Key clinical initiatives

A major commitment to upgrade the quality of mental health services

The care of the mentally ill should be specified in national and regional health plans and should receive adequate budgetary allocations. Primary health care must be 're-engineered' to improve the treatment of neuropsychiatric disorders. Improvements in mental health systems require rational drug policies for psychotropic medications and reliable provision of adequate drug supplies. The human rights of patients require protection in mental health legislation.

A small cadre of well-trained mental health professionals (including, in particular, psychiatric nurses) is essential to mental health programmes in order to design and implement training programmes, provide consultation to general health workers, and supervise the care of the chronically mentally ill. At the same time, major efforts are necessary to educate generalist physicians about psychiatric conditions, to improve behavioural science teaching in medical education, and to provide in-service training for practitioners.

Better mental health services for children and adolescents, including early detection and prevention

Priority should be given to providing effective services integrated within all forms of health care. Early detection of epilepsy and appropriate medication to control seizures will enable children with the disorder to participate fully in school, to prepare for work, and to avoid the burns, injuries, educational failure, and stigma associated with the disorder. Prevention of mental retardation can be achieved through birth planning, prenatal and perinatal care, hospital deliveries for difficult births, immunization, optimal nutrition (calories, protein, and micronutrients), home visits and day care, child safety measures, and school-based programmes on family life and sexuality.(13)

Public schools (state schools) are the principal social institution for furthering the cognitive and emotional development of children. Teachers can learn to recognize signs and symptoms of mental illness and child abuse, to manage early problems in the classroom, and to refer to those children requiring more assistance to mental health facilities.

Systematic efforts to assess the global burden of alcohol and drug abuse, to reduce demand, and to develop treatment and prevention programmes

In no other area of mental health is there such a lack of reliable systematic data on the severity, magnitude, and distribution of the problem needed to develop effective policy strategies as in the area of illicit drugs. International bodies must increase their capacity for meaningful data gathering. Governments must develop stronger policies to reduce demand. Public education is crucial to prevent the onset of use among the young. Traditional and non-traditional treatment approaches at the community and individual levels need implementation and rigorous evaluation. (1.4)

Support for research

Ignorance is always more costly than knowledge; research is all the more essential in difficult economic times. (15) Because mental health problems are common to developing and industrialized countries, knowledge can be transferred in both directions. Priority should be placed on strengthening the indigenous capacity for research among colleagues in developing countries. It is imperative that we encourage national-level interdisciplinary mental health policy research units and connect them with international networks of researchers. Such international networks can serve as a clearinghouse for relevant concepts, methods, and data. (16)

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