In accordance with the Republic Act (RA) 11036, also known as the Mental Health Act of 2017, the Department of Health (DOH) was tasked to "establish a balanced system of community-based and hospital-based mental health services at all levels of the public health care system from the barangay, municipal, city, provincial, regional to the national level." It is also expected that the Local Government Units (LGUs) "promote deinstitutionalization and other recovery-based approaches to the delivery of mental health care services."1 Even before RA 11036 was enacted, the Davao Center for Health Development (DCHD) had already facilitated the establishment of several Community-Based Mental Health Programs (CBMHPs) in rural health units (RHUs) within the region since 2015. These programs are guided by six principles–coordinated level of referral system for better patient care, optimizing the expertise of the regional mental hub to guarantee rational use of drugs, community-based patient care for a more cost-effective treatment, capitalizing family and patient's support groups for better patient outcomes, optimizing innovative long-acting injections for better compliance and decreased relapse, and neutralizing the stigma against schizophrenia to improve mental health.2 The aim of this article is to recommend health care policies based on the report on observations and lessons learned from the implementation of the CBMHPs by the DCHD in four municipalities in Davao Region.
Community Health Services ; Mental Health Services

OBJECTIVE: We aimed to investigate the influence of area-level factors on adolescent suicide and to determine which variables differ according to age and sex.METHODS: We selected variables that were available for collection through an online database from 2005 to 2015 in the Korean Statistical Information Service and the Korea Labor Institute. We used administrative districts of Korea in 2017 for geographical classification. We examined the relationships between regional suicide rates and area-level variables in male and female subjects aged 10–14 years and 15–19 years. In addition, we analyzed area-level variables in adolescents aged 15–19 years according to sex.RESULTS: Our findings indicated that several area-level variables affected adolescent suicide rates, varying according to age and sex. Economic problems were shown to be more associated with suicide in male adolescents than in female adolescents. On the other hand, social fragmentation and health services were shown to be more associated with suicide in females.CONCLUSION: Suicide in adolescents was attributable to area-level factors such as economic status, social fragmentation, and community health services. By identifying area-level variables affecting adolescent suicide rates, we will be able to contribute to implement mental health policies related to adolescent suicide.
Adolescent ; Classification ; Community Health Services ; Female ; Hand ; Health Services ; Humans ; Information Services ; Korea ; Male ; Mental Health ; Suicide

OBJECTIVES: Serious mental illnesses and substance use disorder have a high level of early mortality. This study aimed to identify the causes of their deaths among patients who had been under the care of community mental health and welfare centers and addiction management centers.METHODS: We collected information on deceased individuals, whose mortality was attributable to various causes of death, from 10 Community Mental Health Centers and Addiction Centers in Gwangju Metropolitan City. The primary variables collected included psychiatric diagnosis, cause of death, smoking habits, admission history, and several socio-demographic factors.RESULTS: A total of 214 deaths among service users were studies. In Community Mental Health Centers, 109 deaths were identified, with causes that may be itemized as follows : 27 suicides(24.8%), 56 physical illnesses( 51.4%), 14 accidents(12.8%), and 12 unknown causes(11.0%). Among the physical illnesses reported, cardiovascular illness and cancer were the most common causes of death. A history of frequent admission was common among those that had died by suicide(88.9%), compared with that observed among general service users(62.0%). In Addiction Centers, 105 deaths were identified, with causes that may be itemized as follows : 7 suicides(6.7%), 71 physical illnesses(68.3%), 7 accidents(6.7%), and 20 unknown causes(19.0%). Among the physical illnesses reported, sudden death, hepatic disorder, cancer, and cardiovascular disorder were the most common causes of death.CONCLUSION: Case managers should give due consideration to and carefully manage the physical health of individuals accessing mental health services via community mental health centers and addiction centers.
Case Management ; Cause of Death ; Community Mental Health Centers ; Death, Sudden ; Gwangju ; Humans ; Mental Disorders ; Mental Health Services ; Mental Health ; Mortality ; Smoke ; Smoking ; Substance-Related Disorders ; Suicide

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

Treatment of schizophrenia has as its ultimate goals, the functional recovery of the patients and improvement of their quality of life. While antipsychotic medication is the fundamental method for treating schizophrenia, it has certain limitations in terms of treating the illness beyond its positive symptoms. Therefore, psychosocial intervention should be used in tandem with pharmacological methods in treating schizophrenia. The efficacy of several modes of psychosocial intervention for improving outcomes in schizophrenia is well attested. Approximately 10 modes of psychosocial intervention have been recommended based on existing evidence, including family intervention, cognitive behavioral therapy, supported employment, early intervention services, lifestyle intervention for physical health enhancement, treatment of comorbid substance abuse, assertive community treatment, cognitive remediation, social skills training, and peer support. Ideally, these interventions are offered to patients in combination with one another. Over the last decade, increased emphasis has been placed on early detection and intervention, with particular focus on long-term recovery. Early intervention with comprehensive psychosocial interventions should be enacted promptly from the initial detection of schizophrenia.
Cognitive Therapy ; Community Mental Health Services ; Early Intervention (Education) ; Employment, Supported ; Humans ; Life Style ; Methods ; Quality of Life ; Rehabilitation ; Schizophrenia* ; Social Skills ; Substance-Related Disorders

OBJECTIVES: To evaluate sleep characteristics and factors associated with sleep disturbance in schizophrenia patients with concurrent active psychotic symptoms and insomnia. METHODS: Schizophrenia patients with insomnia and active psychotic symptoms (n = 63) were recruited from communitybased mental rehabilitative facilities. Sleep scales such as the Korean version of the Insomnia Severity Index (ISI-K) and the Korean Version of the Pittsburgh Sleep Quality Index (PSQI-K) were evaluated and those with ISI-K >15 were included in the study. Psychotic, anxiety and depressive symptoms were rated with the Brief Psychotic Rating Scale (BPRS), the Korean Version of the Anxiety Sensitivity Index (K-ASI), and the Korean Version of the Beck Depression Inventory-I (K-BDI), respectively. Pearson correlation analyses were performed between the sociodemographic data, ISI-K and PSQI-K. Multiple linear regression analysis was conducted to investigate the factors which affected the ISI-K and PSQI-K. RESULTS: The mean ISI-K and PSQI-K scores were 18.1 ± 2.6 and 12.0 ± 2.2, respectively. Pearson correlation analysis showed a negative correlation between age of onset and ISI-K score and positive correlations between BRPS and PSQI-K scores and between K-ASI and both ISI-K and PSQI-K scores. Multiple regression analyses for both ISI-K and PSQI-K with K-ASI, age of onset, and BPRS as covariates revealed K-ASI as the only significant remaining factor. CONCLUSION: Our study suggests that anxiety symptoms are associated with insomnia symptoms in schizophrenia patients regardless of depressive or psychotic symptoms.
Age of Onset ; Anxiety ; Community Mental Health Services ; Depression ; Humans ; Linear Models ; Mental Health Services* ; Mental Health* ; Schizophrenia* ; Sleep Initiation and Maintenance Disorders* ; Weights and Measures

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: According to WHO about 80% of people living with a severe mental disorder in Low-and-Middle-income countries (LAMICs) do not have access to appropriate healthcare. Low literacy regarding mental disorders is one of the main barriers that prevent access to mental healthcare, which leads to stigma, socio economic exclusion, suffering of people with mental disorders and forces families to hide their relatives rather than to direct them to the community healthcare centre. To address this issue mental health, stakeholders from more than 20 countries joined forces with the World Association of Social Psychiatry and Sanofi in the FAST program, based on 3 pillars: (1) Mental health literacy, (2) health care professionals training and (3) affordable quality medicines.
OBJECTIVE: This research aimed or develop Information-Education-Communication materials to improve mental health literacy in LAMICs.
METHODOLOGY: Workshops with participants from different sectors (public, academic, associative, private) were set up to develop generic documentsbased on the experienced derived from malaria awareness programs. Then, for each country, documents were revised and adapted by a local working group.
RESULTS: A flip chart, an educational comic book, a leaflet, a poster and a brochure on schizophrenia were made available with versions adapted to the local specificities of (a) Sub - Saharan Africa (b) North Africa (c) Eastern Europe and (d) Latin America. The main message of the educational materials was that: mental disorders are like any other disease i.e. they can be treated and people with mental disorders are like any other person. The following specific topics where covered: frequency of mental disorders, symptoms recognition, cause of disease, where to seek help, stigma. Recommendations on how to use these materials were also available.
CONCLUSION: Improving mental health literacy in developing countries calls for relevant materials. A rigorous evaluation of the impact of the FAST documents is now required.

Human ; Health Literacy ; Mental Health ; Developing Countries ; Social Stigma ; Community Psychiatry ; Schizophrenia ; Community Health Services ; Malaria

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: According to WHO about 80% of people living with a severe mental disorder in Low-and-Middle-income countries (LAMICs) do not have access to appropriate healthcare. Low literacy regarding mental disorders is one of the main barriers that prevent access to mental healthcare, which leads to stigma, socio economic exclusion, suffering of people with mental disorders and forces families to hide their relatives rather than to direct them to the community healthcare centre. To address this issue mental health, stakeholders from more than 20 countries joined forces with the World Association of Social Psychiatry and Sanofi in the FAST program, based on 3 pillars: (1) Mental health literacy, (2) health care professionals training and (3) affordable quality medicines.
OBJECTIVE: This research aimed or develop Information-Education-Communication materials to improve mental health literacy in LAMICs.
METHODOLOGY: Workshops with participants from different sectors (public, academic, associative, private) were set up to develop generic documentsbased on the experienced derived from malaria awareness programs. Then, for each country, documents were revised and adapted by a local working group.
RESULTS: A flip chart, an educational comic book, a leaflet, a poster and a brochure on schizophrenia were made available with versions adapted to the local specificities of (a) Sub - Saharan Africa (b) North Africa (c) Eastern Europe and (d) Latin America. The main message of the educational materials was that: mental disorders are like any other disease i.e. they can be treated and people with mental disorders are like any other person. The following specific topics where covered: frequency of mental disorders, symptoms recognition, cause of disease, where to seek help, stigma. Recommendations on how to use these materials were also available.
CONCLUSION: Improving mental health literacy in developing countries calls for relevant materials. A rigorous evaluation of the impact of the FAST documents is now required.

Human ; Health Literacy ; Mental Health ; Developing Countries ; Social Stigma ; Community Psychiatry ; Schizophrenia ; Community Health Services ; Malaria