Public Health Interventions amidst Mental Health Challenges
Let's share your thoughts on public health interventions and mental health Challenges.
Public Health Interventions amidst Mental Health Challenges
The pandemic had shown the importance of Mental Health, along with physical health. Apart from the stigma associated with mental health services availability and accessibility, awareness is a crucial factor. Public Health interventions involving Mental Health Services Research will focus on the available services and make the communities aware. Several Public Health Interventions like counselling, Cognitive Behavioural Therapy (CBT), etc., have been introduced and implemented.
Mental health services research aims to address unmet needs by increasing access and enhancing treatment quality. The development of practical and cost-effective service delivery initiatives has made some headway toward this goal. Because practices often do not continue these programmes beyond research trials, and other methods may not adopt them even when they are shown helpful, they have had limited public health impact. Traditional techniques to health care research, whether observational or experimental, may be insufficient to address these issues. The causes of the health problem are identified at several levels (individual, family, organisation, community, and public policy) in public health treatments using a socio-ecological framework. Interventions are done within and across levels to lessen individual and collective health hazards. 
Community interventions focus on public behaviour change or community development and social action targets based on community priorities that do not always involve health care transformation. Expert-driven interventions in health services research are common, but community interventions range from expert-driven to participatory. The environment for intervention is complicated in such approaches, and various stakeholders are involved, posing issues in intervention design, implementation, and evaluation. 
- Wells K, Miranda J, Bruce ML, Alegria M, Wallerstein N. Bridging community intervention and mental health services research. American Journal of Psychiatry. 2004 Jun 1;161(6):955-63.
Some Interesting Articles
- Ransing R, Adiukwu F, Pereira-Sanchez V, Ramalho R, Orsolini L, Teixeira AL, Gonzalez-Diaz JM, da Costa MP, Soler-Vidal J, Bytyçi DG, El Hayek S. Mental health interventions during the COVID-19 pandemic: a conceptual framework by early career psychiatrists. Asian Journal of Psychiatry. 2020 Jun 1;51:102085.
- Blankenship KM, Bray SJ, Merson MH. Structural interventions in public health. Aids. 2000 Jun 1;14:S11-21.
Understanding mental health as a public health issue is the first step in formulating interventions that could improve people’s livelihoods. The prevalence of mental health issues that affect individuals’ physical and social well-being makes dealing with them integral to achieving public health goals as public health itself aims to promote healthy lifestyles, as well as to detect, prevent, and respond to diseases.
What has already been done:
- Infant and Early Childhood Mental Health Consultation (IECMHC) program, for example, helps families and adults who work with young children strengthen their ability to cultivate healthy environments that support a child’s social and emotional development.
- Healthy IDEAS (Identifying Depression Empowering Activities for Seniors) aims to detect and mitigate depression symptoms in seniors who have chronic conditions or limited abilities to function.
- Brief Intervention and Treatment for Elders (BRITE) provides substance abuse intervention for seniors. The program offers substance abuse screening, identifies nondependent use of substances and prescription medication issues, and offers intervention strategies that prevent those issues from requiring extensive substance abuse treatment.
- For the current pandemic time, key messages can be developed and used to increase the public’s capacity to handle stress, cope with the current uncertainty, and manage distress to slow the development of behavioral health problems. 
- Results from a study have shown the use of hybrid approaches with a range of modalities included within a programme e.g. counselling and ceremonial rituals as common mental health interventions, while others adhering to more rigidly to their intervention/programme protocols e.g. EMDR or CBT. 
What needs to be done:
- On the road ahead, Public Health professional need to promote mental health, find ways to prevent mental disorders, improve access to mental health services, support recovery and reduce the rate of disease and disability among those with mental illnesses.
- They may come forward to increase awareness of mental health issues and reduce stigmas, so people can get the treatment they need.
- Practitioners should also strive to eliminate health disparities and provide equitable access to health services.
- Identifying risk factors for mental illness, such as trauma and chronic health conditions, plays an important role in implementing prevention programs.
- Public health professionals can fight for policies that foster mental health and allow people living with mental illness to thrive.
- Mental Health Challenge needs wider diving into research to identify causes of mental health problems, prevention and treatment. It would also illuminate the public health professional’s understanding of mental health at the individual and community level. 
- Evans AC, Bufka LF. The Critical Need for a Population Health Approach: Addressing the Nation’s Behavioral Health During the COVID-19 Pandemic and Beyond. Prev Chronic Dis 2020;17:200261. DOI: //dx.doi.org/10.5888/pcd17.200261 //www.cdc.gov/pcd/issues/2020/20_0261.htm
- Maddock, A., Blair, C., Ean, N. et al. Psychological and social interventions for mental health issues and disorders in Southeast Asia: a systematic review. Int J Ment Health Syst 15, 56 (2021). //doi.org/10.1186/s13033-021-00482-y //ijmhs.biomedcentral.com/articles/10.1186/s13033-021-00482-y - an interesting read for various interventions.
psychological strain is defined as a state of emotional suffering usually characterized by symptoms of depression and anxiety, which is accepted as a common mental health condition in the community. generally, mental health-related issues are not recognized in public, and with the pandemic, these ‘silent and deceptive issues can go unnoticed. imprisonment to physical spaces, lack of movement, fright, fear of contraction, loss of livelihood, adaptation to the new normal, and the growing ambiguity were some of the observed combined experiences, affecting the overall well-being during the lockdown. The COVID-19 outbreak has been introduced as stress forming that further impinges the mental health status of the population, making them vulnerable to psychological disorders. A drastic increase in the COVID-19 cases and its enervating impact on psychological health necessitates an empirical diagnosis to explore the prevalence and determinants of psychological distress. Such an investigation or diagnosis will help to identify the vulnerable groups at risk. This will enable policymakers to design interventions with a targeted approach.
references-Dohrenwend B. & Dohrenwend B. Perspectives on the past and future of psychiatric epidemiology. The 1981 Rema Lapouse Lecture. American Journal Of Public Health. 72, 1271–1279 (1982) pmid:7125030
The COVID-19 pandemic brought a complex array of challenges which had mental health repercussions for everyone, including children and adolescents. Grief, uncertainty, social isolation, fear, increased screen time, and parental fatigue have negatively affected the mental health of children. However, some children are at greater risk of developing intense reactions, including severe anxiety, depression, and suicidal tendencies. Any pre-existing mental health problem, past traumatic experiences or abuse, family instability, or losing a loved one can make children highly vulnerable to developing severe mental health conditions. 
In this challenging context some of the interventions which have shown positive results-
- CHILDLINE 1098 has played a crucial role in providing support for children and their families. It has provided frontline responder services.
- UNICEF India worked with leading mental health and child protection experts to produce series of articles for parents on mental health and children. Psychosocial support for children during COVID-19 -a manual for parents and caregivers was released with the aim to provide simple tools, which helps parents and caregivers connect emotionally with children, understand their concerns, be aware of any situation leading to violence and abuse. 
- HAQ- Centre for Child Rights; formed a mental health support across Delhi- NCR providing counselling to child victims of sexual abuse during second wave,  and also created Young Busy Bees :A one stop treasure trove for engaging young minds ( aged 12-18 years), with the aim to provide Mental Health Support to Children of various age group across India during first wave. 
- An established method to identify students who may have difficulties with anxiety or depression through systemic screening of the school population have been effectively used in many countries, through online, secure questionnaire. School mental health professionals (counsellors, school psychologists) use scores on these questionnaires to identify students who appear at risk for anxiety or depression difficulties. Screening is one part of the prevention and support process. Rating scales such as the Behavioral Assessment System for Children- Third Edition (BASC-3) or the Behavioral and Emotional Screening System (BESS) is administered. Given the many health challenges that students may experience during and after pandemic, it is important for the educators to (a) assist in identifying at risk students through systemic screening; (b) advocate for universal screening of school population during and following online phase; (c) increase awareness of the importance of mental health screening with their teacher colleague as well as school administrators and parents. 
In face of the global COVID-19 pandemic, innovative solutions such as crisis hotlines, tele- consultations, digital self- help platforms, novel approaches to ensure supply of psychotropic medicine are being used in many countries to overcome service disruptions and maintain care for those with mental conditions. New technologies to support public health messaging and accessible interventions have shown enormous potential during the pandemic. Still these are not comprehensive replacement for traditional face-to face services, and are themselves inaccessible to certain population. An excellent way to improve mental health is to focus on reducing social inequity through an integrated community-oriented system of care, supported by operational research to guide implementers and policy makers to deal with current and future challenges.
 //www.unicef.org/india/media/3401/file/PSS-COVID19-Manual-ChildLine.pdf&ved=2ahUKEwjBqbOp58fyAhX7zzgGHeP3BfEQFnoECAgQAQ&usg=AOvVaw3LiyucsHsES_EG2qE4ozN M"> //www.google.com/url?sa=t&source=web&rct=j&url=//www.unicef.org/india/media/3401/file/PSS-COVID19-Manual-ChildLine.pdf&ved=2ahUKEwjBqbOp58fyAhX7zzgGHeP3BfEQFnoECAgQAQ&usg=AOvVaw3LiyucsHsES_EG2qE4ozNM
 Eaton J; Rahman A; Gater R; Saxena S; Hammerich A; Saeed K. From adversity to resilience in the COVID-19 era: strengthening mental health systems in the Eastern Mediterranean Region. East Mediterr Health J. 2020;26(10):1148–1150. //doi.org/10.26719/2020.26.10.1148
 Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones N, et al. How mental health care should change as a consequence of the COVID-19 pandemic. The Lancet Psychiatry. 2020;7(9):813-824 //doi.org/10.1016/S2215-0366(20)30307-2
Community Interventions to Promote Mental Health and Social Equity :
Families, workplaces, schools, social services, institutions, and communities are potential resources to support health. In 1948, the World Health Organization defined health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” Multi-sector and community-based mental healthcare approaches can help address health and social inequities by promoting social well-being and addressing structural determinants of mental health (public policies and other upstream forces that influence the social determinants of mental health).
We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, school-based interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention.
The first is an awareness of the multiple forces that exist at all social-ecological levels (i.e., individual, interpersonal, organizational/institutional, community, and policy) that facilitate or obstruct mental health . The second is investment in community participation to provide resources and inform interventions, recognizing expertise outside of the healthcare system. The third is prioritization of community mental health and social outcomes.
Studies have noted the importance of community organizations and social services, particularly when inequities play a large role in determining outcomes and require services beyond the healthcare sector, for example for under resourced populations and natural disasters
Community Partners in Care (CPIC) was a depression collaborative care study that involved 95 programs in five sectors: outpatient primary care, outpatient mental health, substance use treatment services, homeless services, and other community services (e.g., senior centers, churches) A 2015 Cochrane review identified CPIC as the only “high-quality study” that “specifically evaluated the added value of a community engagement and planning intervention (i.e. a coalition-led intervention) over and above resource enhancement and community outreach”
Multiple recent studies consider the effects of war and broad structural forces on mental health. Cilliers et al. assessed the individual and community mental and social well-being outcomes associated with truth and reconciliation commissions (TRCs) in 200 Sierra Leone villages . TRCs are community forums created to uncover wrongdoing by governments or other actors in the aftermath of major conflicts. The authors measured “societal healing” indicators, including forgiveness of perpetrators, trust, strength of social network, and community engagement, and “individual healing” indicators: PTSD, anxiety, and depression symptoms (n = 2383). They found that TRCs yielded improvements in societal healing, but worsened individuals’ health (worsened psychological health, depression, anxiety, and PTSD). The authors suggest policy implications such as integrated counseling in TRCs, reducing delays in holding TRCs after war, and exploring alternative post-conflict unification methods.
There is evidence for the effectiveness of community interventions in multiple topic areas and acting at all social-ecological levels. International lay health worker interventions, a parenting intervention to reduce child abuse, a whole-school cognitive behavioral therapy prevention program, adapted ACT teams for early psychosis and justice-involved populations, Housing First services, and multi-sector collaborative care and prevention services are examples of effective community interventions. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes and the need for policy reform to support healthcare-community partnerships.
Mental health is not just an individual condition. It demands comprehensively designed public health interventions that can target in achieving mental well-being, including awareness campaigns, screenings, and access to mental health care with specific efforts focused on the needs of vulnerable populations. Few of such interventions could be as follows:
Public Health Media Campaigns
Those who need mental health care are not able to afford due to financial obstacles, difficulty finding care, and stigma. The government must invest in public health campaigns that de-stigmatize mental health concerns, promote self-care, normalize distress, communicate effective strategies, suggest prevention and treatment, and help people access mental health services.
Mental Health Screening
Seeing the increase in mental health crisis, wide-scale mental health screening should be considered as an important tool. Using validated instruments that identify anxiety and depressive symptoms while doing screening is also important for specific high-risk groups such as people of different race, colour, LGBTQ communities, frontline workers, those with mental health illness and living in low constrained settings get disproportionately affected. To implement such an approach, funding the necessary workforce and remove financial and other obstacles to referring and accessing social workers, nursing practitioners, mental health counsellors, and other trained mental health care providers is essential.
Target Key Interventions
A third component of a public mental health approach involves population-level efforts to reduce psychological distress, build resilience, and provide specialized supports for the needy. These interventions include individual-level treatments, employer-based programs to treat current distress and prevent exacerbation of symptoms, afford mental health treatment via insurance coverage or out-of-pocket expenses etc.
To diversify and improve the competence of mental health professionals, coverage for these services is essential by increasing the workforce. Indulging students and interns to pipeline the stream.
Mental Health Promotion
Mental health promotion needs to target the whole population, including people with mental health problems and their care-givers.
Prioritize Mental Health Surveillance And Research
To identify risks and understand the longer-term effects of distress, prioritizing real-time population mental health monitoring and the collection of data. Such an approach will allow to identify the highest-risk individuals and communities and will aid in proper dissemination of resources to best mitigate those risks. Ongoing research should evaluate communication efforts, screening programs, systems of care workforce development; and new and existing interventions at the population, organization, and individual levels.
Poor advocacy and a lack of financial support for service providers and users hinder the design and implementation of policies and activities that are sensitive to cater the needs and end the stigma of mental health problems, and reinforcing positive attitudes.
- Five Urgent Public Health Policies To Combat The Mental Health Effects Of COVID-19, " Health Affairs Blog, January 27, 2021. DOI: 10.1377/hblog20210122.959001
The World Health Organization (WHO) developed the mental health Gap Action Programme Intervention Guide (mhGAP-IG) to reduce the reduce the global mental health treatment Gap
For improving access to high quality mental health services, four areas required attention : it is imperative to build mental health system treatment and improve research capacity of researchers. Secondly, stigma associated with mental disorder should be addressed .In addition to it, prevention program should be implemented to decrease the incidence of mental disorders and evidence based interventions should be used for mental health treatment
COVID-19 pandemic has had a negative impact on public mental health. Digital interventions like mobile health applications can serve as an effective intervention to address the mental health issues by reducing the service delivery barriers and addressing the issues such as travel time, cost, anonymity, and household responsibilities thereby providing services in an environment which is less threatening to the patients. There are numerous apps targeting various mental health issues like depression, anxiety, bipolar disorder etc. which aid the users by aiding in self-management, monitoring, education and making the services more accessible and affordable.
However, evidence-based recommendations for the use of digital interventions during public health emergencies is lacking. This paper discusses the theoretical and empirical base, user perspective, safety, effectiveness, and cost-effectiveness of digital interventions related to public mental health provision (i.e., mental health promotion, prevention, and treatment of mental disorders) that may help to mitigate the consequences of the COVID-19 pandemic.
Most diseases not only cause physical implications but also psychological wounds. It is important to realize any disease, with physical symptoms can also have psychological implications that can affect the person's suffering, sometimes do not go away simply if ignored, and may even go on to worsen the disease. A paper (1) mentions that poor mental health(like anxiety) can affect chronic disease symptoms and in certain cases may even lead to the development of new ones.
It is important to recognize warning signs of mental health challenges, to plan interventions that can be taken in order to avoid such circumstances and promote better health outcomes.
There must be plans structured in such a way that there are frameworks set up to address mental health challenges as a genuine public health issue; right from the ground level- through interventions like emergency helplines, counseling, and psychiatric resources, up to the international level through campaigns with the help of NGOs, governmental and international organizations.
There has certainly been a paradigm shift towards mental health over the last few years with the inclusion of mental health in the Sustainable Development Goals and the World bank accepting mental health as a global development priority. Only time will show whether this step forward can lead to better places in opening up new opportunities to address global mental health challenges.
Mental health challenges are caused by a combination of genetic, biological and environmental factors. Psychosis encompasses abnormal psychomotor behavior, cognitive impairment, emotional disturbances, hallucination and delusions. Medications like clozapine, change in lifestyle, patience, support of parents and keeping away from street drugs are recommended. Transcranial magnetic stimulation over the temporo-parietal region is an effective treatment for hallucination.
A person affected by Tics and Tourette syndrome make sudden movements or sounds for no reason and could not be controlled. Tics may be caused as a side effect of medications or due to mental health problems. Eating disorders happen when a person's thoughts are focused too much on food and body weight. The three types of eating disorders are anorexia, bulimia and extreme overeating. A medical practitioner, mental health professional and a nutritionist provide intervention to such problems. Kleptomania is a mental disorder which requires counselling, skills training with doctors and support at initial stages.
- The mental health Gap Action Programme Intervention Guide (mhGAP-IG) provides user-friendly clinical guidelines to be adopted to reduce the global mental health treatment gap. Despite the shortage of mental health workers, lack of research capacities and stigmatization of mental illness should be wiped out.
- PRIME- Programme for Improving Mental Healthcare and a research institute with ministries of 5 LMICs in Asia (Ethiopia, India, Nepal, South Africa and Uganda) has brought out collaborative care and quality improvement in treatment and screening of mental health.
1.Schrimpf LA, Aggarwal A, Lauriello J. Psychosis. Continuum (Minneap Minn). 2018 Jun;24(3, BEHAVIORAL NEUROLOGY AND PSYCHIATRY):845-860. doi: 10.1212/CON.0000000000000602. PMID: 29851881.
2. Arciniegas DB. Psychosis. Continuum (Minneap Minn). 2015 Jun;21(3 Behavioral Neurology and Neuropsychiatry):715-36. doi: 10.1212/01.CON.0000466662.89908.e7. PMID: 26039850; PMCID: PMC4455840.
3. Zhang ZH, Huang FR, Liu DH. Kleptomania: Recent Advances in Symptoms, Etiology and Treatment. Curr Med Sci. 2018 Oct;38(5):937-940. doi: 10.1007/s11596-018-1966-2. Epub 2018 Oct 20. PMID: 30341533.
4. Wainberg ML, Scorza P, Shultz JM, Helpman L, Mootz JJ, Johnson KA, Neria Y, Bradford JE, Oquendo MA, Arbuckle MR. Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective. Curr Psychiatry Rep. 2017 May;19(5):28. doi: 10.1007/s11920-017-0780-z. PMID: 28425023; PMCID: PMC5553319.
Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap.
Recent findings show that common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings.
Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services.
Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally:
- Diminishing pervasive stigma
- Building mental health system treatment and research capacity
- Implementing prevention programs to decrease the incidence of mental disorders
- Establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions.
Effects of interventions or programmes on mental health issues and disorders:
- Lay delivered interventions
Targets: Depression, anxiety, well-being
- Yoga, aerobic and/or meditation based interventions or programmes
Targets: depression, psychological distress, quality of life, PTSD, complicated grief
- CBT oriented interventions or programmes
Targets: depression, schizophrenia
- EMDR based interventions or programmes
Targets: depression, anxiety, PTSD, suicidal ideation, self-harm, psychiatric morbidity
A key element of evidence-based treatment in psychological and social interventions is finding out which forms and types of therapy work for which individuals under what circumstances.
Thus, by identifying the mechanisms of action in these interventions and enhancing the theoretical understanding of how these treatments may work, we can optimize its therapeutic effects.
Wainberg ML, Scorza P, Shultz JM, Helpman L, Mootz JJ, Johnson KA, Neria Y, Bradford JE, Oquendo MA, Arbuckle MR. Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective. Curr Psychiatry Rep. 2017 May;19(5):28. doi: 10.1007/s11920-017-0780-z. PMID: 28425023; PMCID: PMC5553319.
Maddock A, Blair C, Ean N, Best P. Psychological and social interventions for mental health issues and disorders in Southeast Asia: a systematic review. Int J Ment Health Syst. 2021 Jun 5;15(1):56. doi: 10.1186/s13033-021-00482-y. PMID: 34090491; PMCID: PMC8178881.
World Health Organization defined health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”
One can't see mental health in isolation from phycal health and social well being
Mental health promotion seeks to further nurture individual competencies and socio -psychological strengths, to enhance well-being and quality of life for an individual and community as well.
It is evident that the effectiveness of community interventions in multiple areas and action at all social-ecological levels are gradually started meeting the needs..but there is a long long way to go..... health worker interventions, a parenting intervention to reduce child abuse, cognitive behavioral therapy prevention program, for early psychosis and justice-involved populations, and multi-sector collaborative care and prevention services are examples of effective community interventions. Future research should further focus on best practices across the globe for multi-sector collaborations and partnership structures, identify strategies for sustainable change after the end of research activities, and clarify the types of health and social problems that can be improved and revamped in the best way through community interventions . In close and equitable partnerships with communities and policy leaders , future community interventions in mental health should head forward to improve health and achieve large-scale social outcomes through initiatives that address mental health, and social inequities.
Currently, all of us are experiencing emotions, thoughts and situations we have never experienced before. It is not that there were no pandemics earlier. Pandemics, particularly plague outbreaks have been known since times immemorial. The Cholera pandemic followed by the flu pandemic were highlights of the nineteenth century followed by others. The pandemic of COVID-19 is on a completely different scale. It has shaken the entire world and created global panic. As COVID-19 initially creeps in and subsequently spreads at a galloping pace, it has been ravaging country after country. The pandemic has significant and variable psychological impacts in each country, depending on the stage of the pandemic.
Planning and policy making are critical to ensure program effectiveness. It is essential to ensure that mental health is integrated into the broad framework of COVID-19 health care response to ensure adequate and appropriate care to the many thousands who are psychologically disturbed following the pandemic.