Systematic and synchronous activities of the health network from central to local levels have contributed positively to the early detection, treatment and prevention of mental disorders and behavioral disorders in general and mental disorders and behavioral disorders in children and adolescents in particular. However, according to WHO statistics, the health systems of many countries, especially low- and middle-income countries, still have many shortcomings. One of these shortcomings is the lack of human resources in the mental health sector, such as a lack of psychiatrists, psychiatric nurses, psychologists and social workers related to mental health care. Most low- and middle-income countries have only one psychiatrist per 4 million people. The lack of human resources is a major barrier to providing mental health care services to the community [58], [114].
Stigma and discrimination against people with mental disorders have prevented patients and their families from seeking help from the health system. According to a community survey in South Africa, stigma against people with mental illness is even higher in urban areas and among people with higher levels of education (WHO, 2011) [114]. Children and adolescents are vulnerable. Therefore, communication measures to raise awareness about mental health, reduce stigma and discrimination of the community towards mental health patients in general, and children and adolescents with mental health problems in particular, facilitate early detection and prevention of mental health disorders.
Thus, to detect early and prevent mental health problems for children and adolescents, measures need to be implemented in a synchronous and systematic manner, as recommended by WHO for both developed and developing countries, including: (1) Developing policies on mental health for children; (2) Establishing and training a mental health system capable of performing early detection and mental health for children in the community, and having sanctions and policies for this activity; (3) Communicating to parents, teachers, and the community about mental health activities for children, communication measures to raise awareness about mental health, reduce stigma and discrimination in the community against people with mental health problems; (4) Activities to improve the living, learning, and playing environment of children and adolescents; (5) And activities to improve the effectiveness of these activities.
1.3. Current community intervention models in child mental health care
1.3.1. World Health Organization Assessment
According to WHO - 2003, the underdeveloped health care services for children and adolescents are due to the lack of specific policies leading to: (1) No linkage of services;
(2) Poor use of scarce resources; (3) Inability to provide priority services; (4) Lack of stakeholders in program development; and (5) Poor application of new knowledge in a modern system. To address these issues, WHO recommends: (1) Improving the legal system related to child and adolescent mental health; (2) Strengthening training in knowledge about mental health for primary health care, public health and school staff; (3) Paying attention to the continuum of care, providing specific guidelines for child mental health practice, and using scales to detect mental health problems in children and adolescents; (4) Implementing interventions to reduce barriers to child mental health.
1.3.2. Some models in the world
Child mental health care in the world is increasingly of concern to countries due to the increasing rate of children with mental health problems and the increasing burden of disease due to economic, social and environmental changes affecting children [74]. In developed countries, despite the long-standing system of psychological support and health care facilities, it is still found that the majority of children with mental health support needs are not adequately met. In addition, three-quarters of children receive support through the school system [105], [115]. The obvious reason is that most children's activities take place at school. Schools are inherently responsible for nurturing children. Therefore, schools are always ready to organize support activities when students encounter difficulties. Most children only go to clinics and psychological counseling when they are seriously ill and many children are not taken for examination and treatment for fear of being stigmatized, wasting time and money [101], [113]. Furthermore, the advantage of schools is that they can reach the majority, can provide immediate support when children are at risk, and, along with treatment, children can still live in an integrated environment with their peers. Therefore, policies to enhance support services for mental health in these countries tend to shift
and focus on school support activities. School mental health services are considered one of the effective interventions in this work [42], [89], [104]. Providing mental health services through the school system can address economic and health service barriers that often prevent children from receiving necessary services for mental health issues. In some countries, the implementation of school mental health services has achieved good results such as the school mental health programs in the US, France, New Zealand, etc. About 70 - 80% of mental health services received by children are from schools [74], [105], [115].
1.3.2.1. School mental health care model in France
In France, the work of mental health in kindergartens and primary schools always relies on school psychologists. The function of school psychologists is to: prevent learning difficulties; implement and evaluate psychological support work, mental health for students; work with schools to develop pedagogical plans and support implementation; support integration for children with disabilities. Up to secondary and high school, and even university, this work is undertaken by guidance counselors. These are experts in guidance counseling, whose function is to support students to understand themselves, orient themselves, recognize useful information, and make the most appropriate choices for themselves. School psychologists and guidance counselors will intervene in mental health problems when those problems are the direct cause of difficulties in studying and career orientation. If the mental health problems are only secondary, or the children have severe problems, these specialists will not intervene but will send the students to the Medical - Psychological - Educational Centers. Schools are often closely linked to these centers. Here, there are educational psychologists, clinical psychologists, pediatricians, psychiatrists, psychomotorologists, speech pathologists, and social workers working to achieve the best intervention results. This assistance is fully covered by social insurance [13], [45].
1.3.2.2. School mental health care model in the United States
In the United States, the establishment of school-based and school-based CNSs has been implemented with specific strategies and programs [73]. Child CNSs experts recognize the high need for this. Cases
School violence, dropout rates, depression, and risky behaviors are on the rise across the United States. The rate of children with psychosocial problems has increased from 7 to 20 percent over the past 20 years. Experts have also identified barriers to accessing mental health services, including: social insurance, transportation, stigma about mental illness, lack of mental health personnel, and interdisciplinary coordination. School-based mental health is a strategy to overcome these barriers. Moreover, it creates a strategy that is both intervention and prevention. The advantages of school-based mental health are: easy access to children because most children go to school; intervention and treatment take place in a natural environment, avoiding prejudice; easy coordination with teachers (Committee-on-School-Health, 2004). Therefore, US national policy encourages schools to develop school-based social support services programs [105]. Many schools in the US already provide emotional support services, with an estimated majority of US schools (approximately 63%) providing preventive services; 59% providing programs for behavior problems; and approximately 75% of schools having school-wide programs supporting safe and drug-free schools [84].
Preventing ADHD in students
Early intervention for students with mental health problems
Treatment for students with ADHD - HV
* Communication for parents * Community media * Children's education * General health education * Improve the environment |
* Early detection, early intervention * Consulting students and parents * Family support * Support, study advice * Violence prevention |
* Treatment of disorders * Individual and family therapy * Integration program * Special education * Hospitalization |
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Figure 1.4 School CSSKTT model in the US
(Source: Children's Mental Health: An Overview and Key Considerations for Health System Stakeholders, NIHCM2005 [106])
The school's mental health program has 3 levels. Level I is to design mental health prevention programs through integration into subjects, building a healthy learning atmosphere and specific programs in the classroom (social skills training, life skills, etc.). Popular activities are widely interwoven for all students to participate. The goal of this level is to reduce risk factors, form the ability to cope with difficulties and ensure students develop healthy psychology. Level II is to identify students who need care (have 1 or more mental health problems) but can still study and live relatively normally through a psychological survey of students, teachers, parents or are discovered by teachers and parents and then implement intervention therapy. Level III is intervention activities including: consulting teachers about behavioral problems and suggesting possible changes to the classroom environment in ways that reduce behavioral problems; individual therapy; group therapy; family therapy directed at students diagnosed with mental health disorders [73]. Thus, school mental health services range from simple support provided by school counselors to comprehensive, integrated prevention, assessment (diagnosis), and treatment programs delivered within schools. School mental health services can be provided by centers located outside the school or by school-based centers. About half of US schools have school staff providing mental health services to students on campus, 23% of schools have a combination of school staff and outside service providers; the remainder rely entirely on outside community service providers for student mental health services. Currently, there are approximately 1,300 school mental health centers in the United States [68], [84].
1.3.2.3. School mental health care model in Singapore
In Singapore, school counseling is implemented through school counseling. Around the 1960s, school counseling had not yet been established, but there were only welfare programs to support poor students. Students with emotional and behavioral problems were often referred to social work facilities in the community. Later, this program added school counseling activities and from there school counseling developed.
development. In particular, over the past 20 years, this work has been carried out in a synchronous and formal manner, and school counseling has an official and legal position in the Singapore education system. School counselors work directly with school leaders to design counseling services and are also the ones who directly provide counseling, individual therapy, group therapy, and family therapy counseling for students with psychological difficulties. School counselors are also the ones who organize training classes for teachers and students on psychological, social, personality development, and mental health issues. In addition, they also perform career guidance tasks for students. The funding for these tasks is paid by the government [99].
1.3.2.4. School mental health care model in China
In China, as in many developing countries, the mental health system is still very lacking and weak. Mental health for children and adolescents is not yet developed. In addition, the Confucian ideology places education at the top of the priority list and makes parents force their children to study a lot and excel. Therefore, children always feel overloaded with studying and have no time for hobbies, interests, entertainment, are always stressed and are susceptible to mental health problems. However, since around the 80s of the last century, Chinese people have begun to question the pressure that studying puts on children, the Government has realized the importance of taking care of not only the physical but also the mental health of children. In parallel with improving teaching methods, reforming the curriculum, reducing the workload, schools have sought out psychologists and built mental health counseling centers to help students with learning difficulties, anxiety problems and mental health-related problems. In schools from primary to high school, school counselors or school guidance are officially assigned to teach mental health education, and mental health education is also taught in high schools like traditional subjects. In 2007, the Chinese government launched the first large-scale study on the psychological development of children and adolescents to evaluate mental health, evaluate compulsory education programs, and improve school mental health [13], [64].
1.3.3. Child mental health care and some pilot models in Vietnam
In Vietnam, mental illness was not given much attention in the past. During the French colonial period, there were only two facilities to lock up mentally ill people along with prisoners, the “Insane” hospitals in Bac Giang and Bien Hoa. Psychiatry was not taught in medical schools in Vietnam. However, since 1954, the field of Psychiatry has developed strongly, although there are still many difficulties, a series of mental hospital systems have been established. The field has carried out activities of organizing, managing, caring for and treating mentally ill people in the community. It has implemented scientific research programs, training medical staff to serve the care, treatment and prevention of mental illnesses for the country's development (Psychiatry Textbook - University of Medicine and Pharmacy - 2010) [30].
1.3.3.1. National Program on community mental health protection and care of the Vietnam Psychiatric Sector
On October 10, 1998, the Prime Minister signed to add the Community Mental Health Protection Project to the National Target Program for Prevention of Some Social Diseases - Dangerous Epidemics of HIV & AIDS, now part of the National Target Program on Health [23]. The project has built a model for management, treatment and care of schizophrenic patients in the community. However, in the first years, due to low funding, the implementation was only piloted in some provinces. In 2001, the Government approved the Community Mental Health Protection Project through 3 phases:
- Phase 2001 - 2005: Project " Care and protection of mental health in the community " under the National Target Program "Prevention of some social diseases, dangerous epidemics and HIV/AIDS".
- Period 2006-2010: integrate two diseases Epilepsy and Depression under the project "Prevention of some non-communicable diseases" into the project "Protecting community mental health" under the National Target Program " Prevention of some social diseases, dangerous epidemics HIV & AIDS ".
- Phase 2011-2015: Project " Protecting community and children's mental health " under the National Target Program on Health.
General Objective of the Project:
Build a network and deploy a model to integrate mental health care content with other health care content of commune and ward health stations.
- Detect, manage and treat patients promptly so they can soon return to live and integrate into the community.
In provinces and cities, the community health care system includes 3 main levels:
The first level is the agency responsible for the highest level of expertise, which is the Provincial Mental Hospital. The psychiatric station under the Provincial Mental Hospital is responsible for managing the primary health care network at the grassroots level.
The second level is the network of district psychiatric clinics (usually located in district general health centers) whose task is to manage and treat outpatient psychiatric patients and coordinate the activities of the network of staff in charge of the psychiatric program at ward and commune health stations in the area.
The third level is the network of ward and commune health stations responsible for managing local mental patients.
After 12 years of implementation, the network of psychiatric specialists has now covered from central to local levels (63 provinces and cities), the rate of patients with schizophrenia and epilepsy being managed and treated accounts for over 70%. The project's activities such as screening to detect new patients, examining and providing monthly outpatient medication for schizophrenia patients in localities, especially remote areas, are timely, helping them to quickly stabilize, saving economic costs when treating the disease. Through the project, grassroots medical staff have been trained and educated to improve their knowledge of psychiatry and their skills are increasingly solid. In addition, through information and propaganda work, the community's awareness of mental health has also been significantly improved. However, the Psychiatric sector's community-based mental health care is currently only implemented on schizophrenia and epilepsy. Some localities have also implemented it on patients with depression [1].
In Thai Nguyen, the Community Health Care and Protection Program began to be implemented in 1999. Up to now, 181 communes and wards in the whole Thai Nguyen province have implemented the Program. In this Program, schizophrenic patients in 181 communes and wards in the province and epileptic patients in 16 communes and wards have been registered for management, monitoring and prevention. Currently, all the stations