In Japan, the number of people with mental illness, especially depression and dementia, is growing. Although mental health care in Japan is in its transition phase from traditional hospital-based care to community-based in the recent decades, it has been characterized by orientation to large psychiatric institutions. This paper aims to provide recommendations for achieving well-balanced mental health care both in hospital and the community in Japan by reviewing facilitators and barriers of current mental health care system. A narrative literature review was conducted to identify facilitators and barriers to implementing community-based mental health care in Japan. The databases PsycInfo, Medline, Pubmed, CiNii and Google Scholar were searched in English and Japanese. 46 studies published from 1980 to 2016 were included in the review. The review identified six categories of mental health care services provided in the Japanese community: Outpatient clinics, Outreach services, Rehabilitation and Living support, Case management and public health centers, Community-based residential care, and Work and Occupation. The crosscutting themes of facilitators and barriers to implement these services in the community were funding, staff management, and collaboration among community resources. To further promote the transition to community mental health care in Japan, this paper recommends the following actions: to shift funding and human resources from inpatient to community care services, to strengthen a capacity building system and supportive environment for service providers in the community, and to set a clear policy and strategic framework integrating medical and social welfare services in the community.
Mental health services ; mental health care system ; community mental health care ; Mental disorders ; Japan

PURPOSE: This study was carried out to describe the process and evaluation of a critical thinking class for new community health practitioners. METHODS: The case study design was used to develop and evaluate a critical thinking class for 46 participants in the community health practitioners training program. The class was held two hours a week for 8 weeks. Critical thinking disposition was tested before and after the class and critical skill was graded according to the final test score. Data analysis was performed using descriptive statistics and paired t-tests using SPSS WIN 20.0. RESULTS: Clinical critical thinking competences were identified through the literature review. The case situations with questions guiding the problem-solving process were developed and used for group discussion. Critical thinking disposition of participants was determined to have increased slightly after having taken the class. 17.4% of the participants had a competency level high enough to solve a problem and half of them stayed at the level of understanding of critical thinking. Compared with the class's satisfaction with the relevance to their jobs, the satisfaction with the learning method and instructor was high. CONCLUSION: The findings of this research will serve as the basis for developing critical thinking classes for community health nurses in order to improve their critical thinking competence.
Education ; Learning ; Mental Competency ; Nurses, Community Health ; Primary Health Care ; Problem-Based Learning ; Statistics as Topic ; Thinking*

INTRODUCTION: Prevalence of mental disorders is high worldwide. In Low-and-Lower-Middle-income countries (LALMICs) mental illnesses are already the second cause of burden in DALYs. As psychiatrists are extremely rare in LALMICs, addressing this issue calls for shifting mental health to primary care and consequently, training first line health care providers would be the next challenge. Via the FAST program, the World Asssociation of Social Psychiatry (WASP), Sanofi, Ministries of Health, academics, patients/families association and NGOs have joined forces to improve access to mental health care in LALMICs. The program is based on 3 pillars: (1) Mental health literacy, (2) health care professionals (HCP) training and (3) affordable quality medicines.
OBJECTIVE: This study aims to develop a training curriculum and a set of materials to train HCP that is easily adaptable to the singularity of the local environment.
METHODOLOGY: (1) A master-2 public health student conducted the project; (2) two domains were selected in priority: schizophrenia and unipolar mood disorders; (3) two main targets were identified: general practitioners and nurses / community healthcare workers; (4) professional's needs were assessed through a phone questionnaire; (5) WASP experts were in charge of drafting slides kits and other technical documents (6) to avoid any risk of conflict of interest, it was decided that training on medications will be based on the WHO mhGAP guide.
RESULTS: For each disease and each category of HCP (1) a training of trainers manual; (2) a training curriculum; (3) a slide kit; (4) a training brochure; (5) videos of patients; (6) role-play scenarios; (7) clinical cases (8) pre and post assessment questionnaires, were made available.
CONCLUSION: First feed-back indicated that these tools were of great added value for countries with limited human resources, even though, as anticipated, they will have to be adapted locally, especially role-play scenarios, clinical cases and patient's videos.

Mental Health ; General Practitioners ; Health Literacy ; Prevalence ; Students, Public Health ; Mood Disorders ; Community Psychiatry ; Primary Health Care ; Community Health Services ; Curriculum ; Schizophrenia

INTRODUCTION: Prevalence of mental disorders is high worldwide. In Low-and-Lower-Middle-income countries (LALMICs) mental illnesses are already the second cause of burden in DALYs. As psychiatrists are extremely rare in LALMICs, addressing this issue calls for shifting mental health to primary care and consequently, training first line health care providers would be the next challenge. Via the FAST program, the World Asssociation of Social Psychiatry (WASP), Sanofi, Ministries of Health, academics, patients/families association and NGOs have joined forces to improve access to mental health care in LALMICs. The program is based on 3 pillars: (1) Mental health literacy, (2) health care professionals (HCP) training and (3) affordable quality medicines.
OBJECTIVE: This study aims to develop a training curriculum and a set of materials to train HCP that is easily adaptable to the singularity of the local environment.
METHODOLOGY: (1) A master-2 public health student conducted the project; (2) two domains were selected in priority: schizophrenia and unipolar mood disorders; (3) two main targets were identified: general practitioners and nurses / community healthcare workers; (4) professional's needs were assessed through a phone questionnaire; (5) WASP experts were in charge of drafting slides kits and other technical documents (6) to avoid any risk of conflict of interest, it was decided that training on medications will be based on the WHO mhGAP guide.
RESULTS: For each disease and each category of HCP (1) a training of trainers manual; (2) a training curriculum; (3) a slide kit; (4) a training brochure; (5) videos of patients; (6) role-play scenarios; (7) clinical cases (8) pre and post assessment questionnaires, were made available.
CONCLUSION: First feed-back indicated that these tools were of great added value for countries with limited human resources, even though, as anticipated, they will have to be adapted locally, especially role-play scenarios, clinical cases and patient's videos.

Mental Health ; General Practitioners ; Health Literacy ; Prevalence ; Students, Public Health ; Mood Disorders ; Community Psychiatry ; Primary Health Care ; Community Health Services ; Curriculum ; Schizophrenia

PURPOSE: The aim of this study was to evaluate the process and outcome of a mobile computerized system for individual home visiting healthcare. METHODS: A nonequivalent control group non-synchronized design was employed for this study. The newly constructed system was administered to 80 healthcare providers in the experimental group for 8 weeks. Data were analyzed using descriptive analysis, t-test, and ANCOVA with the SPSS 18.0 program. RESULTS: In the process stage, the difference in the frequency of computerized information usage between the experimental and control groups was significant as 8.88+/-3.20 and 7.08+/-2.92, respectively (t=3.90, p<.001). In the outcome evaluation stage, all kinds of healthy lifestyle such as alcohol use, nutrition, weight management and mental health were not improved. CONCLUSION: The findings of this study showed that the revised mobile computerized system was an effective device for individual visiting healthcare providers. Further advanced strategies for using this system should be developed and applied in a broad range of community healthcare.
Community Health Services ; Health Personnel ; Home Care Services ; House Calls ; Humans ; Life Style ; Mental Health ; Mobile Health Units ; Program Evaluation

PURPOSE: The purpose of this study was to identify community health nursing activities that community health practitioners perceive and their achievements in community by reviewing the community health nursing activities that community health practitioners have done for the last 30 years. METHODS: This study was a qualitative study. Thirty one community health practitioners were interviewed using the focus group interview method and data were analyzed using content analysis. Data were collected from April to June in 2011. RESULTS: Community health practitioners perceived themselves as "Community Vitalizers" and 9 categories were identified. They were 'ground to explore new nursing areas', 'assimilation to community', 'ground to establish community diagnosis', 'everyday life health management in the community', 'increased accessibility to medical services for the residents', 'enforced health practices for the residents', 'reinforced self-reliance of community', 'commitment to making a happy village' and 'mental fence of the community.' CONCLUSION: This study was meaningful in that it explained the unique identity of the community health practitionersand could be used as important basic materials in the process of re-establishment of the roles of Health Offices. Hereafter in-depth study on community competence reinforcement should be made to identify the roles of community health nurses.
Achievement ; Community Health Nursing ; Focus Groups ; Korea ; Mental Competency ; Nurse's Role ; Primary Health Care ; Reinforcement (Psychology) ; Rural Health

OBJECTIVE: The role of community mental health centers (CMHCs) in Korea is quite different than that of these centers in Western countries due to nation-specific health care system characteristics. For example, CMHCs of Korea are expected to provide services for serious mental illness in addition to other services in response to community needs, such as internet addiction of adolescents. Consequently, it is important to determine service priorities of CMHCs and to define standard service performances in order to maximize their effectiveness with limited resources. The present study aimed to generate expert consensus on service priorities and to identify standard service performances of CMHCs in South Korea. METHODS: Forty-five mental health professionals participated as experts in a Delphi survey. We made a survey questionnaire based on Korean and international data and guidelines of some countries such as the UK and Australia. Experts answered the first and second round questionnaires and their answers were analyzed using frequency analysis. RESULTS: For the question about future directions of CMHCs, twenty-two experts (49%) answered that the growth of services for serious mental illness should be preferred to other areas. The service for chronic mental illness was thought to be the most important service area (27.1%) and, early psychosis (10.5%) is included, the services for serious mental illness should be regarded as the most important service area of Korean CMHCs. It is followed by child and adolescent services (13.2%) and mental health promotion services (10.8%). The relative importance of service performances on each service domain were given by answers of experts. CONCLUSION: CMHCs in Korea should focus their priority on the management of serious mental illness. Service standardization by the relative importance of service performances on each service domain is needed.
Adolescent ; Australia ; Child ; Community Mental Health Centers ; Consensus ; Delivery of Health Care ; Humans ; Internet ; Korea ; Mental Health ; Psychotic Disorders ; Surveys and Questionnaires ; Republic of Korea

This study attempts to identify attitudes of community leaders toward mental illness in order to obtain useful information concerning the planning of community mental health services. The community sample consists of 50 community leaders including, civil servants, doctors, herb doctors, school nurses, counselors, village leaders, pharmacists, and pastors. Individuals were asked to give demographic data, their personal attitudes toward mental illness' etymology and prognosis, and toward neighbors who are psychiatric patients. The interview with open questions was used to collect data. According to the study community leaders 82% believed than mental illness could be treated, 66% believed that mental illness was caused by genetic factors and environmental stress, and 76% had negative impressions about mentally ill people such as fear, seclusion, asylum, also crime. Only 28% of mentally ill people were accepted as neighbors in community. 52% of community leaders rejected opening of mental hospital, and thought that the Chunchon community needed facilities such as group homes, or day care centers(30%), however, 34% of the leaders they didn't recognize community mental health. These findings suggest that mental health professionals need to pay special attention to change the attitude of Chunchon community leaders and mental health institutions need to a develop mental health education program for community leaders.
Community Mental Health Services ; Counseling ; Crime ; Day Care, Medical ; Education ; Gangwon-do ; Group Homes ; Hospitals, Psychiatric ; Humans ; Mental Health ; Mentally Ill Persons ; Pharmacists ; Prognosis ; Terminology as Topic

PURPOSE: The purpose of this study was to understand levels of both mental health literacy of depression and intention of help-seeking, and then to identify the relationship of them in Korean older adults. METHODS: Participants in this cross-sectional survey were 395 persons over 65 years old receiving customized home visiting health care services at Chungnam province. Data were collected through interviews by visiting nurses in 2011. RESULTS: The proportion of participants with depression was 61.8% (6.7+/-3.6). 78.2% of subjects appeared to have help-seeking intention for solving depression. The proportions of participants with ability to recognize depression was 69.1%. Although the level about knowledge and belief in self-help interventions were varied according to questionnaires, subjects understood self-help intervention of smoking accurately (86.3%) and physical activity (85.5%). Ability to recognize depression, knowledge and belief about self-help managements, and opinion of medication for treatment among health literacy variables measured in this study were related to help-seeking intention. In addition, women, visual impairment, and lower depression scores were related to help-seeking intention. CONCLUSION: Results demonstrate that it is necessary to improve depression health literacy to manage effectively depression of vulnerable elderly in communities. These results could be used in developing mental health literacy programs.
Aged ; Community Health Nursing ; Cross-Sectional Studies ; Delivery of Health Care ; Depression ; Female ; Health Literacy ; House Calls ; Humans ; Intention ; Mental Health ; Motor Activity ; Smoke ; Smoking ; Vision Disorders ; Surveys and Questionnaires

INTRODUCTIONAssertive Community Treatment (ACT) provides community-based treatment to patients with severe and persistent psychiatric illnesses, so that they may continue to live and function in the community as they receive psychiatric care. This study aimed to examine the effects of ACT on the outcome of patients over a 1-year period in an Asian population.

MATERIALS AND METHODSThis naturalistic and retrospective cohort study examined the effects of ACT on 100 patients who had completed 1 year of ACT. Parameters used to measure primary outcome were i) number of admissions (NOA) and ii) total length of stay (LOS) in days. Secondary outcome compared the employment status of patients before and after ACT. Paired sample analyses were performed using SPSS.

RESULTS AND DISCUSSIONThe mean reduction in NOA 1 year post-ACT was 57.1%. The mean reduction in LOS 1 year post-ACT was 61.9%. The median reduction for NOA and LOS were both statistically significant (P <0.01). Thirty-seven patients were employed compared to 6 before the programme, a statistically significant effect on employment (odds ratio 9.69, P <0.01).

CONCLUSIONSACT appears effective in reducing the frequency and duration of admissions for patients in Singapore. The employment status of patients also showed improvement over the course of study.

Adult ; Cohort Studies ; Community Mental Health Services ; methods ; standards ; Community Psychiatry ; standards ; Female ; Follow-Up Studies ; Humans ; Male ; Mental Disorders ; therapy ; Middle Aged ; Outcome Assessment (Health Care) ; methods ; Retrospective Studies ; Severity of Illness Index ; Singapore ; Social Adjustment