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BMC Psychiatry
Published in: BMC Psychiatry 1/2018

Open Access 01-12-2018 | Research article

Policy development and challenges of global mental health: a systematic review of published studies of national-level mental health policies

Authors: Wei Zhou, Yu Yu, Mei Yang, Lizhang Chen, Shuiyuan Xiao

Published in: BMC Psychiatry | Issue 1/2018

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Abstract

Background

Mental health policy can be an essential and powerful tool to improve a population’s mental health. However, around one third of countries do not possess a mental health policy, and there are large disparities in population coverage rates between high- and low-income countries. The goal of this study is to identify the transition and implementation challenges of mental health policies in both high-income countries (HICs) as well as middle- and low-income countries (MLICs).

Methods

PubMed, Cochrane Library and Campbell Library were searched from inception to 31 December 2017, for studies on implemented mental health policies at the national level. Abstracts and the main texts of papers were double screened, and extracted data were analysed through thematic synthesis.

Results

A total of 93 papers were included in this study, covering 24 HICs, 28 MLICs and 5 regions. Studies on mental health policies, especially those of MLICs, kept increasing, but MLICs were still underrepresented in terms of publication quantity and study frequency. Based on the included studies, nine policy domains were summarized: service organizing, service provision, service quality, human resources, legislation and human rights, advocacy, administration, surveillance and research, and financing and budgeting. HICs incrementally enriched their policy content in all domains over centuries of development; following HICs’ experience, mental health policies in MLICs have boomed since the 1990s and quickly extended to all domains. Implementation problems in HICs were mainly related to service organizing and service provision; for MLICs, more severe implementation problems converged on financing and budgeting, administration and human resources.

Conclusions

Mental health policy developments in both HICs and MLICs present a process of diversification and enrichment. In terms of implementation, MLICs are faced with more and greater challenges than HICs, especially in funding, human resources and administration. Therefore, future efforts should not only be made on helping MLICs developing mental health policies, but also on promoting policy implementation under MLICs’ local context.
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Literature
1.
2.
Knapp M, McDaid D, Mossialos E, Thornicroft G, editors. Mental health policy and practice across Europe: the future direction of mental health care. Maidenhead: Open University Press; 2007.
3.
Grob GN. Mental health policy in the liberal state: the example of the United States. Int J Law Psychiatry. 2008;31:89–100.PubMedCrossRef
4.
Lurie S. Comparative mental health policy: are there lessons to be learned? Int Rev Psychiatry. 2005;17:97–101.PubMedCrossRef
5.
Haque A. Mental health concepts and program development in Malaysia. J Ment Health. 2005;2:183–95.CrossRef
6.
7.
Curran WJ. Hospitalization of the mentally IlI. North Carolina L Rev. 1953;31:274.
8.
Curran WJ. Comparative analysis of mental health legislation in forty-three countries: a discussion of historical trends. Int J Law Psychiatry. 1978;1:79–92.PubMedCrossRef
9.
Bertolote JM. Legislation related to mental health: a review of various international experiences. Rev Saude Publica. 1995;2:152–6. [Article in Portuguese]CrossRef
10.
Alarcon RD, Aguilar-Gaxiola SA. Mental health policy developments in Latin America. Bull World Health Organ. 2000;78:483–90.PubMedPubMedCentral
11.
Mosse P, Maury C, Daumerie N, Roelandt JL. Mental health in France, policies and actors: developing administrative knowledge in a segmented world. Int J Health Plann Manag. 2013;28:e242–55.CrossRef
12.
Hamid H, Abanilla K, Bauta B, Huang KY. Evaluating the WHO assessment instrument for mental health systems by comparing mental health policies in four countries. Bull World Health Organ. 2008;86:467–73.PubMedPubMedCentralCrossRef
13.
Draper CE, Lund C, Kleintjes S, Funk M, Omar M, Flisher AJ, et al. Mental health policy in South Africa: development process and content. Health Policy Plan. 2009;24:342–56.PubMedCrossRef
14.
15.
16.
Baker P, Friel S, Kay A, Baum F, Strazdins L, Mackean T. What enables and constrains the inclusion of the social determinants of health inequities in government policy agendas? A narrative review. Int J Health Policy Manage. 2017;2:101–11.CrossRef
17.
Reeve E, Thow AM, Bell C, Engelhardt K, Gamolo-Naliponguit EC, Go JJ, et al. Implementation lessons for school food policies and marketing restrictions in the Philippines: a qualitative policy analysis. Glob Health. 2018;1:8.CrossRef
18.
19.
Surles R, Mazade N. Federal policies which influence the planning of local community mental health programs. J Community Psychol. 1978;6:45–7.PubMedCrossRef
20.
Brown P. The transfer of care: U.S. mental health policy since world war II. Int J Health Serv. 1979;9:645–62.PubMedCrossRef
21.
Andrulis DP, Mazade NA. American mental health policy: changing directions in the 80s. Hosp Community Psychiatry. 1983;34:601–6.PubMed
22.
Merwin MR, Ochberg FM. The long voyage: policies for progress in mental health. Health Aff. 1983;2:96–127.CrossRef
23.
24.
25.
Bloche MG, Cournos F. Mental health policy for the 1990s: tinkering in the interstices. J Health Polit Policy Law. 1990;15:387–411.PubMedCrossRef
26.
Goldie N, Freden L. A ‘crisis’ of closure and openness: the present state of the Swedish mental health system in the light of a policy of sectorisation. Soc Sci Med. 1991;32:499–506.PubMedCrossRef
27.
Grob GN. Mental health policy in America: myths and realities. Health Aff. 1992;11:7–22.CrossRef
28.
29.
VandenBos GR. U.S. mental health policy: proactive evolution in the midst of health care reform. Am Psychol. 1993;48:283–90.PubMedCrossRef
30.
Levav I, Restrepo H, Guerra de Macedo C. The restructuring of psychiatric care in Latin America: a new policy for mental health services. J Public Health Policy. 1994;15:71–85.PubMedCrossRef
31.
Yfantopoulos J. Economic and legal aspects of mental health policies in Greece. Int J Soc Psychiatry. 1994;40:296–305.PubMedCrossRef
32.
Mandiberg JM. The Japanese mental health system and law: social and structural impediments to reform. Int J Law Psychiatry. 1996;19:413–35.PubMedCrossRef
33.
Pearson V. The Chinese equation in mental health policy and practice: order plus control equal stability. Int J Law Psychiatry. 1996;19:437–58.PubMedCrossRef
34.
Barbato A. Psychiatry in transition: outcomes of mental health policy shift in Italy. Aust N Z J Psychiatry. 1998;32:673–9.PubMedCrossRef
35.
Bindman J, Beck A, Glover G, Thornicroft G, Knapp M, Leese M, et al. Evaluating mental health policy in England: care programme approach and supervision registers. Br J Psychiatry. 1999;175:327–30.PubMedCrossRef
36.
McCulloch A, Muijen M, Harper H. New developments in mental health policy in the United Kingdom. Int J Law Psychiatry. 2000;23:261–76.PubMedCrossRef
37.
Silfverhielm H, Kamis-Gould E. The Swedish mental health system: past, present, and future. Int J Law Psychiatry. 2000;23:293–307.PubMedCrossRef
38.
Whiteford H, Thompson I, Casey D. The Australian mental health system. Int J Law Psychiatry. 2000;23:403–17.PubMedCrossRef
39.
Shera W, Aviram U, Healy B, Ramon S. Mental health system reform: a multi country comparison. Soc Work Health Care. 2002;35:547–75.PubMedCrossRef
40.
Simmons LA, Wright DW. National practice guidelines for mental health care: a comparative policy analysis of the United Kingdom and the United States. J Health Soc Policy. 2004;19:59–80.PubMedCrossRef
41.
42.
43.
Keste D, Lazeri L, Demi N, Severoni S, Lora A, Saxena S. Mental health system and services in Albania. Epidemiol Psichiatr Soc. 2006;15:194–201.PubMedCrossRef
44.
Jenkins R, Heshmat A, Loza N, Siekkonen I, Sorour E. Mental health policy and development in Egypt: integrating mental health into health sector reforms 2001-9. Int J Ment Heal Syst. 2010;4:17.CrossRef
45.
Kahng SK, Kim H. A developmental overview of mental health system in Korea. Soc Work Public Health. 2010;25:158–75.PubMedCrossRef
46.
Omar MA, Green AT, Bird PK, Mirzoev T, Flisher AJ, Kigozi F, et al. Mental health policy process: a comparative study of Ghana, South Africa, Uganda and Zambia. Int J Ment Heal Syst. 2010;4:24.
47.
Salvador-Carulla L, Costa-Font J, Cabases J, McDaid D, Alonso J. Evaluating mental health care and policy in Spain. J Ment Health Policy Econ. 2010;13:73–86.PubMed
48.
Faydi E, Funk M, Kleintjes S, Ofori-Atta A, Ssbunnya J, Mwanza J, et al. An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia. Health Res Policy Syst. 2011;9:17.PubMedPubMedCentralCrossRef
49.
Jenkins R, Mussa M, Haji SA, Haji MS, Salim A, Suleiman S, et al. Developing and implementing mental health policy in Zanzibar, a low income country off the coast of East Africa. Int J Ment Heal Syst. 2011;5:6.CrossRef
50.
Liu J, Ma H, He YL, Xie B, Xu YF, Tang HY, et al. Mental health system in China: history, recent service reform and future challenges. World Psychiatry. 2011;10:210–6.PubMedPubMedCentralCrossRef
51.
Munizza C, Gonella R, Pinciaroli L, Rucci P, Picci RL, Tibaldi G. CMHC adherence to National Mental Health Plan standards in Italy: a survey 30 years after national reform law. Psychiatr Serv. 2011;62:1090–3.PubMedCrossRef
52.
Abel WD, Kestel D, Eldemire-Shearer D, Sewell C, Whitehorne-Smith P. Mental health policy and service system development in the English-speaking Caribbean. West Indian Med J. 2012;61:475–82.PubMedCrossRef
53.
Banfield MA, Gardner KL, Yen LE, McRae IS, Gillespie JA, Wells RW. Coordination of care in Australian mental health policy. Aust Health Rev. 2012;36:153–7.PubMedCrossRef
54.
55.
Lora A. An overview of the mental health system in Italy. Annali dell'Istituto superiore di sanita. 2009;45:5–16.PubMed
56.
Puzynski S, Moskalewicz J. Evolution of the mental health care system in Poland. Acta Psychiatr Scand. 2001;104:69–73.
57.
Roberts M, Mogan C, Asare JB. An overview of Ghana’s mental health system: results from an assessment using the World Health Organization's assessment instrument for mental health systems (WHO-AIMS). Int J Ment Heal Syst. 2014;8:16.CrossRef
58.
Lovell AM. The paradoxes of reform: reevaluating Italy's mental health law of 1978. Hosp Community Psychiatry. 1986;37:802–8.PubMed
59.
Ofori-Atta A, Read UM, Lund C, MHaPP research Programme consortium. A situation analysis of mental health services and legislation in Ghana: challenges for transformation. Afr J Psychiatry. 2010;13:99–108.CrossRef
60.
Kelly BD. Mental health law in Ireland, 1945 to 2001: reformation and renewal. Medico-legal J. 2008;76:65–72.CrossRef
61.
Kelly BD. Mental health law in Ireland, 1821 to 1902: building the asylums. Medico-legal J. 2008;76:19–25.CrossRef
62.
Mosher LR. Italy’s revolutionary mental health law: an assessment. Am J Psychiatry. 1982;139:199–203.PubMedCrossRef
63.
Felix RH. The national mental health program: a progress report. Public Health Rep. 1948;63:837–47.PubMedCrossRef
64.
Grob GN. The forging of mental health policy in America: world war II to new frontier. J Hist Med Allied Sci. 1987;42:410–46.PubMedCrossRef
65.
Grob GN. Mental health policy in post-world war II America. New Dir Ment Health Serv. 1987;1987(36):15–32.
66.
Mangen SP. Mental health policies in Europe: an analysis of priorities and problems. Int J Soc Psychiatry. 1987;33:76–82.PubMedCrossRef
67.
68.
Grob GN. From hospital to community: mental health policy in modern America. Psychiatr Q. 1991;62:187–212.PubMedCrossRef
69.
Whiteford HA. Australia’s national mental health policy. Hosp Community Psychiatry. 1993;44:963–6.PubMed
70.
71.
Ganju V. The mental health system in India: history, current system, and prospects. Int J Law Psychiatry. 2000;23:393–402.PubMedCrossRef
72.
Attah Johnson FY. Mental health care and the law in developing countries: the independent state of Papua New Guinea. Med Law. 1988;7:359–63.PubMed
73.
Whiteford H, Buckingham B, Manderscheid R. Australia’s national mental health strategy. Br J Psychiatry. 2002;180:210–5.PubMedCrossRef
74.
Joseph R, Birchwood M. The national policy reforms for mental health services and the story of early intervention services in the United Kingdom. J Psychiatry Neurosci. 2005;30:362–5.PubMedPubMedCentral
75.
Asai K. From mental health law to mental health and welfare law. Psychiatry Clin Neurosci. 1998;52(Suppl):S247–9.PubMedCrossRef
76.
Crosbie DW. Mental health policy--stumbling in the dark? Med J Aust. 2009;190:S43–5.PubMed
77.
Awenva AD, Read UM, Ofori-Attah AL, Doku VC, Akpalu B, Osei AO, et al. From mental health policy development in Ghana to implementation: what are the barriers? Afr J Psychiatry. 2010;13:184–91.
78.
Kiima D, Jenkins R. Mental health policy in Kenya: an integrated approach to scaling up equitable care for poor populations. Int J Ment Heal Syst. 2010;4:19.CrossRef
79.
Muga FA, Jenkins R. Health care models guiding mental health policy in Kenya 1965-1997. Int J Ment Heal Syst. 2010;4:9.CrossRef
80.
81.
82.
83.
Nicaise P, Dubois V, Lorant V. Mental health care delivery system reform in Belgium: the challenge of achieving deinstitutionalisation whilst addressing fragmentation of care at the same time. Health Policy. 2014;115:120–7.PubMedCrossRef
84.
Liverpool N. A survey of mental health legislation in the eastern Caribbean. Int J Law Psychiatry. 1986;8:119–31.PubMedCrossRef
85.
Abdulmalik J, Kola L, Gureje O. Mental health system governance in Nigeria: challenges, opportunities and strategies for improvement. Global Mental Health. 2016;3:e9.PubMedPubMedCentralCrossRef
86.
Aboaja A, Arroyo GR, Grant L. Mental health law in Bolivia. BJPsych Int. 2015;4:89–92.CrossRef
87.
Alhassani G, Osman OT. Mental health law profile: the United Arab Emirates. BJPsych Int. 2015;3:70–2.CrossRef
88.
89.
Chaskel R, Shultz JM, Gaviria SL, Taborda E, Vanegas R, Garcia NM, et al. Mental health law in Colombia. BJPsych Int. 2015;4:92–4.CrossRef
90.
Dos Santos PF, Wainberg ML, Caldas-de-Almeida JM, Saraceno B, Mari JJ. Overview of the mental health system in Mozambique: addressing the treatment gap with a task-shifting strategy in primary care. Int J Ment Heal Syst. 2016;10:1.CrossRef
91.
Grace FC, Meurk CS, Head BW, Hall WD, Carstensen G, Harris MG, et al. An analysis of policy levers used to implement mental health reform in Australia 1992-2012. BMC Health Serv Res. 2015;15:479.PubMedPubMedCentralCrossRef
92.
Grace FC, Meurk CS, Head BW, Hall WD, Harris MG, Whiteford HA. An analysis of policy success and failure in formal evaluations of Australia’s National Mental Health Strategy (1992-2012). BMC Health Serv Res. 2017;1:374.CrossRef
93.
Karam E, El Chammay R, Richa S, Naja W, Fayyad J, Ammar W. Lebanon: mental health system reform and the Syrian crisis. BJPsych Int. 2016;4:87–9.CrossRef
94.
Ndetei DM, Muthike J, Nandoya ES. Kenya’s mental health law. BJPsych Int. 2017;4:96–7.CrossRef
95.
Tareen A, Tareen KI. Mental health law in Pakistan. BJPsych Int. 2016;3:67–9.CrossRef
96.
97.
Datta A, Frewen J. Mental health law profile on the Republic of Ireland. BJPsych Int. 2016;1:15–7.CrossRef
98.
Firdosi MM, Ahmad ZZ. Mental health law in India: origins and proposed reforms. BJPsych Int. 2016;3:65–7.CrossRef
99.
Ho RC, Ho CS, Khan N, Kua EH. An overview of mental health legislation in Singapore. BJPsych Int. 2015;2:42–4.CrossRef
100.
Khan NN, Yahya B, Abu Bakar AK, Ho RC. Malaysian mental health law. BJPsych Int. 2015;2:40–2.CrossRef
101.
102.
Soosay I, Kydd R. Mental health law in New Zealand. BJPsych Int. 2016;2:43–5.CrossRef
103.
Stevovic LI, Jovanovic TP, Raznatovic A. Mental health law in Montenegro. BJPsych Int. 2016;4:94–5.CrossRef
104.
Upadhaya N, Jordans MJD, Pokhrel R, Gurung D, Adhikari RP, Petersen I, et al. Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study. Int J Ment Heal Syst. 2017;11:37.CrossRef
105.
Knapp M, Funk M, Curran C, Prince M, Grigg M, McDaid D. Economic barriers to better mental health practice and policy. Health Policy Plan. 2006;3:157–70.CrossRef
106.
Kopinak JK. Mental health in developing countries: challenges and opportunities in introducing western mental health system in Uganda. Int J MCH AIDS. 2015;1:22–30.
107.
108.
Metadata
Title
Policy development and challenges of global mental health: a systematic review of published studies of national-level mental health policies
Authors
Wei Zhou
Yu Yu
Mei Yang
Lizhang Chen
Shuiyuan Xiao
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2018
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-018-1711-1

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