The WHO Pyramid Framework describing the optimal mix of services for mental health [34]

The WHO Pyramid Framework describing the optimal mix of services for mental health [34]

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Background: This study describes the Moldovan mental health system and reform needs before and during the initial phase of the MENSANA project (2014-2022) over the period 2007-2017. Methods: A situation analysis was performed on: (1) the comparative need based on a country comparison using publicly available mental health system data; (2) the no...

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... Ninety-two publications were from high-income countries (HIC), most from the United Kingdom and the United States. Fourteen studies referred to LMIC including Bhutan (68), Brazil (35,53,104), China (94), Ghana (74,114), Moldova (88), Malawi (76), South Africa FIGURE 1 | Flow diagram according to the preferred reporting items for systematic reviews and meta-analyses. (55,62), Uganda (103) and two publications referred to South America (8,105). ...
... Recommendations based on expert consensus or opinion were found in 38 publications. Eleven recommendations were in line with a normative approach using institutional or governmental guidelines (14,36,53,58,79,81,88,98,103,106). Two studies combined approaches (14,88). ...
... Eleven recommendations were in line with a normative approach using institutional or governmental guidelines (14,36,53,58,79,81,88,98,103,106). Two studies combined approaches (14,88). Most expert arguments came from HIC (31) and only few (10) from LMIC ( Table 2). ...
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Introduction: Mental health policies have encouraged removals of psychiatric beds in many countries. It is under debate whether to continue those trends. We conducted a systematic review of expert arguments for trends of psychiatric bed numbers. Methods: We searched seven electronic databases and screened 15,479 papers to identify expert opinions, arguments and recommendations for trends of psychiatric bed numbers, published until December 2020. Data were synthesized using thematic analysis and classified into arguments to maintain or increase numbers and to reduce numbers. Results: One hundred six publications from 25 countries were included. The most common themes arguing for reductions of psychiatric bed numbers were inadequate use of inpatient care, better integration of care and better use of community care. Arguments to maintain or increase bed numbers included high demand of psychiatric beds, high occupancy rates, increasing admission rates, criminalization of mentally ill, lack of community care and inadequately short length of stay. Cost effectiveness and quality of care were used as arguments for increase or decrease. Conclusions: The expert arguments presented here may guide and focus future debate on the required psychiatric bed numbers. The recommendations may help policymakers to define targets for psychiatric bed numbers. Arguments need careful local evaluation, especially when supporting opposite directions of trends in different contexts.
... Historically, mental healthcare was largely institution-based provided within 3 psychiatric hospitals (Table 2), and residential institutions, referred to as internats in many Central and Eastern European countries, function as a long-term care facility for people with mental illness [11,12]. Specialised outpatient services within small psychiatric units based in general hospitals largely renewed medication prescriptions and staffed by small teams (psychiatrists and nurses). ...
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In 2014, the Republic of Moldova started a systematic process of reforming its mental health system, implementing priority actions set out in the National Mental Health Programme. The reform entailed a service delivery re-design, instituting mechanisms for collaboration across health and social sectors, and revision of the policy framework. Outcomes of the first 4 years of the reform included: 1) the establishment of a network of mental health services in 4 pilot districts embedding mental health diagnosis, treatment and referral in primary and specialized mental healthcare; 2) creation of an enabling policy environment at the national and district level; and 3) strengthened community support and acceptance of mental health issues. Objectives of the first Phase were achieved and the reform is now in its second Phase (2018-2022). The implementation strategy in Phase 1 focused efforts on 4 pilot districts, whereas Phase 2 harnesses lessons learned from Phase 1 and facilitates local leaders and actors to scale-up the model to all 32 districts and municipalities in Moldova. Ownership over the reform process shifted from project-led in Phase 1 to national and local government-led in Phase 2. We reflect on the process and contents of the mental health reform, discuss lessons learned and implementation challenges encountered. We conclude with learning points for policymakers and researchers considering mental health reform in other countries.
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