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1.  Knowledge transfer in the field of parental mental illness: objectives, effective strategies, indicators of success, and sustainability 
Background
Mental health problems are often transmitted from one generation to the next. However, transferring knowledge about interventions that reduce intergenerational transmission of disease to the field of parental mental illness has been very difficult. One of the most critical issues in mental health services research is the gap between what is generally known about effective treatment and what is provided to consumers in routine care.
Discussion
In this article we discuss several aspects of knowledge transfer in the field of parental mental illness. Effective strategies and implementation prerequisites are explored, and we also discuss indicators of success and sustainability.
Summary
Altogether, this article presents a rationale for the importance of preventive strategies for children of mentally ill parents. Furthermore, the discussion shows how complex it is to change clinical practice.
doi:10.1186/1752-4458-9-6
PMCID: PMC4327801
Health system improvement; Children of mentally ill parents; Effective strategies; Sustainability
2.  Defining outcome measures of hospitalization for assessment in the Japanese forensic mental health scheme: a Delphi study 
Background
A new legislation concerning forensic mental health was established by the Japanese Government in 2005, the “Act on Medical Care and Treatment for the Persons Who Had Caused Serious Cases under the Condition of Insanity,” or the Medical Treatment and Supervision (MTS) Act. Since it was passed, however, there has been broad controversy over Hospitalization for Assessment (HfA), the first stage of the MTS scheme.
Methods
Following a comprehensive literature search to assemble a list of candidates, we conducted a Delphi study to establish standard outcome measures for HfA.
Results
Five Delphi rounds were conducted by 19 panelists including medical practitioners and lawyers. A total of 139 items were accepted as outcome measures for HfA based on panel agreement.
Conclusion
The Delphi study established a list of HfA outcome measures for the MTS act, which will contribute to the optimization of the new forensic mental health system in Japan.
Electronic supplementary material
The online version of this article (doi:10.1186/1752-4458-9-7) contains supplementary material, which is available to authorized users.
doi:10.1186/1752-4458-9-7
PMCID: PMC4328080
Forensic mental health; Delphi study; the Medical Treatment and Supervision Act; Hospitalization for Assessment; Outcome measure
3.  Psychosocial correlates of using faith healing services in Riyadh, Saudi Arabia: a comparative cross-sectional study 
Background
In this study, we compared the prevalence of psychiatric disorders and the characteristics of those who either use or do not use faith healers (FHs) services. We also assessed the independent factors of study subjects associated with using FHs.
Methods
This cross-sectional study compared those who use FHs (n = 383) with a control group of those who do not use them (i.e., shopping mall visitors, n = 424) using a survey of sociodemographic characteristics and a validated Arabic version of the Mini International Neuropsychiatric Interview (MINI 6.0).
Results
Participants who ranked higher among FH users included males, people who were either married, divorced, or widowed, those with less education, and those with lower income. They were more likely to report past medical and psychiatric history. Those with diagnosable psychiatric disorders were more likely to visit FHs, especially if the diagnosis was of psychotic and bipolar disorders. The prevalence of psychiatric disorders was higher among FH users, and depressive and anxiety disorders were the most prevalent.
Conclusions
The study showed that having past psychiatric history and a current psychiatric disorder are risk factors for using FHs. Also, a high percentage of FH users had a diagnosable psychiatric disorder. Further research should assess how to facilitate their access to the mental health system.
doi:10.1186/1752-4458-9-8
PMCID: PMC4328536
Faith healing; Psychosocial correlates; Prevalence; Psychiatric disorders; Saudi Arabia
4.  Existing public health surveillance systems for mental health in China 
Mental health is a challenging public health issue worldwide and surveillance is crucial for it. However, mental health surveillance has not been developed until recently in certain developed countries; many other countries, especially developing countries, have poor or even no health information systems. This paper presents surveillance related to mental health in China, a developing country with a large population of patients with mental disorders. Detailed information of seven relevant surveillance systems is introduced respectively. From the perspective of utilization, problems including accessibility, comprehensiveness and data quality are discussed. Suggestions for future development are proposed.
doi:10.1186/1752-4458-9-3
PMCID: PMC4298056  PMID: 25601892
Public health surveillance; Mental health; China; Review
5.  Correlates of psychological functioning of homeless youth in Accra, Ghana: a cross-sectional study 
Background
Research on homeless youth has shown that this population is at high risk for various mental health problems. Previous studies conducted among homeless young adults in Ghana have focused primarily on economic, social and cultural causes of homelessness, their engagement in risky sexual behaviours and the prevalence of STI including HIV/AIDS. We are therefore not fully informed of the prevalence of psychological symptoms and their associated factors. The aim of the study was to determine the association between psychological functioning and social and health risk behaviours among a sample of homeless youth in Ghana.
Methods
A cross-sectional survey of a convenience sample of 227 (122 male and 105 female) homeless youth was conducted in Ghana in 2013. An interviewer-administered questionnaire was used to collect data due to low level of literacy among the study population. Pearson-moment correlation coefficient (r) and multiple standard regression models were fitted to analyse the data.
Results
Approximately 87% of the participants in this study exhibited moderate to severe psychosocial symptoms. Specifically, emotional, conduct, hyperactivity and peer relationship problems among the participants were 69%, 74%, 54% and 89% respectively. Overall psychosocial functioning was predicted by stigma (self-stigma and experienced stigma), violent behaviours and suicidal ideation. Substance use and perceived resilience were significantly associated with emotional problems.
Conclusion
There is a need for holistic interventions to help improve the psychological and social functioning of homeless youth. Such programmes should strengthen socio-emotional coping strategies in street youth as well as address contextual risk factors such as stigma and discrimination by the public.
doi:10.1186/1752-4458-9-1
PMCID: PMC4292989  PMID: 25587353
Homeless youth; Mental health; Psychological functioning; Resilience; Substance use; Violent behaviours
6.  Social network analysis of international scientific collaboration on psychiatry research 
Background
Mental disorder is harmful to human health, effects social life seriously and still brings a heavy burden for countries all over the world. Scientific collaboration has become the indispensable choice for progress in the field of biomedicine. However, there have been few scientific publications on scientific collaboration in psychiatry research so far. The aim of this study was to measure the activities of scientific collaboration in psychiatry research at the level of authors, institutions and countries.
Methods
We retrieved 36557 papers about psychiatry from Science Ciation Index Expanded (SCI-Expanded) in web of science. Additionally, some methods such as social network analysis (SNA), K-plex analysis and Core-Periphery were used in this study.
Results
Collaboration has been increasing at the level of authors, institutions and countries in psychiatry in the last ten years. We selected the top 100 prolific authors, institutions and 30 countries to construct collaborative map respectively. Freedman, R and Seidman, LJ were the central authors, Harvard university was the central institution and the USA was the central country of the whole network. Notably, the rate of economic development of countries affected collaborative behavior.
Conclusion
The results show that we should encourage multiple collaboration types in psychiatry research as they not only help researchers to master the current research hotspots but also provide scientific basis for clinical research on psychiatry and suggest policies to promote the development of this area.
doi:10.1186/1752-4458-9-2
PMCID: PMC4297364  PMID: 25598839
Psychiatry; Collaboration; SNA
7.  “Walking alongside:” collaborative practices in mental health and substance use care 
Background
Although the importance of collaboration is well established as a principle in research and in theory, what it actually means for practitioners to collaborate in practice, to be partners in a collaborative relationship, has thus far been given less attention. The aim of this study was to identify key characteristics of the ways in which mental health practitioners collaborate with service users and their families in practice.
Methods
This was a qualitative action research study, with a cooperative inquiry approach that used multi-staged focus group discussions with ten mental health care and social work practitioners in community mental health and substance use care. Thematic analysis was applied to identify common characteristics.
Results
We identified three major themes related to practitioners’ experiences of collaborative practices: (1) walking alongside through negotiated dialogues, (2) maintaining human relationships, and (3) maneuvering relationships and services.
Conclusions
It appears that even with the rich knowledgebase that has developed on the merits of collaborative relationships, it continues to be challenging for practitioners to reorient their practice accordingly. The findings of this study indicate that the practitioners focus on two types of processes as characterizing collaborative practice: one focusing on conversations among practitioners and service users and their families and the other focusing on management and control among health care providers, service sectors, and service users (i.e., inter/intra-system collaboration).
doi:10.1186/1752-4458-8-55
PMCID: PMC4276107  PMID: 25540670
Community mental health care; Collaborative practices; Co-occurring mental health and substance use problems; Recovery; Shared decision-making; Action Research; Cooperative Inquiry
8.  Power distance and mentor-protégé relationship quality as moderators of the relationship between informal mentoring and burnout: evidence from China 
Background
The topic of how to prevent and reduce burnout has drawn great attention from researchers and practitioners in recent years. However, we know little about how mentoring as a form of social support exerts influence on employee burnout.
Aim
This study aims to examine the contingency side of the mentoring-burnout relationship by addressing the exploratory question of whether individual differences in power distance and relationship quality play important roles in mentoring effectiveness in terms of reducing a protégé’s burnout level.
Methods
A total of 210 employees from a technology communications company completed the survey questionnaire.
Results
(1) A protégés’ power distance moderates the negative relationship between mentoring and burnout in such a way that the relationship is stronger for protégés who are lower rather than higher in power distance; (2) mentor-protégé relationship quality moderates the negative relationship between mentoring and burnout in such a way that the relationship is stronger when the relationship quality is higher rather than lower.
Conclusions
In sum, our results highlight the importance of studying the contingency side of mentoring effects on protégé burnout. Our findings suggest that the individuals’ different cultural values of power distance and mentor-protégé relationship quality are the boundary conditions for the mentoring-burnout relationship. We therefore suggest that research on mentoring-burnout will be advanced by considering the role of the moderating process.
doi:10.1186/1752-4458-8-51
PMCID: PMC4280691  PMID: 25553060
Burnout; Mentoring; Power distance; Mentor-protégé relationship quality
9.  Potential predictors of delay in initial treatment contact after the first onset of depression in Japan: a clinical sample study 
Background
A growing body of evidence shows that reducing the duration of untreated illness (DUI) correlates with improved clinical outcome and course of depression. However, the factors involved in delaying treatment contact after the first onset of lifetime depression are not fully understood. This cross-sectional study aims to identify the characteristics that may predict the delay in initial treatment contact after the first onset of lifetime depression by comparing the socio-demographics and clinical characteristics between those with longer and shorter DUI in a well-characterized Japanese clinical sample.
Methods
Ninety-five patients with depression with longer (>12 months) and shorter DUI (≤12 months) at three Japanese outpatient clinics were studied. Subjects received a comprehensive evaluation, including semi-structured clinical interviews and assessment battery, and their clinical charts were reviewed.
Results
Of the total sample, the median of DUI was 4 months (interquartile range (IQR) 25th–75th percentile, 2–13). We found that 72.6% of patients seek treatment contact within the first year of depression onset. Multivariate logistic regression analysis showed that longer DUI in patients was associated with marital status (never married). Further, the DSM-IV melancholic features approached significance.
Conclusions
Our findings suggest that most Japanese patients with depression are likely to seek treatment within 1 year of onset, and that marital status and melancholia may be potential predictors of the delay in the initial treatment contact after the first onset of lifetime depression.
doi:10.1186/1752-4458-8-50
PMCID: PMC4271502  PMID: 25530800
Duration of untreated illness; Help-seeking; Major depressive disorder; Marital status
10.  Mental health training program for community mental health staff in Guangzhou, China: effects on knowledge of mental illness and stigma 
Background
In order to reduce the huge treatment gap in mental health, WHO has called for integrating mental health into primary care. The purposes of this study are to provide a training course to improve the community mental health staff’s knowledge of mental health and reduce stigma related to mental illness, as well as to evaluate the impact of this training on knowledge and stigma.
Methods
The training intervention was a one day course for community mental health staff in Guangzhou, China. Evaluation questionnaires were given before and after the training session. Mental health knowledge was assessed using two vignettes. Stigma was evaluated by the Mental Illness: Clinicians’ Attitudes Scale (MICA) and the Reported and Intended Behavior Scale (RIBS).
Results
A total of 99 community mental health staff from eight regions in Guangzhou, China were recruited for the study. The training course did not lead to a significant improvement of participants’ levels of mental health knowledge. The mean score of MICA decreased from 47.92 ± 8.63 to 43.53 ± 9.61 after the training (t = 6.64, P < 0.001). As for the RIBS, the mean scores increased from (14.12 ± 3.90) to (15.38 ± 3.41) at post-test (t = -5.44, P < 0.001), indicating a significant improvement.
Conclusions
The results from this study show that the training course is an effective way to improve community mental health staff’s attitudes toward people with mental illness in the short term, as well as to lessen the social distance between staff and people with mental illness.
doi:10.1186/1752-4458-8-49
PMCID: PMC4268793  PMID: 25520750
Training course; Stigma; Community mental health staff
11.  Institutionalization of deinstitutionalization: a cross-national analysis of mental health system reform 
Background
Policies generate accountability in that they offer a standard against which government performance can be assessed. A central question of this study is whether ideological imprint left by policy is realized in the time following its adoption. National mental health policy expressly promotes the notion of deinstitutionalization, which mandates that individuals be cared for in the community rather than in institutional environments.
Methods
We investigate whether mental health policy adoption induced a transformation in the structure of mental health systems, namely psychiatric beds, using panel data on 193 countries between 2001 and 2011.
Results
Our striking regression results demonstrate that late-adopters of mental health policy are more likely to reduce psychiatric beds in mental hospitals and other biomedical settings than innovators, whereas they are less likely than non-adopters to reduce psychiatric beds in general hospitals.
Conclusions
It can be inferred late adopters are motivated to implement deinstitutionalization for technical efficiency rather than social legitimacy reasons.
Electronic supplementary material
The online version of this article (doi:10.1186/1752-4458-8-47) contains supplementary material, which is available to authorized users.
doi:10.1186/1752-4458-8-47
PMCID: PMC4253997  PMID: 25473417
Diffusion of innovation; Institutional theory; Governance; Mental health policy
12.  A theory-informed approach to mental health care capacity building for pharmacists 
Background
Pharmacists are knowledgeable, accessible health care professionals who can provide services that improve outcomes in mental health care. Various challenges and opportunities can exist in pharmacy practice to hinder or support pharmacists’ efforts. We used a theory-informed approach to development and implementation of a capacity-building program to enhance pharmacists’ roles in mental health care.
Methods
Theories and frameworks including the Consolidated Framework for Implementation Research, the Theoretical Domains Framework, and the Behaviour Change Wheel were used to inform the conceptualization, development, and implementation of a capacity-building program to enhance pharmacists’ roles in mental health care.
Results
The More Than Meds program was developed and implemented through an iterative process. The main program components included: an education and training day; use of a train-the-trainer approach from partnerships with pharmacists and people with lived experience of mental illness; development of a community of practice through email communications, a website, and a newsletter; and use of educational outreach delivered by pharmacists. Theories and frameworks used throughout the program’s development and implementation facilitated a means to conceptualize the component parts of the program as well as its overall presence as a whole from inception through evolution in implementation. Using theoretical foundations for the program enabled critical consideration and understanding of issues related to trialability and adaptability of the program.
Conclusions
Theory was essential to the underlying development and implementation of a capacity-building program for enhancing services by pharmacists for people with lived experience of mental illness. Lessons learned from the development and implementation of this program are informing current research and evolution of the program.
doi:10.1186/1752-4458-8-46
PMCID: PMC4254206  PMID: 25473416
Community pharmacy; Mental illness; Behaviour Change Wheel; Consolidated Framework for Implementation Research
13.  Acute stress responses in Chinese soldiers performing various military tasks 
Background
To examine Chinese soldiers’ acute stress responses, we did this study.
Methods
The soldiers completed the Acute Stress Response Scale (ASRS) when engaged in major tasks, such as earthquake rescue in Wenchuan, Sichuan, and maintaining social stability in Urumchi, Xinjiang. The ASRS has good reliability and validity. The study enrolled 1,832 male soldiers.
Results
The results showed significant differences among five dimensions and the overall response index when comparing four diverse military tasks. Further analysis found that reduced work efficiency and 24 symptom clusters were significantly positively correlated.
Conclusions
The acute stress response of soldiers performing various tasks was influenced by many factors, including the task characteristics and external factors. In addition, the acute stress response affected their work efficiency.
doi:10.1186/1752-4458-8-45
PMCID: PMC4247674  PMID: 25435903
Chinese soldiers; Major tasks; Acute stress
14.  Excess cost of non-remission among outpatients with major depressive disorder 
Background
The purpose of this study was to assess the economic benefit of achieving remission among outpatients with major depressive disorder (MDD) who are currently employed in Korea.
Methods
Cross-sectional observational study. A total of 337 outpatients with MDD with paid jobs were recruited from 14 psychiatric clinics in Korea and were then divided into three groups as follows: new visit group (n = 128), remitted group (n = 100) and non-remitted group (n = 109). The 17-item Hamilton Depression Rating Scale (HAM-D) was used to decide whether a patient should be assigned to the remitted or non-remitted group. Direct medical and non-medical costs were measured via interview with the subjects. The World Health Organization Health and Work Performance Questionnaire (HPQ) were applied in order to measure the lost productive time (LPT) and related productivity costs.
Results
The three groups did not show a significant difference in direct medical cost. However, the difference between the remitted group and non-remitted group was statistically significant (25.49 ± 52.99 vs. 44.79 ± 126.55, χ2 = 12.99, p = 0.0015). The remitted group demonstrated a significant improvement in productivity (particularly presenteeism) when compared with the new visit group (Z = −3.29, p = 0.001). Although the non-remitted group received treatment at psychiatric clinics similar to the remitted group, it lost 33 more working hours per month, which is compatible to $332 per month.
Conclusion
These results suggest the economic importance of achieving remission in treating depression.
doi:10.1186/1752-4458-8-42
PMCID: PMC4246569  PMID: 25435902
Major depressive disorder; HPQ; Lost productive time; Presenteeism; Remission
15.  Social support moderates stress effects on depression 
This study examined the moderator effect of social support on the relationship between stress and depression of university students. A total of 632 undergraduate students completed the measures of perceived stress, perceived social support, and depression. Hierarchical regression analysis showed that social support moderated the association between stress and depression. Undergraduate students with high stress reported higher scores in depression than those with low stress with low social support level. However, the impact of stress on depression was much smaller in the high social support group compared with that in the low social support group.
doi:10.1186/1752-4458-8-41
PMCID: PMC4242489  PMID: 25422673
Stress; Social support; Depression; Moderating effect; University students
16.  Engagement in assertive community treatment as experienced by recovering clients with severe mental illness and concurrent substance use 
Background
Clients with severe mental illness (SMI) who use substances are less engaged in treatment than those who do not use substances, and assertive community treatment (ACT) engages and retains clients with SMI and concurrent substance use at a higher rate compared with traditional treatment. This qualitative study aimed to explore the experiences of being recruited to, and remaining in, ACT among recovering clients diagnosed with SMI and concurrent substance use.
Methods
Twenty semi-structured interviews were undertaken among 11 clients with SMI and concurrent substance use who were included in ACT teams. The inclusion criteria were SMI and concurrent substance use and improvement after a minimum of 12 months in treatment regarding one or several of the following parameters: quality of life, general functioning and substance use. Systematic text condensation was applied in the analyses.
Results
The experiences of building trust through enduring involvement and receiving benefits were most important for the acceptance of ACT by clients. A feeling of exclusiveness, perceiving ACT as a safety net and the clients’ own personal responsibility for taking part in the treatment were stated as the most important factors for remaining in treatment.
Conclusions
The implications of the results of the present study are that service providers have to prove that they can be trusted in the initial phase of the clients’ contact with the team. The feeling by clients with SMI and concurrent substance use that service providers in ACT believe they can improve their client’s quality of life, is of importance for feeling exclusive, having hope for the future and remaining in treatment.
doi:10.1186/1752-4458-8-40
PMCID: PMC4226907  PMID: 25389446
Severe mental illness; Substance use; Assertive community treatment; Client experiences; Engagement; Qualitative study
17.  Structural characteristics of specialised living units for people with dementia: a cross-sectional study in German nursing homes 
Background
Living units (LU) specialised for people with dementia are an important feature of nursing homes. Little is known about their structural characteristics, and an international definition is lacking. This study explored characteristics of the environment and staff from defined LU types to identify differences between them.
Design
Cross-sectional study comparing five types of LUs. LUs were defined based on their living concept (segregated and integrated), size (small and large scale), and funding (extra funded and not extra funded). Differences were identified using descriptive statistics, Chi-Square resp. Kruskal-Wallis-Test and post-hoc analysis with Bonferroni corrections.
Results
In total, 103 LUs from 51 nursing homes participated: 63 integrated and 40 segregated LUs; 48 integrated and 31 segregated LUs were large. Sixteen large segregated LUs were extra funded. Regarding the environment, a distinctive feature of small LUs was a higher percentage of single rooms. Small integrated LUs provided and served meals more in a homelike manner than other LUs. LUs did not differ in their interior and access for the residents to use outdoor areas. Regarding the staff, small LUs provided more staff, but they were not exclusively assigned to the LUs. Large segregated LUs with additional funding provided more registered nurses and nurses with a special qualification per resident than the other large LUs.
Conclusion
Nursing homes implemented different features in their specialised LUs. Because single room availability, homelike provision of meals, staff quantity, quality and continuity may influence residents’ outcomes, it is necessary to investigate whether differences are apparent in future evaluation studies of specialised LUs for people with dementia.
doi:10.1186/1752-4458-8-39
PMCID: PMC4213458  PMID: 25360154
Dementia; Dementia special care unit; Small-scale living unit; Structural characteristics
18.  Why should mental health have a place in the post-2015 global health agenda? 
Background
The tenure of the Millennium Development Goals formally expires in 2015 and will be replaced with a new development agenda. The MDGs did not include goals or targets for mental health. Despite gathering momentum during the last 15 years, mental health has not enjoyed the same pace of progress as the sectors explicitly mentioned within the MDGs. This article outlines the evidence indicating that mental health should be firmly positioned in post-2015 health policy and discusses strategies to advance the global mental health agenda.
Discussion
The interactions between mental health and other development goals are numerous and complex. Consequently, investment in mental health pays dividends on a wider level than simply psychiatric clinical outcomes. Mental health’s reciprocal relationship with poverty is consistent with the strong focus on economic development, rather than health in isolation, detailed in the post-2015 UN statements to date. A focus on the quality of mental health care provided in low and middle-income countries deserves priority in the new health agenda. This should include consideration of the accessibility of mental health care and the use of evidence based diagnosis and management in these settings.
Summary
Lack of investment in the mental health of populations is a key driver of poverty and inequality in low and middle-income countries. Renewed focus on mental health post-2015 is an opportunity to address the global burden of mental disorders and make a positive impact on the wider development agenda.
doi:10.1186/1752-4458-8-38
PMCID: PMC4252991  PMID: 25473415
19.  Professionals’ perceptions about healthcare resources for co-occuring disorders in Spain 
Background
Since provision of integrated services for patients with dual pathology or dual disorders (coexistence of an addictive disorder and other psychiatric disorders) constitutes an important challenge, this study compared the perceptions of health-care professionals with the existing, current state of specific resources for patients with dual pathology in Spain.
Methods
Epidemiological, observational, cross-sectional, multicenter study with a large, representative sample of health care professionals attending patients with dual pathology in treatment resources throughout Spain. Participants completed a specifically designed ad-hoc on-line questionnaire about their perceptions on the existence of available resources and treatment needs for patients with dual pathology. To compare professionals’ perceptions with existing available resources, the same on-line questionnaire was also completed by commissioners and managers responsible for national and regional healthcare plans on drug abuse.
Results
A total of 659 professionals, mostly psychologists (43.40%) or psychiatrists (32.93%) agreed to participate in the study. The highest degree of concordance between the perceptions of professional and the actual situation was found regarding the existence of mental health and addiction networks (either separately or unified) (74.48%), followed by specific workshops (73.08%) and sub-acute inpatient units (67.38%), specific hospitalization units (66.26%), detoxification units (63.15%) and outpatient programs (60.73%). We detected a lower degree of agreement regarding specific occupational rehabilitation centers (59.34%) day hospitals (58.93%), day centers (57.88%), outpatient intermediate resources (48.87%), psychiatric acute admission units (46.54%) and therapeutic communities (43.77%). In addition, on average, health care professionals underestimated the number of resources present in their respective communities.
Conclusions
Relevant differences exist between the perceptions of professional and existing available resources for dual pathology patients in Spain, thus supporting the need of additional efforts and strategies to establish a registry and clearly inform about available resources for patients with dual diagnosis.
doi:10.1186/1752-4458-8-35
PMCID: PMC4158069  PMID: 25206926
Dual pathology; Dual disorders; Co-occurring disorders; Resources; Professionals’ perception; Mental health; Drug abuse
20.  Developing an instrument for assessing fidelity of motivational care planning: The Aboriginal and Islander Mental health initiative adherence scale 
Purpose
The aim of this study was to design and trial an Adherence Scale to measure fidelity of Motivational Care Planning (MCP) within a clinical trial. This culturally adapted therapy MCP uses a client centered holistic approach that emphasises family and culture to motivate healthy life style changes.
Methods
The Motivational Care Planning-Adherence Scale (MCP-AS) was developed through consultation with Aboriginal and Islander Mental Health Initiative (AIMhi) Indigenous and non-Indigenous trainers, and review of MCP training resources. The resultant ten-item scale incorporates a 9-Point Likert Scale with a supporting protocol manual and uses objective, behaviourally anchored criteria for each scale point. A fidelity assessor piloted the tool through analysis of four audio-recordings of MCP (conducted by Indigenous researchers within a study in remote communities in Northern Australia). File audits of the remote therapy sessions were utilised as an additional source of information. A Gold Standard Motivational Care Planning training video was also assessed using the MCP-AS.
Results
The Motivational Care Planning-Adherence Scale contains items measuring both process and content of therapy sessions. This scale was used successfully to assess therapy through observation of audio or video-recorded sessions and review of clinical notes. Treatment fidelity measured by the MCP-AS within the pilot study indicated high fidelity ratings. Ratings were high across the three domains of rapport, motivation, and self-management with especially high ratings for positive feedback and engagement, review of stressors and goal setting.
Conclusions
The Motivational Care Planning-Adherence Scale has the potential to provide a measure of quality of delivery of Motivation Care Planning. The pilot findings suggest that despite challenges within the remote Indigenous community setting, Indigenous therapists delivered therapy that was of high fidelity. While developed as a research tool, the scale has the potential to support fidelity of delivery of Motivation Care Planning in clinical, supervision and training settings. Larger studies are needed to establish inter-rater reliability and internal and external validity.
doi:10.1186/1752-4458-8-36
PMCID: PMC4161858  PMID: 25221622
Motivational care planning; Adherence scale; Treatment fidelity; Australian aboriginal and torres strait islanders; Instrument development
21.  Effect of social support on depression of internet addicts and the mediating role of loneliness 
Background
Many studies have determined the existence of an extremely close association between Internet addiction and depression. However, the reasons for the depression of Internet addicts have not been fully investigated.
Aim
This cross-sectional study aims to explore the factors that influence depression among Internet addicts.
Methods
A total of 162 male Internet addicts completed the Emotional and Social Loneliness Scale, Multidimensional Scale of Perceived Social Support, and Self-Rating Depression Scale.
Results
Loneliness and lack of social support are significantly correlated with depression among Internet addicts. Structural Equation Modeling results indicate that social support partially mediates loneliness and depression.
Conclusions
Both social support and loneliness were negatively associated with depression of Internet addicts whereas loneliness plays a mediating role between social support and depression.
doi:10.1186/1752-4458-8-34
PMCID: PMC4139580  PMID: 25147581
Internet addiction; Depression; Social support; Loneliness; Structural equation modeling
22.  How can a change in the operating system of the mental health review board promote the discharge of long-term hospitalized psychiatric patients? A case study of Seoul city 
Background
One of the most typical and chronic problem in Korean mental health system is the prolonged length of hospital stay. In contrast to there are many components which leads to long length of stay of psychiatric patients in Korean situation such as low and fixed medical fee for psychiatric inpatient treatment, shortage of community resources, lack of care-givers’ awareness and so on, there are just few mechanisms to handle this issue such as Mental Health Review Board (MHRB) which is based on Mental Health Act since 1995. However, the discharge order rate was very low and there community care system after discharge order is still very weak.
Case description
The Korean government has revised the Mental Health Act in 2008 and changed the operating principals of the MHRB from a regional level to a local level to strengthen the function of MHRB. However, the discharge order rate versus the whole evaluation requests still remains at a very low level or less than 5%. And it is still very difficult to execute a discharge order against a patient whose symptoms and conditions become psychiatrically stabilized enough for discharge, due to a shortage of community care facilities and a lack of social support system. These results are exactly same with former studies.
Discussion
Any policies to promote psychiatric discharge including MHRB are needed to take the comprehensive factors into consideration, such as payment program, community infrastructure, increasing care-givers’ acceptance and so on.
Conclusion
Despite of the political trial of Korean government to reduce length of stay of chronic psychiatric patients, it was not successful. Still it had failed to propose a detailed policy measure in terms of the above-mentioned prerequisites. Therefore, new system and program developments including reform of payment system which reflect prior studies’ recommendations are essential.
doi:10.1186/1752-4458-8-33
PMCID: PMC4128823  PMID: 25114716
Length of hospital stay; Mental Health Review Board; Discharge order rate
23.  Structural equation model of factors related to quality of life for community-dwelling schizophrenic patients in Japan 
Background
This study aimed to clarify how community mental healthcare systems can be improved.
Methods
We included 79 schizophrenic patients, aged 20 to 80 years, residing in the Tokyo metropolitan area who regularly visited rehabilitation facilities offering assistance to psychiatric patients and were receiving treatment on an outpatient basis. No subjects had severe cognitive disorders or were taking medication with side effects that could prevent the completion of questionnaires. Questionnaires included items related to quality of life, self-efficacy, self-esteem, psychosis based on the Behavior and Symptom Identification Scale, health locus of control, and socio-demographic factors. We performed multiple linear regression analysis with quality of life as the dependent variable and, based on covariance structural analysis, evaluated the goodness of fit of the resulting structural equations models.
Results
Self-efficacy, self-esteem, and degree of psychosis significantly impacted quality of life. Marital status, age, and types of medications also influenced quality of life. Multiple linear regression analysis revealed psychiatric symptoms (Behavior and Symptom Identification Scale-32 [daily living and role functioning] (Beta = −0.537, p < 0.001) and self-efficacy (Beta = 0.249, p < 0.05) to be predictors of total quality of life score. Based on covariance structural analysis, the resulting model was found to exhibit reasonable goodness of fit.
Conclusions
Self-efficacy had an especially strong and direct impact on QOL. Therefore, it is important to provide more positive feedback to patients, provide social skills training based on cognitive behavioral therapy, and engage patients in role playing to improve self-efficacy and self-concept.
doi:10.1186/1752-4458-8-32
PMCID: PMC4123304  PMID: 25101143
Quality of life; Schizophrenia; Self-efficacy; Self-esteem; Regression analysis; Structured equation modeling
24.  Goals and organisational structure of the movement for global mental health 
Background
The Movement for Global Mental Health (MGMH), established in 2008, is in a period of transition, as is the field of global mental health. The transfer of Secretariat functions from the Centre for International Mental Health to the Public Health Foundation of India was a suitable time to reflect on the goals of MGMH and on the form of organisational structure that would best serve the organisation in its efforts to achieve its goals.
Methods
An online survey was sent to the 4,000 registered members of MGMH seeking the views of the membership on both the goals of MGMH and on the preferred form of organisational structure.
Results
There was near unanimous (95%) agreement with the MGMH goals as stated at the time of the survey. The current form of organisation of MGMH, a loose network of individuals and organisations registered through the MGMH website, was the least preferred (29.9%) form of organisation for the future of MGMH. More than two thirds (70.1%) of respondents would prefer a formal legal structure, with 60% of this group favouring a Charitable Organisation structure and 40% preferring an international Association structure.
Discussion
The response rate (7%) was too small and too skewed (predominantly academics and health professionals from high income countries) to allow any clear conclusions to be drawn from the survey. However, both the fact that responses were too few and skewed and the preferences expressed by respondents raise issues for careful consideration by the current MGMH Secretariat.
Conclusions
The global mental health field and MGMH are in a time of transition. The move to the new secretariat is an opportunity for systematic consideration of the organisational structure and governance arrangements that will best serve the goals of MGMH.
doi:10.1186/1752-4458-8-31
PMCID: PMC4127045  PMID: 25110518
25.  The development of mental health services within primary care in India: learning from oral history 
Background
In India very few of those who need mental health care receive it, despite efforts of the 1982 National Mental Health Programme and its district-level component the District Mental Health Programme (DMHP) to improve mental health care coverage.
Aims
To explore and unpack the political, cultural and other historical reasons for the DMHP’s failures and successes since 1947 (post-independence era), which may highlight issues for today’s current primary mental health care policy and programme.
Methods
Oral history interviews and documentary sourcing were conducted in 2010–11 with policy makers, programme managers and observers who had been active in the creation of the NMHP and DMHP.
Results
The results suggest that the widely held perception that the DMHP has failed is not entirely justified, insofar that major hurdles to the implementation of the plan have impacted on mental health coverage in primary care, rather than faults with the plan itself. These hurdles have been political neglect, inadequate leadership at central, state and district levels, inaccessible funding and improperly implemented delivery of services (including poor training, motivation and retention of staff) at district and community levels.
Conclusion
At this important juncture as the 12th Five Year Plan is in preparation, this historical paper suggests that though the model may be improved, the most important changes would be to encourage central and state governments to implement better technical support, access to funds and to rethink the programme leadership at national, state and district levels.
doi:10.1186/1752-4458-8-30
PMCID: PMC4118270  PMID: 25089154
Mental health; History; India; Developing countries; Health policy; Health planning; Primary health care; Health workers

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