Although the world is suffering from an increasing burden of mental disorders, budgets allocated for mental health in the majority of countries make up a relatively small proportion of total health expenditures.

To review the mental health situation in Ireland with regards to mental health Policy and Planning through review of relevant literature.

To assess the extent of mental health problems in Ireland and discuss the obstacles and priorities in Mental Health Policy and Planning to achieving good mental health in Ireland.

To review available hardcopy and internet literature since WHO 2001 health report regarding current mental health situation, issues that are significant obstacles to implementation of mental health policy and what should be prioritised in order to achieve good mental health in Ireland.

In Ireland 24-25% of the population develop mental health problems at some point but only 7% of the health budget is allocated to mental health services. Mental health services are not equitable. There is a need for reorganisation of services and transitional funding. There are human resource shortages and lack of transparency and accountability especially around past expenditures.

The core problem with mental health services in Ireland is an increasingly shrinking budget with poor financial administration consistent with lack of or inadequate implementation of mental health policy. The stumbling block in mental health policy implementation is the lack of a clear authority with defined responsibility for overall mental health policy and budgetary matters.

Social phobia is the most prevalent anxiety disorder. It is accompanied by a deterioration of the quality of life and social adaptation. This has further impact that this disorder begins at a young age at the time where the topic has not yet acquired a stable socio-professional status.

The aim of our study was to assess the sounding of the social phobia among a population of 200 students.

It was a cross-sectional study, focusing on a group of 200 students from 5 universities in Sfax city, Tunisia.

We used:

1. - The Liebowitz Social Anxiety Scale for screening the social phobia,

2. - The Sheehan scale for the evaluation of the sounding on the social, professional and family life.

Thirty three per cent of this population presented a social phobia.

According to Sheehan scale, the disturbance in school, social and family life was mild to moderate (schooling: 3. 29; social: 2.95; family: 2.62).

Discussion and conclusion: Our study showed that the impact of the social phobia is lightweight at the family and social level but more important in the area of schooling. This suggests the necessity for screening and treatment of social phobia among students for a better socio-family insertion and especially for better academic achievement.

To assess trainees’ opinions on the quality of provided educational programs, as recently pointed out in several European countries.

The opinions of 198 Italian trainees in psychiatry on their training and their future career were assessed by means of the Questionnaire on Training in Psychiatry (QTP).

Recruited trainees were predominantly female (68%), with a mean age of 30.0 (± 3.0) years. Thirty-seven percent of them chose psychiatry because “it has always been a dream”, 20% by chance and 17% because they felt “keen on it”. Seventy-seven percent of residents interviewed would make the same choice again if they could turn back time.

Seventy percent of the respondents were “globally satisfied” with their training, especially in clinical psychiatry, psychopathology and psychopharmacology. Residents reported that training in psychotherapy, in psychiatric rehabilitation and in forensic psychiatry were the most neglected areas in their specialization course. Only 9% of them participated in exchange programs, finding them useful for their professional life and experience.

These results show that Italian psychiatric trainees are globally satisfied with the quality of their training. However, they feel that the training course in some neglected areas, such as psychotherapy, rehabilitation and forensic psychiatry, should be improved, and that exchange programs in other countries should be promoted.

Geographical separation of psychiatric units from general hospitals may significantly delay provision of optimal treatment for patients in a medical emergency. Following a ‘near miss’ event, we explored how well equipped our unit is for managing such cases. Our objectives were: To explore how confident staff are in dealing with medical emergencies

1. 1. To measure staff confidence levels in emergency care procedures

2. 2. To evaluate staff orientation by exploring how well staff could locate key equipment

Distribution of a questionnaire survey asking respondents to rate their confidence in various emergency skills, for example maintaining an airway. Staff were also asked to rate their confidence in being able to locate emergency equipment and medication when necessary. In addition, suggestions for improvement in provision of any aspect of emergency care were sought.

Following this, data collation was performed by various members of the multi-disciplinary team with scrutiny of current practice. Areas of change include layout of emergency trolley, revision of staff induction to emergency equipment and provision of easily accessible protocols for common medical emergencies. Following these changes, the questionnaire will be re-distributed and the datasets compared.

We anticipate that the survey will be completed by February 2010

This investigation will provide very useful, practical data on how well prepared for an emergency a typical psychiatric ward and staff are for providing immediate emergency care. This will have implications for induction and staff training policy, to ensure patient safety and provision of appropriate medical treatment.

Identification of dependence of dynamic of mental health of the family in the process of demographic reproduction with adaptive possibilities of family members.

Complex investigation of 249 families of patients with mental disorders has been carried out revealing new forms of family and identification of qualitative and quantitative parameters of family interrelations with scale of family adaptation and cohesion FACES.

Peculiarities of the contemporary family are as follows:

1. 1) family with one child predominates;

2. 2) number of birth beyond registered marriage increases;

3. 3) marriage consciously without children;

4. 4) process of nuclearization;

5. 5) open marriage;

6. 6) marital contract;

7. 7) alternative families emerge;

8. 8) number of lonely people and people consciously avoiding to get married increases.

Families according to degree of cohesion have been divided into balanced - 69% and imbalanced - 31% of families. According to degree of adaptability there were 39% of balanced families, 61% - imbalanced. We observe variability of families. For real cohesion disconnected level is typical, for adaptation - chaotic style. Thus, concordance of real and ideal images about the family is absent. Thereby we have identified potential possibilities of the families. Most of them pass onto balanced level of cohesion (5 types of families in total), remaining at the level of chaotic forms of adaptation when there are conditions for changes.

Mental health of the family at various stages of development of family system depends on adaptive possibilities.

The voluntary interruption of pregnancy (or voluntary abortion), authorized in Tunisia since 1973, has always been a public health problem, given the number of women affected each year.

The objective of this work was to develop, through a descriptive study, the profile of girls who aborted in the regional center of family planning (FP)of Sfax.

This is a descriptive study, conducted in the regional center of FP of Sfax, with 130 unmarried girls, who asked for abortion during the period from October 2008 to June 2009.

In our series, the girls had an average age of 25.4 years and the majority was between 20 and 29 years.

Most of them were from urban origin (63.1% versus 36.9% rural origin).

63.9% had a primary or a secondary education and 70.9% had low socioeconomic status.

More than half of the studied girls (55.4%) lived with their families. The rest lived independently or in dormitories.

The majority of surveyed girls’ parents (76.9%) lived together.

The existence of major family problems was reported at 65.3% cases, essentially family violence (49.3%) and financial problems (45.6%).

It appears from this work that the risk factors involved in most of the unwanted pregnancies with abortion are:

1. . The young adulthood with a longer period of celibacy.

2. . The urban origin.

3. . The low education level.

4. . The low socioeconomics status.

5. . The lacks of family communication.

6. . The existence of major family problems, mostly violence and financial problems.

The aim of this study was to clarify effects of Clozapine and its metabolites on insulin resection and expression of glucose transporter 2 (GLUT2) located in cell membrane of isolated rat's islets.

The cells of isolated rat's islets were prepared by a modified collagenase digestion methods. At 5.5 mmol/L glucose, the cells of islets was treated with 1mmol/L clozapine, desmethyl-clozapine(DCLO), clozapine N-oxide(CNO), respectively, blank control group was also set.

1. 1. After incubation 48h, the insulin in supernatant was assayed by radioimmunoassay.

2. 2. The cells of isolated rat's islets in each group were detected GLUT2 mRNA level with RT-PCR and its protein expression with Western-blot.

1. 1. Compared to control group, clozapine significantly inhibited insulin secretion (P=0.007< 0.01); DCLO has a tendency to inhibit insulin secretion after 48h of incubation, but no significant difference was found (P=0.154>0.05). There was no difference of insulin secretion between CNO group and the control group after 48h of incubation (P>0.05).

2. 2. The mRNA and protein expression of GLUT2 located in cell membrane of slets: clozapine group was significantly lower than control group (P=0.017< 0.05, P=0.035< 0.05), DCLO group was also lower than control group, but no significant difference was found (P>0.05), and no significant difference between CNO group and control group (P>0.05).

Clozapine can inhibit GLUT2 expression of cells of islets, and then hamper glucose transport through cell membrane, which was one of mechanisms to explain the effect of clozapine on insulin secretion.

People with severe enduring mental illness (SMI) are at least twice as likely to die from cardiovascular disease (CVD) than the general population, with 60% of excess mortality rate attributable to physical illness.

We report implementation in primary care of screening and intervention for cardiometabolic risk factors in SMI in Cheshire, UK. Data search was performed through the EMIS software provider.

453 patients (55.8% male 44.2% female) on the SMI Register in Cheshire, UK were screened for dysglycaemia (screening rate 57.3 %) and dyslipidaemia (screening rate 36.2%). There were no differences in BMI by gender, but a greater proportion of women (25% vs 20%) were obese (BMI ≥ 30 kg/m2). Fasting glucose was in the impaired fasting glycaemia range (6.1-6.9mM) in 6.5% of those screened and at or above the threshold for type 2 diabetes (7.0mM) in 17.3% of the group. Fasting serum cholesterol was high at >5mmol/L in 62.8% of those screened for whom the mean cholesterol was 6.2±0.8 mmol/L). Despite high rates of dysglycaemia and dyslipidaemia, systolic blood pressure was greater than 140mmHg in only 13% of those examined. 61% were active smokers.

Multivariate linear regression analyses revealed a direct relation between fasting glucose levels and BMI (beta = 0.22, p< 0.001) independent of age, gender, systolic blood pressure and fasting cholesterol and triglycerides.

There is scope for cardiometabolic risk reduction in patients with severe mental illness. Measures to encourage weight reduction and smoking cessation would be vital in risk reduction strategies.

The objective of the study is to gain knowledge about the interaction process by nurse students and users in the field of District Psychiatry practice in Norway.

A qualitative study design was chosen. The data came from the students written day books and from focus-group interviews repeated two times in the two different eight weeks period of practice. 28 students were interviewed and 16 students delivered the day books.

Analyzing the data was done by using grounded theory as described by Strauss & Corbin (1997). The main process was called “To be in change”. The findings were insecurity in between users and students, security in between users and students. The interaction process between users and students was to Balance.

Based on this result, we need to focus on the students need for time for reflections over practice and the need for time to discuss their personal competence as well as their learning process in this field of practice.

To determine incidence of complicated grief in the families of enforced disappearance in the conflict torn Kashmir valley. Complicated GRIEF is a recently identified symptom complex marked by continued separation distress and bereavement related accompanying traumatic distress.

A total of 100 family members who were recruited from a workshop conducted by department of psychiatry and MEDICENS SAN FRONTIERS with family members of enforced disappearances were screened by psychiatrists.

COMPLICATED GREIF was very prevalent, 79% screened positive for complicated grief, PTSD was present in 30% of screened, 41% met criteria for major depressive disorder, 38% neither met criteria for major depressive disord: er nor PTSD, even though everybody who met criteria for PTSD had major depressive disorder as comorbidity.

COMPLICATED GRIEF is a important diagnosis in this subgroup of population and results into significant distress and dysfunction and hence warrants attention.

Significant physical co-morbidity is recognised as prevalent among patients with severe mental illness. UK guidelines for treatment of both schizophrenia (NICE 2009; Clinical guideline 82) and bipolar disorder (NICE 2006; Clinical guideline 38) provide recommendations for screening physical health problems. Despite the evidence base, physical health screening in this population is inconsistent. The Dundee Health Screen Clinic was set up to monitor cardiovascular and metabolic problems by providing health checks and offer exercise and dietary advice along with smoking cessation groups. This survey demonstrates the prevalence of metabolic syndrome in this sample, associated risk variables and prescribed antipsychotics.

Metabolic syndrome prevalence was assessed among 240 new patients attending the Dundee Health Screening clinic from Nov 2005-Aug 2008. The health screen designed included demographic details, clinical investigations, a lifestyle history and a record of prescribed medication.

Metabolic syndrome (defined by the International Diabetes Federation (IDF) criteria) prevalence was 39.7%, with a higher propensity among those prescribed atypical versus typical antipsychotics. Predictors of metabolic syndrome suggested that BMI, a 10-year risk of CHD and diabetes are significantly associated with metabolic syndrome. 135 patients had dyslipidaemia with only 5.9% receiving lipid-lowering agents. Only 13 out of 94 patients with hypertension had received antihypertensive treatment.

This study identifies significant unmet medical need in the health screening of the severely mentally ill. Health screening programmes are required for this high risk population with early intervention and appropriate medical follow up to minimise cardiovascular risk and its associated morbidity and mortality.

Acute Care Model introduced in 2006 in UK has revolutionised the way Adult inpatient services are provided. Here, we look at the impact of this model on detained patients, which might serve as a service evaluation tool.

Our objective is to study the effect of the acute care model on the application of the 1983 Mental Health Act (MHA) in Adult Psychiatry Wards at Clatterbridge Hospital, England.

Our aim is to measure any difference in the number and duration of detentions, use of tribunal hearings after the inception of this new model.

Data on Section 2 (for assessment) and Section 3 (for treatment) were collected retrospectively from the Register at the hospital MHA Office. As the Acute Care Model was implemented on 6th June 2007, the data were collected from 6th March 2006 to 5th Oct 2008. From these data, the number and duration of stay of detained patients were calculated.

The number of people who were detained in hospital before and after the introduction of acute care did not change (n=122). However, the average duration of detention under Section 3 reduced significantly from 81.44 days to 46.25 days (43.21% reduction). There had also been a 55% decrease in the utilisation of tribunal hearings after the new model (45 tribunals before vs 18 tribunals after).

The Acute Care Model in Adult Psychiatry seems to have had a significant positive impact on detained patients in reducing their in-patient stay and the need for tribunal hearings.

There is growing concern about the influence of the pharmaceutical industry on psychiatric teaching and psychiatric professionalism as a whole. As a consequence, several national and international medical and psychiatric associations have issued guidelines to regulate the interactions between physicians and industry.

The EFPT-PRIRS study aims to provide the lacking data on the extent and nature of these interactions among psychiatric trainees across Europe.

Study objectives were determined by the EFPT research group (EFPT-RG), after discussion with national and international experts. A survey was then devised compiling previously published questionnaires extending them by questions with specific relevance to psychiatric trainees. The resulting questionnaire was piloted amongst members of the EFPT-RG, modified accordingly and subsequently distributed to the national study coordinators. All 24 EFPT member countries were invited to participate in the study and data collection is currently ongoing.

Preliminary analysis reveals the vast differences in industry - trainee relationships across European countries as well as major differences in personal attitudes towards these interactions.

EFPT-PRIRS will potentially have an impact on the regulation of the interactions between the pharmaceutical industry and psychiatric trainees.

To understand how healthy siblings visualize and represent health and disease as conditions affecting them and others in their family. Furthermore, to evaluate the emotional settings following health and disease for healthy siblings, the reasons lead to illness and what could be done to avoid that path. Additionally, this study aims to investigate the parameters that interfere with the physical and emotional living of healthy siblings and finally to access their subjective knowledge on disease and in particular, cancer.

Fourteen healthy children, aged between 7 and 14, siblings to children diagnosed and receiving treatment for leukemia (acute lymphoblastic & myelogenous leukemia), nephroblastoma (Wilms’ tumor), lymphoma, rhabdomyosarcoma, where evaluated according to the Hatira's Projective Technique.

Analyzing the interviews lead to different kind of responses; some positive but mainly negative ones. The negative reactions addressed emotional instability, rejection, separation, siblings’ rivalry, the medical treatment itself and the fear of death, while positive reactions concerned self-awareness, sensitization, earlier maturing and increased family coherence after the crisis.

The physical relationship between siblings is a special kind of human relationship that can outrun time and crises, even outgrowing in some cases the relationship between parents and their children. On the other hand, it is simultaneously a very fragile and vulnerable relationship, since traumatic experiences such as those arising from childhood cancer interfere with the mental and emotional growing of the healthy brother or sister, causing confusion to the body, mind and soul.