the trial's null findings to identify considerations for future male-targeted programming tackling multiple risks concurrently. We explored trial participants’ perceptions of factors influencing engagement and effectiveness.

Methods

The descriptive, qualitative sub-study was nested within the RCT, conducted in two peri-urban townships outside Cape Town. Data was collected post-intervention, in November-December 2020. In-depth interviews, at a single timepoint, were conducted with individuals (n = 30) who had participated in the RCT. Data were analysed using thematic analysis.

Results

Three major themes emerged from the data: 1) participants’ positive perceptions of the programme's impact, despite the trial's null results; 2) reflections on the intervention's mechanisms, related to its impact on group cohesion, and 3) perceptions of contextual factors influencing intervention engagement and effectiveness.

Conclusion

Behavioural interventions that are embedded in communities and utilise sport to influence health-related outcomes have the potential to expand knowledge, foster social capital, and offer platforms for positive, meaningful connections for young men exposed to multiple adversities. However, these programmes need to be sustained over time to effectively enable behaviour change to take hold and be sustained when implemented with other environmental constraints.