key: cord-0706991-fc9yc35c
authors: Kim, Chul Eung; Ko, Young-Mi; Lee, Sang-Uk; Choi, SungKu; Han, Kiwan; Park, Se Jin; Jo, MinKyung; Park, Yu Kyong; Lee, Hye Young; Park, Subin
title: A Preliminary Study to Determine Comprehensive Research and Development Plans for Promoting Mental Health Services
date: 2018-12-03
journal: Osong Public Health Res Perspect
DOI: 10.24171/j.phrp.2018.9.6.05
sha: 5ceca9883a0930498d29cdfc09b942f6a9c6bf89
doc_id: 706991
cord_uid: fc9yc35c

OBJECTIVES: The aim of this study was to analyze research and development projects in mental health services in Korea, using priority evaluation of mental health promotion policies to determine direction of the service. METHODS: An online survey was conducted that targeted experts in the mental health service regarding promotion of mental health in Korea in 2016. The survey was based on 32 policy projects that resulted from 12 strategies according to 4 policy objectives. RESULTS: Analysis of 32 mental health projects were assessed regarding the possibility of technology development success, magnitude of the ripple effect, and necessity of a national response. It was observed that 3 policy projects relevant to suicide, had a high relative priority. This was followed by policies for improvement of health insurance and the medical benefit cost system, and policies for reinforcement of crisis psychological support such as those for disaster victims. CONCLUSION: The prioritization of mental health services should place an emphasis on promotion of a healthy mental lifestyle, rehabilitation support for patients with serious mental illness, and reinforcement of social safety networks for suicide prevention.

"The Epidemiological Survey of Mental Disorders" in Korea has been conducted every 5 years starting from 2001, and has reported that mental illness including depression, has been gradually on the rise. Prevalence of mental illness rose from 9.1% in 2006 to 10.2% in 2011, and a prevalence of a lifetime of mental illness increased from 12.6% to 14.4% [1, 2] In spite of the high prevalence of mental illness, it was found that the proportion of patients receiving counseling from a psychiatrist or another mental health professional was 15.3% in 2011, and thereby approximately 85% of the patients had no experience of using mental health services [3] . Compared to 39.2% in the US (2010), 34.9% in Australia (2009) and 38.9% in New Zealand (2006) , mental health services were significantly underutilized [4] . Thus, it is important to prepare national strategies for mental health problems in all age groups in Korea.

The paradigm shift in treatment of patients with mental illnesses in hospital to mental health promotion among the general population [5] , early detection of mental illness and integration of these patients into local communities, requires of the whole national health service R&D budget per year [6] [7] [8] . The proportion of the R&D research budget for national mental health treatment from 2008 to 2012 was 53.5% for basic mechanism research, followed by 35.4% for the first stages of translational research (T1), and 5.3% for the second stage of translational research (T2). By 2014, 47.9% of the R&D budget was allocated for basic mechanism research, 30.8% for T1, and 10.3% for T2 [9] . by establishing national mental health strategies as a 5-year plan from 1992. Currently in the 4th plan, the focus has been on prevention of mental illness and early intervention [15] .

Developed countries recognize the importance of mental health research, making aggressive investments in science and technology which is directly connected with the national economy. In particular, it was shown that mental health R&D projects have great effectiveness in reducing socio-economic costs relative to the investment [8, 16] . This is because disease prevention through early intervention and mental health promotion, may reduce national health expenditure, and indirectly improve human productivity, and reduce public sector expenses (for instance judicial administrative expenses) [8, 16] . Mental health R&D investment in Korea, may be disparate at each research stage, and application and diffusion of research outcomes to local communities are insufficient compared to developed countries. Therefore, support and enhancement of translational research are required to improve mental health research [8, [16] [17] [18] . This study was conducted as a preliminary analysis to examine R&D projects in mental health in Korea, and to evaluate crucial projects according to the relative priority of national policy coordination meetings assessing the mental health problem in 2016 [5] . This may be considered as the current national mental health policy of Korea. The aim of this study was to assess the validity in establishing medium-and long-term plans for national mental health R&D strategies.

The questionnaire was created to evaluate mental health R&D core projects, utilizing a comprehensive plan reported in a national policy coordination meeting in February 2016.

The plan was based on 12 strategies, 214 detailed contents of 32 policy projects for achieving each strategy, according to 4 policy objectives [5] .

The questionnaire items were categorized into 3 sections: 1) relative importance of policy objectives, 2) relative importance of policy projects and detailed contents of strategies, and 3) socio-demographic characteristics. Scores ranged from 1 to 9 points, with the higher the score, the stronger the relative influence. The relative importance was deduced using a pairwise comparison method. The evaluation criteria for deducing priority weighting are presented in Table 1 .

The items for measuring the relative importance of policy projects and detailed content of strategies for a comprehensive plan on mental health promotion are shown in Table 2 Table 3 shows an example of the method for evaluating the relative importance.

Multi-criteria evaluation of 214 detailed contents of a comprehensive plan on mental health promotion The importance of 214 detailed contents was evaluated by considering detailed criteria, with emphasis on multi-criteria to determine preferential support areas. It was utilized as a basic score to decide the priorities of 32 policy projects which were the parent category of the 214 detailed contents. Table 4 shows an example of the multi-criteria evaluation measurement of the 214 detailed contents.

The Analytic Hierarchy Process (AHP) was used for identification of qualitative factors that support systematic evaluation or evaluation criteria that were complex. It was useful as quantitative results were obtained by systematically scaling the ratio of the relative importance or preferences.

It can also be employed in the decision-making process in the private and public sector (plans for higher education, were conducted in sequence.

The scores of 32 policy projects (parent category of detailed contents), were calculated by adding average scores according Areas of market failure Areas of private advantage Areas in which the government has to invest in R&D because the private sector finds it difficult to invest in these areas (scale of the study budget, etc.)

Technology areas required for improvement in quality of life of the people or social contribution promotion through mental health promotion Table 1 . Evaluation criteria for deducing priority weighted values (evaluation items for multi-criteria evaluation). 

As a result of the online survey, 27 questionnaires were used for analysis. Sociodemographic characteristics of the respondent experts according to age were included; 7 people in their 30s, 17 people in their 40s, and 3 people in their 50s.

Their majors were psychiatry, nursing science, preventive medicine, health science, social welfare, clinical psychology, medical biotechnology, medical informatics, and humanities and social sciences (sociology, education, economy, science and technology policy), and they also had work experience relevant to mental health and worked in hospitals, national and private universities, research centers and companies, and their employment history in each major field of study was as follows:

5 people were employed for less than 10 years, 16 people were employed for 10 years or more, 5 people were employed for 20 years or more, and 1 person was employed for 30 years or more. Promotion of mental health improvement service accessibility (Expansion of infrastructure) Installation of mental health promotion centers in all states, provinces and counties, expansion of additional infrastructure according to the population after installation (2016) (Budget support) Placement of staff exclusively responsible for mental health promotion within a mental health promotion center to raise mental health service quality and for expansion of budget support (2017) (Self-management support) Self-diagnosis of mental health problems by a smartphone, evidence-based programs suitable to user characteristics* and provision of information related to mental health *Cognitive behavior treatment (CBT), Sleeping/hygiene management, meditation, relaxation therapy, etc.

(Connection with high risk groups) Supporting connection with mental health promotion centers or medical institutions located in the user region in case subjects are selected as the high-risk group by self-screening (Moving bus for psychological support) Operation of 'Moving bus for psychological support' mainly in 5 national hospitals, provision of psychological support by directly visiting schools and work places (Connection with visiting health and welfare projects) Combining screening and counseling support for depression, etc., during a home visit, connection with specialized institutions for high risk groups Table 4 . Multi-criteria evaluation measurement of 214 detailed contents of a comprehensive plan on mental health promotion (an example). Table 6 . Analytic process for deducing the weighted average value. Table 6 indicates the analytic process calculating the Establishment of a suicide prevention research system, using a cohort study for analyzing the causes of suicide, have not yet been performed [7, 16] . In addition, there are insufficient independent R&D projects, medium-and longterm R&D promotion strategies, and roadmaps that can play a central/integrated role in national mental health R&D [27] . In Europe, mental health research is developed through a mediumand long-term roadmap which focuses on 6 major priority fields for mental health and wellbeing in Europe. This process is based on translational research essential to field applications to offer assistance in solving mental health problems connected with overall issues including politics, society, and economy in Europe [28, 29] . The National Institute of Mental Health in the USA also set 4 strategic objectives as a roadmap for mental health promotion. It promotes brain and behavioral science discoveries as priority, with a broad roadmap to influence public health for the next 5 years [30] . Therefore, the national mental health R&D investment and its supporting systems in Korea should be secured as a long-term policy.

Lastly, only a small number of questionnaires were analyzed from the online survey carried out by the experts, reflecting the limitation of this study. The collection rate of questionnaires was low because the survey contents required professional knowledge related to R&D in the field of mental health, and there were many measurement items. This led to partial and untrustworthy responses being excluded. Further follow-up studies will need to increase the sample size of the survey in subsequent studies.

No potential conflicts of interest relevant to this article was reported.

Prevalence of DSM-IV major mental disorders among Korean adults: a 2006 National Epidemiologic Survey (KECA-R)

Prevalence and correlates of DSM-IV mental disorders in South Korean adults: the Korean epidemiologic catchment area study

The epidemiological survey of mental disorders in Korea

Department of Health and Human Services. Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings

Ministry of Health and Welfare. Comprehensive plan on mental health

Ministry of Science and Technology, Ministry of Commerce, Industry and Energy, Ministry of Information and Communication, Ministry of Health and Welfare. Second basic plan for promoting brain research

The budget of Ministry of Health and Welfare in 2015 is 5190 million Won

Research on the reasonable size of research bud get for Korea National Institute of Mental Health. Seoul (Korea): Seoul Na tional Hospital

Ministry of Health and Welfare, Caleb & Company. A Study on Mental Health R&D Services Planning

Mental Health Research-Principles and Priorities for the Future

Korea Intellectual Property Strategy Institute. Mental health R&D project planning patent trend report. Daejeon, Sejong (Korea): Korea Intellectual Property Office, Ministry of Health and Welfare

Mental health services and R&D in South Korea

Activation Plans for Psychiatric Research

I could suffer too' The safety of Korea is getting lower

Sewol ferry survivors struggle with PTSD

Epidemiology, clinical manifestations, and management of pandemic novel Influenza A (H1N1)

The government's research and development policies and institutions for health technology

Ministry of Education and Science Technology; Ministry for Food, Agriculture, Forestry and Fisheries; Ministry of Know-ledge Economy

Ministry of Health and Welfare; Ministry of Environment; Ministry of Land, Transport and Maritime Affairs

Ministry of Health and Welfare. Development of national policies for addiction prevention management and service delivery systems

Korean Academy of Addiction Psychiatry [Internet]. Data for hospitals treating addictions

The current status and cause of the addiction problem

Ministry of Health and Welfare. Government-wide R&D Mid to Long-Term Plan for National Health

A Roadmap for Mental Health Research in Europe, ROAMER, Final Roadmap

Research priorities for public mental health in Europe: recommendations of the ROAMER project

National Institute of Mental Health Strategic Plan for Research