Harvard review of psychiatry
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Harv Rev Psychiatry · Jul 2012
ReviewCampus suicide prevention: bridging paradigms and forging partnerships.
Colleges and universities are increasingly recognizing the need to expand suicide-prevention efforts beyond the standard, clinical-intervention paradigm of suicide prevention, which relies on referral to, and treatment by, mental health services. These services frequently struggle, however, to provide effective, comprehensive care. After reviewing findings that support the need to adopt a broader, problem-focused paradigm, the article provides a framework for bridging this paradigm with the clinical-intervention approach and for conceptualizing a full continuum of preventive interventions. For each level of intervention (ranging from the individual to the ecological), we describe the goals and methods used, and provide examples to illustrate the role of psychiatrists and other campus mental health providers in the collaborative partnerships that must form to support a comprehensive, campus-wide suicide-prevention strategy.
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Research-generated information about mental disorders is crucial in order to establish the health needs in a given setting, to propose culturally apt and cost-effective individual and collective interventions, to investigate their implementation, and to explore the obstacles that prevent recommended strategies from being implemented. Yet the capacity to undertake such research in low- and middle-income countries is extremely limited. ⋯ A structured approach is proposed for the career development of research staff at every career stage, to be accompanied by performance monitoring and support. A case example from the Mental Health and Poverty Project in sub-Saharan Africa illustrates how this approach can be put into practice-in particular, by focusing upon training in core transferrable research skills.
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Harv Rev Psychiatry · Jan 2012
Mental health response in Haiti in the aftermath of the 2010 earthquake: a case study for building long-term solutions.
Significant challenges exist in providing safe, effective, and culturally sound mental health and psychosocial services when an unforeseen disaster strikes in a low-resource setting. We present here a case study describing the experience of a transnational team in expanding mental health and psychosocial services delivered by two health care organizations, one local (Zanmi Lasante) and one international (Partners in Health), acting collaboratively as part of the emergency response to the 2010 Haiti earthquake. In the year and a half following the earthquake, Zanmi Lasante and Partners in Health provided 20,000 documented individual and group appointments for mental health and psychosocial needs. ⋯ Throughout the collaboration, efforts were made to coordinate planning with multiple organizations interested in supporting the development of mental health programs following the disaster, including national governmental bodies, nongovernmental organizations, universities, foreign academic medical centers, and corporations. The collaborative interventions are framed here in terms of four overarching categories of action: direct service delivery, research, training, and advocacy. This case study exemplifies the role of psychiatrists working in low-resource settings as public health program implementers and as members of multidisciplinary teams.
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Harv Rev Psychiatry · Jan 2012
Relevance or excellence? Setting research priorities for mental health and psychosocial support in humanitarian settings.
Humanitarian crises are associated with an increase in mental disorders and psychological distress. Despite the emerging consensus on intervention strategies in humanitarian settings, the field of mental health and psychosocial support (MHPSS) in humanitarian settings lacks a consensus-based research agenda. ⋯ To advance a collaborative research agenda, actors in this field need to bridge the perceived disconnect between the goals of "relevance" and "excellence." Research needs to be more sensitive to questions and concerns arising from humanitarian interventions, and practitioners need to take research findings into account in designing interventions.