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Policy development and challenges of global mental health: a systematic review of published studies of national-level mental health policies

Abstract

Background

Mental health policy can be an essential and powerful tool to improve a population’s mental health. However, around one third of countries do not possess a mental health policy, and there are large disparities in population coverage rates between high- and low-income countries. The goal of this study is to identify the transition and implementation challenges of mental health policies in both high-income countries (HICs) as well as middle- and low-income countries (MLICs).

Methods

PubMed, Cochrane Library and Campbell Library were searched from inception to 31 December 2017, for studies on implemented mental health policies at the national level. Abstracts and the main texts of papers were double screened, and extracted data were analysed through thematic synthesis.

Results

A total of 93 papers were included in this study, covering 24 HICs, 28 MLICs and 5 regions. Studies on mental health policies, especially those of MLICs, kept increasing, but MLICs were still underrepresented in terms of publication quantity and study frequency. Based on the included studies, nine policy domains were summarized: service organizing, service provision, service quality, human resources, legislation and human rights, advocacy, administration, surveillance and research, and financing and budgeting. HICs incrementally enriched their policy content in all domains over centuries of development; following HICs’ experience, mental health policies in MLICs have boomed since the 1990s and quickly extended to all domains. Implementation problems in HICs were mainly related to service organizing and service provision; for MLICs, more severe implementation problems converged on financing and budgeting, administration and human resources.

Conclusions

Mental health policy developments in both HICs and MLICs present a process of diversification and enrichment. In terms of implementation, MLICs are faced with more and greater challenges than HICs, especially in funding, human resources and administration. Therefore, future efforts should not only be made on helping MLICs developing mental health policies, but also on promoting policy implementation under MLICs’ local context.

Peer Review reports

Background

Mental health policy is a government statement specifying values, principles and objectives for mental health. It can be implemented in the forms of mental health plans, programmes, strategies and legislation at multiple levels [1]. If properly formulated and implemented, mental health policy can be an essential and powerful tool for countries to improve mental health and reduce the burden of mental disorders. Mental health policies have undergone long periods of transition, tracing back to the removal of the chains of lunatics in 1793 by Philippe Pinel, to the second psychiatric revolution in the 1960s thanks to the advent of new psychosocial and biological therapies, to the growth of attention towards mental health policies and finally to a boom of policy statements over the last two decades [2,3,4,5]. In 2013, the adoption of the Comprehensive Mental Health Action Plan 2013–2020 by the 66th World Health Assembly would promote further development of mental health policies across the world. Despite the importance of mental health policy, centuries of developments and active promotion by international organizations, by 2011 only 60% of member countries of the World Health Organization (WHO) possessed their own mental health policies, only 71% had mental health plans and just 59% had legislation on mental health. Moreover, large disparities in population coverage rates exist between high- and low-income countries. For example, mental health legislation covers 92% of people living in high-income countries, whereas only 36% are covered in low-income countries [6].

There were international comparative reviews on mental health legislation in the 1950s, 1970s and in 1995 [7,8,9], as well as reviews of mental health policy in individual countries or certain regions [3, 10,11,12,13]. However, these international reviews are mostly outdated and only focused on legislation, and some have a narrow geographic scope. Thus, to update and broaden our understanding on mental health policies, this systematic review aims to present global mental health policy developments and search for the answers to two questions that may be critical to future policy making: (i) What are the focuses of mental health policy content in different countries and at different periods? and (ii) What are the policy implementation problems across the world and throughout the centuries?

To explore these answers, the current review is focused on identifying the differences in mental health policy development trajectories and implementation challenges between high-income countries (HICs) and middle- and low-income countries (MLICs) [14], by using thematic synthesis of published studies of implemented national-level mental health policies. We hope to provide some inspiration to both HICs and MLICs for their future development of mental health policies.

Methods

Search strategy and selection criteria

For inclusion in the review we screened published research on implemented mental health policies at the national level. We searched PubMed, the Cochrane Library, and the Campbell Library from their collections’ inception to 31 December 2017. “Policy(ies)”, “national plan”, “national program(me)”, “national strategy(ies)”, “legislation”, “law”, “national reform”, and “system”, were combined with “mental health” in our search. We set no restriction on the publication date or language. A title search was adopted, as the pilot title/abstract search identified a large amount of irrelevant research whose abstracts only mentioned mental health policy in the studies’ background.

Studies were excluded if they: (i) were theoretical studies, describing standards that mental health policies are expected to meet; (ii) focused on only one aspect of policy content (to avoid over-weighted statistics); (iii) studied the process of policy formulation; (iv) were policy interpretation for operation/practice; (v) were news, interviews, editorials, commentaries, letters, personal narratives, speeches, conference abstracts, case reports or research protocols (to guarantee objectivity and research quality).

Screening, abstraction and synthesis

Identified citations were first screened based on their titles and abstracts, and if they met the selection criteria, their full texts were obtained for further screening to determine whether or not they would be included. The screening process was carried out independently by two authors (ZW and YY), and any disagreement was resolved through consensus.

The authors (ZW, YY, YM, CLZ, and XSY) extracted data on publication year, countries/regions being studied, policy time and content, implementation problems, barriers and progress. Extracted data were compiled by country and further grouped into HICs and MLICs.

As all the included papers except for one were qualitative studies, a thematic synthesis was adopted, which is a tested method for qualitative research in systematic reviews [15] and has been used in health policy and systems research and review [16, 17]. Extracted information was first coded line by line into descriptive themes. Like the process of generating analytical themes in classical thematic synthesis [15, 18], the descriptive themes were then summarized into the main domains of mental health policy. This summarizing process was informed by ideas from the 12 areas of action suggested by the WHO [1].

Results

From the initially identified 1751 studies, 1588 references were excluded on the basis of the title or abstract, leaving 163 full-text papers for further scrutiny. Of these, 93 met the selection criteria [3, 4, 8, 10,11,12,13, 19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104]. Ten non-English studies were further excluded from analysis (Additional file 1: Appendix A) because their eligibility was difficult for the reviewers to determine (Fig. 1).

Fig. 1
figure 1

Process and results of study selection

Characteristics of included studies

The 93 included papers were published between 1948 and 2017 and covered mental health policies in 24 HICs, 28 MLICs and 5 regions (Additional file 1: Appendix B) on five continents. There was an overall increasing trend in research on mental health policies. Compared to HICs, there was a quick increase of MLICs studies after 2000 (Table 1, Fig. 2).

Table 1 The number of included studies by the country category and publication years
Fig. 2
figure 2

The number of included studies by country categories & publication years

Despite the rapid increase of studies on MLICs since 2000, there were only 33 publications included in our review. In terms of frequency, HICs were studied 68 times, while MLICs were studied only 44 times. Among HICs, as well as among all 52 countries, the United States was the most frequently studied (18 times); among MLICs, Ghana was studied with the highest frequency (6 times) (Additional file 1: Appendix B).

Policy development

Based on the descriptive themes and action areas suggested by the WHO, nine domains were summarized, and their main features are listed as follows: (i) service organizing, referring to the way in which mental health services are organized; (ii) service provision, including promotion, prevention, treatment, rehabilitation, essential drug provision, service availability and accessibility; (iii) service quality, including accreditation and management of service providers, service standards and guidelines; (iv) human resources, including quantity and quality of workforce, professional training and education; (v) legislation and human rights, including the rights of patients in and outside the health sector, social security and welfare; (vi) advocacy, including awareness raising, anti-stigma, empowering consumers; (vii) administration, including coordination within mental health systems and among all levels of governments, designation of agencies’ responsibilities and collaboration across sectors; (viii) surveillance and research, including mental health information systems, monitoring and evaluation of policy implementation and research on service provision; and (ix) financing and budgeting, including government funding arrangements, service payment and health insurance. The detailed list of descriptive themes and their corresponding domains is presented by policy time period and country category in Additional file 1: Appendix C.

Generally, the transition of mental health policy was a process of diversification and enrichment in both HICs and MILCs. The form of mental health policy was diversified from early laws to recent policies, plans, programmes, strategies and legislation, and its content was enriched from the limited focus on institutionalization of patients in asylums to full coverage of all nine policy domains (Fig. 3, Additional file 1: Appendix D). According to the included studies, service organizing, legislation and human rights, service provision and service quality were four domains of traditionally focus across the world.

Fig. 3
figure 3

The number of countries expressing each domain in policies based on included studies

Differences existed in the development trajectories of HICs and MLICs. Many HICs had a much longer history of mental health policy, dating back to the nineteenth century or even earlier, and their policy content transformed incrementally throughout their practical exploration. Before the end of World War II, institutionalization of service organizing and relevant legislation were the most common policy themes. After that, policy debate in service organizing remained heated, as the movement of transferring patients into the community, originating in North America in the 1960s, spread to almost all HICs in the 1990s. At the same time, measures were also proposed for heightened consideration for patients in service provision and service quality; legislation and human rights extended from protecting patients’ rights in the health sector to guaranteeing patients’ and their families’ social welfare. Since the 1990s, community mental health care has been accepted and developed in almost all HICs, and policy debate in service organizing has become less heated. Currently, policy attention is less focused on certain domains. In comparison, HICs’ policy expressions place less emphasis on financing and budgeting and human resources (Table 2).

Table 2 The number of HICs and MLICs expressing each domain in policies based on included studies

Most MLICs have a shorter history of mental health policy and experienced a boom of development in the 1990s and 2000s. As late arrivers, many followed the experience of HICs. Before 1945, mental health policies in countries like India and Algeria had origin in ones in the United Kingdom and France. Between the late 1940s and the 1980s, some MLICs developed their own mental health policies and sporadically discussed service organizing, provision, quality and legislation. In the 1990s, the policy content of MLICs was further enriched, and every policy domain was mentioned by at least one or two countries, but without obvious focuses. In 2000s, the community-oriented policy was accepted as a trend in MLICs; countries like South Africa and Uganda had comprehensive mental health policies covering all nine domains. In comparison, current MLICs policies contain less expression of financing and budgeting, surveillance and research, and human resources (Table 2).

Implementation challenges

Of the included studies, 64 provided information regarding implementation evaluation [3, 4, 10,11,12,13, 19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63, 97,98,99,100,101,102,103,104]. The descriptive themes of implementation problems were categorized into each policy domain, and the unsorted items were grouped by policy time period and country category (Additional file 1: Appendix E).

There were some positive evaluation results. For example, many of the HICs effectively closed down mental hospitals and successfully transferred patients to community-based mental health organizations by the 2000s. Some research showed an increase in treatment access as a result of the implementation of community-oriented policies [28]. However, challenges were also present and problems increased as policy content extended. Slow or inconsistent implementation and under-implementation existed in both HICs and MLICs.

The included studies reported implemented problems of HICs between the 1970s and 1990s mostly on domains of service organizing and service provision, which was closely related to their shift towards community mental health care at that time. However, deinstitutionalization, but without sufficient community mental health care to take over discharged patients, once hampered service availability, accessibility and response to certain populations like the severely ill. In the 2000s, few implementation problems were discussed (Table 3).

Table 3 The number of HICs and MLICs with implementation problems in each domain based on included studies

For MLICs, problems have persistently and commonly existed in financing and budgeting, administration and human resources (Table 3). Though some HICs also listed similar problems in these three domains, the problems’ severity was much greater for MLICs. For example, underfunding for many MLICs was so severe that their formulation of mental health policies depended on international funding and the cessation of international funding greatly impacted policy sustainability [44].

Discussion

Reflections on policy development

Mental health policies in many MLICs are developed with financial and technical assistance from HICs and international organizations. Thus, they follow the experience and policy practices of HICs. This is reflected in their intensive policy attention on community mental health care in the 2000s and in the comprehensiveness of domain coverage as compared to their high-income counterparts. However, the experience of HICs is accumulated through centuries of development and their current practices are based on well-established mental health systems. Seriously under-resourced and under-developed mental health systems are commonly found in many MLICs [105]. Therefore, MLICs should be cautious about potential problems arising from the direct transplantation of HICs’ experience [106]. Foreign experience developed in different social and cultural contexts should be carefully selected and MLICs should consider policy feasibility based on their own situations. For example, because funding and resources for mental health are scare in MLICs, excessive policy focus will result in fewer inputs in each domain and a possibly result in underdevelopment.

Reflections on implementation evaluation

Of note is that this review’s findings on policy implementation present only a limited understanding of existing problems, as a lack of information and evaluation of policy implementation itself was listed as a problem in both HICs and MLICs.

Moreover, among the limited implementation information provided by the included studies, many were just general comments such as “while significant gains had been made in mental health reform, these had been uneven across and within jurisdictions” [69]. Even for the included assessment studies, different evaluation frameworks and indicators were applied. The WHO-AIMS (WHO’s Assessment Instrument for Mental Health Systems) Version 2.2 and the WHO Checklist for Mental Health Policy were the only two internationally recognized evaluation instruments related to mental health policies, but they focus on policy content and formulation [107, 108]. Therefore, exploring evaluative frameworks for policy implementation is an important future research topic in mental health policy.

Limitation

One major limitation is that this review is based on published research rather than first-hand government documents and grey literature. Though advantages of using published research include quick acquisition of policy information from centuries ago, easy determination of a policy’s implementation, and the guarantee of basic quality through a peer review mechanism, there may be bias of result representativeness.

Conclusion

Global mental health policy developments present a process of diversification and enrichment. The process in HICs is long and incremental through centuries. Based on HICs’ experience, MLICs have quickly developed mental health policies covering domains as comprehensive as HICs, in the recent three decades. In terms of implementation, problems exist in both HICs and MLICs. However, MLICs are faced with more and greater challenges, especially in funding, human resources and administration. Therefore, future efforts should not only be made on helping MLICs developing mental health policies, but also on promoting policy implementation under MLICs’ local context.

Abbreviations

HICs:

High-income countries

MLICs:

Middle- and low-income countries

WHO:

World Health Organization

WHO-AIMS:

WHO’s Assessment Instrument for Mental Health Systems

References

  1. WHO. Mental health policy, plans and programmes. World Health Organization. 2005. Available from: http://www.who.int/mental_health/policy/services/2_policy%20plans%20prog_WEB_07.pdf.

  2. Knapp M, McDaid D, Mossialos E, Thornicroft G, editors. Mental health policy and practice across Europe: the future direction of mental health care. Maidenhead: Open University Press; 2007.

    Google Scholar 

  3. Grob GN. Mental health policy in the liberal state: the example of the United States. Int J Law Psychiatry. 2008;31:89–100.

    Article  PubMed  Google Scholar 

  4. Lurie S. Comparative mental health policy: are there lessons to be learned? Int Rev Psychiatry. 2005;17:97–101.

    Article  PubMed  Google Scholar 

  5. Haque A. Mental health concepts and program development in Malaysia. J Ment Health. 2005;2:183–95.

    Article  Google Scholar 

  6. WHO. Mental Health Atlas 2011. World Health Organization. 2011. Available from: http://apps.who.int/iris/bitstream/10665/44697/1/9799241564359_eng.pdf.

  7. Curran WJ. Hospitalization of the mentally IlI. North Carolina L Rev. 1953;31:274.

    Google Scholar 

  8. Curran WJ. Comparative analysis of mental health legislation in forty-three countries: a discussion of historical trends. Int J Law Psychiatry. 1978;1:79–92.

    Article  PubMed  CAS  Google Scholar 

  9. Bertolote JM. Legislation related to mental health: a review of various international experiences. Rev Saude Publica. 1995;2:152–6. [Article in Portuguese]

    Article  Google Scholar 

  10. Alarcon RD, Aguilar-Gaxiola SA. Mental health policy developments in Latin America. Bull World Health Organ. 2000;78:483–90.

    PubMed  PubMed Central  CAS  Google Scholar 

  11. Mosse P, Maury C, Daumerie N, Roelandt JL. Mental health in France, policies and actors: developing administrative knowledge in a segmented world. Int J Health Plann Manag. 2013;28:e242–55.

    Article  Google Scholar 

  12. Hamid H, Abanilla K, Bauta B, Huang KY. Evaluating the WHO assessment instrument for mental health systems by comparing mental health policies in four countries. Bull World Health Organ. 2008;86:467–73.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Draper CE, Lund C, Kleintjes S, Funk M, Omar M, Flisher AJ, et al. Mental health policy in South Africa: development process and content. Health Policy Plan. 2009;24:342–56.

    Article  PubMed  Google Scholar 

  14. World Bank. Country and lending groups. 2018. Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519.

    Google Scholar 

  15. Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Baker P, Friel S, Kay A, Baum F, Strazdins L, Mackean T. What enables and constrains the inclusion of the social determinants of health inequities in government policy agendas? A narrative review. Int J Health Policy Manage. 2017;2:101–11.

    Article  Google Scholar 

  17. Reeve E, Thow AM, Bell C, Engelhardt K, Gamolo-Naliponguit EC, Go JJ, et al. Implementation lessons for school food policies and marketing restrictions in the Philippines: a qualitative policy analysis. Glob Health. 2018;1:8.

    Article  Google Scholar 

  18. Barnett-Page E, Thomas J. Methods for the synthesis of qualitative research: a critical review. BMC Med Res Methodol. 2009;9:59.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Surles R, Mazade N. Federal policies which influence the planning of local community mental health programs. J Community Psychol. 1978;6:45–7.

    Article  PubMed  CAS  Google Scholar 

  20. Brown P. The transfer of care: U.S. mental health policy since world war II. Int J Health Serv. 1979;9:645–62.

    Article  PubMed  CAS  Google Scholar 

  21. Andrulis DP, Mazade NA. American mental health policy: changing directions in the 80s. Hosp Community Psychiatry. 1983;34:601–6.

    PubMed  CAS  Google Scholar 

  22. Merwin MR, Ochberg FM. The long voyage: policies for progress in mental health. Health Aff. 1983;2:96–127.

    Article  CAS  Google Scholar 

  23. Goldman HH, Morrissey JP. The alchemy of mental health policy: homelessness and the fourth cycle of reform. Am J Public Health. 1985;75:727–31.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Jansen MA. Mental health policy: observations from Europe. Am Psychol. 1986;41:1273–8.

    Article  PubMed  CAS  Google Scholar 

  25. Bloche MG, Cournos F. Mental health policy for the 1990s: tinkering in the interstices. J Health Polit Policy Law. 1990;15:387–411.

    Article  PubMed  CAS  Google Scholar 

  26. Goldie N, Freden L. A ‘crisis’ of closure and openness: the present state of the Swedish mental health system in the light of a policy of sectorisation. Soc Sci Med. 1991;32:499–506.

    Article  PubMed  CAS  Google Scholar 

  27. Grob GN. Mental health policy in America: myths and realities. Health Aff. 1992;11:7–22.

    Article  CAS  Google Scholar 

  28. Kiesler CA. U.S. mental health policy: doomed to fail. Am Psychol. 1992;47:1077–82.

    Article  PubMed  CAS  Google Scholar 

  29. VandenBos GR. U.S. mental health policy: proactive evolution in the midst of health care reform. Am Psychol. 1993;48:283–90.

    Article  PubMed  CAS  Google Scholar 

  30. Levav I, Restrepo H, Guerra de Macedo C. The restructuring of psychiatric care in Latin America: a new policy for mental health services. J Public Health Policy. 1994;15:71–85.

    Article  PubMed  CAS  Google Scholar 

  31. Yfantopoulos J. Economic and legal aspects of mental health policies in Greece. Int J Soc Psychiatry. 1994;40:296–305.

    Article  PubMed  CAS  Google Scholar 

  32. Mandiberg JM. The Japanese mental health system and law: social and structural impediments to reform. Int J Law Psychiatry. 1996;19:413–35.

    Article  PubMed  CAS  Google Scholar 

  33. Pearson V. The Chinese equation in mental health policy and practice: order plus control equal stability. Int J Law Psychiatry. 1996;19:437–58.

    Article  PubMed  CAS  Google Scholar 

  34. Barbato A. Psychiatry in transition: outcomes of mental health policy shift in Italy. Aust N Z J Psychiatry. 1998;32:673–9.

    Article  PubMed  CAS  Google Scholar 

  35. Bindman J, Beck A, Glover G, Thornicroft G, Knapp M, Leese M, et al. Evaluating mental health policy in England: care programme approach and supervision registers. Br J Psychiatry. 1999;175:327–30.

    Article  PubMed  CAS  Google Scholar 

  36. McCulloch A, Muijen M, Harper H. New developments in mental health policy in the United Kingdom. Int J Law Psychiatry. 2000;23:261–76.

    Article  PubMed  CAS  Google Scholar 

  37. Silfverhielm H, Kamis-Gould E. The Swedish mental health system: past, present, and future. Int J Law Psychiatry. 2000;23:293–307.

    Article  PubMed  CAS  Google Scholar 

  38. Whiteford H, Thompson I, Casey D. The Australian mental health system. Int J Law Psychiatry. 2000;23:403–17.

    Article  PubMed  CAS  Google Scholar 

  39. Shera W, Aviram U, Healy B, Ramon S. Mental health system reform: a multi country comparison. Soc Work Health Care. 2002;35:547–75.

    Article  PubMed  Google Scholar 

  40. Simmons LA, Wright DW. National practice guidelines for mental health care: a comparative policy analysis of the United Kingdom and the United States. J Health Soc Policy. 2004;19:59–80.

    Article  PubMed  Google Scholar 

  41. Grob GN. Public policy and mental illnesses: Jimmy Carter’s presidential commission on mental health. Milbank Q. 2005;83:425–56.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Goldman HH. Making progress in mental health policy in conservative times: one step at a time. Schizophr Bull. 2006;32:424–7.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Keste D, Lazeri L, Demi N, Severoni S, Lora A, Saxena S. Mental health system and services in Albania. Epidemiol Psichiatr Soc. 2006;15:194–201.

    Article  PubMed  Google Scholar 

  44. Jenkins R, Heshmat A, Loza N, Siekkonen I, Sorour E. Mental health policy and development in Egypt: integrating mental health into health sector reforms 2001-9. Int J Ment Heal Syst. 2010;4:17.

    Article  Google Scholar 

  45. Kahng SK, Kim H. A developmental overview of mental health system in Korea. Soc Work Public Health. 2010;25:158–75.

    Article  PubMed  Google Scholar 

  46. Omar MA, Green AT, Bird PK, Mirzoev T, Flisher AJ, Kigozi F, et al. Mental health policy process: a comparative study of Ghana, South Africa, Uganda and Zambia. Int J Ment Heal Syst. 2010;4:24.

    Google Scholar 

  47. Salvador-Carulla L, Costa-Font J, Cabases J, McDaid D, Alonso J. Evaluating mental health care and policy in Spain. J Ment Health Policy Econ. 2010;13:73–86.

    PubMed  Google Scholar 

  48. Faydi E, Funk M, Kleintjes S, Ofori-Atta A, Ssbunnya J, Mwanza J, et al. An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia. Health Res Policy Syst. 2011;9:17.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Jenkins R, Mussa M, Haji SA, Haji MS, Salim A, Suleiman S, et al. Developing and implementing mental health policy in Zanzibar, a low income country off the coast of East Africa. Int J Ment Heal Syst. 2011;5:6.

    Article  Google Scholar 

  50. Liu J, Ma H, He YL, Xie B, Xu YF, Tang HY, et al. Mental health system in China: history, recent service reform and future challenges. World Psychiatry. 2011;10:210–6.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Munizza C, Gonella R, Pinciaroli L, Rucci P, Picci RL, Tibaldi G. CMHC adherence to National Mental Health Plan standards in Italy: a survey 30 years after national reform law. Psychiatr Serv. 2011;62:1090–3.

    Article  PubMed  Google Scholar 

  52. Abel WD, Kestel D, Eldemire-Shearer D, Sewell C, Whitehorne-Smith P. Mental health policy and service system development in the English-speaking Caribbean. West Indian Med J. 2012;61:475–82.

    Article  PubMed  CAS  Google Scholar 

  53. Banfield MA, Gardner KL, Yen LE, McRae IS, Gillespie JA, Wells RW. Coordination of care in Australian mental health policy. Aust Health Rev. 2012;36:153–7.

    Article  PubMed  Google Scholar 

  54. Dlouhy M. Mental health policy in Eastern Europe: a comparative analysis of seven mental health systems. BMC Health Serv Res. 2014;14:42.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Lora A. An overview of the mental health system in Italy. Annali dell'Istituto superiore di sanita. 2009;45:5–16.

    PubMed  Google Scholar 

  56. Puzynski S, Moskalewicz J. Evolution of the mental health care system in Poland. Acta Psychiatr Scand. 2001;104:69–73.

  57. Roberts M, Mogan C, Asare JB. An overview of Ghana’s mental health system: results from an assessment using the World Health Organization's assessment instrument for mental health systems (WHO-AIMS). Int J Ment Heal Syst. 2014;8:16.

    Article  Google Scholar 

  58. Lovell AM. The paradoxes of reform: reevaluating Italy's mental health law of 1978. Hosp Community Psychiatry. 1986;37:802–8.

    PubMed  CAS  Google Scholar 

  59. Ofori-Atta A, Read UM, Lund C, MHaPP research Programme consortium. A situation analysis of mental health services and legislation in Ghana: challenges for transformation. Afr J Psychiatry. 2010;13:99–108.

    Article  CAS  Google Scholar 

  60. Kelly BD. Mental health law in Ireland, 1945 to 2001: reformation and renewal. Medico-legal J. 2008;76:65–72.

    Article  Google Scholar 

  61. Kelly BD. Mental health law in Ireland, 1821 to 1902: building the asylums. Medico-legal J. 2008;76:19–25.

    Article  Google Scholar 

  62. Mosher LR. Italy’s revolutionary mental health law: an assessment. Am J Psychiatry. 1982;139:199–203.

    Article  PubMed  CAS  Google Scholar 

  63. Felix RH. The national mental health program: a progress report. Public Health Rep. 1948;63:837–47.

    Article  PubMed  CAS  Google Scholar 

  64. Grob GN. The forging of mental health policy in America: world war II to new frontier. J Hist Med Allied Sci. 1987;42:410–46.

    Article  PubMed  CAS  Google Scholar 

  65. Grob GN. Mental health policy in post-world war II America. New Dir Ment Health Serv. 1987;1987(36):15–32.

  66. Mangen SP. Mental health policies in Europe: an analysis of priorities and problems. Int J Soc Psychiatry. 1987;33:76–82.

    Article  PubMed  CAS  Google Scholar 

  67. Walsh D. Mental health policy developments in Ireland. Int J Soc Psychiatry. 1987;33:111–4.

    Article  PubMed  CAS  Google Scholar 

  68. Grob GN. From hospital to community: mental health policy in modern America. Psychiatr Q. 1991;62:187–212.

    Article  PubMed  CAS  Google Scholar 

  69. Whiteford HA. Australia’s national mental health policy. Hosp Community Psychiatry. 1993;44:963–6.

    PubMed  CAS  Google Scholar 

  70. Ramsay J. The National Mental Health strategy. Aust J Rural Health. 1996;4:53–6.

    Article  PubMed  CAS  Google Scholar 

  71. Ganju V. The mental health system in India: history, current system, and prospects. Int J Law Psychiatry. 2000;23:393–402.

    Article  PubMed  CAS  Google Scholar 

  72. Attah Johnson FY. Mental health care and the law in developing countries: the independent state of Papua New Guinea. Med Law. 1988;7:359–63.

    PubMed  CAS  Google Scholar 

  73. Whiteford H, Buckingham B, Manderscheid R. Australia’s national mental health strategy. Br J Psychiatry. 2002;180:210–5.

    Article  PubMed  Google Scholar 

  74. Joseph R, Birchwood M. The national policy reforms for mental health services and the story of early intervention services in the United Kingdom. J Psychiatry Neurosci. 2005;30:362–5.

    PubMed  PubMed Central  Google Scholar 

  75. Asai K. From mental health law to mental health and welfare law. Psychiatry Clin Neurosci. 1998;52(Suppl):S247–9.

    Article  PubMed  Google Scholar 

  76. Crosbie DW. Mental health policy--stumbling in the dark? Med J Aust. 2009;190:S43–5.

    PubMed  Google Scholar 

  77. Awenva AD, Read UM, Ofori-Attah AL, Doku VC, Akpalu B, Osei AO, et al. From mental health policy development in Ghana to implementation: what are the barriers? Afr J Psychiatry. 2010;13:184–91.

    CAS  Google Scholar 

  78. Kiima D, Jenkins R. Mental health policy in Kenya: an integrated approach to scaling up equitable care for poor populations. Int J Ment Heal Syst. 2010;4:19.

    Article  Google Scholar 

  79. Muga FA, Jenkins R. Health care models guiding mental health policy in Kenya 1965-1997. Int J Ment Heal Syst. 2010;4:9.

    Article  Google Scholar 

  80. Ssebunnya J, Kigozi F, Ndyanabangi S. Developing a national mental health policy: a case study from Uganda. PLoS Med. 2012;9:e1001319.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Narayan CL, Shikha D. Indian legal system and mental health. Indian J Psychiatry. 2013;55:S177–81.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Qureshi NA, Al-Habeeb AA, Koenig HG. Mental health system in Saudi Arabia: an overview. Neuropsychiatr Dis Treat. 2013;9:1121–35.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Nicaise P, Dubois V, Lorant V. Mental health care delivery system reform in Belgium: the challenge of achieving deinstitutionalisation whilst addressing fragmentation of care at the same time. Health Policy. 2014;115:120–7.

    Article  PubMed  Google Scholar 

  84. Liverpool N. A survey of mental health legislation in the eastern Caribbean. Int J Law Psychiatry. 1986;8:119–31.

    Article  PubMed  CAS  Google Scholar 

  85. Abdulmalik J, Kola L, Gureje O. Mental health system governance in Nigeria: challenges, opportunities and strategies for improvement. Global Mental Health. 2016;3:e9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  86. Aboaja A, Arroyo GR, Grant L. Mental health law in Bolivia. BJPsych Int. 2015;4:89–92.

    Article  Google Scholar 

  87. Alhassani G, Osman OT. Mental health law profile: the United Arab Emirates. BJPsych Int. 2015;3:70–2.

    Article  Google Scholar 

  88. Benmebarek Z. Mental health legislation in Algeria. BJPsych Int. 2017;14:12–5.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Chaskel R, Shultz JM, Gaviria SL, Taborda E, Vanegas R, Garcia NM, et al. Mental health law in Colombia. BJPsych Int. 2015;4:92–4.

    Article  Google Scholar 

  90. Dos Santos PF, Wainberg ML, Caldas-de-Almeida JM, Saraceno B, Mari JJ. Overview of the mental health system in Mozambique: addressing the treatment gap with a task-shifting strategy in primary care. Int J Ment Heal Syst. 2016;10:1.

    Article  Google Scholar 

  91. Grace FC, Meurk CS, Head BW, Hall WD, Carstensen G, Harris MG, et al. An analysis of policy levers used to implement mental health reform in Australia 1992-2012. BMC Health Serv Res. 2015;15:479.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Grace FC, Meurk CS, Head BW, Hall WD, Harris MG, Whiteford HA. An analysis of policy success and failure in formal evaluations of Australia’s National Mental Health Strategy (1992-2012). BMC Health Serv Res. 2017;1:374.

    Article  Google Scholar 

  93. Karam E, El Chammay R, Richa S, Naja W, Fayyad J, Ammar W. Lebanon: mental health system reform and the Syrian crisis. BJPsych Int. 2016;4:87–9.

    Article  Google Scholar 

  94. Ndetei DM, Muthike J, Nandoya ES. Kenya’s mental health law. BJPsych Int. 2017;4:96–7.

    Article  Google Scholar 

  95. Tareen A, Tareen KI. Mental health law in Pakistan. BJPsych Int. 2016;3:67–9.

    Article  Google Scholar 

  96. Walker GH, Osei A. Mental health law in Ghana. BJPsych Int. 2017;2:38–9.

    Article  Google Scholar 

  97. Datta A, Frewen J. Mental health law profile on the Republic of Ireland. BJPsych Int. 2016;1:15–7.

    Article  Google Scholar 

  98. Firdosi MM, Ahmad ZZ. Mental health law in India: origins and proposed reforms. BJPsych Int. 2016;3:65–7.

    Article  Google Scholar 

  99. Ho RC, Ho CS, Khan N, Kua EH. An overview of mental health legislation in Singapore. BJPsych Int. 2015;2:42–4.

    Article  Google Scholar 

  100. Khan NN, Yahya B, Abu Bakar AK, Ho RC. Malaysian mental health law. BJPsych Int. 2015;2:40–2.

    Article  Google Scholar 

  101. Shao Y, Wang J, Xie B. The first mental health law of China. Asian J Psychiatr. 2015;13:72–4.

    Article  PubMed  Google Scholar 

  102. Soosay I, Kydd R. Mental health law in New Zealand. BJPsych Int. 2016;2:43–5.

    Article  Google Scholar 

  103. Stevovic LI, Jovanovic TP, Raznatovic A. Mental health law in Montenegro. BJPsych Int. 2016;4:94–5.

    Article  Google Scholar 

  104. Upadhaya N, Jordans MJD, Pokhrel R, Gurung D, Adhikari RP, Petersen I, et al. Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study. Int J Ment Heal Syst. 2017;11:37.

    Article  Google Scholar 

  105. Knapp M, Funk M, Curran C, Prince M, Grigg M, McDaid D. Economic barriers to better mental health practice and policy. Health Policy Plan. 2006;3:157–70.

    Article  Google Scholar 

  106. Kopinak JK. Mental health in developing countries: challenges and opportunities in introducing western mental health system in Uganda. Int J MCH AIDS. 2015;1:22–30.

    Google Scholar 

  107. WHO. Monitoring and evaluation of mental health policies and plans. World Health Organization. 2007. Available from: http://www.who.int/mental_health/policy/services/14-monitoring%20evaluation_HKprinter.pdf.

  108. World Health Organization. World Health Organization Assessment Instrument for Mental Health Systems (AIMS) Version 2.2. 2005. World Health Organization. Available from: http://www.who.int/mental_health/evidence/AIMS_WHO_2_2.pdf?ua=1.

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Funding

This work was supported by the China Medical Board (CMB-14-188) to XSY, the China Postdoctoral Science Foundation (2017 M622618) and the Central South University Postdoctoral Science Foundation (185708) to ZW. Then funding agencies did not take part in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

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All data and materials related to the study can be obtained through contacting the first author at weizhou86@163.com.

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ZW and XSY designed this research; ZW and YY screened for inclusion papers; ZW, YY, YM, CLZ and XSY extracted and analysed data; ZW drafted the manuscript and all authors read and approved the final manuscript.

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Correspondence to Shuiyuan Xiao.

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Appendix A to E. (DOC 230 kb)

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Zhou, W., Yu, Y., Yang, M. et al. Policy development and challenges of global mental health: a systematic review of published studies of national-level mental health policies. BMC Psychiatry 18, 138 (2018). https://doi.org/10.1186/s12888-018-1711-1

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