Toolkitfor e-Mental HealthImplementationAugust 2018mentalhealthcommission.ca
AcknowledgementsThe creation of the Toolkit for e-Mental Health Implementation for Canada was a jointeffort of the Centre for Research in Family Health (CRFH), IWK Health Centre andthe Mental Health Commission of Canada (MHCC), in consultation with stakeholders.IWK Health Centre Project Team Dr. Patrick McGrath, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada Dr. Lori Wozney, Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada Dr. Andrea Bishop, Strenghening Transitions in Care, IWK Health Centre, Halifax, NS, Canada Dr. Janet Curran, School of Nursing, Dalhousie University, Halifax, NS, Canada Dr. Jill Chorney, Clinical Psychology, IWK Health Centre, Halifax, NS, Canada Swati S Rathore, Centre for Research in Family Health, IWK Health Centre, Halifax, NS, CanadaMHCC Knowledge Exchange Centre MaryAnn Notarianni, Manager, e-Mental Health, Knowledge Exchange Centre, Mental Health Commission of Canada Meg Schellenberg, Program Manager, e-Mental Health, Knowledge Exchange Centre, Mental Health Commission of CanadaCe document est disponible en français.Citation informationCopyrightSuggested Citation: McGrath, P., Wozney, L., Rathore, S.S., Notarianni, (2018) Mental Health Commission of CanadaM., Schellenberg, M. (2018). Toolkit for e-Mental Health Implementation.The views represented herein solely represent the views of the MentalHealth Commission of Canada.Mental Health Commission of Canada. Ottawa, ON.This document is available at http://www.mentalhealthcommission.caProduction of this document is made possible through a financialcontribution from Health Canada.ISBN: 978-1-77318-062-5 (Print), 978-1-77318-061-8 (Online)Legal deposit National Library of Canada
TABLE OF CONTENTSIntroduction to the toolkit3Module 2: Roadmap for launching e-mental health What is e-mental health?3 Objectives31 Why an e-mental health implementation toolkit?4 Formula for success32 Who is the toolkit for?5 Launching e-mental health in practice33 How to use the toolkit6 Stage 1: Map the destination33 Disclaimer7Module 1: Exploring the world of e-mental health9 Objectives931- Define what needs to change and why33- Locate accessible data34 Table 5: Possible data sources- Consider costs3435 Getting to know existing e-mental health options10- Start-up costs for practitioners35 Table 1: Types of e-mental technologies11- Costs for patients36 Examples of e-mental health13- Train and communicate36 Benefits and outcomes linked to e-mental health14 Challenges in selecting & evaluating e-mental health tools15 Deciding how to use e-mental health16- Countdown checklist37- People first - putting patients centre-stage16- Checking in on how it is going38- Social and cultural relevance16- Familiarity and developmental readiness17- Patient access to electronic products17 Table 2: Pros and cons of different technologiesfor e-mental health18 Diagnostic severity and therapy needs19 Building e-mental health into the clinician workflow21 Table 3: Five typical approaches to e-mentalhealth integration22 Evaluating potential e-mental health tools yourself23 Table 4: Checklist: Five things to think about whileassessing e-mental health tools24 Module 1 Mini-case scenario27 Stage 2: Launching new e-mental healthprograms and services Stage 3: Go: Full-scale integration- Determine next steps373939 Module 2: Mini-case scenario41 Table 6: Live Chat vs Texting42E-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I T1
Module 3: Building your digital skill set47Module 5: Leadership for e-mental health innovation 77 Objectives47 Objectives77 E-mental health skills and competencies48 Develop a compelling but realistic vision78- Technology attitudes and skills48 Clinical leadership and team working79- Interpretation and analysis of e-mental health data49 Champion disruptive innovation79- E-communication49 Know your champions80- ‘Do no harm’: Protection of personal health information50 Policy experimentation80 Federal and provincial privacy policies and standards51 Module 5: Mini-case scenario83 Regulation of medical devices52 Professional policies and standards53References86 Organizational policies54 E-mental health professional development plan55Appendices9157 Appendix 1: Readiness for e-Mental Health Self-Assessment9259 Appendix 2: Implementation Project Checklist93 Appendix 3: Workflow Checkup97- Tips for a good e-mental health learning plan Module 3 Mini-case scenarioModule 4: Engaging patients in e-mental health63 Appendix 4: E-Mental Health Planning Canvas98 Objectives63 Appendix 5: Workflow Mapping99 What we think we know about e-mental health64 Appendix 6: Computer Skills Self-Assessment100 The impact of clear endorsement65 Appendix 7: SWOT Brainstorm101 Strategies for engaging patients in e-mental health66 Appendix 8: SMART Goals Worksheet for Clinical Staff102- Inform me68 Appendix 9: Training Planner104- Engage me68 Appendix 10: Patient Satisfaction Survey106- Empower me69- Partner with me69 Appendix 11: Informed Consent forElectronic Communication107- Support my e-community69 Appendix 12: Patient FAQ Sheet10971 Glossary110 Module 4 Mini-case scenario2E-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I T
Introductionto the toolkitWhat is e-mental health?The term e-mental health refers to the use ofthe internet and other electronic communicationtechnologies to deliver mental health informationand care. E-mental health services are aneffective and complementary option totraditional face-to-face mental health support.By providing accessible and convenient assistance,e-mental health can play an important role forpatients seeking help [1].Technology is evolving and new innovation comes intothe market at a very fast pace. E-mental health caninclude but are not limted to: instant messaging and video-based counselling services(also known as telehealth or telepsychiatry) consumer information portals online support groups, forums and social networks mobile phone applications online assessment or diagnostic tools blogs and podcasts therapeutic gaming programs, robotic simulationand virtual reality systems.E-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I T3
Why an e-mental health implementation toolkit?Provincial and territorial jurisdictions have improved e-health resourcesTo support the establishment of e-mental health programs, thisfor health providers. But mental health care practitioners continue toimplementation toolkit was developed. The goal of the toolkit is toidentify common barriers around the provision of e-mental health,provide:including [2]: procedural and administrative hurdles demanding workloads for clinicians patient concerns regarding privacy of personal data lack of evidence surrounding cost effectiveness lack of leadership lack of e-mental health legislation or regulation lack of interoperability in connecting with currenthealth systemOvercoming these barriers is a challenge for financially strained mentalhealth care systems that face increasing demand and an aging clinicalworkforce. However, research shows the likelihood of achieving successfule-health programs increases when [3]: leaders at all levels (e.g., government, health authorities, healthcentres, etc.) support the implementation of e-health initiatives implementation guidelines are systematic and participatory before implementation, an environmental readiness assessmentis conducted barriers and facilitators are assessed and addressed adequate resources are dedicated to the implementationof e-health4E-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I T an introductory resource for practitioners who may not yet haveany formal e-health training evidence-informed samples and templates for e-mental healthplanning and implementation a useful resource for front-line practitioners, managers and seniormental health leaders with a project implementation / quality /risk focus a support to e-mental health champions and leaders who providetraining and guidance to other health practitioners a map of current internationally recognized e-mental healthpractices and trends a starting point for promoting knowledge sharing, lessonslearned, successes and challengesThe toolkit reflects information gathered from the knowledge andexperience of the authors and research group, an environmental scan[4] and rapid review of existing literature [5], interviews conducted withkey informants across Canada and internationally [6], peer-reviewedresearch, templates and examples provided by relevant organizations, andinsights shared by many on-the-ground practitioners at various meetings,gatherings and forums.
WHO IS THE TOOLKIT ding general, clinical, health, counsellingCommunity health workersSocial workersOccupational therapistsMental health nursesPeer support workersPrimary health care nursesOther allied health workersE-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I T5
MOHow to use the toolkitDULE2Launching andsustaining progressThe toolkit includes a set of strategies tosuccessfully plan and initiate e-mental healthinnovation in clinical practice. These fivemodules reflect a process that is dynamicand iterative rather than linear. Each moduleincludes groundwork information, planning andguidance models, self-assessments, mini-casescenarios and links to other resources.MODULE1MOExploring the worldof e-mental healthUnderstanding trends and currente-health solutions so they can beembedded into practice. Learningto review and select appropriatee-mental health knowledgetools/resources for the rightclinical context.6Preparing, launching andevaluating new e-mental healthuptake. Effectively monitoringand evaluating progress forsustainability.E-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I TDULE3Building your digital skill setAssessing e-mental healthcompetencies to map e-mentalhealth training needs. Developingconfidence in using e-mentalhealth in clinical practice.
MODULE4Engaging patientsin e-mental healthLearning about perceptions, issuesand expectations of patients andcolleagues. Reviewing strategiesfor communicating better withpatients.DisclaimerCanadian mental health services exist in many different formsand service models. This toolkit is not an exhaustive list of allactions your practice may need to take before launching ane-mental health program; you should take your own steps toensure your practice is prepared to deliver safe and effectiveelectronic-based health care.This toolkit is intended to be generic (i.e., applicable to allDULEMOe-mental health tools); therefore, as you move forward5to seek additional information from relevant resourceswith your e-mental health implementation, you may needand stakeholders.Leadership for e-mentalhealth innovationEvery reasonable effort has been made to ensure theinformation presented in this toolkit is current and accurate.The toolkit does not replace the advice, guidance and supportProviding strategic leadershipfor sustainable e-mental healthintegration.provided by local health authorities, professional associationsor software vendors.E-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I T7
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Exploringthe world ofe-mental healthObjectives Recognize opportunities for e-mental health integrationin your practice Obtain detailed understanding of the range of e-mentalhealth tools and applications currently availableMODULE1 Be able to evaluate the quality and appropriatenessof different e-mental health tools Understand the appropriate use of e-mental healthE-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I T9
Getting to know existinge-mental health optionsDigital resources and services have a significant roleto play in promoting and supporting people’s mentalhealth. It is convenient, can provide services tailored tothe needs and requirements of the patients, and help inavoiding stigma. Thereby, using technology potentiallyimproves the quality and efficiency and brings equity inmental health services in Canada.There are a few critical realities to keep in mind [7].E-mental health implementation is a process, not a one-time event.Adapt to your local context. This toolkit provides advice based on others’experiences with e-mental health implementation. But there are no hardand fast rules. Every place is different and every roll-out is unique; youhave to adapt the tools to fit your situation and clinical requirements.There may not be a digital solution for every patient. E-mental healthtools will not be appropriate for every patient.Not all barriers are under your control. Many e-mental health effortsfail. Industry players, funding models, policy directives, technologyinfrastructure, patient and provider needs and accountability structuresall contribute to implementation challenges.Do not expect to simply find an e-mental health tool and start usingToday’s digital patient has broad access to tools that promise to helpit immediately. Initially, it will be disruptive and will likely introducethem self-test, self-diagnose and self-treat mental health conditions andinefficiencies. But it can be transformative for patients and clinicaldisorders. These tools vary in their intended audience, purpose, modeworkflow. E-mental health will touch all aspects of your practice.of delivery, theoretical basis, style, level of complexity, cost, quality andAfter launching a new e-mental health service or integrating a newefficacy.tool, regular monitoring and updating of the system will keep it usefulIt will be difficult for you to communicate with patients about electronicand relevant.tools if you do not understand their functionality. In order to explore theA good plan is important, but be flexible. The perfect implementationpotential for e-mental health with your patients, you must understandscenario does not exist. The unexpected will arise. Even after thoroughthe digital health landscape.planning, last-minute changes will occur. For example, there may bechanges in patient needs, policies, or regulations. Plans can, and should,be adjusted throughout the implementation process. Be willing to adapt.10E-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I T
TABLE 1Types of e-mental technologiesAppCloud serviceA software program made to run onExternal server space availablea small device, such as a cell phonethrough the internet(apps are downloaded from Apple’sApp Store or Google Play)Instant messagingArtificial intelligenceA free or low-cost way to exchange textand media using mobile data or Wi-FiWhen computer systems that apply algorithmsand machine learning techniques perform tasksthat normally require human intelligence(e.g., speech recognition, decision making,Operating systemlanguage translation)What controls a device(e.g., Windows on a PC, iOS on an Apple)Big dataAn extremely large data set that may beanalyzed computationally to reveal patterns,trends and associations, especially relatingto human behaviour and interactionsPortal/ElectronicMedical RecordA secure website that gives patients 24-houraccess to their personal health informationE-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I T11
TABLE 1Types of e-mental technologies – con’tSearch engineTelehealthA tool for searching the internetThe use of live video to deliver(Google is the best knownhealth services over long distancessearch engine)SmartphoneA computer-generated simulation that can be interactedA cellular phone that connectswith by a person using special electronic equipment, such asto the internet and runs softwarea helmet with a screen inside or gloves fitted with sensorsSocial mediaA space on the internet wherecontent is created and sharedby users (e.g., blogs, forums,chat rooms, photo diaries)SoftwareA program run by a computer(also called an application, or app)12Virtual realityE-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I TWearableClothing or an accessory that incorporates computerand electronic technologies, such as sleep trackersand pedometersWebsiteA space on the internet, usually found by typing a webaddress into a browser; websites can be viewed on differentdevices (computer, tablet, television, mobile phone, etc.)
Examples of e-mental healthTo date, e-mental health tools have predominantly applied cognitivebehavioural therapy (CBT) techniques. But as time goes on, otherpsychological treatments traditionally delivered face-to-face (e.g.,acceptance and commitment therapy, interpersonal psychotherapy,solution-focused therapy, mindfulness-based therapies and motivationalinterviewing) are being incorporated into e-mental health platforms.Most programs are arranged into a series of lessons or modules accessedin a particular order, with follow-up activities that assist patients toconsolidate learning, practise new skills and monitor changes over time.Many e-mental health tools use a range of multimedia (text, graphics,audio and video) and interactive elements (reminders and graphing tools),downloadable content, and skill-building exercises that deliver automatedfeedback to patients. The tools are employed either as self-help resourcesor guided interventions.Self-help tools are typically accessed through free publicly-availablewebsites or apps, can be used anonymously and offer users onlyautomated feedback. In many cases, patients log in to view and downloadpsychoeducational material and engage in therapeutic activities.Some self-help tools provide automated emergency or crisis messaging web-based self-management intervention includes education,supports recovery, and provides motivational email support personalized monitoring/support for individuals in recoveryfrom substance use disorders; global positioning system to detectwhen users are nearing high-risk environments; personalizedstories of recovery experiences; links to support network [5] virtual online community for parents of children with emotionaland behavioural challenges in which they can do social sharingof different strategies and lastest technology in rowHuman-supported interventions are generally accessed through a paid,password-protected platform, occasionally require users to register andcomplete a screening questionnaire and sometimes request a referralfrom a health practitioner. These platforms offer individualizedfeedback and support from a health professional. Some examplesof human-supported interventions are: delivery of telemedicine-supported services to womenat high risk for post-partum depression. automated home messaging device which presents diseaseand can direct patients to additional resources. Some examples ofmanagement content for rating symptoms, providing alerts,self-help tools are:and illness information. Responses are monitored remotely smartphone intervention provides automated real-time illnessmanagement support to facilitate symptom management,by a nurse practitioner each day. access to mental health services for children and adultsmood regulation, medication adherence, social functioning,including emergency psychiatry services utilizing two-wayand improved sleepaudio-video interactive services.E-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I T13
Benefits and outcomeslinked to e-mental healthFor patientsFor practitioners patients for whom e-MH is appropriate can be treatedeffectively with less in-person clinical time, freeingup resources for more complex cases, therebyreducing waitlists can offer health services in concert with patientneeds and preferences can fill service gaps and help to address concernsdue to stigma and other reasons can access services at low or no cost can resolve access issues in situations where specialistreferral is difficult, such as in rural, remote and lowsocioeconomic areas can provide an introduction to therapy for individualswho are experiencing mental health issues for the firsttime or who have long-standing problems but havenever sought professional assistance can play a bigger role in identifying different treatmentoptions available in different sources with their mentalhealth professional by taking a step ahead themselvesand initiating towards a change can present a convenient and flexible option forpatients by empowering them to decide whenand where treatment will take place (comparisonsbetween e-mental health interventions and in-personinterventions report comparable outcomes [8-13])14E-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I T
Challenges in selecting & evaluatinge-mental health tools Digital moves faster than research; Need to identify the degree to whichThe academic research literature hasby the time research is completedpatients commitment to change theiryet to identify precisely who theand published, digital technology hasspecific health behaviour is matchingideal candidates for e-mental healthusually evolved.with their relevant skills or abilitiesare. However, there are some digitalto successfully adapt any new publicinterventions that have a strong evidencehealth intervention while implementingbase, and others that are developed usingany tool into practice.evidence-based principles, meaning they There is less evidence for the use ofe-mental health for certain populations,in part because research protocolstypically exclude higher-risk groupsfrom clinical trials. The tools need to focus on thepatient-identified needs andconcerns that benefits thembenefit them in the long run asthere are high chances of potential Innovation funded by start-up investorsis not always evaluated beyond theuser opinion, and programs fundedare evidence informed. (Learn more aboutevaluating e-health tools in modules twoand three.)by the public and charitable sectorsdo not always include funding forrigorous evaluation. Few quality control mechanisms existdownfalls while adopting anyto ensure e-mental health tools aree-mental health tool in any primaryuser-friendly, accurate, evidence-basedhealthcare setting.or efficacious. Buying smart is the biggestchallenge for any organizationor consumer. So is the case frompatients and clinicians point of view.It is difficult to create demand inthe area to use these tools.E-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I T15
Deciding how to use e-mental healthMental health practitioners may integratee-mental health into their day-to-day practice forprevention or early intervention, first-line care,adjunctive treatment and/or relapse prevention.The appropriate application ofWhen assessing theuse of e-mental health,the patient’s medical,emotional, social,environmental, spiritualand economic contextshould remain at thecentre of all decisions.e-mental health means matching thesenew tools to the patient, the diagnosticscenario and the provider workflow.presence. Individualized attention can be achieved, but carefulforethought is needed so that critical patient-practitionerinterchanges are not lost.Social and cultural relevanceCulture influences an individual’s health care. It impacts beliefs,attitudes toward the disclosure of medical information andtreatment preferences [14].Patient decisions regarding the use of e-mental healthPeople first - putting patientscentre-stagemay have a number of influences [15]:Depending on comfort, familiarity information gapswith technology and/or the provider, stigmaindividual patients will have varyingdegrees of receptiveness to specific rural isolation electronic literacy and numeracye-mental health options. Not all experiences of online bullying or fraudtechnologies are equally available or excessive, obsessive or inappropriate use of technologyuseful for all clinical areas or target primary and secondary language usegroups, and practitioners may need to help patients use the ‘right’service at the ‘right’ time.Many marginalized communities in Canada such as IndigenousWhen assessing the use of e-mental health, the patient’s medical,toward technology; this will have an impact on e-mental healthemotional, social, environmental, spiritual and economic contextshould remain at the centre of all decisions. Practitioners andpatients need to weigh the advantages (empowerment, in-timelearning, increased self-efficacy) versus liabilities or potentiallynegative experiences. Keep in mind that each patient’s autonomyand right to make care decisions must always be respected.16Through e-mental health tools, it is possible to create a caringE-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I Tpopulations face circumstances that seem to influence attitudesimplementation.For example, traditional knowledge, beliefs, values, language andcultural ways to support healing and wellbeing among Indigenouspeoples are often not reflected in Western approaches to mentalwellness [16].
Recognizing that patients’ use of e-mental NetAware provides a reliable, highSome basic technology skills your patienthealth is situated within their cultural andvalidity guide to the social media toolsmight need to develop in order to fully engagesocial experiences will help ensure treatmentyoung people use such as Facebook,with e-mental health include:expectations are clear.ASKfm, Google , Twitter, Tumblr,Familiarity and developmental readinessE-mental health tools vary in the kinds ofcognitive skills required to read, completeactivities, self-monitor and navigate thetechnology. If information is too complex tounderstand, especially under periods of duressor high cognitive load, patients will not be ableto engage with tools optimally [17,18].Omegle, Instagram What happens in an internet minute? Pew Research Centre: Teens andTechnologyPatient access to electronic productsupload a file, navigate a menu bar, send atext message) internet skills (e.g., ability to download antechnologies can vary radically betweenreceive email)communities, regions and individuals.specific audiences (children, young adults,phone ownership and internet accessibility,mothers, caregivers, etc.) and incorporate specificit should not be assumed everyone hasstrategies, reading levels and motivationalreliable access to the net.which tools you use or recommend. basic computer skills (e.g., ability to log in,app, locate a website through a URL, send/Even in places with high rates of mobilefit all, so it is important to think critically aboutWhat does ‘posting’ a comment mean?)Access to the internet and other digitalMany e-mental health tools are designed forsupports for those populations. One size does not computer vocabulary (e.g., What’s an app?While the majority of Canadians still ownand use wireline phones, data confirm the online resource awareness and ability(e.g., knowledge of online resources relatedto health) information retrieval (e.g., ability to use asearch engine, navigate online cataloguesor libraries)steady shift away from this technologyAt the same time, it is unlikely a single tool willin favour of wireless services. Morebe exactly tailored to the unique preferences,Canadian households have mobile phonesprior knowledge and cultural experiences of(85.6%) than landlines (75.5%) – a big changeeach patient. Using a ‘best fit’ approach is tofrom only ten years ago, when just over halfbe expected.(62.9%) subscribed to mobile phones andengage in e-mental health.almost all subscribed to landlines (94.0%) [19].Approaching each patient in the context ofpeople are active technology users, for many itIn addition to physical access, patients alsotheir individual technological situation will helpis a seamless part of the world they operate in.need a degree of e-health literacy in orderThe use of technology in mental health servicesto be able to navigate tools confidently [20].While it would be unwise to suggest all youngAn individual’s educational background mayalso correlate to their exposure to technology;this could, in turn, impact their willingness toinform decisions about appropriate use [21].for this age group has clear opportunity, andpractitioners who support young people needto engage within the digital realm.E-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I T17
TABLE 2Pros and cons of different technologiesfor e-mental healthSOURCEWebsiteChat group / “community”SMS/textingSelf-directed assessmentvia screening toolsPROSCONS Learn more about a topic Quality of information varies Problem-solve Potential for inaccurate self-diagnosis Feel part of a group Dissimilar experiences Learn what others are doing to cope Quality of information varies More ‘in-time,’ get immediateanswers to questions Often not secure/encrypted Increase feelings of being heard Boundary issues with self-disclosure and privacy Customize to learning preference Not all problems can be self-assessed Make progress outside of a clinic Some illnesses affect insight; qualityof assessment varies Reduced demand on clinician timeEmail Get quick advice on routine mattersMobile apps Improved prompting of patients (i.e.,appointments) Practitioners generally have no time for this Privacy compliance issues if not secure Patient may expect ongoing conversation Privacy issues for compliance maybe more complex Patient may expect future response Data integration issues are complexReal-time telemedicine18E-ME N TA L HE A LT H IMP L E ME N TAT I O N T O O L K I T See and hear each other in real-time Always has to be scheduled (and paid for)
Diagnostic severity and therapy needsThe technology chosen must also be appropriate and effective for theThe research evidence base is strongest for using e-mental health to treatpatient’s health condition. As a primary care pathway, e-mental healthanxiety, depression and stress [28-31]. The use of e-mental health toolsinterventions are likely to be an appropriate option for people
Module 1: Exploring the world of e-mental health 9 Objectives 9 Getting to know existing e-mental health options 10 Table 1: Types of e-mental technologies 11 . e-mental health options Digital resources and services have a significant role to play in promoting and supporting people's mental health. It is convenient, can provide .
Mental Health, Mental Health Europe NGO and the UK Royal College of Psychiatrists7. "No health without mental health" has also been adopted by the Irish organisation Mental Health Ireland, Supporting Positive Mental Health. Burden of Mental Disorders Mental disorders have been found to be common, with over a third of people worldwide
3.2 european Policy 12 3.4 Happiness and wellbeing debates 14 4.0 Concepts and definitions: what is mental health? 15 4.1 Dual continuum model of mental health 16 4.2 Measuring mental health 17 5.0 Benefits of mental health promotion 19 5.1 Benefits of preventing mental illness 19 5.2 Benefits of promoting positive mental health 22
3.1 Prevalence of mental ill health 9 3.2 Mental health service need 9 3.3 Mental health service provision gap 10 3.4 Housing system and homelessness 10 3.5 Entries into homelessness 11 3.6 Mental health and housing system capacity 12. 4 Links between housing and mental health 13 5 Housing for people with lived experience of mental ill health 16
A mental health policy (1996) and plan (2007-2011) existed. Emergency and disaster plans for mental health did not exist. Legislation A new Mental Health Act 846 2012 was passed in 2012 and was awaiting Government to establish the Mental Health Board. Financing of mental health services Mental health had a ring-fenced budget of 1.4% of
Workplace Mental Health Toolkit This mental health toolkit has been developed by the Black Dog Institute as a practical guide for Australian workers to assist them in understanding common mental health issues in the workplace, and to provide strategies and resources to support
mental health is about much more than mental illness, and that there are significant benefits to be gained by approaching mental health from a public health perspective. Positive mental health, mental wellness and mental health promotion have emerged as the missing pieces in a system that has traditionally been
Mental capacity and the Mental Capacity Act 2005 - A literature review 1.0 SUMMARY This literature review was carried out to collate academic literature relating to mental capacity issues and to the implementation of the Mental Capacity Act 2005. Mental capacity is the ability to make one's own decisions. The Mental Capacity Act (MCA),
eral thousands of genes, but only for a few hundred tissue samples. The classical statistical methods are often simply not applicable in these \high-dimensional" situations. The course is divided into 4 chapters (of unequal size). Our rst chapter will start by introducing ridge regression, a simple generalisation of ordinary least squares. Our study of this will lead us to some beautiful .