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Welfare Reform on the Web (September 2005): Mental Health Services - Overseas

Overt and covert barriers to the integration of primary and specialist mental health care

L. Gask

Social Science and Medicine, vol.61, 2005, p.1785-1794

This paper is concerned with attempts over the past 20 years to improve the integration between primary and specialist mental health care in a large group model Health Maintenance Organisation (HMO) in the USA. Both overt (financial) and covert (attitudinal) barriers to integration were uncovered. Integration was perceived to lack support of senior managers, and the organisation failed to provide professional interest groups within it with the conceptual, temporal and geographical space in which to negotiate change and challenge covert barriers. Financial pressures in the system may have led to failure on the part of management to encourage opportunities for inter-professional conversation, and the geographical distance between places of work may also have limited opportunities for contact. However, an alternative explanation may be that covert attitudinal barriers to integration may have effectively prevented professional groups from negotiating with each other in the first place.

Research use in children's mental health policy in Canada: maintaining vigilance amid ambiguity

C. Waddell and others

Social Science and Medicine, vol.61, 2005, p.1649-1657

Public policy often appears to be based on anything but research evidence, as is shown by how problems of conduct disorder in children are tackled in Canada. Few children receive effective prevention or treatment programmes, and incarceration is overused, despite evidence that it is ineffective and potentially harmful. Using the example of conduct disorder, study investigated why research evidence is not more used in policy formulation. Policy-makers told the research team that research evidence was only one source of ideas and influences among many. They also had to consider public opinion, the role of the media in shaping public opinion, conflicting priorities, financial constraints and fragmentation across levels and sectors of government. Findings suggest that use of research evidence in policy-making could be improved if researchers learned about competing influences in the policy process, formed research-policy partnerships, challenged incentives within research institutions, and engaged in public debate about important problems.

Western model, Eastern context: cultural adaptations of family interventions for patients with schizophrenia in China

W.W. Chung

International Social Work, Vol. 46, 2005, p.409 - 418

Family interventions in Western schizophrenia cases have been used effectively for delaying relapses and improving well-being since the 1970s, but despite some promising results, high drop-out rates amongst caregivers have been experienced in mainland China where Western approaches have been tried in the last ten years. Attempting to develop an indigenous approach for caregiver interventions in schizophrenia, this socio-cultural analysis highlights the disparity in cultural beliefs and mental health service provision between rural and urban China, shortage of professional staff, the rapid change in social norms, and the importance of rehabilitation and comprehensive psychiatric follow up.

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