International Journal of Mental Health Systems

Similar to other health care sectors, mental health has moved towards the secondary prevention, with the effort to detect and treat mental disorders as early as possible. However, converging evidence sheds new light on the potential of primary preventive and promotion strategies for mental health of young people. We aimed to reappraise such evidence.

Marco Colizzi

Antonio Lasalvia

Mirella Ruggeri

Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care?

青少年心理健康的预防与早期干预：是否到了采用多学科和跨诊断模式进行护理的时候？

Effective mental healthcare coverage (EMHC) is an important health system performance indicator of a population's mental healthcare needs. This study aims to assess the factors and healthcare costs associated with the receipt of EMHC for anxiety and depression. This study draws on data from participants from Alberta's Tomorrow Project with moderate or severe symptoms of anxiety and depression during the first wave of the COVID-19 pandemic (2020) with available medico-administrative and complete data [n = 720]. EMHC was assessed during the eighteen months as of March 1, 2020, and defined as adequate pharmacotherapy (i.e., antidepressant dispensed, with ≥ 80% proportion of days covered and 4 follow-up medical visits) and/or adequate psychotherapy (≥ 8 physician consultations for psychotherapy) depending on the severity of symptoms. Logistic regression analysis was used to study EMHC as a function of study variables. Regressions with augmented inverse probability weighting were used to estimate the total healthcare costs attributable to receipt of EMHC during the first 18-month period of the pandemic, controlling for confounders. Mean adjusted differences with 95% bias-corrected bootstrap confidence intervals (CIs) are presented. The proportion receiving EMHC was 26.7%. Individuals with worse self-rated mental health after the pandemic than before were less likely to receive EMHC. Those with a lifetime diagnosis of depression and anxiety were more likely to receive EMHC. The overall mean adjusted total healthcare costs attributable to receipt of EMHC during the pandemic was $2601 [ – $247, $5694]. The mean adjusted outpatient costs attributable to EMHC was significantly higher and reached $1613 [$873, $2577]. The study's findings highlight the existence of health inequalities and potential unmet mental health needs in individuals with worsening mental health during the pandemic. The receipt of EMHC during the pandemic was not significantly associated with increased total healthcare costs. These findings underscore the need for mental health policies that are aimed at improving timely access to EMHC to address population unmet mental health service needs.

Helen-Maria Vasiliadis

Pasquale Roberge

Grace Shen-Tu

Jennifer Vena

Healthcare costs associated with receipt of effective mental healthcare coverage in individuals with moderate or severe symptoms of anxiety and depression

与中重度焦虑和抑郁症状患者获得有效心理健康保障相关的医疗费用

Abstract Background Stigma and discrimination towards people with mental health conditions by their communities are common worldwide. This can result in a range of negative outcomes for affected persons, including poor access to health care. However, evidence is still patchy from low- and middle-income countries (LMICs) on affordable, community-based interventions to reduce mental health-related stigma and to improve access to mental health care. Methods This study aims to conduct a feasibility (proof-of-principle) pilot study that involves developing, implementing and evaluating a community-based, multi-component, awareness-raising intervention (titled Indigo-Local), designed to reduce stigma and discrimination and to increase referrals of people with mental health conditions for assessment and treatment. It is being piloted in seven sites in five LMICs—China, Ethiopia, India, Nepal and Tunisia—and includes several key components: a stakeholder group workshop; a stepped training programme (using a ‘Training of Trainers’ approach) of community health workers (or similar cadres of workers) and service users that includes repeated supervision and booster sessions; community engagement activities; and a media campaign. Social contact and service user involvement are instrumental to all components. The intervention is being evaluated through a mixed-methods pre-post study design that involves quantitative assessment of stigma outcomes measuring knowledge, attitudes and (discriminatory) behaviour; quantitative evaluation of mental health service utilization rates (optional, where feasible in sites); qualitative exploration of the potential effectiveness and impact of the Indigo-Local intervention; a process evaluation; implementation evaluation; and an evaluation of implementation costs. Discussion The output of this study will be a contextually adapted, evidence-based intervention to reduce mental health-related stigma in local communities in five LMICs to achieve improved access to healthcare. We will have replicable models of how to involve people with lived experience as an integral part of the intervention and will produce knowledge of how intervention content and implementation strategies vary across settings. The intervention and its delivery will be refined to be feasible and ready for larger-scale implementation and evaluation. This study thereby has the potential to make an important contribution to the evidence base on what works to reduce mental health-related stigma and discrimination and improve access to health care.

Maya Semrau

Petra C. Gronholm

Julian Eaton

Pallab K. Maulik

Bethel Ayele

Ioannis Bakolis

Gurucharan Bhaskar Mendon

Kalpana Bhattarai

Elaine Brohan

Anish V. Cherian

Mercian Daniel

Eshetu Girma

Dristy Gurung

Ariam Hailemariam

Charlotte Hanlon

Andy Healey

Sudha Kallakuri

Jie Li

Santosh Loganathan

Ning Ma

Yurong Ma

Amani Metsahel

Uta Ouali

Nahel Yaziji

Yosra Zgueb

Wufang Zhang

Xiaotong Zhang

Graham Thornicroft

Nicole Votruba

Reducing stigma and improving access to care for people with mental health conditions in the community: protocol for a multi-site feasibility intervention study (Indigo-Local)

减少社区中精神健康状况患者的污名化并改善其就医途径：多地点可行性干预研究（靛蓝-本地）方案

Abstract Background Access to traditional mental health services in Canada remains limited, prompting exploration into digital alternatives. The Government of Ontario initiated access to two internet-based cognitive behavioral therapy (iCBT) programs, LifeWorks AbilitiCBT and MindBeacon TAiCBT, for adults with mental health issues. Methods An uncontrolled observational study utilizing secondary retrospective program data was conducted to evaluate the reach, uptake, and psychological symptom changes among participants engaging with either iCBT program. Results Between May 2020 and September 2021, 56,769 individuals enrolled in LifeWorks AbilitiCBT, and 73,356 in MindBeacon TAiCBT. However, substantial exclusions were made: 56% of LifeWorks participants and 68% of MindBeacon participants were ineligible or failed to initiate treatment. Consequently, 25,154 LifeWorks participants and 23,795 MindBeacon participants were included in the analysis. Of these, 22% of LifeWorks and 26% of MindBeacon participants completed over 75% of iCBT treatment. On average, LifeWorks participants received 13 ± SD 7.1 therapist messages and sent 5 ± SD 10.3 messages, while MindBeacon participants received 25 ± SD 20.7 therapist messages and sent 13 ± SD 16.4 messages. LifeWorks included synchronous therapist contact averaging 1.4 ± SD 1.9 h per participant, while MindBeacon was purely asynchronous. Baseline severity of anxiety (37%) and depression symptoms (22%) was higher for LifeWorks participants compared to MindBeacon participants (24% and 10%, respectively). Clinically significant changes in anxiety and depression scores were observed: 22% of LifeWorks and 31% of MindBeacon participants exhibited reliable recovery in PHQ-9 scores, while 26% of LifeWorks and 25% of MindBeacon participants demonstrated reliable recovery in GAD-7 scores. Conclusion In conclusion, iCBT programs show promise for engaged participants with varying levels of severity in anxiety and depression symptoms. Future iterations of iCBT should consider adopting a broad entry criterion to iCBT programming to increase accessibility, especially for those with severe symptoms, alongside integrated intake care pathways, and potential payment structure adjustments for iCBT service providers. Taken all together, these factors could temper high dropout rates post-intake assessment. This evaluation underscores the potential and value of digital mental health interventions for individuals with mild to severe anxiety or depression symptoms, emphasizing the importance of addressing participant dropout.

Bilal Noreen Khan

Rebecca H. Liu

Cherry Chu

Blanca Bolea-Alamañac

Megan Nguyen

Serena Thapar

Roz Fanaieyan

Marisa Leon-Carlyle

Mina Tadrous

Paul Kurdyak

Anne O’Riordan

Maggie Keresteci

Onil Bhattacharyya

Reach, uptake, and psychological outcomes of two publicly funded internet-based cognitive behavioural therapy programs in Ontario, Canada: an observational study

加拿大安大略省两个公共资助的基于互联网的认知行为疗法项目的覆盖范围、接受程度及心理结果：一项观察性研究

We set out to assess the appropriateness of current placement of mentally disordered offenders allocated by the courts in Italy to REMS or to forensic community residences. We hypothesised that as in other countries, the match between a standardised assessment and the decision of the court would be imperfect. The DUNDRUM Toolkit was translated into Italian. The translation had good psychometric properties. In order to compare the current level of therapeutic security with a calculated safest current placement, we compared the DUNDRUM-1 triage security assessment of need for therapeutic security prior to treatment, with evidence for progress made in treatment (DUNDRUM-3) and forensic recovery (DUNDRUM-4). The more conservative of these two would be taken as the safe current level of need for therapeutic security. The Italian translation of the DUNDRUM Toolkit had good internal consistency and mean scores had a Reliable Change Index less than one unit. 3.7% of those in REMS (medium security) were assessed as needing high security and 38% were ready to move to a less secure place. In low secure places, 56% were assessed as needing a higher level of therapeutic security and 6% could have moved to open non-secure places. The Italian translation of the DUNDRUM Toolkit allows an assessment of the current working of the model of care for forensic psychiatry following the reforms of 2015. Most patients are safely placed. A small but important proportion needed high secure places that are not currently available. (3.7% of 604 nationally, 95% Confidence Interval 1.2% to 8.4%, 7 to 50). A greater use of such measures would enable better health gains and safer outcomes. Trial registration ClinicalTrials.gov ID: NCT06018298 Unique Protocol ID: ITAL-EE-REMS.

Lia Parente

Fulvio Carabellese

Alan Felthous

Donatella La Tegola

Mary Davoren

Harry G. Kennedy

Felice F. Carabellese

Italian Evaluation and Excellence in REMS (ITAL-EE-REMS): appropriate placement of forensic patients in REMS forensic facilities

意大利REMS评估与卓越计划（ITAL-EE-REMS）：法医病人在REMS法医设施中的适当安置

Pakistan faces profound mental health challenges, which necessitate the urgent need for a comprehensive assessment of its mental healthcare system. A holistic understanding of the mental health landscape is essential to identify strengths, weaknesses, and existing gaps within the system, which can inform targeted interventions and policy enhancements to improve mental healthcare accessibility. The primary objective of this desk research is to conduct an in-depth analysis of Pakistan's mental healthcare system across various dimensions, guided by the World Health Organization's Assessment Tool for Mental Health Systems (WHO-AIMS). Data for this desk research and scoping was obtained through desk research, including an examination of existing policies and legislation and consultations with various health facilities across Pakistan. This comprehensive analysis focused on six critical domains within the WHO-AIMS framework: policy and legislation, mental health services, integration of mental health into primary care, public awareness and collaboration with other sectors, human resources, and monitoring and research initiatives. The findings provides a snapshot of strength and opportunities for improvement in Pakistan's mental healthcare system that can serve as the foundation for revising and updating national priorities. Key areas of focus include enhancing policy and legislation, expanding access to mental health services, improving existing initiatives for better integration of mental health into primary care, improving public awareness and sector collaboration, addressing human resource challenges, and strengthening monitoring and research initiatives. This desk research provides a roadmap for refining and enhancing Pakistan's mental health ecosystem and informs the prioritization of mental health campaigning efforts.

Komal Dayani

Mekaiel Zia

Onaiza Qureshi

Maria Baig

Taha Sabri

Evaluating Pakistan’s mental healthcare system using World Health Organization’s assessment instrument for mental health system (WHO-AIMS)

使用世界卫生组织心理健康系统评估工具评估巴基斯坦的心理健康保健系统

Abbreviation	Int. J. Ment. Health Syst.
Journal Impact	3.08
Quartiles(Global)	PSYCHIATRY(Q2)

ISSN	1752-4458
h-index	52

Publication Information	Publisher: BioMed Central Ltd，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2007，Proportion of original research papers: 81.03%，Self Citation Rate:0.00%， Gold OA Rate: 99.47%
Journal Fees	$3390Details
Average review cycle	网友分享经验：13 Weeks

International Journal of Mental Health Systems

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Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care?

Healthcare costs associated with receipt of effective mental healthcare coverage in individuals with moderate or severe symptoms of anxiety and depression

Reducing stigma and improving access to care for people with mental health conditions in the community: protocol for a multi-site feasibility intervention study (Indigo-Local)

Reach, uptake, and psychological outcomes of two publicly funded internet-based cognitive behavioural therapy programs in Ontario, Canada: an observational study

Italian Evaluation and Excellence in REMS (ITAL-EE-REMS): appropriate placement of forensic patients in REMS forensic facilities

Healthcare costs associated with receipt of effective mental healthcare coverage in individuals with moderate or severe symptoms of anxiety and depression

Reducing stigma and improving access to care for people with mental health conditions in the community: protocol for a multi-site feasibility intervention study (Indigo-Local)

Reach, uptake, and psychological outcomes of two publicly funded internet-based cognitive behavioural therapy programs in Ontario, Canada: an observational study

Italian Evaluation and Excellence in REMS (ITAL-EE-REMS): appropriate placement of forensic patients in REMS forensic facilities

Evaluating Pakistan’s mental healthcare system using World Health Organization’s assessment instrument for mental health system (WHO-AIMS)