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  1. Home
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  3. Unmet Need in Psychiatry
  • Cited by 71
Publisher:
Cambridge University Press
Online publication date:
August 2009
Print publication year:
2000
Online ISBN:
9780511543562
DOI:
https://doi.org/10.1017/CBO9780511543562
Subjects:
Economics, Economics: General Interest, Psychiatry and Clinical Psychology, Medicine, Psychiatry
Information

Book description

This book considers ways to resolve the imbalance between the demand and supply of mental health services. Treatment services in most countries reach only a minority of people identified as suffering from a mental disorder. Few countries can provide adequate health services for all the mentally ill, yet none has developed a rational system to decide who should be treated. The questions are clear. Could we develop a staged treatment process to reach all in need? If not, how do we decide who to treat? What should the criteria be for deployment of scarce treatment resources? How do we determine such criteria? What are the ethical implications of applying such criteria? In this pioneering work, an international team of eminent psychiatrists, epidemiologists, health administrators, economists and health planners examine these questions. The result will inform and encourage all concerned with the equitable provision of mental health care.

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Contents

Page 2 of 2

Contents
  • 22 - Unmet need in mental health service delivery: children and adolescents
    pp 330-344
  • View abstract

    Summary

    This chapter focuses on three issues relevant to the unmet need for treatment of children and adolescents: identification of the needs of children with mental disorders; treatment of children's mental disorders; and prevention of children's mental disorders. Responses to the unmet needs of children and adolescents with mental disorders must take into account a number of key features of childhood disorders if they are to successfully address this issue. The approach to need described by Bradshaw provides a useful framework within which the unmet needs of children with mental disorders can be considered. Bradshaw suggests that the concept of need includes: normative need, felt need, expressed need, and comparative need. Clinical interventions based in treatment settings can be grouped into three categories: indicated interventions, treatment of discrete episodes, and maintenance of remission and prevention of relapse.
  • 23 - Assessing psychopathology among children aged four to eight
    pp 345-355
  • View abstract

    Summary

    In young children, impairment in basic social interactions and the slowed development of self-care behaviors are thought to predict psychopathology and consequent mental health service use. Specifically, a parent may be more likely to identify externalizing disorder symptoms, while a child may report the same behavior as an internalizing depression symptom. To facilitate reports of behavior among very young children, pictures, or cartoons, have been used. The pictorial format has been found to focus the attention of children and to stimulate their interest. Puppets have been used since the 1950s in studies of young children to equalize the expressive abilities of verbal and nonverbal children, as well as inhibited and noninhibited children. Studies have shown that two puppets using a standardized script can enable even the youngest cohort of children to express their feelings and behaviors.
  • 24 - Unmet need in Indigenous mental health: where to start?
    pp 356-362
  • View abstract

    Summary

    This chapter emphasizes the social justice issues underlying Indigenous ill-health and the consequences for Aboriginal and Torres Strait Islander mental health. Health is worse where no formal treaty has been concluded between the colonizing and indigenous populations, and worse where states and provinces retain responsibility for Indigenous health rather than federal or national governments. In terms of Aboriginal and Torres Strait Islander mental health, social disadvantage both undermines wellbeing and compromises the capacity of Indigenous populations to access services or to benefit, as have non-Indigenous Australians, from the health promotion initiatives of recent decades. Ultimately, addressing underlying social injustice and achieving reconciliation between the Indigenous and non-Indigenous populations of this nation will necessarily involve all Australians. Mental health professionals and health planners may both facilitate that process, and help Aboriginal and Torres Strait Islander communities find solutions to the pressing problems of daily existence, by collaborating rather than imposing.
  • 25 - Health systems research: a pragmatic model for meeting mental health needs in low-income countries
    pp 363-377
  • View abstract

    Summary

    Mental illness is recognized as one of the commonest and most disabling of all non-communicable disorders in low-income countries. This chapter examines the existing models of research and proposes an alternative model, the health systems research (HSR) model. This model helps understanding and meeting the mental health needs of communities in diverse regions in the low-income world. The vast majority of psychiatric research measures only biological or cultural variables. The health system is regarded as being independent. The health systems model recognizes that different cultures may share a similar health system while similar cultures may have widely different health systems. Priorities and objectives reflect the needs of psychiatrists and academics rather than those of the health care providers and patients. Culturally relativist studies tend to recognize the role of traditional medicine in many developing countries.
  • 27 - The assessment of perceived need
    pp 390-398
  • View abstract

    Summary

    Perceived need is relevant to an assessment of the dynamics of a service delivery system. An individual's perceptions of what is appropriate treatment may influence the acknowledgement of a problem. Current models of mental health care delivery increasingly emphasize the role of the individual as an active consumer, influenced by the development of consumer empowerment movements. The Perceived Need for Care Questionnaire is an instrument that can be delivered in some two minutes in a population-based survey. To illustrate the operation of the questionnaire, this chapter presents the sequence of responses from one imaginary survey participant. The concept of perceived need overlaps with a number of other ideas such as literacy, demand and want. The described instrument for assessing perceived need relies on a particular conception of need, which is based on an internal cognitive process that occurs in an individual seeking help.
  • 28 - Public knowledge of and attitudes to mental disorders: a limiting factor in the optimal use of treatment services
    pp 399-414
  • View abstract

    Summary

    This chapter presents data on public knowledge and attitudes towards mental disorders from three national surveys carried out in Australia, Austria, and Germany. It compares the results to those from other surveys and discusses the implications for the optimal distribution of mental health services. All three surveys examined beliefs about pharmacological treatments and found negative opinions. In all three surveys, the public's beliefs about psychotherapy were, by contrast, predominantly favorable. The surveys asked about prognosis with and without treatment. They also investigated attitudes towards people with mental disorders. The effects of these variables are interesting because they suggest possibilities for change in knowledge and beliefs. Age group differences may be due to cohort effects and, if so, suggest the direction in which beliefs may move in the future, while education and contact with mental disorders suggest ways of producing change.
  • 29 - A personal overview
    pp 417-421
  • View abstract

    Summary

    In this chapter, the author presents some off-the-cuff remarks on unmet needs for mental disorders. No health service can provide unlimited care. It has to prioritize, however uncomfortable that may be to politicians, and however much they may wish to shift the burden of that responsibility onto others. According to the author, the aim should be to cut the costs of mental health care and improve its quality by computerizing clinical psychiatry as much as possible for the majority of straightforward psychiatric problems, thus avoiding the inevitable variation and lapses in human behavior. The author adds that unless we automate our methods, make our services better and cheaper, and are prepared to share our expertise among a wider circle of health workers, we shall fail our communities and we will lose out to 'commercial managed care' in which shareholders can increase their financial gain from other people's suffering.
  • 30 - Conclusion: the central issues
    pp 422-428
  • View abstract

    Summary

    Psychiatric epidemiology has played a vital part in two ways in the process of achieving greater recognition for the needs of people with mental disorders. The use of epidemiological information for advocacy stands separately from scientific studies of what determines the onset and course of mental disorders. Clearly, epidemiology has done much to advance the care of the mentally ill by demonstrating both the extent of such morbidity and that it has received short shrift in most communities; but epidemiology has at the same time opened a Pandora's box of problems for providing adequate mental health services. This chapter presents information to allow the situation to be assessed from a global perspective. The problem of unmet need straddles both advocacy and science. Estimation of unmet need for services is one of the most important tasks of psychiatric epidemiology.

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