March 2010: This Month's Highlights

International Issue

This issue of Psychiatric Services is a first for the journal: all of the articles, brief reports, and columns report on studies conducted in other countries. The titles listed in the table of contents should make it clear that the interests of mental health services researchers are remarkably similar the world over: how to deliver effective care in an equitable manner when resources are limited and the need is great. :Science is now global," as Editor Emeritus John A. Talbott, M.D., notes in Taking Issue, and since 1950 the journal has evolved into a forum for presenting findings that have implications without borders ( Original article: page 215 ). This issue introduces a new column, Mental Health Care Reforms in Latin America, which will address developments in South American, Central American, and Caribbean countries and Mexico. The initial overview column by editors José Miguel Caldas de Almeida, M.D., Ph.D., and Marcela Horvitz-Lennon, M.D., M.P.H., describes progress in the region since the Caracas Declaration of 1990, a landmark in the mental health reform process that focused attention on community-based care and the protection of human rights of people with disabilities ( Original article: page 218 ).

Mental Illness and Services in Africa

Five reports focus on patients and their care in African countries. Rachel Jenkins, F.R.C.Psych., M.D., and colleagues describe efforts to ensure that the development agenda for sub-Saharan Africa includes mental health as a priority. A particular challenge is to raise awareness of the links between mental disorders and morbidity and mortality in a region where donor countries often focus narrowly on controlling the spread of major communicable diseases ( Original article: page 229 ). A study by Crick Lund, M.Soc.Sci., Ph.D., and colleagues in South Africa found that community-based services created since the mid-1990s, when deinstitutionalization greatly reduced the number of psychiatric hospital beds, are inadequate to prevent hospitalization of people with severe mental illness ( Original article: page 235 ). In another study from South Africa, where there are 11 official languages, Sanja Kilian, M.A., and colleagues found that the skills of hospital interpreters varied widely and some did not understand basic psychiatric concepts and terms ( Original article: page 309 ). In a commentary on this study, Joseph Westermeyer, M.D., Ph.D., notes that the authors have made a valuable contribution to cross-language psychiatric care by documenting a problem that exists in many countries—inequities in care that result from a lack of attention to interpreters' skills and training ( Original article: page 313 ). A study in Nigeria found that outpatients with schizophrenia expressed high levels of life satisfaction even though their objective living conditions were poor. Authors Abiodun O. Adewuya, F.W.A.C.P., F.M.C.Psych., and Roger O. Makanjuola, F.W.A.C.P., Ph.D., call for efforts to improve work opportunities and transportation options for these patients ( Original article: page 314 ). The Public-Academic Partnerships column describes a collaboration between institutions in the United Kingdom and an array of agencies in Somaliland to strengthen the fragile mental health care sector in that country ( Original article: page 225 ).

Reports From Europe and the Middle East

Eight reports in this issue examine services in Europe. One describes a three-round Delphi study involving participants from ten European countries in various stages of deinstitutionalization. Service users, providers, family caregivers, and advocates identified components of institutional care that are most supportive of recovery ( Original article: page 293 ). A national survey in Israel found that 22% of adolescents had sought help for an emotional or behavioral problem in the past year and that schools played a significant role in providing it ( Original article: page 241 ). Among primary care patients in the Netherlands who had an anxiety disorder or depression, 21% expressed a need for care but had not received any ( Original article: page 250 ). A six-year study in a psychiatric emergency ward in Marseille, France—a country with near-universal access to free mental health care—found high rates of use by homeless patients ( Original article: page 264 ). Finnish researchers found elevated death rates among patients after a first episode of schizophrenia, which differed inexplicably between geographical regions ( Original article: page 272 ). An initiative in Norway to increase access to mental health services for youths was also successful in increasing treatment intensity ( Original article: page 280 ). In the year after discharge, researchers in the United Kingdom conducted three follow-up interviews with patients who had been involuntarily admitted to 22 hospitals and found an inverse relationship between treatment satisfaction and perceived coercion ( Original article: page 286 ). The column Mental Health Care Reforms in Europe describes how several aspects of service organization in Russia combine to promote social exclusion of people with mental illness ( Original article: page 222 ).