The Integration of Mental Health Care in Rural Iran

Iran’s rural mental health care system emerged in a context that included experiments in health care prior to the 1979 Revolution and the establishment of a primary health care (PHC) system after the Revolution. Beginning in the 1980s, Iran integrated mental health care into the existing PHC system by treating mental illness much like a communicable disease. Iran advanced treatment options compatible with the existing system, added new training for existing care providers, and incorporated specialists. The integration of mental health care led to the rapid improvement of health outcomes. The integration also created the unintended consequence of privileging pharmaceutical treatments and overlooking mental illnesses affected by somatization.     

The Americans With Disabilities Act and Medical Providers: Ten Years After Passage of the Act

This article discusses the impact of the Americans With Disabilities Act (ADA) on health care providers in the last decade. Even though some ADA training has been provided for health care providers, more education will help to improve access to their offices, improve health care practices for their patients with disabilities, and be an incentive for the providers to help raise the consciousness of the rest of the community about the ADA.     

Is There a National Policy For Children and Youth With Serious Emotional Disturbance?

This article examines the status of a national mental health policy for children in need of mental health services. The need for systems planning and services integration involving multiple agencies is presented. The different programs of the major governmental agencies involved in the delivery of services to children are reviewed, as are the range of services provided. This article demonstrates the fragmentation and duplication that is endemic in all aspects of mental health, and that consequently makes policy implementation exceedingly difficult.     

Interaction during mental health floating support home visits: managing host–guest and professional–client identities in home-spaces

Mental health work has been transformed by ‘shifting geographies of care’ from institutions to care in communities, in particular by the emergence of support located within home-spaces. This article studies a floating support service targeted at people with mental health problems and contributes to research on post-institution and home care geographies. The data contain 17 audio-recorded home visits conducted by professional care workers. An ethnomethodological analysis informed by geographies of care in home-spaces shows how the home as a material space has consequences for conversations and the relations between the service users and workers. The parties orient to two relational and shifting identity pairs in their ‘home-space talk’: a host–guest pair (social call talk) and a professional–client pair (targeted intervention talk). Professional–client pair dominates, and in this sense floating support produces institutionalization of home-spaces. However, social call talk that enables service users to act as hosts governing their home-spaces has important functions. Orientations to hosts and guests create symmetry and trust among the parties that encourages recovery promoting interaction. The article also demonstrates the applicability of the methods developed in the geographies of mental health and home in the ethnomethodological interaction analysis, and the other way round.     

从精神健康看美国华人的文化适应

华人作为美国的一个少数族群,其精神健康状况总体上好于当地主体族群,而其应对方式却较为独特。美国华人应对精神健康问题的态度与方式,从某些侧面反映了他们对主流社会文化的适应情况。作者认为,华人的“选择性同化策略”使他们在一定程度上减缓了主流社会的文化压力,并保持了较为良好的精神健康状态。     

The Meaning of Normality: the controversy about the mental health campaign in Sweden 1969

At the height of the Swedish welfare society, a campaign with the aim of promoting mental health issues within the Swedish labour market was launched. The title and purpose of the campaign, ‘Mental health – an action of increased understanding and solidarity at work’, was to illuminate mental health issues at work. Surprisingly to the organizers, the mental health campaign stirred up major opposition, especially from the political left. The idea of mental hygiene in an industrial and workplace setting, a cross-breed between the values of the Human Relations School and psychiatric science, was received with deep mistrust. The campaign caused an agitated debate in the media about power relations between employers and employees. The political disagreements were exposed in a number of articles in the daily newspapers and in the evening papers during the summer of that year. This article undertakes an investigation of the campaign literature and the media debate. The interpretation of the debate highlights different opinions about the meaning of normal mental health. Four different views of normality and mental health which demonstrate the complexity of the issue are presented. Mental health could mean adjustment and harmony, it could be a medical weapon to suppress the working class, it could even mean a neutral state of absence of mental problems, or lastly it could be a claim for the right to live a normal life.     

From ‘Invisible Problem’ to Global Priority: The Inclusion of Mental Health in the Sustainable Development Goals

Perceptions regarding the importance of mental health are shifting at a global level. Once described as an ‘invisible problem’ in international development, mental health is now being framed as one of the most pressing development issues of our time. Concern over the historical absence of mental health from the development agenda — despite its being regarded as a major obstacle to development — has led to its recent inclusion in the UN Sustainable Development Goals (SDGs). This article critically examines three intersecting axes key to its inclusion in the SDGs: 1) the conceptualization and calculation of the contribution of mental disorder to the global burden of disease; 2) the quantification of mental disorder as an economic burden; and 3) the relationship between mental distress and poverty. The article highlights the urgent need to foster a more nuanced understanding of the interplay between mental health and development, and shows how, at times, interventions in the two fields work together in producing reductionist, economistic, individualized and psychologized responses to poverty.     

Mental Health in the Elderly

Abstract

Increase in life expectancy, together with a reduction in fertility, is causing unprecedented changes in the age structure of the world population. The importance of age-related diseases, mental illness among them, is increasing – in the developed countries, some 25% of the elderly population suffer from mental disorder. This review delineates the factors – social, behavioural, physical, economic, genetic – contributing to severe forms of mental disorder, particularly Alzheimer's disease, cerebrovascular dementia and depression, and discusses recent technological advances. The interaction of physical and mental health is also discussed.     

复杂理论视角下城市健康地理学探析

城市公共健康问题是根植于所依托的地域空间背景下的复杂问题,因而,目前学界主要以还原论的模型假设来分析影响城市健康的复杂多因子关系时存在一定局限。本文在分析城市健康地理问题的"地方"复杂性基础上,提出用复杂理论认识城市的健康问题,将城市健康地理系统看作为具有开放性、组分的知识局限性、自组织性、路径依赖、涌现性、正反馈和锁定特征的复杂系统。从复杂理论视角探讨了当前城市健康地理学研究的三个主要议题,进而提出复杂理论视角下城市健康地理学研究框架及未来研究展望。     

Social and Spiritual Capital: Building ‘Emotional Resilience’ In Communities and Individuals

Abstract

The article examines the relationship between mental health, mental health promotion, religious communities and general issues of public health. It begins with an exploration of what is meant by mental health drawing a distinction between it, mental illness and mental health promotion, and argues that mental health can have a profound impact on physical health. The relationship between religious communities and the mentally ill is analysed next. Despite the attitudes of many in mental health provision, religious communities can offer a supportive environment for the mentally ill. The article avoids a ‘faith communities—good’, ‘mental health services—bad’ dichotomy, recognizing that religious communities can be excluding and discriminatory. The ambiguity of some experiences is recognized: are they forms of religious experience or symptoms of psychosis? The article highlights the inceasing advocacy of the user/survivor movement. In the final section, the relationship between mental health and public health is explored. It is suggested that religious communities can be places for the promotion of mental health. Mental health promotion is understood as aiming to strengthen both individuals and communities; its value is explored in relation to public health issues. It is suggested that those who are socially excluded are at a greater risk of some form of mental illness and that this may well impact on their physical health. Related to this are the beneficial effects of opportunities for participation in decision making, be it in the workplace or the local community. The article ends by arguing that service providers and service users need to be involved in decisions and planning. Further, some elements of mental health promotion will need to involve those outside the statutory sector.     

Rural mental health and social geographies of caring

This paper contributes to an emerging geographical literature on the social geographies of caring. Drawing on recently undertaken empirical work in the Scottish Highlands, personal accounts about the provision of both formal and informal care for people with mental health problems are evaluated. The notion of ‘community care’ is critiqued, as too are claims about how rural and remote rural locations engender particular configurations of caring roles, practices and relations. It is shown that geographical distance, social proximity, stoic cultures and rural gossip networks all have a part to play in how caring occurs in such places. The paper concludes by suggesting areas of future research.     

Bishop Bickersteth’s Visitation Returns for the Archdeaconry of Craven,Diocese of Ripon, 1858

Abstract

In 1868, an article in the Yorkshire Post about the West Riding Pauper Lunatic Asylum drew attention to Yorkshire's pivotal role in the history of mental health care. It was because of this history, it was claimed, that Yorkshiremen had a special interest in the treatment of the insane. The purpose of this paper is to explore critically this assumption in light of the recent work on the Poor Law's relationship with the asylum. The growth and development of two asylums in the neighbouring North and West Ridings of Yorkshire will be compared and contrasted. The first part of the paper offers a brief explanation of Yorkshire's pivotal role in the history of the institutional approach to the problems of mental health and the growth of institutions in the counties. Central to the paper will be an examination of how each county responded to the differing demands on its resources and how this impacted on the nature of care at each institution. Ultimately, this paper aims to show how Poor Law finances contributed significantly to the development of each institution.     

An Undiscovered Victorian Institution of Care: A Short Introduction to the Cumberland and Westmorland Joint Lunatic Asylum

Interest surrounding the Victorian county asylum network and its treatment of mental illness has been, and still remains, somewhat substantial. This article will add to, and expand, the existing literature by redressing the geographical imbalance of previous institutional research. Asylum histories have centred upon establishments in prominent towns and cities, and on those with an importance to the evolution of the psychiatry profession, for example the York Retreat. Apart from the examinations of Lancashire and Yorkshire asylums, little exists in the far North of England. This article will specifically use the records of the Cumberland and Westmorland Joint Lunatic Asylum to show the experience of pauper patients from a rural, Northern locality. Particular attention will be paid to the circulation of patients in and out of the asylum to build a comprehensive picture of the nineteenth-century transferral of care. To fully understand the treatment of mental health in this period, one cannot solely look at the asylum, as it formed only one part of a whole system of care.     

An overview of women's health in the U.S. since the mid-1960 s

Women's health became intertwined with the second wave of feminism in the 1960s. The process and history of the interactions among physicians, feminists, health care consumers, activists, and politicians have brought women's health into the foreground of health research and curricular agendas in several ways. It identified major gaps in research and practice and initiated a critique of the current health care system at all levels; it originated from, and remains connected with, the non-medical community; it is interdisciplinary and requires interdisciplinary teams for research and clinical practice, as well as collaboration with colleagues in non-medical academic fields; it developed new curriculum focused on women's health; it emphasizes race, class, sexual orientation, and other diversities among women. The continuing presence of activists and feminist scholars will insure that health and science include women's needs to provide better health for all.     

Access anxiety: HIPAA and historical research

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) establishes new standards for the protection of private health information in the United States. The Privacy Rule, one of the specific regulatory provisions of the act, went into effect 14 April 2003 for covered health care providers, institutions, and businesses. The Privacy Rule directly affected medical archivists and their collections. It has significant implications for historians of health care, as well. The Privacy Rule is the first major regulation that protects the privacy of the deceased in perpetuity. It establishes requirements that researchers must satisfy in order to gain access to "individually identifiable health information" held by HIPAA-protected institutions. While these requirements will burden historians in some cases, the Privacy Rule could open up opportunities for well-prepared historians to work with a more extensive range of twentieth-century documents.     

国外健康地理学研究进展

传统医学地理学研究从自然生态学角度出发,着重探讨自然环境对人类身体健康的影响。随着社会经济的发展,自然环境对人类健康的作用逐渐减小,社会文化环境成为影响人类健康,特别是城市居民身体健康的主要因素。本文回顾了20世纪70年代社会文化转型以来,医学地理学研究的重点转向以社会文化视角探究社会文化环境对人们身体健康,特别是心理健康的影响,以及医学地理学向一门新的健康地理学转变的过程,并梳理了新的健康地理学理论和研究内容的变化,总结了当前学科存在的一些问题,最后对新时期我国健康地理学的发展提出了展望。     

Mental Health Policy Inquiry, Its Importance, and Its Rewards

This article suggests some characteristics of the field of mental health that might explain why political scientists and public policy analysts have evidenced little interest in the study of mental health policy. Following a brief overview of United States mental health policy, the author makes the case for the importance of menial health policy inquiry on grounds of both pragmatic and theoretical significance.     

A Model for Mental Health Needs and Resourcing in Small Geographic Areas: A Multivariate Spatial Perspective

This paper considers how small area variations in a set of psychiatric referral outcomes in a London health authority of 750,000 people may inform health need assessment and health resourcing for mental illness based on true need. As well as adopting a multivariate perspective, the spatial interdependence of the outcomes is included in the modelling approach outlined. By contrast, existing studies on mental health need tend to focus on single outcomes, and may not include spatial dependence. The analysis relates to three hospital referral outcomes for psychiatric conditions, and to total community mental health referrals across sixty‐seven electoral wards in East London.     

Health geography in Canada: where are we headed?

This paper overviews the emergence of medical/health geography in Canada. The paper discusses the key questions that Canadian health geographers have explored in the past two decades, how these enquiries have featured in the field and how they contribute to the wider discourse of human geography. It also addresses questions on emerging themes and where Canadian health geography will go in the years ahead. With shifting health landscapes in terms of changes in social, political and physical environments, and changes in health care restructuring, Canadian health geographers are entering a new phase of research, teaching and policy. The complexity of the questions that health geographers seek to address means it is necessary to continue to highlight the policy implications of their findings. Health geographers need to emphasize the public agenda through interdisciplinary research and by continuing to work with geographers in other subfields.     

Principles of Mental Health Systems Change

Policy development is of little moment if those policies are never implemented. In this article a governor who had considerable success in implementing major changes in the mental health delivery system of his state suggests seven principles of successful policy implementation. The relevance, general utility, and applicability of these principles should be of interest to those political scientists who study issues related to policy implementation.