mental health care thesis

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Mental health awareness is a crucial topic in contemporary society that seeks to educate individuals on mental health disorders, reduce stigma, and advocate for accessible treatment. When constructing a thesis on this topic, a decisive, clear, and specific thesis statement is imperative. This text will provide and analyze good and bad thesis statement examples on mental health awareness to guide students in developing robust research arguments.

Good Thesis Statement Examples

Specific and Clear: “The research quantitatively analyzes the impact of school-based mental health awareness programs on adolescents’ levels of depression and anxiety.” Bad: “School programs about mental health awareness are important.”

The good example is specific and clear, offering a quantitative approach, focus group (adolescents), and measurable outcomes (levels of depression and anxiety). Conversely, the bad example is vague, lacking clear metrics or specific focus areas.

Well-defined Scope: “This thesis explores the role of social media in propagating mental health stigma among adults in the United States.” Bad: “Social media plays a role in mental health.”

The good statement precisely defines the scope, focusing on stigma propagation, the adult demographic, and limiting the study to the United States. The bad example is too broad and lacks specificity on the aspect of mental health and target demographic.

Arguable and Debatable: “The availability of teletherapy services significantly improves access to mental health care for rural populations facing transportation barriers.” Bad: “Teletherapy services are beneficial.”

The good thesis is arguable and presents a specific claim about teletherapy’s impact on rural populations and access barriers, whereas the bad example is non-debatable and too general without a particular focus or claim.

Bad Thesis Statement Examples

Overly Broad: “Mental health is important for everyone.”

This statement, while true, is too broad and general. It doesn’t guide the reader towards a specific aspect of mental health, making it ineffective for a thesis.

Lack of Clear Argument: “Mental health issues affect people in different ways.”

While this statement is factual, it lacks a clear argument or focus, leaving the reader without direction or understanding of the paper’s purpose. Seeking paraphrasing help can enhance the clarity and focus of your statement, ensuring your paper effectively communicates its purpose.

Unmeasurable and Unresearchable: “Positive thinking can cure mental disorders.”

This statement is not only scientifically incorrect but also unmeasurable and unresearchable, making it inappropriate for scholarly research.

A strong thesis statement is pivotal for the success of a thesis on Mental Health Awareness. As illustrated, good thesis statements are clear, specific, and arguable with a well-defined scope, guiding the reader effortlessly through the research’s purpose and objectives. In contrast, bad thesis statements are often overly broad, lack clear arguments, and are not measurable or researchable, leading to confusion and a lack of direction. By carefully considering these examples, students can craft thesis statements that offer clarity, precision, and a roadmap for their research on the vital and complex issue of mental health awareness.

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Home — Essay Samples — Nursing & Health — Mental Health — Mental Health Thesis Statement

Mental Health Thesis Statement

• Categories: Mental Health

About this sample

Words: 432 |

Published: Mar 13, 2024

Words: 432 | Page: 1 | 3 min read

Table of contents

1. the importance of mental health awareness and support, 2. the implications of neglecting mental health, 3. strategies for promoting mental health and well-being.

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Research Topics & Ideas: Mental Health

100+ Mental Health Research Topic Ideas To Fast-Track Your Project

If you’re just starting out exploring mental health topics for your dissertation, thesis or research project, you’ve come to the right place. In this post, we’ll help kickstart your research topic ideation process by providing a hearty list of mental health-related research topics and ideas.

PS – This is just the start…

We know it’s exciting to run through a list of research topics, but please keep in mind that this list is just a starting point . To develop a suitable education-related research topic, you’ll need to identify a clear and convincing research gap , and a viable plan of action to fill that gap.

If this sounds foreign to you, check out our free research topic webinar that explores how to find and refine a high-quality research topic, from scratch. Alternatively, if you’d like hands-on help, consider our 1-on-1 coaching service .

Overview: Mental Health Topic Ideas

• Mood disorders
• Anxiety disorders
• Psychotic disorders
• Personality disorders
• Obsessive-compulsive disorders
• Post-traumatic stress disorder (PTSD)
• Neurodevelopmental disorders
• Eating disorders
• Substance-related disorders

Mood Disorders

Research in mood disorders can help understand their causes and improve treatment methods. Here are a few ideas to get you started.

• The impact of genetics on the susceptibility to depression
• Efficacy of antidepressants vs. cognitive behavioural therapy
• The role of gut microbiota in mood regulation
• Cultural variations in the experience and diagnosis of bipolar disorder
• Seasonal Affective Disorder: Environmental factors and treatment
• The link between depression and chronic illnesses
• Exercise as an adjunct treatment for mood disorders
• Hormonal changes and mood swings in postpartum women
• Stigma around mood disorders in the workplace
• Suicidal tendencies among patients with severe mood disorders

Anxiety Disorders

Research topics in this category can potentially explore the triggers, coping mechanisms, or treatment efficacy for anxiety disorders.

• The relationship between social media and anxiety
• Exposure therapy effectiveness in treating phobias
• Generalised Anxiety Disorder in children: Early signs and interventions
• The role of mindfulness in treating anxiety
• Genetics and heritability of anxiety disorders
• The link between anxiety disorders and heart disease
• Anxiety prevalence in LGBTQ+ communities
• Caffeine consumption and its impact on anxiety levels
• The economic cost of untreated anxiety disorders
• Virtual Reality as a treatment method for anxiety disorders

Psychotic Disorders

Within this space, your research topic could potentially aim to investigate the underlying factors and treatment possibilities for psychotic disorders.

• Early signs and interventions in adolescent psychosis
• Brain imaging techniques for diagnosing psychotic disorders
• The efficacy of antipsychotic medication
• The role of family history in psychotic disorders
• Misdiagnosis and delayed treatment of psychotic disorders
• Co-morbidity of psychotic and mood disorders
• The relationship between substance abuse and psychotic disorders
• Art therapy as a treatment for schizophrenia
• Public perception and stigma around psychotic disorders
• Hospital vs. community-based care for psychotic disorders

Personality Disorders

Research topics within in this area could delve into the identification, management, and social implications of personality disorders.

• Long-term outcomes of borderline personality disorder
• Antisocial personality disorder and criminal behaviour
• The role of early life experiences in developing personality disorders
• Narcissistic personality disorder in corporate leaders
• Gender differences in personality disorders
• Diagnosis challenges for Cluster A personality disorders
• Emotional intelligence and its role in treating personality disorders
• Psychotherapy methods for treating personality disorders
• Personality disorders in the elderly population
• Stigma and misconceptions about personality disorders

Obsessive-Compulsive Disorders

Within this space, research topics could focus on the causes, symptoms, or treatment of disorders like OCD and hoarding.

• OCD and its relationship with anxiety disorders
• Cognitive mechanisms behind hoarding behaviour
• Deep Brain Stimulation as a treatment for severe OCD
• The impact of OCD on academic performance in students
• Role of family and social networks in treating OCD
• Alternative treatments for hoarding disorder
• Childhood onset OCD: Diagnosis and treatment
• OCD and religious obsessions
• The impact of OCD on family dynamics
• Body Dysmorphic Disorder: Causes and treatment

Post-Traumatic Stress Disorder (PTSD)

Research topics in this area could explore the triggers, symptoms, and treatments for PTSD. Here are some thought starters to get you moving.

• PTSD in military veterans: Coping mechanisms and treatment
• Childhood trauma and adult onset PTSD
• Eye Movement Desensitisation and Reprocessing (EMDR) efficacy
• Role of emotional support animals in treating PTSD
• Gender differences in PTSD occurrence and treatment
• Effectiveness of group therapy for PTSD patients
• PTSD and substance abuse: A dual diagnosis
• First responders and rates of PTSD
• Domestic violence as a cause of PTSD
• The neurobiology of PTSD

Neurodevelopmental Disorders

This category of mental health aims to better understand disorders like Autism and ADHD and their impact on day-to-day life.

• Early diagnosis and interventions for Autism Spectrum Disorder
• ADHD medication and its impact on academic performance
• Parental coping strategies for children with neurodevelopmental disorders
• Autism and gender: Diagnosis disparities
• The role of diet in managing ADHD symptoms
• Neurodevelopmental disorders in the criminal justice system
• Genetic factors influencing Autism
• ADHD and its relationship with sleep disorders
• Educational adaptations for children with neurodevelopmental disorders
• Neurodevelopmental disorders and stigma in schools

Eating Disorders

Research topics within this space can explore the psychological, social, and biological aspects of eating disorders.

• The role of social media in promoting eating disorders
• Family dynamics and their impact on anorexia
• Biological basis of binge-eating disorder
• Treatment outcomes for bulimia nervosa
• Eating disorders in athletes
• Media portrayal of body image and its impact
• Eating disorders and gender: Are men underdiagnosed?
• Cultural variations in eating disorders
• The relationship between obesity and eating disorders
• Eating disorders in the LGBTQ+ community

Substance-Related Disorders

Research topics in this category can focus on addiction mechanisms, treatment options, and social implications.

• Efficacy of rehabilitation centres for alcohol addiction
• The role of genetics in substance abuse
• Substance abuse and its impact on family dynamics
• Prescription drug abuse among the elderly
• Legalisation of marijuana and its impact on substance abuse rates
• Alcoholism and its relationship with liver diseases
• Opioid crisis: Causes and solutions
• Substance abuse education in schools: Is it effective?
• Harm reduction strategies for drug abuse
• Co-occurring mental health disorders in substance abusers

Choosing A Research Topic

These research topic ideas we’ve covered here serve as thought starters to help you explore different areas within mental health. They are intentionally very broad and open-ended. By engaging with the currently literature in your field of interest, you’ll be able to narrow down your focus to a specific research gap .

It’s important to consider a variety of factors when choosing a topic for your dissertation or thesis . Think about the relevance of the topic, its feasibility , and the resources available to you, including time, data, and academic guidance. Also, consider your own interest and expertise in the subject, as this will sustain you through the research process.

Always consult with your academic advisor to ensure that your chosen topic aligns with academic requirements and offers a meaningful contribution to the field. If you need help choosing a topic, consider our private coaching service.

Good morning everyone. This are very patent topics for research in neuroscience. Thank you for guidance

What if everything is important, original and intresting? as in Neuroscience. I find myself overwhelmd with tens of relveant areas and within each area many optional topics. I ask myself if importance (for example – able to treat people suffering) is more relevant than what intrest me, and on the other hand if what advance me further in my career should not also be a consideration?

This information is really helpful and have learnt alot

Phd research topics on implementation of mental health policy in Nigeria :the prospects, challenges and way forward.

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Home > Education > Counseling & Human Services > ETDs

Counseling & Human Services Theses & Dissertations

Theses and dissertations published by graduate students in the Department of Counseling and Human Services, College of Education, Old Dominion University, since Fall 2016 are available in this collection. Backfiles of all dissertations (and some theses) have also been added.

In late Fall 2023 or Spring 2024, all theses will be digitized and available here. In the meantime, consult the Library Catalog to find older items in print.

Theses/Dissertations from 2024 2024

Dissertation: The Lived Experiences of Counselors-in-Training Completing Practicum and Internship During COVID-19 , Shelby Lauren Dillingham

Dissertation: Climbing the Academic Ladder While Black: Exploring the Experiences of Institutional Belongingness for Black Counselor Education and Supervision Doctoral Students at Predominantly White Institutions , Jasmine Alicia Hawa Griffith

Dissertation: Understanding the Role of Adverse Childhood Experiences on Resilience in Police Officers , Wayne F. Handley

Thesis: The Experiences of Multilingual Learning-Focused School Counselors: A Phenomenological Investigation , Chelsea Jo Hilliard

Dissertation: Partners in Crisis: A Phenomenological Exploration of Collaboration Between Crisis Intervention Team Officers and Mental Health Professionals , Jessica L. Huffman

Dissertation: Exploring the Experiences of School Counselors Advocating for Social Justice Within Urban PK-12 Charter Schools , Betsy Marina Perez

Dissertation: Supervision Needs of Novice Behavioral Health Providers in Integrated Primary Care Settings: A Delphi Study , Nicholas D. Schmoyer

Dissertation: Wellness as a Predictor of Turnover Intention in the Active Duty Military , Thomas Clifford Seguin

Dissertation: Consensus on Best Practices in Neuroscience-Informed Treatment of Combat-Related Posttraumatic Stress in Military Veterans: A Delphi Study of Experts in the Field of Mental Health , Danielle Lauren Winters

Theses/Dissertations from 2023 2023

Dissertation: Providing Family Centered Care Within Pediatric Integrated Care Settings , Emily D. Bebber

Dissertation: The Lived Experiences of 911 Dispatchers With Compassion Fatigue: An Interpretive Phenomenology , Angela Johnson

Dissertation: Exploring the Lived Experiences of Self-Identified Politically Conservative Students in Graduate Counseling Programs in Public Universities , Elizabeth A. Orrison

Theses/Dissertations from 2022 2022

Dissertation: Mental Health Counselors’ Perceptions of Professional Identity as Correctional Counselors in an Integrated Behavioral Health Care Setting , Jeanel L. Franklin

Dissertation: Complex Thought for Complex Work: Preparing Cognitively Complex Counselors for Work in Diverse Settings , Alexandra C. Gantt

Dissertation: Trauma and Crisis Counselor Preparation: The Relationship of an Online Trauma and Crisis Course and Counseling Self-Efficacy , Julia Leigh Lancaster

Dissertation: An Investigation of Healthcare Professionals’ Perspectives on the Tasks of Mental Health Counselors in Hospital Settings , Suelle Micallef Marmara

Dissertation: Broaching Race and Race-Related Issues: Phenomenological Inquiry of Doctoral Student Supervisors of Counselor Trainees , Judith Wambui Preston

Dissertation: A Phenomenological Investigation of School Counselor Antiracist Social Justice Practices , Stephanie Deonca Smith-Durkin

Dissertation: Counselor Perceived Competence Diagnosing Disorders from DSM-5 Diagnostic Categories Survey Results and the Development and Validation of Scores on the Diagnostic Self-Efficacy Scale , Erin Elizabeth Woods

Dissertation: The Experiences of School Counselors Providing Virtual Services During Covid-19: A Phenomenological Investigation , Allison Kathryn Worth

Dissertation: A Comparison of Sorority Women and Non-Sorority Women’s Alcohol Use: Perception, Rate of Use, and Consequences , Betsy Zimmerman

Theses/Dissertations from 2021 2021

Dissertation: Effectiveness of College Counseling Interventions in International Student Adjustment to United States Higher Education Systems: A Meta-Analysis , Joshua Ebby Abraham

Dissertation: What Are We Missing?: A Comparison of Experiences of Race-Based Trauma by Black Americans and Black Jamaicans , Bianca R. Augustine

Dissertation: Site Supervisors' Perspectives on Supervision of Counselor Trainees in Integrated Behavioral Health (IBH) Settings: A Q Methodology Approach , Yeşim Giresunlu

Dissertation: The Impact of a Crisis Intervention Team Program on Psychiatric Boarding , Kurtis Hooks

Dissertation: A Case Study on the Application and Implementation of Positive Behavioral Interventions and Supports for Students with Emotional Disabilities in Alternative Education , Kira Candelieri Marcari

Dissertation: Initial Development of the Escala de Fortaleza en Jóvenes para Padres , David Moran

Dissertation: Incivility of Coworker Behaviors and Minority Firefighters’ Belongingness in the Workplace , Alyssa Reiter

Dissertation: A Meta-Analysis of Three Years of Data on Outcomes of Therapy Groups for Inmates in the Virginia Department of Corrections , Abie Carroll Tremblay

Theses/Dissertations from 2020 2020

Dissertation: Improving Veterans’ Psychological Well-Being with a Positive Psychology Gratitude Exercise , Clara Im Adkins

Dissertation: An Examination of the Relationship Among Social Services Support, Race, Ethnicity and Recidivism in Justice Involved Mothers , Ne’Shaun Janay Borden

Dissertation: Development and Validation of the Students With Learning Disabilities School Counselor Self- Efficacy Scale: A Psychometric Study , Rawn Alfredo Boulden, Jr.

Dissertation: Minority Counselor Multicultural Competence in the Current Sociopolitical Climate , Kathleen Brown

Dissertation: A Meta-Analysis of Group Treatment Outcomes for Veterans with Substance Use Disorders , Robert “Tony” Dice

Dissertation: Investigating the Impact of the FAVA Well-Being Protocol on Perceived Stress and Psychological Well-Being With At-Promise High School Students , Renee L. Fensom

Dissertation: Mental Health Counselors' Perceptions on Preparedness in Integrated Behavioral Healthcare in Underserved Areas , Kyulee Park

Dissertation: Group Treatment Effectiveness for Substance Use Disorders: Abstinence vs. Harm Reduction , Jill D. Parramore

Dissertation: Best Practices in Clinical Supervision: What Must Supervisees Do? , Johana Rocha

Dissertation: A Phenomenological Investigation of Counselors’ Experiences With Clients Affected by Problematic Internet Pornography Use , Kendall R. Sparks

Dissertation: Counselor Education Doctoral Students’ Research Self-Efficacy: A Concept Mapping Approach , Zahide Sunal

Dissertation: A Systemic Review and Meta-Analysis of Psychoeducational Groups for the Treatment of Psychopathology Resulting from Child Sexual Abuse , Alexis Lynnette Wilkerson

Dissertation: School Counseling Professionals’ Experiences Using ASCA’s Mindsets & Behaviors for Student Success to Achieve College and Career Readiness , George Wilson

Theses/Dissertations from 2019 2019

Dissertation: Exploring the Lived Experiences of Career Oriented Military Spouses Pursuing Education for Career Advancement , Melody D. Agbisit

Dissertation: Reshaping Counselor Education: The Identification of Influential Factors on Multisystemic Therapy , T'Airra C. Belcher

Dissertation: An Investigation of Posttraumatic Growth Experienced By Parents After a Miscarriage , Barbara Elizabeth Powell Boyd

Dissertation: The Psychometric Properties of the School Counseling Internship Competency Scale , Melanie Ann Burgess

Dissertation: Intersectional Identities and Microaggressions: The Experience of Transgender Females , Cory Daniel Gerwe

Dissertation: Comparing Higher Order Value Differences By Religious and Spiritual Association and Implications for Counseling: An Exploratory Study , Gregory C. Lemich

Dissertation: The Effects of Supervisory Style and Supervisory Working Alliance on Supervisee Disclosure in Supervision: A Moderated Mediation Analysis , Chi Li

Dissertation: A Comparison of College Student-Athletes With Attention-Deficit Hyperactivity Disorder (ADHD) and Nonathletes With ADHD: Academic Adjustment, Severity of Mental Health Concerns, and Complexity of Life Concerns , Sonja Lund

Dissertation: An Experimental Study of Research Self-Efficacy In Master’s Students , Nicola Aelish Meade

Theses/Dissertations from 2018 2018

Dissertation: Multilevel Confirmatory Factor Analysis of the Family Adjustment Measure with Lower-Income, Ethnic Minority Parents of Children with Disabilities , Vanessa Nicole Dominguez-O'Hare

Dissertation: Risk and Resiliency Factors Affecting the College Adjustment of Students with Intersectional Ethnocultural Minority and LGBTQ Identities , Stacey Christina Fernandes

Dissertation: The Relationship Between Childhood Adversity and Adult Relationship Health for Economically Marginalized, Racially and Ethnically Diverse Individuals , Sandy-Ann M. Griffith

Dissertation: An Exploration of Practicum Students' Experiences of Meaning-Making Through Altruism , Debra Paige Lewis

Dissertation: Addiction Counselors' Perceptions of Clinical Supervision Practices , Marla Harrison Newby

Dissertation: Exploring the Variant Experiences Through Which Racial/Ethnic Minorities Select Art Therapy as a Career , Mary Ritchie Roberts

Dissertation: Psychosocial Determinants of Medication Adherence among HIV-Positive Individuals in Mexico City , Anthony Vajda

Theses/Dissertations from 2017 2017

Dissertation: Cross-Racial Trust Factors: Exploring the Experiences of Blacks Who Have Had White Mentors in the Counseling Profession , Eric Montrece Brown

Dissertation: Personality, Motivation, and Internet Gaming Disorder: Understanding the Addiction , Kristy L. Carlisle

Dissertation: The Relationship Between Trauma Exposure and College Student Adjustment: Factors of Resilience as a Mediator , Amber Leih Jolley

Dissertation: Establishing the Psychometric Properties of the Understanding Mental Health Scale: A Dissertation Study , Michael Thomas Kalkbrenner

Dissertation: Attitudes and Actions that Adoptive Parents Perceive as Helpful in the Process of Raising Their Internationally Adopted Adolescent , Marina V. Kuzmina

Dissertation: Towards a New Profession: Counselor Professional Identity in Italy. A Delphi Study , Davide Mariotti

Dissertation: Exploring the Relationship Between Depression and Resilience in Survivors of Childhood Trauma , Marquis A. Norton

Dissertation: Understanding the Experiences of Women with Anorexia Nervosa Who Complete an Exposure Therapy Protocol in a Naturalistic Setting , Gina B. Polychronopoulos

Dissertation: An Exploratory Factor Analysis Examining Experiences and Perceptions of Campus Safety for International Students , Sonia H. Ramrakhiani

Dissertation: The Role of Self-Care and Hardiness in Moderating Burnout in Mental Health Counselors , Traci Danielle Richards

Theses/Dissertations from 2016 2016

Dissertation: Examining Changes in College Counseling Clients’ Symptomology and Severity over an Eight Year Span , Caroline Lee Bertolet

Dissertation: Initial Development and Validation of the Transgender Ally Identity Scale for Counselors , Jamie D. Bower

Dissertation: A Counselor’s First Encounter with Non-Death Loss: A Phenomenological Case Study on New Counselor Preparation and Experience in Working with Non-Death Loss , Charles P. Carrington

Dissertation: The Relationship Between Counselors' Multicultural Counseling Competence and Poverty Beliefs , Madeline Elizabeth Clark

Dissertation: Counselors’ Perceived Preparedness for Technology-Mediated Distance Counseling: A Phenomenological Examination , Daniel C. Holland

Theses/Dissertations from 2015 2015

Dissertation: Factors Associated with Family Counseling Practices: The Effects of Training, Experience, and Multicultural Counseling Competence , Amanda A. Brookshear

Dissertation: An Examination of Supervisory Working Alliance, Supervisee Demographics, and Delivery Methods in Synchronous Distance Supervision , Robert Milton Carlisle III

Dissertation: A Phenomenological Investigation of Counselors' Perceived Degree of Preparedness When Working with Suicidal Clients , Heather Danielle Dahl

Dissertation: African American Pastors and Their Perceptions of Professional School Counseling , Krystal L. Freeman

Dissertation: A Phenomenological Investigation of Wellness and Wellness Promotion in Counselor Education Programs , Brett Kyle Gleason

Dissertation: Examining Disordered Eating Amongst Sorority Women , Andrea Joy Kirk

Dissertation: Bhutanese Counselors' Experiences with Western Counseling: A Qualitative Study , Susan V. Lester

Dissertation: An Exploration of Health Providers' Responses to Intimate Partner Violence (IPV) in Malaysia , Kee Pau

Dissertation: A Mixed Methods Study of the Intersection of Sexual Orientation and Spiritual Development in the College Experience , Kevin C. Snow

Theses/Dissertations from 2014 2014

Dissertation: Ethical and Legal Knowledge, Cognitive Complexity, and Moral Reasoning in Counseling Students , Matthew W. Bonner

Dissertation: A Grounded Theory of the College Experiences of African American Males in Black Greek-Letter Organizations , David Julius Ford Jr.

Dissertation: The Experiences of School Counselors with Court Involvement Related to Child Custody , Crystal E. Hatton

Dissertation: A Grounded Theory of Suicidality in Children Ten and Younger , Katherine Angela Heimsch

Dissertation: School Counseling Program Models Utilized By School Districts , Tracy L. Jackson

Dissertation: The Relationship Among Counseling Supervision Satisfaction, Counselor Self-Efficacy, Working Alliance and Multicultural factors , Jennifer Dawn Logan

Dissertation: Development of the Profession of Counseling in Kenya, Uganda, and Tanzania: A Grounded Theory Study , Mueni Joy Maweu Mwendwa

Dissertation: Resident Assistants' Self- Efficacy for Participation in Counseling Activities , Miranda Johnson Parries

Dissertation: Role Ambiguity of Counseling Supervisors , Aaron Gabriel Shames

Dissertation: Degree of Implementation of the American School Counselor Association National Model and School Counselor Burnout , Katrina Marie Steele

Dissertation: College Health and Mental Health Outcomes on Student Success , Daniel Joseph St. John

Dissertation: Supervisor Perceptions of Their Multicultural Training Needs for Working with English Language Learning Supervisees , Hsin-Ya Tang

Theses/Dissertations from 2013 2013

Dissertation: Experiences of Resident Assistants with Potentially Suicidal Students: Identification, Referral, and Expectations , Katherine M. Bender

Dissertation: Counselor Demographics, Client Aggression, Counselor Job Satisfaction, and Confidence in Coping in Residential Treatment Programs , Erik Braun

Dissertation: School Personnel Perceptions of Professional School Counselor Role and Function , Caron N. Coles

Dissertation: Factors That Influence Minority Student Enrollment at Various Levels of Postsecondary Education , LaShauna Mychal's Dean

Dissertation: Experiences and Perceptions of Mental Health Professionals Considered Effective in the Diagnosis and Treatment of Adults with Attention Deficit Hyperactivity Disorder , Bonita H. Erb

Dissertation: A Qualitative Study of the Experiences of Gatekeeping Among PhD Counselor Educators , Carol A. Erbes

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• Published: 20 August 2024

Examining the mental health services among people with mental disorders: a literature review

• Yunqi Gao 1 ,
• Richard Burns 1 ,
• Liana Leach 1 ,
• Miranda R. Chilver 1 &
• Peter Butterworth 2 , 3  

BMC Psychiatry volume  24 , Article number:  568 ( 2024 ) Cite this article

182 Accesses

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Mental disorders are a significant contributor to disease burden. However, there is a large treatment gap for common mental disorders worldwide. This systematic review summarizes the factors associated with mental health service use.

PubMed, Scopus, and the Web of Science were searched for articles describing the predictors of and barriers to mental health service use among people with mental disorders from January 2012 to August 2023. The initial search yielded 3230 articles, 2366 remained after removing duplicates, and 237 studies remained after the title and abstract screening. In total, 40 studies met the inclusion and exclusion criteria.

Middle-aged participants, females, Caucasian ethnicity, and higher household income were more likely to access mental health services. The use of services was also associated with the severity of mental symptoms. The association between employment, marital status, and mental health services was inconclusive due to limited studies. High financial costs, lack of transportation, and scarcity of mental health services were structural factors found to be associated with lower rates of mental health service use. Attitudinal barriers, mental health stigma, and cultural beliefs also contributed to the lower rates of mental health service use.

This systematic review found that several socio-demographic characteristics were strongly associated with using mental health services. Policymakers and those providing mental health services can use this information to better understand and respond to inequalities in mental health service use and improve access to mental health treatment.

Peer Review reports

Introduction

Mental disorders such as depression and anxiety are prevalent, with nationally representative studies showing that one-fifth of Australians experience a mental disorder each year [ 5 ]. More recent estimates derived from a similar survey during the period of the COVID-19 pandemic were 21.5% [ 11 ]. Mental illness can reduce the quality of life, and increase the likelihood of communicable and non-communicable diseases [ 116 , 137 ], and is among the costliest burdens in developed countries [ 22 , 34 , 80 ]. The National Mental Health Commission [ 96 ] stated that the annual cost of mental ill-health in Australia was around $4000 per person or $60 billion. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 reported that mental disorders rank the seventh leading cause of disability-adjusted life years and the second leading cause of years lived with disability [ 48 ]. Helliwell et al. [ 56 ] indicated that chronic mental illness was a key determinant of unhappiness, and it triggered more pain than physical illness. Mental health issues can have a spillover effect on all areas of life, poor mental health conditions might lead to lower educational achievements and work performance, substance abuse, and violence [ 102 ]. In Australia, despite considerable additional investment in the provision of mental health services research suggests that the rate of psychological distress at the population level has been increasing [ 38 ], this has been argued to reflect that people who most need mental health treatment are not accessing services. Insufficient numbers of mental health services and mental healthcare professionals and inadequate health literacy have been reported as the pivotal determinants of poor mental health [ 18 ]. Previous studies have reported large treatment gaps in mental health services; finding only 42–44% of individuals with mental illness seek help from any medical or professional service provider [ 85 , 112 ] and this active proportion was much lower in low and middle-income countries [ 32 , 114 , 130 ].

Several studies have investigated factors associated with high and low rates of mental health service use and identified potential barriers to accessing mental health service use. Demographic, social, and structural factors have been associated with low rates of mental health service use. Structural barriers include the availability of mental health services and high treatment costs, social barriers to treatment access include stigma around mental health [ 125 ], fear of being perceived as weak or stigmatized [ 79 ], lack of awareness of mental disorders, and cultural stigma [ 17 ].

Existing studies that have systematically reviewed and evaluated the literature examining mental health service use have largely been constrained to specific population groups such as military service members [ 63 ] and immigrants [ 33 ], children and adolescents [ 35 ], young adults [ 76 ], and help-seeking among Filipinos in the Philippines [ 93 ]. These systematic reviews emphasize mental health service use by specific age groups or sub-groups, and the findings might not represent the patterns and barriers to mental health service use in the general population. One paper has reviewed mental health service use in the general adult population. Roberts et al. [ 112 ] found that need factors (e.g. health status, disability, duration of symptoms) were the strongest determinants of health service use for those with mental disorders.

The study results from Roberts et al. [ 112 ] were retrieved in 2016, and the current study seeks to build on this prior review with more recent research data by identifying publications since 2012 on mental health service use with a focus on high-income countries. This is in the context of ongoing community discussion and reform of the design and delivery of mental health services in Australia [ 140 ], and the need for current evidence to inform this discussion in Australia and other high-income countries. This systematic review aims to investigate factors associated with mental health service use among people with mental disorders and summarize the major barriers to mental health treatment. The specific objectives are (1) to identify factors associated with mental health service use among people with mental disorders in high-income countries, and (2) to identify commonly reported barriers to mental health service use.

Methodology

Selection procedures.

Our review adhered to PRISMA guidelines to present the results. We utilized PubMed, Scopus, and the Web of Science to search for articles describing the facilitators and barriers to mental health service use among people with mental illness from January 2012 up to August 2023. There were no specific factors that were of interest as part of conducting this systematic review, instead, the review had a broad focus intending to identify factors shown to be associated with mental health service use in the recent literature. The keywords used in our search of electronic databases were related to mental disorders and mental health service use. The full search terms and strategies were shown in Supplementary Table 1. We uploaded the search results to Covidence for deduplication and screening. After eliminating duplicates, the first author retrieved the title abstract and full-text articles for all eligible papers. Then each title and abstract were screened by two independent reviewers, to select those that would progress to full-text review. Subsequently, the two reviewers screened the full text of all the selected papers and conducted the data extraction for those that met the eligibility criteria. There were discrepancies in 12% of the papers reviewed, and all conflicts were resolved through discussion and agreed on by at least three authors.

Selection criteria

Inclusion and exclusion criteria.

In this systematic review, the scope was restricted to studies that draw samples from the general population, and the participants were either diagnosed with mental disorders or screened positive using a standardized scale. Case-control studies and cohort studies were considered for inclusion. The applied inclusion and exclusion criteria are listed in Table 1 .

Data extraction

After the full-text screening, details from all eligible studies were extracted by field into a data extraction table with thematic headings. The descriptive data includes the study title, author, publication year, geographic location, sample size, population details (gender, age), type of study design, mental disorder type (medical diagnosis or using scales) and quality grade (e.g. good, fair, and poor).

Quality assessment

The Newcastle Ottawa Scale [ 136 ] was used to evaluate the study quality for all eligible papers. We assessed the cross-sectional and cohort studies using separate assessment forms and graded each study as good, fair, or poor. The quality grade for each study was included in the data extraction table. The first author conducted the quality assessment using the Newcastle Ottawa Scale for cohort studies and the adapted scale for cross-sectional studies.

The search process is summarized in Fig. 1 . The initial search from PubMed, Scopus, and the Web of Science yielded 3230 articles: 2366 remained after removing duplicates; 2129 studies were considered not relevant; and 237 studies remained following title and abstract screening. In total, 40 studies met the inclusion criteria. Of these, four were cohort studies while thirty-six were cross-sectional studies. Ten studies (25.0%) were conducted in Canada, and nine (22.5%) were from the United States. Three studies used data from Germany (7.5%). Two studies each reported data from Australia, Denmark, Sweden, Singapore, or South Korea (5.0% of studies for each country). A single study was included with data from either the United Kingdom, Italy, Israel, Portugal, Switzerland, Chile, New Zealand, or reported pooled multinational data from six European countries (each country/ study representing 2.5% of the total sample of studies) (Table 2 ).

Flowchart for selections of studies

Study characteristics

As shown in Tables 2 ,  3 and 4 , the sample size of studies varies; a cross-sectional study from Canada had the largest sample which contained over seven million participants [ 39 ], while the smallest sample size was 362 [ 100 ]. Sixteen studies (40.0%) used DSM-IV diagnoses [ 4 ] to measure mental disorders, twelve studies (30.0%) applied the International Classification of Disease [ 138 ], and six studies used (15.0%) the Kessler Psychological Distress Scale [ 69 ]. Only three studies (7.5%) had a hospital diagnosis of mental disorders, while three studies (7.5%) used the Patient Health Questionnaire [ 72 ] to define mental disorders.

Twenty-seven studies (67.5%) analyzed the rate of mental health service use over the last 12 months, six studies (15.0%) focused on lifetime service use, and three studies (7.5%) assessed both 12-month and lifetime mental health service use. A few studies examined other time frames, with single studies investigating mental health service use over the past 3 months, 5 years, and 7 years, and one included study considered mental health service use during the 24 months before and after a sibling’s death.

Twenty of the forty studies were classified as good quality (50.0%), seventeen as fair (42.5%), and three as poor quality (7.5%).

Overview of samples and factors investigated

The included studies examined a range of different factors associated with mental health service use. These included gender, age, marital status, ethnic groups, alcohol and drug abuse, education and income level, employment status, symptom severity, and residential location. The review identified service utilization factors related to socio-demographics, differences in utilization across countries, emerging socio-demographic factors and contexts, as well as structural and attitudinal barriers. These are described in further detail below.

Socio-demographic characteristics

Fifteen studies analyzed the association between gender and mental health service use, with fourteen studies reporting that mental health service use was more frequent among females with mental disorders than males [ 2 , 37 , 42 , 43 , 47 , 54 , 66 , 67 , 90 , 103 , 119 , 123 , 128 , 130 ]. A South Korean study concluded that gender was not associated with mental health service use [ 100 ], which might be due to the small sample size of 362 participants in the study.

Fourteen studies investigated age in association with mental health service use. Nine studies concluded that mental health service use was lower among young and old adult groups, with middle-aged persons with a mental disorder being most likely to access treatment from a mental health professional [ 26 , 42 , 43 , 47 , 54 , 66 , 67 , 123 , 130 ]. Forslund et al. [ 43 ] reported that mental health service use for women in Sweden peaked in the 45-to-64-year age group, while amongst males, mental health service use was stable across the lifespan. In contrast, two articles from New Zealand and Singapore each reported that young adults were the age group most likely to access services [ 28 , 119 ]. Reich et al. [ 103 ] concluded that age was unrelated to mental health service use when considered for the whole population, but sex-specific analyses reported that mental health service use was higher in older than younger females, while the opposite pattern was observed for males. A Canadian study using community health survey data also observed no significant age-related differences in mental health service use [ 104 ].

Marital status

There was mixed evidence concerning marital status. Studies from the United States and Germany concluded that participants who were married or cohabiting had lower rates of mental health service use [ 26 , 90 ], while Silvia et al. [ 120 ] found that mental health service use was higher among married participants in Portugal. Shafie et al. [ 119 ] reported being widowed was associated with lower rates of mental health service use in Singapore.

Ethnic groups

Eight studies examined the relationship between ethnic background and mental healthcare service use. Non-Hispanic White respondents were more likely to use mental health services in Canada and the United States [ 24 , 26 , 30 , 130 , 139 ], while Asians showed lower rates of mental health service use [ 28 , 139 ]. Chow & Mulder [ 28 ] investigated mental health service use among Asians, Europeans, Maori, and Pacific peoples in New Zealand. They concluded that Maori had the highest rate of mental health service use compared with other ethnic groups. De Luca et al. [ 30 ] reported that mental health service use was lower among ethnic minority non-veterans compared to veterans in the United States, especially for those with Black or Hispanic backgrounds. In contrast, a study conducted in the UK found that mental health service use did not vary by ethnicity, with no difference between white and non-white persons [ 54 ].

Alcohol and drug abuse

Two studies reported risky alcohol use was negatively associated with mental health service use [ 26 , 132 ]. However, within the time frame of the current review, there was insufficient published evidence on the impact of drug abuse on mental health service use among people with mental disorders. Choi, Diana & Nathan [ 26 ] found that drug abuse can lead to lower rates of mental health service use in the United States. In contrast, Werlen et al. [ 132 ] reported that risky use of (non-prescribed) prescription medications was associated with higher rates of mental health service use in Switzerland.

Education, income, and employment status

Four studies analyzed the relationship between education level, income, and mental health service use. Higher levels of educational attainment [ 26 , 120 ] and higher income [ 26 ] were generally reported to be associated with an increased likelihood of mental health service use. However, Reich et al. [ 103 ] observed that in Germany, high education and perceived middle or high social class were associated with reduced mental health service use. One paper reported no significant difference in mental health service use in South Korea, possibly due to the small number of people accessing mental healthcare services [ 100 ].

Three studies reported that compared to those who are unemployed, those in work were less likely to use mental health services [ 26 , 90 , 119 ]. This outcome aligned with a Canadian study consisting of immigrants and general populations, Islam et al. [ 66 ] concluded that immigrants who were currently unemployed had higher odds of seeking treatment than those who were employed. However, an Italian [ 123 ] and a South Korean study [ 100 ] found that employment status was not related to mental health service use.

Symptom severity

Ten studies investigated the association between symptom severity and mental health service use and ten papers concluded that participants with moderate or serious psychological symptoms were more likely to use mental health services compared to those with mild symptoms [ 23 , 27 , 66 , 103 , 120 , 123 , 130 , 139 ]. Other studies showed that study participants who viewed their mental health as poor [ 42 ], who were diagnosed with more than one mental disorder [ 103 ], and those who recognized their own need for mental health treatment [ 54 , 139 ] were more likely to receive mental health services.

Residential location

Three studies investigated the association between residential location and mental health service use. Volkert et al. [ 128 ] concluded that the rates of mental health service use in Germany were significantly lower among those living in Canterbury than those living in Hamburg. A Canadian study found individuals living in neighborhoods where renters outnumber homeowners were less likely to access mental health services [ 42 ]. In the United States, for participants with low or moderate mental illness, mental health service use was lower for those residing closer to clinics [ 46 ].

Immigrants & refugees

The reviewed research found that non-refugee immigrants had slightly higher rates of mental health service use than refugees [ 10 ]. Other research found that long-term residents were more likely to access services than immigrants regardless of their origin [ 31 , 134 ]. For example, Italian citizens were found to have higher rates of mental health service use compared to immigrants, especially for affective disorders [ 123 ]. In Canada, immigrants from West and Central Africa were more likely to access mental health services compared to immigrants from East Asia and the Pacific [ 31 ]. Research from Chile found that the rates of mental health service use were similar for immigrants and non-immigrants [ 40 ]. Although, a positive association between the severity of symptoms and rates of mental health service use was only observed among immigrants [ 40 ]. Whitley et al. [ 134 ] found that immigrants born in Asia or Africa had lower rates of mental health service use, but higher rates of service satisfaction scores compared to immigrants from other countries.

Emerging areas

Our literature review identified several areas in which only a small number of studies were found. We briefly describe them here as these may reflect emerging areas of research interest. Few published articles examined mental health treatment among participants with mental disorders together with chronic physical health conditions, and we only included the papers in this systematic review if they contained a healthy comparison group. We identified two papers that focused on survivors of adolescent and young adult cancer [ 68 ] and participants with physical health problems [ 110 ]. Both studies reported that participants with other chronic conditions reported higher rates of mental health service use than the general population [ 68 , 110 ].

Two studies compared treatment seeking among people experiencing stressful life events. Erlangsen et al. [ 39 ] investigated the impact of spousal suicide, and Gazibara et al. [ 45 ] examined the effect of a sibling’s death on mental health service use. People bereaved by relatives’ deaths were more likely to use mental health services than the general population [ 39 , 45 ]. The peak effect was observed in the first 3 months after the death for both genders, while evidence of an increase in mental health service use was evident up to 24 months before a sibling’s death and remained evident for at least 24 months after the death [ 45 ].

One paper studied the impact of the COVID-19 pandemic lockdown on mental health service use. An Israeli study concluded that compared to 2018 and 2019, adults reported they were reluctant to receive treatment during the pandemic lockdown and observed a decrease in mental health service use [ 13 ].

Structural and attitudinal barriers

In addition to the research considering a range of population characteristics (e.g. male, younger, or older age), several papers examined how attitudinal and structural factors were associated with mental health service use. The most frequently reported of these factors were cost [ 23 , 46 , 68 , 120 ], lack of transportation [ 46 , 83 ], inadequate services/ lack of availability [ 23 , 46 , 83 , 128 ], poor understanding of mental disorders and what services were available [ 10 , 11 , 22 , 83 , 100 , 105 , 120 ], language difficulties [ 10 ], and stigma-related barriers [ 83 , 100 , 103 , 105 , 128 ]. Cultural issues and personal beliefs may influence the understanding of mental disorders and prevent people from using mental health services due to mistrust or fear of treatment [ 100 , 128 ]. The review also observed some unique barriers to different population groups. Choi, Diana & Nathan [ 26 ] mentioned that lack of readiness and treatment cost were the biggest difficulties for older adults, while young participants were more concerned about stigma. Females also reported childcare as a factor limiting their ability to use mental health services, while the evidence reviewed argued that males prefer to solve mental health issues on their own, with internal control beliefs and lack of social support likely reducing their use of mental health services [ 37 , 103 ].

Summary of evidence

This systematic review investigated mental health service use among people with mental disorders and identified the factors associated with service use in high-income countries.

Most studies found that females with mental health conditions were more likely to use mental health services than males. The relationship between age and mental health service use was bell-shaped, with middle-aged participants having higher rates of mental health service use than other age groups. Possible explanations included that the elderly might be reluctant to disclose mental health symptoms, they might attribute their mental health symptoms to increasing age [ 20 ], and they may prefer to self-manage instead of seeking help from health professionals [ 44 ]. Caucasian ethnicity and higher household income were also associated with higher rates of mental health service use. Greater use of mental health services was observed in participants with severe mental symptoms, including among veterans [ 19 , 37 , 92 ]. Two studies also concluded that compared to other cultural groups, Asian respondents were more likely to receive treatment when problems were severe or had disabling effects [ 86 , 97 ]. There was mixed evidence regarding employment status, although some studies found employment to be negatively related to receiving treatment [ 26 , 90 ], and unemployed people are more likely to seek help [ 119 ]. There was inconsistent evidence for the association between marital status and service utilization. This contradictory evidence on marital status might be attributed to a lack of specification, some papers categorize it as married and non-married [ 26 , 71 , 131 ], while others further differentiate between those who were widowed, separated, and divorced [ 90 , 119 ].

A number of studies showed that immigrants can face unique stressors owing to their experience of migration, which may exacerbate or be the source of their mental health issues, and impact the use of mental health services [ 1 , 8 ]. These include separation from families, support networks, linguistic and cultural barriers [ 9 , 113 ].

Due to the increased number of international migrants, immigrants’ mental health status and healthcare use has drawn growing attention [ 7 , 77 , 99 ]. Kirmayer et al. [ 70 ] and Helman [ 57 ] found that culture might be associated with people’s attitudes and understanding of mental health, influencing help-seeking behaviors. In general, the current results showed that immigrants and refugees were less likely to use mental health services than their native-born counterparts, and this finding was consistent with previous studies [ 75 , 82 , 127 ]. For immigrants, the length of stay in the host country was closely related to rates of mental health service use, which was argued to reflect increasing familiarity with the host culture and language proficiency [ 1 , 59 ].

Both mental disorders and chronic diseases contribute significantly to the global burden of disease. Prior studies have shown that people with chronic disease have a higher chance of experiencing psychological distress [ 6 , 14 , 68 , 73 ], and vice versa [ 49 , 74 ]. Hendrie et al. [ 58 ] concluded that respondents with chronic diseases were more likely to attend mental healthcare and reported higher costs. Negative experiences and stressful consequences related to chronic disease might contribute to the increased potential for mental illness but more opportunities to seek help from health professionals [ 60 , 108 , 135 ]. People with chronic diseases and mental health problems might experience more long-term pain and limitations in their daily lives, and these stressors can exacerbate their health conditions, and impact their attitude toward seeking help.

The COVID-19 pandemic had a major impact on mental health service use worldwide, the hospital admission and consultation rate decreased dramatically during the first pandemic year [ 118 ]. This reduction in service access might be a side effect of social distancing measures taken as mitigation measures, reducing both inciting incidents and physical access to services.

Financial difficulty, service availability, and stigma were frequently identified in the literature as structural and attitudinal factors associated with lower rates of mental health service use. These factors were associated with the different rates of mental health service use for different ethnicities. For example, Asian people were less likely than other groups to identify cost as a factor limiting their use of mental health services, with a major barrier for Asian people being stigma and cultural factors [ 139 ].

Limitations

This systematic review employed a broad search strategy with broad search terms to capture relevant articles. Rather than emphasizing a particular mental disorder, this review focused on the rates of mental health service use among adults aged 18 years or older who were experiencing a common mental disorder. However, this review still contained limitations. First was the potential for selection bias. Although we used various search terms for mental health service use and mental disorder, it is possible that the service use was not the primary research question for some papers, or that the relevant service use outcome was not statistically significant- in these cases, if the information was not reported in the abstract, relevant papers might have been missed. It is also important to note that this systematic review includes studies conducted in different countries and that the mental health systems and opportunities for access vary among countries. We only searched for full-text peer-reviewed articles published in English. Grey literature and papers published in other languages were excluded from the search. Most of the included literature used self-reported data to measure service access, and these data can be liable to recall bias. Studies using administrative data were also included in the systematic review, and we note that although they have large datasets, compared to survey data, there is often a lack of adequate control variables included to minimize possible confounding influences.

Future research

There is a need for more published articles on several aspects that may influence the service utilization among people with mental disorders, including the impact of residential or neighborhood areas, and household income across various income groups. These aspects are important population characteristics that require further research to inform the targeting and type of support (e.g. low-cost, accessible). Additionally, there was a lack of longitudinal research on mental health service use, future studies could use the data to identify changes over time and relate events to specific exposures (e.g. Covid-19 pandemic). Future studies can investigate the cost of mental health treatment in detailed aspects, (e.g. publicly funded mental health services, community-based support for free or low-cost mental health services). Overall, there was a lack of studies for ethnic minorities, given ethnic minority groups were more vulnerable to mental disorders but with less mental health service use. Future research can expand gender identity representation in data collection and move beyond the binary genders. People with non-binary gender identities can face greater challenges and disadvantages in mental health and mental health service use.

This review identified that middle-aged, female gender, Caucasian ethnicity, and severity of mental disorder symptoms were factors consistently associated with higher rates of mental health service use among people with a mental disorder. In comparison, the influence of employment and marital status on mental health service use was unclear due to the limited number of published studies and/ or mixed results. Financial difficulty, stigma, lack of transportation, and inadequate mental health services were the structural barriers most consistently identified as being associated with lower rates of mental health service use. Finally, ethnicity and immigrant status were also associated with differences in understanding of mental health (i.e. mental health literacy), effectiveness of mental health treatments, as well as language difficulties. The insights gained through this review on the factors associated with mental health service use can help clinicians and policymakers to identify and provide more targeted support for those least likely to access services, and this in turn may contribute to reducing inequalities in not only mental health service use but also the burden of mental disorders.

Availability of data and materials

All data and materials related to the study are available on request from the first author, [email protected].

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Gao, Y., Burns, R., Leach, L. et al. Examining the mental health services among people with mental disorders: a literature review. BMC Psychiatry 24 , 568 (2024). https://doi.org/10.1186/s12888-024-05965-z

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Ubc theses and dissertations, mental health and happiness of healthcare workers : narrative review, realist review, and proposed study design gray, patricia --> -->.

Introduction: Healthcare workers experience high rates of mental ill health such as burnout, stress and depression, due to workplace conditions including excessive workloads, workplace violence and bullying. Based on the significant burden of mental ill health in the healthcare workforce as well as the recognized need for research on how to promote mental health in the workplace, this thesis aims to synthesize the state of knowledge in this area and chart future research that would be useful to provide further evidence-based insight on ways to promote mental health of healthcare workers. Methods: This thesis comprises three components needed to advance knowledge in this field: a narrative review on the mental health of healthcare workers, a realist review on workplace-based interventions to promote mental wellbeing among healthcare workers, and a detailed proposal for a three-phased cluster randomized controlled trial to develop and evaluate workplace-based interventions to promote mental wellbeing among healthcare workers in Gauteng, South Africa. Results: The narrative review affirmed the significant burden of mental ill health among healthcare workers and the need for workplace-based solutions to improve the current situation. In addition, the narrative review highlighted the growing recognition and adoption of positive mental health constructs such as happiness while also highlighting the complexity and challenges involved in workplace-based health promotion. Similarly, the realist review highlighted the complexities of both mental health in the workplace and the implementation and evaluation of workplace-based interventions, as well as issues of sustainability, the importance of employee engagement, and challenges around aligning organizational-level factors to affect change in individuals’ mental health. Lastly, the proposed study presents a comprehensive approach to designing, developing, implementing, and evaluating workplace-based interventions to promote mental wellbeing among a diverse and distributed healthcare workforce. Discussion: With healthcare workers experiencing significant mental ill health in various professions, countries and settings around the world, there is an urgent need to test and evaluate workplace-based interventions to promote mental wellbeing within this sector. In particular, more research from low- and middle-income countries is needed, as well as more research on organizational-level changes that can be done to improve healthcare workers’ mental wellbeing.

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Understanding and Addressing Mental Health Stigma Across Cultures for Improving Psychiatric Care: A Narrative Review

Ahmed a ahad.

1 Psychiatry and Behavioral Sciences, Florida International University, Herbert Wertheim College of Medicine, Miami, USA

Marcos Sanchez-Gonzalez

2 Health Services Administration, Lake Erie College of Osteopathic Medicine, Bradenton, USA

Patricia Junquera

Stigma, characterized by negative stereotypes, prejudice, and discrimination, is a significant impediment in psychiatric care, deterring the timely provision of this care and hindering optimal health outcomes. Pervasive in all aspects of psychiatric care, stigma leads to delayed treatment, increased morbidity, and diminished quality of life for those with poor mental health. Hence, better understanding the impact of stigma across different cultural contexts is critically essential, aiming to inform culturally nuanced strategies to minimize its consequences and contribute to a more equitable and effective psychiatric care system. The purpose of the present literature review is twofold (i) to examine the existing research on the stigma surrounding psychiatry across different cultural contexts and (ii) to identify the commonalities and differences in the nature, magnitude, and consequences of this stigma in different cultures in the psychiatry field. In addition, potential strategies for addressing stigma will be proposed. The review covers a range of countries and cultural settings, emphasizing the importance of understanding cultural nuances to combat stigma and promote mental health awareness globally.

Introduction and background

Stigma, characterized by societal prejudice and discrimination, profoundly influences psychiatric care, creating barriers to the timely recognition and treatment of mental health disorders [ 1 ]. Deeply embedded in societal norms, stigma is a multifaceted issue permeating every level of psychiatric care, leading to delayed treatment, increased morbidity, and a diminished quality of life for patients.

The importance of addressing stigma in psychiatry cannot be overstated as stigma impacts individuals seeking care, their families, healthcare professionals, and broader society. At the individual level, stigma can lead to fear and avoidance of mental health services, causing delays in seeking help even when a patient is in dire need. Delays in seeking care can exacerbate mental health conditions leading to worse outcomes and reduced quality of life [ 2 ]. For families, the stigma can lead to shame and isolation, making seeking necessary support and resources more difficult. Interestingly, in healthcare professionals, stigma can lead to burnout and demoralization, reducing the quality and provision of care. Stigmatization can also create barriers between healthcare providers and patients, complicating matters to establishing trustful and therapeutic relationships, which are essential for effective care [ 1 ]. For society at large, stigma can result in the misallocation of resources, with mental health services often being underfunded and overlooked [ 3 ]. Hence stigma has profound effects at personal and societal levels, negatively impacting multiple levels of the psychotic care continuum. 

Addressing the stigma surrounding mental health can significantly enhance the effectiveness of psychiatric care. To this end, developing programs and strategies that foster a culture of understanding and acceptance may encourage more individuals to seek help when they need it, improving early detection and intervention, which are crucial for better health outcomes. Furthermore, challenging and changing stigmatizing attitudes can improve the therapeutic relationship between healthcare providers and patients, leading to more personalized and effective treatment strategies.

Stigma, however, is not a monolithic entity but varies across cultures, influenced by distinct societal norms, values, and beliefs. Understanding these cultural variations is essential for developing effective, culturally sensitive interventions. Therefore, this literature review aims to examine the manifestation and impacts of stigma across different cultural contexts, laying the foundation for tailored strategies to combat this healthcare barrier.

Stigma as a psychological construct

In the literature, there have been several attempts at creating instruments to measure and understand stigma as a psychological construct in the context of mental health. In this vein, the Internalized Stigma of Mental Illness (ISMI) scale and the Perceived Devaluation-Discrimination Scale, among others, seek to quantify stigma more objectively [ 4 , 5 ] . The ISMI scale, as defined by Ritsher et al. (2003), measures the subjective experience of stigma, including the internalization of negative stereotypes and beliefs about mental illness [ 4 ]. It includes five subscales: Alienation, Stereotype Endorsement, Discrimination Experience, Social Withdrawal, and Stigma Resistance. These subscales were further defined as follows: (i) Alienation: The feeling of being less than a full member of society due to one's mental illness, (ii) Stereotype Endorsement: The extent to which the individual agrees with common negative stereotypes about people with mental illness, (iii) Discrimination Experience: Personal experiences of rejection or exclusion due to mental illness, (iv) Social Withdrawal: The extent to which the individual avoids social situations for fear of being stigmatized, and (v) Stigma Resistance: The individual's ability to resist or counteract stigma. The Perceived Devaluation-Discrimination Scale, as described by Link (1987), measures the extent to which individuals believe that most people will devalue or discriminate against someone with a mental illness [ 5 ]. It focuses on the individual's perceptions of societal attitudes, rather than their personal experiences with stigma. Overall, while the ISMI scale can give insights into the internalization and personal experience of stigma, the Perceived Devaluation-Discrimination Scale can provide a view of societal attitudes and perceived discrimination. The above are crucial to understanding the full landscape of stigma in psychiatry across different cultures by helping identify where interventions might be most needed and most effective, whether at the level of societal attitudes, personal beliefs, or both. The pervasive nature of stigma presents a daunting challenge to psychiatry, necessitating a rigorous and nuanced approach to its understanding and mitigation. However, despite recent awareness campaigns, the field still struggles with the barriers that stigma imposes on patient care, necessitating additional analysis of the effects.

Individual and societal impact of stigma

Stigmatization of mental illness across cultures is a significant barrier to psychiatric care. The stigma can lead to delayed diagnosis and treatment-seeking behaviors, reduced quality of life, and an increased risk of social exclusion and discrimination [ 2 ]. Furthermore, mental illness stigma often intersects with other forms of stigma, such as gender, race, and socio-economic status, leading to further marginalization of already vulnerable populations making it challenging to provide equitable, culturally sensitive, and effective psychiatric care to individuals with mental illness. Accumulating research suggests that stigma toward mental illness is common in various cultures, which can affect mental illness diagnosis, treatment, and management [ 6 ]. Furthermore, some studies reveal that mental health stigma manifests differently across cultures and can be influenced by cultural beliefs, attitudes, and values [ 7 ]. The stigma surrounding psychiatry and mental health disorders has numerous detrimental effects on individuals and communities, including:

1. Delayed Treatment-Seeking Behavior

Stigma plays a significant role in delaying treatment-seeking behavior for individuals struggling with mental health issues. The fear of being labeled, ostracized, or misunderstood due to their condition often deters individuals from seeking help promptly. According to a study by Clement et al. (2015), stigma was associated with an increased likelihood of delaying or avoiding seeking help for mental health concerns [ 8 ]. Consequently, symptoms may worsen over time, escalating the condition's severity and making treatment and prospective recovery more challenging. Healthcare delays can also lead to decreased self-esteem and increased depressive symptoms, creating a vicious cycle of self-blame, isolation, and hopelessness. Prolonged untreated mental health issues can further impair an individual's functionality in various life domains, including work, relationships, and self-care, thus reducing their overall quality of life [ 9 ].

2. Social Isolation and Discrimination

Stigma can lead to social isolation and discrimination for those affected by mental health issues. Brohan and Thornicroft (2010) found that individuals with mental health disorders often face discrimination in multiple life domains, including employment and interpersonal relationships [ 2 ]. The negative stereotypes and misconceptions surrounding mental illness often result in a lack of understanding and empathy from others, leading to social exclusion [ 10 ]. Individuals with mental health issues might face discrimination in various aspects of life, including the workplace, where they might encounter bias in hiring, job retention, and career advancement. Furthermore, to complicate matters, discrimination can further strain personal relationships, as friends and family may distance themselves due to discomfort, fear, or misunderstanding, exacerbating feelings of isolation and loneliness [ 9 ].

3. Reduced Treatment Adherence

Stigma can significantly impact adherence to mental health treatments. Sirey et al. (2001) found that perceived stigma predicted treatment discontinuation in older adults with depression [ 11 ]. People living with mental health conditions may avoid or discontinue treatment due to fear of being identified as a mental health patient. This fear could stem from concerns about the stigma associated with visiting mental health facilities, taking psychiatric medications, or being seen engaging in therapeutic activities [ 12 ]. Non-adherence to treatment regimens can lead to suboptimal treatment outcomes, hinder recovery, and increase the risk of relapse or worsening symptoms. Furthermore, stigma can diminish self-efficacy, making individuals less likely to actively engage in their treatment process, which is crucial for successful recovery.

4. Perpetuation of Misconceptions

Stigmatizing attitudes towards mental illness contribute to the perpetuation of harmful stereotypes and misinformation. AsCorrigan and Watson (2007) discussed, stereotypes such as appearing dangerous, unpredictable, or culpable for their illness can make people with mental illness perceived inaccurately as dangerous or to blame for their condition, both internally and externally [ 12 ]. Stereotyping, deeply embedded in societal attitudes, can foster a culture of fear, rejection, and discrimination against individuals with mental health conditions. Misconceptions often result in people with mental health issues being perceived inaccurately as dangerous, unpredictable, or responsible for their condition. In addition, misinformation can hinder public understanding and acceptance of mental illness, exacerbating stigma while negatively influencing policy and legislation, leading to inadequate funding and support for mental health services.

5. Influence of Gender on Stigma

The impact of stigma on individuals with mental illness is known to vary across different social and demographic categories, including gender. Research evidence indicates that the experience of stigma related to mental illness can be significantly different for men and women, and these differences can be further influenced by cultural context.

In some societies, women seem to face higher levels of stigma related to mental health issues compared with men. A study by Al Krenawi et al. (2006) conducted in the Bedouin-Arab community found that women experienced a significantly higher degree of stigma associated with mental illness than their male counterparts [ 13 ]. This may be due to traditional gender roles and societal expectations, which often place women in a more subordinate position and associate mental illness with weakness or vulnerability. Women with mental illnesses may therefore face dual discrimination - first for their gender and then for their mental health condition. This can make women less likely to seek help for mental health issues, further exacerbating their condition and creating a vicious cycle of stigma and untreated mental illness.

However, the influence of gender on stigma is not uniform across all cultures. Ayalon and Areán's (2004) study on older adults in an Arab cultural context found that men reported higher levels of perceived stigma related to mental illness than women [ 14 ]. This discrepancy might be rooted in traditional masculine norms prevalent in many Arab societies, which value strength, stoicism, and emotional control. Mental illness, which is often erroneously perceived as a sign of emotional weakness or lack of control, can be particularly stigmatizing for men in these contexts. Furthermore, the expectation for men to be the primary earners and providers in the family can make the potential economic impacts of mental illness, such as unemployment or reduced productivity, particularly stigmatizing.

These findings underscore the importance of considering gender and cultural context in understanding and addressing stigma related to mental illness. It is crucial to develop and implement culturally sensitive strategies that consider these differences in the experience of stigma. This might involve, for example, promoting mental health literacy, challenging harmful gender norms, and providing gender-specific mental health services. We can move toward a more equitable and effective mental health care system by acknowledging and addressing the unique stigma-related challenges different groups face.

Ethnic and cultural variations in stigma

The stigma surrounding psychiatry, as research suggests, manifests differently across cultures due to various factors [ 7 ]. This stigma operates at various levels, including individuals, families, healthcare providers, and society, and cultural norms, religious beliefs, and social attitudes influence its manifestations and implications.

At the individual level, mental health issues may be internalized differently depending on cultural background. For instance, some Asian cultures may view mental health issues as a sign of personal weakness or a failure of self-control [ 15 ]. The internalization of stigma can significantly influence an individual's self-perception and willingness to seek help. In the family context, cultural beliefs also play a significant role in shaping attitudes toward mental health. A study by Yang and Kleinman (2008) found that in Chinese culture, mental illness is often attributed to social and interpersonal factors, such as family conflict [ 16 ]. Such attributions can contribute to a sense of shame or blame within the family, exacerbating the stigma experienced by the individual with mental illness.

Healthcare providers are not immune to these cultural beliefs and they can influence their practice. In some cultures, mental illnesses are viewed through a supernatural lens rather than a medical one. Girma et al. (2013) found that in Ethiopian culture, mental illness is commonly associated with supernatural causes, such as evil spirits or curses [ 17 ]. This widely held belief can influence healthcare providers' approach and potentially limit the provision of evidence-based psychiatric care.

Lastly, at the societal level, these cultural perceptions and beliefs can contribute to the broader social stigma surrounding mental health, leading to discrimination and social exclusion. Differences in societal perceptions across cultures can lead to distinct forms of discrimination, further compounding the challenges faced by individuals with mental health issues. Hence, understanding and addressing cultural stigma in psychiatry involves a multifaceted approach that considers individual, family, healthcare providers, and societal levels. Each level offers potential avenues for stigma reduction and improved mental health outcomes.

Asian Cultures

In many Asian societies, mental health issues are often perceived as a sign of personal weakness or a failure of self-control. The concept of 'face' is significantly influential, and the stigma associated with mental illness can be seen as bringing shame to the family [ 15 ]. For instance, a strong cultural emphasis on academic and professional achievement in South Korea contributes to stigmatizing attitudes toward mental illness, which may discourage individuals from seeking help [ 18 ].

African Cultures

Mental illnesses in some African cultures are often attributed to spiritual or supernatural causes such as curses or possession by evil spirits. This understanding can contribute to high levels of stigma and deter individuals from seeking psychiatric help [ 19 ]. In Ethiopia, the belief in supernatural causes of mental illness has been reported, leading to the stigmatization of affected individuals [ 17 ].

Arab Cultures

Mental illness in Arab societies is frequently viewed as a form of divine punishment. Religious belief perpetuating mental health stigma can lead to delayed or avoided treatment as individuals may resort to religious or spiritual interventions [ 20 ].

Latin American Cultures

In some Latin American cultures, mental illness is often attributed to personal weakness or lack of willpower. This perspective could stigmatize individuals with mental health disorders and discourage them from seeking psychiatric care [ 21 ].

Western Cultures

In Western societies, stigma often stems from misconceptions about mental illness, including the belief that individuals with mental health disorders are dangerous or unpredictable. While mental illness is recognized more as a health issue, stigma still exists, often resulting in social exclusion and discrimination [ 12 ].

Additionally, culture-bound syndromes, defined here as a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease within specific cultures or societies, are a critical component of a discussion on cultural stigma in psychiatry. That is to say, culture-bound syndromes refer to unique mental health conditions closely tied to specific cultures or ethnic groups. For instance, among the Latino community, 'Ataque de Nervios,' characterized by uncontrollable shouting, crying, trembling, and sometimes aggressive behavior, is a recognized condition often associated with a stressful event such as a panic attack [ 21 ].

Hence, a clinician's awareness and understanding of such culture-bound syndromes can enhance their diagnostic and therapeutic effectiveness. In fact, a study conducted by Hughes and Wintrob (1995) in New York discovered a significant improvement in therapeutic relationships when clinicians were knowledgeable about culture-bound syndromes prevalent in their patients' cultures, such as 'Qigong Psychotic Reaction' in Chinese immigrants, a condition associated with overdoing Qigong, a type of spiritual martial art [ 22 ].

Furthermore, cultural competence, which includes knowledge about culture-bound syndromes, has a substantial impact on treatment outcomes. Culturally competent care, defined by an understanding and respect for cultural differences, can improve patient satisfaction and adherence to treatment. A systematic review by Truong et al. (2014) demonstrated the positive effect of cultural competence on healthcare outcomes, including in a Native American population suffering from 'Ghost Sickness,' a culture-bound syndrome characterized by feelings of terror, weakness, and a sense of impending doom, often linked to the perceived presence of the supernatural [ 23 ].

Simultaneously, addressing culture-bound syndromes can influence and reduce mental health stigma across cultures. Misinterpretation of these syndromes can contribute to stigma, as individuals might be wrongly diagnosed or misunderstood. For instance, Kirmayer's (2012) study on cultural variations in depression and anxiety found that misunderstanding culture-bound syndromes, such as 'Taijin Kyofusho,' a Japanese syndrome characterized by an intense fear that one's body or bodily functions are displeasing to others, could lead to misdiagnosis and increase stigma [ 24 ]. Practices that raise awareness of culture-bound syndromes offer a deeper, richer perspective on cultural influences on mental health. Awareness and understanding of these syndromes can enhance diagnostic and treatment approaches, optimize patient outcomes, and potentially contribute to reducing mental health stigma across various cultures.

Taken together, these studies highlight the importance of understanding cultural contexts when addressing the stigma surrounding mental health disorders and psychiatric care. The cultural beliefs and attitudes towards mental health disorders, summarized below in Table ​ Table1, 1 , influence how stigma is manifested and the approaches needed to reduce it effectively. By acknowledging cultural variations, more culturally appropriate and effective strategies can be developed to combat stigma and improve mental health care across different societies worldwide.

Strategies for addressing mental health stigma

Several strategies have been proposed in the literature to address the stigma surrounding psychiatry across cultures:

1. Public Awareness Campaigns

Awareness campaigns can be instrumental in dismantling misconceptions and fostering understanding of mental health disorders. Public awareness campaigns can dispel myths, reduce stigma, and encourage empathy towards affected individuals by promoting accurate information about mental illnesses, their prevalence, and the possibilities for recovery. For instance, a study by Pinfold et al., (2003) showed that public campaigns using direct social contact with people with mental illness could significantly improve public attitudes towards mental health [ 25 ]. The study by Pinfold et al., (2003) implemented educational interventions in UK secondary schools, consisting of video presentations and direct social contact with individuals who had personal experiences with mental illness [ 25 ]. The UK campaign's goal was to challenge common myths about mental illness and replace them with accurate information. The results showed that students exposed to this intervention demonstrated less fear and avoidance of people with mental health problems and were more likely to see them as individuals rather than defining them by their illness.

2. Cultural Competency Training for Healthcare Professionals

Medical education can equip healthcare providers with the necessary knowledge and skills to understand and respect their patients' cultural backgrounds and experiences, which is critical for reducing stigma in healthcare settings. Research indicates that healthcare providers who lack cultural competence may inadvertently contribute to stigma, further deterring patients from seeking help [ 26 ]. A study by Kirmayer (2012) found that cultural competence training improved healthcare providers' understanding of cultural influences on health behaviors and led to more effective patient-provider communication, thereby reducing perceived stigma [ 24 ]. For instance, a study in Australia provided cultural competency training to healthcare providers and found that their understanding of Indigenous Australians' health needs significantly improved [ 24 ]. They were able to better respect and incorporate Indigenous perspectives in treatment, which led to increased trust and better patient-provider relationships.

3. Peer Support Programs

People with lived experiences of mental health disorders who share their stories, can normalize mental health issues and challenge stigma. By providing real-life examples of individuals living with and managing their mental health disorders, peer-to-peer advocacy programs may debunk myths and reduce the perceived 'otherness' of mental illness. A study by Pitt et al. (2013) showed that peer support reduced self-stigma and improved self-esteem and empowerment among individuals with mental health disorders [ 27 ]. The study focused on "consumer-providers," individuals who had personally experienced mental health issues and were now providing support services to others. The findings demonstrated that consumer-providers significantly reduced self-stigma among service users, while also improving self-esteem and feelings of empowerment.

4. Community-Based Mental Health Services

Integrating mental health care into primary care and community settings can reduce the stigma associated with seeking psychiatric help. This emphasis on integrating measures for mental well-being along with other routine and standard primary care protocols allows mental health care to be more accessible and less intimidating, encouraging individuals to seek help when needed. A study by Thornicroft et al. (2015) found that community-based mental health services can reduce stigma and discrimination and improve mental health outcomes [ 28 ]. For instance, a program in India called the MANAS project integrated mental health services into primary care and community settings [ 28 ]. This approach not only made mental health services more accessible but also more 'normal' and less stigmatizing. The project reported a significant increase in the utilization of mental health services and a decrease in the experience of stigma among service users.

5. Evidence-Based Approach

Another approach to overcoming the barriers created by stigma is to use evidence-based methods to reduce mental illness stigma. A meta-analysis by Corrigan et al. (2016) found that various evidence-based interventions, including education and contact-based interventions, can effectively reduce mental illness stigma across cultures [ 9 ]. Contact-based interventions involve interaction between people with mental illness and members of the public to challenge negative attitudes and beliefs. Education-based interventions aim to increase knowledge and awareness of mental illness and reduce negative stereotypes. Educational interventions can be delivered in a variety of formats, such as in-person workshops, online courses, and mass media campaigns.

The role of the healthcare provider in ameliorating stigma cannot be overlooked. Moreover, a review by Ayalon and Areán (2004) suggests that mental health providers can play a critical role in reducing mental illness stigma by engaging in culturally sensitive practices [ 14 ]. For instance, mental health providers can develop cultural competence, which refers to the ability to provide effective services to individuals from diverse cultural backgrounds. Cultural competence involves understanding and respecting cultural differences, tailoring treatment to meet diverse populations' unique needs, and integrating cultural factors into treatment planning.

Research also highlights that stigma towards mental illness has significant implications for treating and managing mental health conditions. For example, several studies suggest that stigma can lead to delayed diagnosis and treatment-seeking behaviors [ 13 , 16 ]. This is concerning because early intervention is critical for managing mental illness and improving outcomes for individuals living with these conditions. Considering the documented impact of stigma on timely diagnosis and treatment-seeking behaviors, strategies such as public awareness campaigns, cultural competency training for healthcare professionals, peer support programs, community-based mental health services, and an evidence-based approach can play a crucial role in combating cultural stigma in psychiatry. These measures collectively contribute to improved awareness, understanding, and acceptance of mental health conditions, thus facilitating early intervention and better management of mental illnesses across diverse cultural contexts.

Conclusions

Stigma surrounding mental health and psychiatric care is a complex and multifaceted issue that varies across ethnic and cultural contexts. To effectively address and reduce stigma in mental healthcare settings, developing culturally sensitive interventions and promoting understanding and acceptance of mental health issues is crucial. By doing so, we can work towards improving access to mental health care and promoting the well-being of individuals and communities across the globe.

Overall, the literature suggests that stigma is a complex and pervasive issue that affects individuals with mental illness across cultures. The studies reviewed reveal that mental illness stigma is influenced by cultural beliefs, attitudes, and values, and can manifest in different ways across cultures. It is important to understand these cultural differences to develop more effective interventions to reduce mental illness stigma and improve outcomes for individuals living with mental illness. Furthermore, stigma across cultures impacts psychiatric care in various ways and can create significant barriers to effective treatment. Evidence-based interventions, including education, contact-based interventions, and culturally sensitive practices can help overcome these barriers. Mental health providers should strive to develop cultural competence and deliver culturally sensitive interventions to meet the needs of diverse populations. Research to understand the impact of stigmatization of mental health patients and its impact in providing services is warranted. Reducing mental illness stigma is critical to providing equitable, effective, and compassionate psychiatric care to individuals with mental illness.

The authors have declared that no competing interests exist.

Graduate Thesis Or Dissertation

Mental health in the united states through the lens of one city’s mental health system: organizational roles and inter-organizational dynamics of a multi-institutional system public deposited.

• In this dissertation, I take a multi-method qualitative approach to examine one city's ("Elkgate") adult mental health system. Using a combination of observation and in-depth and informal interviews of police officers, jail employees, private and public outpatient mental health clinicians and emergency room staff, and archival analysis of official forms and state and federal legislation, I consider this Elkgate's mental health system an amalgamation of correctional and medical organizations based on environmental necessity as opposed to organizational will. Beyond providing a detailed examination of one mental health system and identifying effective and strained inter-organizational interactions in place--an important contribution in the present political climate criticizing the "broken" mental health system nationwide--this research questions traditional beliefs surrounding health disparities and applies a multi-level analysis to examine and explain complaints and frustrations of professionals. For example, I analyze the benefits of Elkgate's public mental health services available to the poor and indigent over private services. Contextualizing the structure of care of these two service types within the role of a federal Act regarding patient information and privacy (Health Insurance Portability and Accountability Act), I also question how continuity of care may both positively and negatively affect patient care. This research also considers the consequences of poor inter-organizational integration across the system on consumer populations identified by professionals as disproportionately underserved. Combining organizational and intersectionality literatures, I propose that underserved populations in Elkgate's mental health system are the result of gaps between organizations that do not serve populations located at intersections of mental health who are both mentally ill and have other needs. I argue that this results in consumers who face greater disadvantage across multiple statuses. Finally, the timeliness of this research in terms of national and international interest in mental illness and systems of mental health, lends itself to significant policy implications presented in this dissertation for organizations involved in mental health, mental health systems and state and federal legislation.
• Deyell, Tracy Anne
• Mollborn, Stefanie
• Bair, Jennifer
• Mojola, Sanyu
• Matthew, Dayna
• Krueger, Patrick
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Mental Health Essay

Introduction

Mental health, often overshadowed by its physical counterpart, is an intricate and essential aspect of human existence. It envelops our emotions, psychological state, and social well-being, shaping our thoughts, behaviors, and interactions. With the complexities of modern life—constant connectivity, societal pressures, personal expectations, and the frenzied pace of technological advancements—mental well-being has become increasingly paramount. Historically, conversations around this topic have been hushed, shrouded in stigma and misunderstanding. However, as the curtains of misconception slowly lift, we find ourselves in an era where discussions about mental health are not only welcomed but are also seen as vital. Recognizing and addressing the nuances of our mental state is not merely about managing disorders; it's about understanding the essence of who we are, how we process the world around us, and how we navigate the myriad challenges thrown our way. This essay aims to delve deep into the realm of mental health, shedding light on its importance, the potential consequences of neglect, and the spectrum of mental disorders that many face in silence.

Importance of Mental Health

Mental health plays a pivotal role in determining how individuals think, feel, and act. It influences our decision-making processes, stress management techniques, interpersonal relationships, and even our physical health. A well-tuned mental state boosts productivity, creativity, and the intrinsic sense of self-worth, laying the groundwork for a fulfilling life.

Negative Impact of Mental Health

Neglecting mental health, on the other hand, can lead to severe consequences. Reduced productivity, strained relationships, substance abuse, physical health issues like heart diseases, and even reduced life expectancy are just some of the repercussions of poor mental health. It not only affects the individual in question but also has a ripple effect on their community, workplace, and family.

Mental Disorders: Types and Prevalence

Mental disorders are varied and can range from anxiety and mood disorders like depression and bipolar disorder to more severe conditions such as schizophrenia.

• Depression: Characterized by persistent sadness, lack of interest in activities, and fatigue.
• Anxiety Disorders: Encompass conditions like generalized anxiety disorder, panic attacks, and specific phobias.
• Schizophrenia: A complex disorder affecting a person's ability to think, feel, and behave clearly.

The prevalence of these disorders has been on the rise, underscoring the need for comprehensive mental health initiatives and awareness campaigns.

Understanding Mental Health and Its Importance

Mental health is not merely the absence of disorders but encompasses emotional, psychological, and social well-being. Recognizing the signs of deteriorating mental health, like prolonged sadness, extreme mood fluctuations, or social withdrawal, is crucial. Understanding stems from awareness and education. Societal stigmas surrounding mental health have often deterred individuals from seeking help. Breaking these barriers, fostering open conversations, and ensuring access to mental health care are imperative steps.

Conclusion: Mental Health

Mental health, undeniably, is as significant as physical health, if not more. In an era where the stressors are myriad, from societal pressures to personal challenges, mental resilience and well-being are essential. Investing time and resources into mental health initiatives, and more importantly, nurturing a society that understands, respects, and prioritizes mental health is the need of the hour.

• World Leaders: Several influential personalities, from celebrities to sports stars, have openly discussed their mental health challenges, shedding light on the universality of these issues and the importance of addressing them.
• Workplaces: Progressive organizations are now incorporating mental health programs, recognizing the tangible benefits of a mentally healthy workforce, from increased productivity to enhanced creativity.
• Educational Institutions: Schools and colleges, witnessing the effects of stress and other mental health issues on students, are increasingly integrating counseling services and mental health education in their curriculum.

In weaving through the intricate tapestry of mental health, it becomes evident that it's an area that requires collective attention, understanding, and action.

  Short Essay about Mental Health

Mental health, an integral facet of human well-being, shapes our emotions, decisions, and daily interactions. Just as one would care for a sprained ankle or a fever, our minds too require attention and nurture. In today's bustling world, mental well-being is often put on the back burner, overshadowed by the immediate demands of life. Yet, its impact is pervasive, influencing our productivity, relationships, and overall quality of life.

Sadly, mental health issues have long been stigmatized, seen as a sign of weakness or dismissed as mere mood swings. However, they are as real and significant as any physical ailment. From anxiety to depression, these disorders have touched countless lives, often in silence due to societal taboos.

But change is on the horizon. As awareness grows, conversations are shifting from hushed whispers to open discussions, fostering understanding and support. Institutions, workplaces, and communities are increasingly acknowledging the importance of mental health, implementing programs, and offering resources.

In conclusion, mental health is not a peripheral concern but a central one, crucial to our holistic well-being. It's high time we prioritize it, eliminating stigma and fostering an environment where everyone feels supported in their mental health journey.

Frequently Asked Questions

• What is the primary focus of a mental health essay?

Answer: The primary focus of a mental health essay is to delve into the intricacies of mental well-being, its significance in our daily lives, the various challenges people face, and the broader societal implications. It aims to shed light on both the psychological and emotional aspects of mental health, often emphasizing the importance of understanding, empathy, and proactive care.

• How can writing an essay on mental health help raise awareness about its importance?

Answer: Writing an essay on mental health can effectively articulate the nuances and complexities of the topic, making it more accessible to a wider audience. By presenting facts, personal anecdotes, and research, the essay can demystify misconceptions, highlight the prevalence of mental health issues, and underscore the need for destigmatizing discussions around it. An impactful essay can ignite conversations, inspire action, and contribute to a more informed and empathetic society.

• What are some common topics covered in a mental health essay?

Answer: Common topics in a mental health essay might include the definition and importance of mental health, the connection between mental and physical well-being, various mental disorders and their symptoms, societal stigmas and misconceptions, the impact of modern life on mental health, and the significance of therapy and counseling. It may also delve into personal experiences, case studies, and the broader societal implications of neglecting mental health.

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Three years of conflict takes its psychological toll on the people of Ukraine

Those who have suffered the traumas of war are suffering from extreme stress and a sense of utter helplessness – but little can be done to reach them, article bookmarked.

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The village’s last remaining civilians shuffle into an abandoned nursery, now commandeered by aid workers as a weekly, frontline clinic. Colourful cars and cartoon animals beam from cheerful wallpaper; rows of tiny, empty beds – once used for nap time before war broke out – line the adjacent room of this immaculate, lovingly-decorated nursery.

Once a house of children, now a waiting room for the ailing and the aged.

Chief psychologist, Elena Pylaeva, is on a mission. These patients came for check-ups for a range of complaints – diabetes, heart disease, hypertension – but she knows there lurks at least one more condition: invisible, immobilising, ingrained and ignored.

Almost three years of armed conflict have wrought a profound psychological toll upon the civilian population of eastern Ukraine yet stigma surrounding mental health issues, coupled with the collapse of medical infrastructure are thwarting treatment and recovery.

Elena petitions the group of 20 locals – mostly older women dressed in floral headscarves, woollen cardigans and shin-length skirts – to talk with her so she can assess their psychological health. This is a war in which the oldest have proved particularly vulnerable, refusing to leave home when others have fled.

Protracted fighting between government forces and Russian-backed separatists has claimed around 10,000 lives and repeatedly exposed civilians to the horrors of combat while state support has crumbled. Many are deeply traumatised and endure extreme stress, heightening a sense of utter helplessness and overwhelming their capacity to cope. And yet they resist relief.

“I’m frightened all the time,” says 80-year-old Nadiya Davidenko. “I barely sleep anymore, whether there’s fighting or not.” She remembers when Pavlopil was a sleepy, peaceful community – not this ghost village wrecked by bombing, pinned between minefields and emptied of its inhabitants.

“But I’ve never seen a psychologist before and I’m not going to start now,” she adds indignantly, tightening her headscarf. “Better to go to church instead and speak with the priest.”

Her friend whispers to me: “The priest fled months ago.”

There is great resistance to psychotherapy in Ukraine, where a macho, patriarchal culture dominates and mechanisms for licencing effective counsellors are weak. The problem is compounded by a shame fostered by the Soviet era when repressive authorities rendered psychiatry a tool for punishment by imprisoning political dissidents in asylums, thus demonising mental health issues further.

“At the start, the patients say, ‘No, we don’t want help’. There’s no trust, they don’t understand the benefits of therapy,” says Elena, a psychologist with the international medical aid charity, Médecins sans Frontières (MSF), which runs this weekly clinic. “These civilians suffer from depression, isolation, nervous stress and fear. The young ones have left, the elderly remain with no relatives to support them. Many lived their lives through their children and expected to care for their grandchildren on retirement. Now that is completely overturned.”

Tanya Sabutskaya, 65, is living proof. She grew up in Pavlopil and fondly remembers the excitement around public holidays when children played in the streets and Second W veterans, adorned with Red Army medals, gathered at the village’s monument to the fallen.

“My grandchildren can’t visit me for long because of the shelling,” says Tanya, as she waits for the doctor to check her diabetes. “This war is a thief and has robbed me of a family.”

Tatiana Ticona, an MSF field coordinator, explains how the unpredictable rhythm of the east’s cycles of violence exacerbates stress and anxiety. “The conflict is not yet frozen but can sometimes give a false image of normality. It can seem peaceful and quiet but then change very quickly.”

Lulls provide much needed respite but also prompt fearful civilians to brace themselves for further fighting. “We’re afraid of silence, that’s when something can happen,” says Avdotya Buragina, 75, who waits for a blood pressure test while chatting with other patients about the next aid delivery and the soaring cost of food, medicine and utilities. “Here, we are not living. We are merely surviving.”

The previous day, fifty miles further north along the line, nine teachers gathered at a primary school in Krasnohorivka, where violence is now entrenched in everyday life. This small, government-held town, close to separatist-controlled Donetsk, continues to endure mortar attacks, exchanges of heavy gunfire and haphazard shelling that strike apartment blocks.

Beneath the stark glare of strip lights in a rudimentary classroom, psychologist Sergey Scherbak pulled out a set of projection slides and began training the teachers on how to support traumatised pupils and to manage personal burnout and fear.

The school’s deputy headmistress, Olga Mashutina, says approximately half of the school’s 70 students, aged between 6 and 14, show signs of war-related stress and need support to overcome psychological and behavioural disorders.

By day, there are panic attacks and moments of rage; some are withdrawn, distrustful, even mute. By night, there is insomnia, bed-wetting and nightmares. The pattern is repeated throughout the war-wracked Donetsk region, where around 8,000 students attend dozens of schools near the front line.

The war has exerted a devastating impact on children, inflicting repeated layers of shock and emotional injury that can develop into post-traumatic stress disorder (PTSD), months or even years later. This conflict is the first time they have experienced the terror of artillery barrages, the grief of losing relatives, the anguish of screaming parents, the turmoil of displacement and the lurking threat of landmines.

“Around 80 per cent may be able to heal themselves,” Sergey, a psychologist of ten years, now a member of MSF’s regional taskforce of doctors, told The Independent . “But around 20 per cent of them will be severely affected and the trauma will get worse. They will never forget what they have seen and, for many, the fighting is far from over.”

During the session, the teachers were taught breathing exercises to alleviate stress and advised on the importance of sleep for recovery. This triggered some dispute.

“How can we sleep when the shooting keeps us awake?” interjected one teacher. “But the shooting has stopped now, hasn’t it?” Sergey calmly replied (referring to a recent truce that has since collapsed). “Yeah but even when it’s silent, we’re just waiting for the shooting to start over again.”

According to Sergey: “Many adults and children are still forced to shelter in basements from the bombing, which has a big impact on their mental health.

“This is a key reason for training teachers: if they can be calm, the children will be calm. Next, we will train parents. This is all about improving and stabilising the circle around the town’s children.”

At a village school in Vinogradne, near the Azov Sea frontline, child psychologist Maria Yakovleva says even the sound of a bursting balloon can cause acute reactions of shock and fear.

One classroom poster is titled: “How to behave when the school is shelled”; another illustration shows a boy and girl backing away from an unexploded mortar, captioned: “Call 101 if you see a dangerous or suspicious object”.

More than 235,000 Ukrainian children have been internally displaced from their homes by fighting since 2014, according to government figures. Unicef and its partners offer psychosocial support to around 224,000 affected youngsters and carers.

But aid workers warn that the true psychological devastation of this forgotten war on Europe's fringes remains hidden.

“It is impossible to know the extent of the problem,” said Anneli Droste, MSF’s mental health manager in Mariupol. The same event can traumatise some while leaving others relatively unscathed. “It is very hard to get concrete data.”

A hotline providing psychological and legal assistance to Ukrainian children and parents has seen a huge spike in calls since 2014's outbreak of war. Before the conflict, the service – supported by Unicef and run by La Strada – was contacted by distressed children around 18,600 times in 2013 and has more than doubled to over 43,000 calls this year.

MSF operates throughout government-controlled territory in the war-wracked Donbass region but is banned from Ukraine’s breakaway territories after separatists blacklisted the aid group last year, denying thousands urgent medical care.

Mark Walsh, who heads MSF’s mission in Ukraine, said the organisation continues to lobby the de-facto authorities in rebel-held Donetsk and Luhansk – and “whoever they will listen to” – to regain access.

“All the patients that we were helping in those regions are still without care. As far as we know, nobody has stepped in,” Mr Walsh told The Independent. “The needs are still the same as when we left – perhaps even greater.”

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Ukraine: Crimea

• Read a Section: Crimea

In February 2014 Russian forces entered Ukraine’s Crimean Peninsula and occupied it militarily. In March 2014 Russia announced the peninsula had become part of the Russian Federation following a sham referendum that violated Ukraine’s constitution. The UN General Assembly’s Resolution 68/262 on the “Territorial Integrity of Ukraine” of March 27, 2014, and Resolution 74/168 on the “Situation of Human Rights in the Autonomous Republic of Crimea and the City of Sevastopol (Ukraine)”of December 9, 2019, called on states and international organizations not to recognize any change in Crimea’s status and affirmed the commitment of the United Nations to recognize Crimea as part of Ukraine. In April 2014 Ukraine’s legislature (Verkhovna Rada) adopted a law attributing responsibility for human rights violations in Crimea to the Russian Federation as the occupying state. The United States does not recognize the attempted “annexation” of Crimea by the Russian Federation. Russian law has been applied in Ukraine’s Crimea since the Russian occupation and purported “annexation” of the peninsula. For detailed information on the laws and practices of the Russian Federation, see the Country Reports on Human Rights for Russia.

• Executive Summary

A local occupation authority installed by the Russian government and led by Sergey Aksyonov as “prime minister” of the “state council of the republic of Crimea” administers occupied Crimea. The “state council” is responsible for day-to-day administration and other functions of governing. In 2016 Russia’s nationwide parliamentary elections included seats allocated for purportedly annexed Crimea, a move widely condemned by the international community and that contravened the Ukrainian constitution.

Russian government agencies, including the Ministry of Internal Affairs, the Federal Security Service (FSB), the Federal Investigative Committee, and the Office of the Prosecutor General applied and enforced Russian law in Crimea as if it were a part of the Russian Federation. The FSB also conducted security, counterintelligence, and counterterrorism activities and combatted organized crime and corruption. A “national police force” operated under the aegis of the Russian Ministry of Internal Affairs. Russian authorities maintained control over Russian military and security forces deployed in Crimea.

Significant human rights issues included: disappearances; torture, including punitive psychiatric incarceration; mistreatment of persons in detention as punishment or to extort confessions; harsh prison conditions and transfer of prisoners to Russia; arbitrary arrest and detention; political prisoners; pervasive and arbitrary interference with privacy; severe restrictions on free expression, the press, and the internet, including violence against journalists and website blocking; gross and widespread suppression of freedom of assembly and religion; severe restriction of freedom of association, including barring the Crimean Tatar Mejlis; significant restrictions on freedom of movement; restrictions on political participation; systemic corruption; and violence and systemic discrimination against Crimean Tatars and ethnic Ukrainians.

Occupation authorities took few steps to investigate or prosecute officials or individuals who committed human rights abuses, creating an atmosphere of impunity and lawlessness.

Respect for the Integrity of the Person, Including Freedom from:

• a. Arbitrary Deprivation of Life and Other Unlawful or Politically Motivated Killings

There were several reports of killings of Crimean Tatars by unknown individuals. At least four missing Crimean Tatars were found dead during the year; there were no reported investigations nor indications that occupation authorities took action to apprehend perpetrators. For example, on April 22, Rashid Yagyaev went missing. On July 9, his body washed up on the shore of the Black Sea near the village of Nikolayevka with a weight tied to his neck. No arrests had been made in the case by year’s end.

Occupation authorities did not adequately investigate killings of Crimean residents from 2014 and 2015. According to the Ukrainian Ministry of Foreign Affairs, 12 Crimean residents who had disappeared during the occupation were later found dead. Occupation authorities did not investigate other suspicious deaths and disappearances, occasionally categorizing them as suicide. Human rights observers reported that families frequently did not challenge findings in such cases due to fear of retaliation.

• b. Disappearance

There were reports of abductions and disappearances by occupation authorities. For example, according to press reports, the FSB arrested Crimean Tatar Edem Yayachikov during mass raids on Crimean Tatar homes that took place on March 27 (see section 1.d.); as of November his whereabouts were still unknown. Relatives filed a missing-person’s report, which was reportedly under investigation, and human rights defenders sought to find him in the detention facilities holding others arrested that day, but they were unable to establish his whereabouts.

According to an August special report by the UN secretary-general, citing data from the HRMMU, from 2014 to June 30, some 42 persons were victims of enforced disappearances. Occupation authorities did not adequately investigate the deaths and disappearances. Human rights groups reported that police often refused to register reports of disappearances and intimidated and threatened with detention those who tried to report disappearances. Ukrainian government and human rights groups believed Russian security forces kidnapped the individuals for opposing Russia’s occupation to instill fear in the population and prevent dissent.

• c. Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment

There were widespread reports occupation authorities in Crimea tortured and otherwise abused residents who opposed the occupation. Human rights monitors reported that Russian occupying forces subjected Crimean Tatars and ethnic Ukrainians in particular to physical abuse. For example, on April 17, FSB agents detained Crimean Tatar activist Raim Aivazov when he attempted to cross the administrative line from Crimea into government-controlled Ukraine. According to his lawyer, FSB officers beat him, put him in a car, and took him to a nearby forest, carried out a mock execution by shooting several times next to his head. Aivazov was charged with terrorism and remained in pretrial detention in Simferopol as of October. Observers believed the charges to be baseless.

Occupation authorities demonstrated a pattern of using punitive psychiatric incarceration as a means of pressuring detained individuals. For example, according to press reports, on July 25, Arsen Abkhairov, Eskender Abdulganiev and Rustem Emiruseinov, who were on trial for allegedly belonging to the Islamic organization Hizb ut-Tahrir, which is banned in Russia as a terrorist group but legal in Ukraine, were transported to a Simferopol hospital for a forced psychiatric evaluation. Their lawyer viewed the authorities’ move as an attempt to break his clients’ will and intimidate them.

According to the Crimean Human Rights Group, as of early October, approximately 30 Crimean Tatar defendants had been subjected to psychiatric evaluation and confinement against their will without apparent medical need since the beginning of the occupation (see section 1.d.).

Human rights monitors reported that occupation authorities also threatened individuals with violence or imprisonment if they did not testify in court against individuals whom authorities believed were opposed to the occupation.

There were reports of attacks on opponents of the occupation by unknown individuals. For example, on January 2, according to the Kharkiv Human Rights Protection Group, two unknown assailants attacked Crimean Tatar activist Risa Asanov, known for his support of Crimean Tatar political prisoners, while he was filming for a documentary. He was hit in the head with a baton. When he regained consciousness, the two men told him that this was his “last warning” and “next time you’ll die.” Doctors diagnosed a concussion and other injuries. He reported the attack to police but claimed he received no confirmation of his report.

• Prison and Detention Center Conditions

Prison and detention center conditions reportedly remained harsh and life threatening due to overcrowding and poor conditions.

Physical Conditions : The HRMMU reported inhuman conditions in official places of detention in Crimea. According to the August special report by the UN secretary-general, the Simferopol pretrial detention facility was heavily overcrowded; its maximum capacity was 747, but the average number of prisoners has reached more than 1,300 during the past few years. Overcrowding forced prisoners to sleep in shifts in order to share beds. According to the Crimean Human Rights Group, detainees held in the Simferopol pretrial detention center complained about poor sanitary conditions, broken toilets, and insufficient heating. Detainees diagnosed with HIV, as well as tuberculosis, and other communicable diseases were kept in a single cell.

There were reports that detainees were denied medical treatment, even for serious health conditions. According to the August UN secretary-general’s special report, “prison officials are alleged to have either ignored the health needs of detainees or not provided effective medical assistance.” For example, according to Human Rights Watch, Edem Bekirov, a 58-year-old Crimean Tatar with an amputated leg, diabetes, and a serious heart condition, and in detention at the Simferopol pretrial detention facility since December 2018, received improper treatment for diabetes, was denied essential heart surgery, and was not provided essential medical supplies to care for an unhealed wound. On June 11, the European Court of Human Rights ruled that he be urgently hospitalized for examination and treatment, but occupation authorities refused to do so, claiming that they could not verify the facts in the court’s ruling nor the authenticity of the ruling itself. He was transferred to a hospital on August 27, after his condition worsened, and was released to mainland Ukraine on September 7 as one of the subjects of a “prisoner exchange” between Ukraine and Russia.

According to the Crimean Human Rights Group, as of September 1, 61 Crimean prisoners have been transferred to the Russian Federation since the occupation began in 2014. One factor in the transfers was the lack of specialized penitentiary facilities in Crimea, requiring the transfer of juveniles, persons sentenced to life imprisonment, and prisoners suffering from serious physical and mental illnesses.

According to the August UN secretary-general’s special report, prisoners considered Russian citizens by the Russian Federation were denied Ukrainian consular visits, and some Crimeans were transferred to prison facilities in Russia without Ukrainian passports.

There were reports of prisoner-on-prisoner violence. For example, according to the Crimean Human Rights Group, on May 15, occupation authorities reported a prisoner had been injured in the Simferopol pretrial detention center and later died at a hospital. Authorities claimed the prisoner was attacked by his cellmate.

Prison authorities reportedly retaliated against detainees who refused Russian Federation citizenship by placing them in smaller cells or in solitary confinement.

Independent Monitoring : Occupation authorities did not permit monitoring of prison or detention center conditions by independent nongovernmental observers or international organizations. Occupation authorities permitted the “human rights ombudsman,” Lyudmila Lubina, to visit prisoners, but human rights activists regarded Lubina as representing the interests of occupation authorities and not an independent actor.

• d. Arbitrary Arrest or Detention
• Arrest Procedures and Treatment of Detainees

See the Country Reports on Human Rights for Russia for a description of the relevant Russian laws and procedures that the Russian government applied and enforced in occupied Crimea.

Arbitrary Arrest : Arbitrary arrests continued to occur, which observers believed were a means of instilling fear, stifling opposition, and inflicting punishment on those who opposed the occupation. Security forces regularly conducted raids on Crimean Tatar villages, accompanied by detentions, interrogations, and often criminal charges. The Crimean Resource Center recorded 69 detentions and 97 interrogations that were politically motivated as of June.

The HRMMU noted that justifications underpinning the arrests of alleged members of “terrorist” or “extremist” groups often provided little evidence that the suspect posed an actual threat to society by planning or undertaking concrete actions.

The HRMMU noted the prevalence of members of the Crimean Tatar community among those apprehended during police raids. According to the Crimean Tatar Resource Center, of the 69 individuals detained between January and June, 57 were Crimean Tatars. The HRUMMU noted raids were often carried out on the pretext of purported need to seize materials linking suspects to groups which are banned in the Russian Federation, but which are lawful in Ukraine.

For example, according to the HRMMU, on March 27, the FSB raided 25 houses of Crimean Tatars in the city of Simferopol as well as villages in the Bilohirsky and Krasnohvardiysky districts. Security forces targeted the houses of activists belonging to the Crimean Solidarity movement, a human rights organization that provides the relatives and lawyers of political prisoners with legal, financial, and moral support, 20 individuals were arrested during the raid, but one man disappeared immediately following arrest (see section 1.b.). According to human rights groups, security forces had no warrant for the raid and denied detained individuals access to lawyers. The following day FSB agents searched every house in the village of Strohanivka seeking, unsuccessfully, four Crimean Tatars who were not at their own homes during the searches the previous day. Occupation officials cordoned off the village and set up checkpoints to examine all vehicles. On March 28, three of the men were detained in Rostov-on-Don in Russia. Of the 24 men arrested over March 27-28, five were charged with organizing the activities of a terrorist organization (Hizb ut-Tahrir, which is legal in Ukraine), which carries a sentence of up to life in prison. The rest were charged with participating in the activities of a terrorist organization, which carries a sentence of up to 20 years in prison. On March 30, all of the men were transferred to Russia for pretrial detention, where they remained as of October.

Jehovah’s Witnesses were also targeted during the year for raids and arbitrary arrests. For example, on March 20 occupation authorities raided the homes of Jehovah’s Witnesses in Yalta and Alupka and detained six members of the group, which is banned in Russia as an extremist organization, for questioning.

Detainees were often denied access to a lawyer during interrogation. For example, on May 30, occupation authorities from the “ministry of interior’s” “center for combating extremism” detained two Crimean Tatar female activists–Mumine Salieva, the wife of a political prisoner and a participant in the Crimean Solidarity movement, and Luftie Zudieva, a director of a children’s center and a civic activist. According to the Crimean Human Rights Group, the activists were interrogated for several hours, while authorities refused to inform their lawyers where they were detained or grant them access to their clients. Both women were charged with propaganda for public display of “extremist symbols.” A court fined them 1,000 Russian rubles ($15) and 2,000 Russian rubles ($30) respectively.

• e. Denial of Fair Public Trial

Under the Russian occupation regime, the “judiciary” was neither independent nor impartial. Judges, prosecutors, and defense attorneys were subject to political directives from occupation authorities, and the outcomes of trials appeared predetermined by government interference. The HRMMU noted that lawyers defending individuals accused of extremism or terrorism risked facing similar charges themselves. The HRMMU cited longstanding pressure on human rights lawyer Emil Kurbedinov, who was arrested in December 2018 and sentenced to eight days in prison for a social media post, made before the occupation began, that purportedly contained “extremist symbols.” Following the conviction, the occupation authorities’ “ministry of justice” filed a complaint in January with the Crimean “bar chamber,” seeking his disbarment. As of November he had not been disbarred.

• Trial Procedures

Defendants in politically motivated cases were increasingly transferred to the Russian Federation for trial. See the Country Reports on Human Rights for Russia for a description of the relevant Russian laws and procedures that the Russian government applied and enforced in occupied Crimea.

Occupation authorities interfered with defendants’ ability to access an attorney. According to the August UN secretary-general’s special report, defendants facing terrorism or extremism-related charges were often pressured into dismissing their privately hired lawyers in exchange for promised leniency.

• Political Prisoners and Detainees

According to the Crimean Human Rights Group, as of August, 93 Crimeans were being deprived of freedom in occupied Crimea or in Russia on political or religious charges, 66 of whom were Crimean Tatar Muslims prosecuted on terrorism charges.

Charges of extremism, terrorism, or violation of territorial integrity were particularly applied to opponents of the occupation, such as Crimean Tatars, independent journalists, and individuals expressing dissent on social media.

• f. Arbitrary or Unlawful Interference with Privacy, Family, Home, or Correspondence

Occupation authorities and others engaged in electronic surveillance, entered residences and other premises without warrants, and harassed relatives and neighbors of perceived opposition figures.

Occupation authorities routinely conducted raids on homes to intimidate the local population, particularly Crimean Tatars and ethnic Ukrainians, ostensibly on the grounds of searching for weapons, drugs, or “extremist literature.” According to the Crimean Tatar Resource Center, occupation authorities conducted 73 searches between January and June, 55 of which were in the households of Crimean Tatars.

Human rights groups reported that Russian authorities had widespread authority to tap telephones and read electronic communications and had established a network of informants to report on suspicious activities. Authorities reportedly encouraged state employees to inform on their colleagues who might oppose the occupation. According to human rights advocates, eavesdropping and visits by security personnel created an environment in which persons were afraid to voice any opinion contrary to the occupation authorities, even in private.

On October 11, the SBU reported that the FSB was pressuring Crimeans working at local internet service providers to provide the FSB with information about internet users suspected of having pro-Ukrainian views. The FSB reportedly demanded the service providers’ employees gather and turn over personal data, information about social media use, and well as other private information on certain users.

Respect for Civil Liberties, Including:

• a. Freedom of Expression, Including for the Press

See the Country Reports on Human Rights for Russia for a description of the relevant Russian laws and procedures the Russian government applied and enforced in occupied Crimea.

Occupation authorities significantly restricted freedom of expression and subjected dissenting voices including the press to harassment and prosecution.

Freedom of Expression : The HRMMU noted occupation authorities placed “excessive limitations on the freedoms of opinion and expression.” Individuals could not publicly criticize the Russian occupation without fear of reprisal. Human rights groups reported the FSB engaged in widespread surveillance of social media, telephones, and electronic communication and routinely summoned individuals for “discussions” for voicing or posting opposition to the occupation.

Occupation authorities often deemed expressions of dissent “extremism” and prosecuted individuals for them. For example, according to press reports, on June 10, the Sevastopol “district court” sentenced the head of the Sevastopol Worker’s Union, Valeriy Bolshakov, to two years and six months of suspended imprisonment for “public calls to extremist activities” for his criticism of occupation authorities on social networks. Bolshakov called to replace the “Putin regime” with a “dictatorship of the proletariat.”

Occupation authorities harassed and fined individuals for the display of Ukrainian or Crimean Tatar symbols, which were banned as “extremist.” For example, according to NGO reporting, on June 26, the Saky “district court” fined local resident Oleg Prykhodko for “public demonstration of paraphernalia or symbols of extremist organizations.” Prykhodko had displayed Ukrainian and Crimean Tatar flags on his car. On October 9, authorities arrested Prykhodko during a raid on his home, where they purportedly “found” explosives in his garage, which human rights defenders maintained were planted there. On October 28, authorities charged Prykhodko with terrorism and possession of explosives.

Occupation authorities deemed expressions of support for Ukrainian sovereignty over the peninsula to be equivalent to undermining Russian territorial integrity. For example, according to the Crimean Human Rights Group, on January 29, occupation authorities charged Crimean Tatar Mejlis member Iskander Bariyev with calling for the violation of the territorial integrity of the Russian Federation, in connection with a December 2018 Facebook post in which he called for the “liberation” of Crimea from Russian occupation and criticized repression taking place on the peninsula.

There were multiple reports that occupation authorities detained and prosecuted individuals seeking to film raids on homes or court proceedings. For example, according to press reports, on March 27, a Simferopol court sentenced Crimean Tatar activist Iskender Mamutov to five days in prison for “minor hooliganism” because he filmed security services as they raided Crimean Tatar homes.

During the year occupation authorities prosecuted individuals for the content of social media posts written before Russia began its occupation of Crimea. For example, on July 2, police detained a resident of the town of Sudak, Seyar Emirov, for a video posted on a social network in 2013. The video was of a local meeting of Hizb ut-Tahrir, which is legal in Ukraine. The local occupation “court” fined him 1,500 rubles ($23) for “production of extremist material.”

There were reports that authorities prosecuted individuals for their appearance in social media posts that they did not author. For example, according to the Crimean Human Rights Group, on May 31, a court in Simferopol fined Crimean Tatar activist Luftiye Zudiyeva 2,000 rubles ($30) for being tagged in social media posts in 2014 authored by another person, which authorities alleged also contained banned symbols.

Press and Media, Including Online Media : Independent print and broadcast media could not operate freely. Most independent media outlets were forced to close in 2015 after occupation authorities refused to register them. According to the Crimean Human Rights Group, after the occupation began, many local journalists left Crimea or abandoned their profession. With no independent media outlets left in Crimea and professional journalists facing serious risks for reporting from the peninsula, civic activists were a major source of information on developments in Crimea.

Violence and Harassment : There were numerous cases of security forces or police harassing activists and detaining journalists in connection with their civic or professional activities. For example, during the year security forces reportedly harassed, abused, and arrested journalist Yevgeniy Haivoronskiy. Haivoronskiy initially supported the Russian occupation, but in recent years came to oppose it, a position he expressed publicly. On March 6, police raided Haivoronskiy’s home and seized computers and documents. On March 22, the newspaper that published his articles, Primechania , announced it would no longer carry his work due to his pro-Ukrainian position. On March 26, Haivoronskiy was arrested several hours after he gave an interview criticizing occupation authorities and calling for control of the peninsula to be returned to Ukraine. Police alleged he had been using drugs, and a judge sentenced him to 12 days in jail and to undergo drug treatment. Haivoronskiy denied he used drugs and maintained the charge was an effort to frame him in retaliation for his political views. On May 7, a court sentenced him to a further 10 days in jail for refusing a medical examination during the March prison stay. On October 22, police detained Haivoronskiy, reportedly beating him and slamming his head into the side of a police car during detention. The same day a court sentenced him to 15 additional days in jail for failing to complete the drug treatment program ordered by the court in March. On December 31, Russian occupation authorities forcibly removed Haivoronskiy from Crimea to mainland Ukraine.

Censorship or Content Restrictions : Following Russia’s occupation of Crimea, journalists resorted to self-censorship to continue reporting and broadcasting. The August UN secretary-general’s special report stated, “In order to avoid repercussions for independent journalistic work, [journalists] frequently self-censored, used pseudonyms and filtered their content prior to publication. Ukrainian journalists, as well as public figures who are perceived as critics of Crimea’s occupation, have faced entry bans issued by FSB and were unable to access Crimea to conduct their professional activities.”

There were reports occupation authorities sought to restrict access to or remove internet content about Crimea they disliked. For example, on February 5, YouTube informed the Crimea-focused website The Center for Journalistic Research , which operated in mainland Ukraine, that it had received a notification from Russian censorship authorities (Roskomnadzor) that material on the Center ’ s YouTube account violated the law. Occupation authorities specifically deemed a documentary about Crimean Tatar political prisoner Emir-Usain Kuku to be “extremist.” YouTube notified the Center that if it did not delete the material, it could be forced to block it. On February 7, Amnesty International released a statement urging YouTube not to block the video, and YouTube did not do so.

Occupation authorities banned most Ukrainian and Crimean Tatar-language broadcasts, replacing the content with Russian programming. According to Crimean Human Rights Group media monitoring, during the year occupation authorities jammed the signal of Ukrainian radio stations by transmitting Russian radio stations at the same frequencies.

Human rights groups reported occupation authorities continued to forbid songs by Ukrainian singers from playing on Crimean radio stations.

Censorship of independent internet sites was widespread (see Internet Freedom).

According to the Crimean Human Rights Group, 10 Crimean internet service providers blocked 14 Ukrainian information websites and two social networks during the year, including the sites of the Jehovah’s Witnesses and of the Mejlis of the Crimean Tatar People.

National Security : Authorities cited laws protecting national security to justify retaliation against opponents of Russia’s occupation.

The Russian Federal Financial Monitoring Service included prominent critics of the occupation on its list of extremists and terrorists. Inclusion on the list prevented individuals from holding bank accounts, using notary services, and conducting other financial transactions. As of October the list included 47 persons from Crimea, including numerous political prisoners and their relatives as well as others reportedly being tried for their pro-Ukrainian political positions, such as Oleh Prykhodko (see Freedom of Expression, above).

Authorities frequently used the threat of “extremism,” “terrorism,” or other purported national security grounds to justify harassment or prosecution of individuals in retaliation for expressing opposition to the occupation. For example, on July 12, according to press reports, a court authorized the in absentia arrest of independent Crimean Tatar journalist Gulsum Khalilova for “participating in an armed formation in the territory of a foreign state” for allegedly joining an armed battalion in Ukraine. Khalilova, who moved to mainland Ukraine, denied having any dealings with armed groups and characterized the case as fabricated in retribution for her independent reporting on the peninsula.

• Internet Freedom

Russian occupation authorities restricted free expression on the internet by imposing repressive Russian Federation laws on Crimea (see section 2.a. of the Country Reports on Human Rights for Russia). Security services routinely monitored and controlled internet activity to suppress dissenting opinions. According to media accounts, occupation authorities interrogated and harassed residents of Crimea for online postings with pro-Ukrainian opinions (see Censorship or Content Restrictions, above).

More than 30 Ukrainian online outlets were among the hundreds that authorities blocked in Crimea, including several sites that were not on the Russian federal internet block list.

• Academic Freedom and Cultural Events

Occupation authorities engaged in a widespread campaign to suppress the Crimean Tatar and Ukrainian languages (see section 6, National/Racial/Ethnic Minorities).

• b. Freedoms of Peaceful Assembly and Association
• Freedom of Peaceful Assembly

According to the August UN secretary-general’s special report, “public events initiated by perceived supporters of Ukrainian territorial integrity or critics of policies of the Russian Federation in Crimea were reportedly prevented and/or prohibited by occupation authorities.” For example, on August 9, the head of the Zarechenskoye village council denied an application filed by Crimean Tatar activist Kemal Yakubov to hold a public celebration of the Muslim holiday Kurban Bayram. She cited a lack of a support letter from the pro-occupation Administration of Muslims of Crimea as the reason for her denial.

The Crimean Human Rights Group reported Crimeans were regularly charged with administrative offenses for peacefully assembling without permission. For example, on August 21, a court in Sudak convicted environmental activist Igor Savchenko of holding an unauthorized demonstration and fined him 20,000 rubles ($313); Savchenko had organized a demonstration on August 14 against illegal construction on the Meganom Cape.

Occupation authorities brought charges for “unauthorized assemblies” against single-person protests, even though Russian law imposed on Crimea does not require preauthorization for individual protests. For example, according to the Crimean Human Rights Group, on March 29, police in Simferopol detained Crimean Tatar activist Tair Ibragimov, who was standing alone with a poster that read, “Give 166 children their fathers back!!!,” in protest against the mass arrests of March 27. He was charged with violating regulations on public protest. A court convicted him the same day and fined him 15,000 rubles ($235).

There were reports that authorities used a ban on “unauthorized missionary activity” to restrict public gatherings of members of religious minorities. For example, three administrative cases were initiated against a group of members of the Hare Krishna faith who gathered in a Sevastopol park to sing mantras. On August 6, the Leninskiy “district court” in Sevastopol fined each of them 5,000 rubles ($78) for “unauthorized missionary activity.”

A “regulation” limits the places where public events may be held to 366 listed locations. The HRMMU noted that the “regulation” restricted freedom of assembly to a shrinking number of “specially designated spaces,” a move that appeared “designed to dissuade the exercise of the right of freedom of assembly.”

There were reports of occupation authorities using coercive methods to provide for participation at rallies in support of the “government.” Students, teachers, and civil servants were forced to attend a commemoration event on the day of deportation of the Crimean Tatars organized by occupation authorities in Simferopol on May 18.

There were reports occupation authorities charged and fined individuals for allegedly violating public assembly rules in retaliation for gathering to witness security force raids on homes.

• Freedom of Association

Occupation authorities broadly restricted freedom of association for individuals who opposed the occupation. For example, there were numerous reports of authorities taking steps to harass, intimidate, arrest, and imprison members of the human rights group Crimean Solidarity, an unregistered movement of friends and family of victims of repression by occupation authorities (see section 1.d.). During the year the Crimean Human Rights Group documented multiple cases in which police visited the homes of Crimean Solidarity activists to threaten them or warn them not to engage in “extremist” activities. For example, at least seven Crimean Solidarity activists were given such “preventative warnings” on the eve of the May 17 anniversary of the 1944 deportation of the Crimean Tatar people.

Occupation authorities placed restrictions on the Spiritual Administration of Crimean Muslims, which was closely associated with Crimean Tatars. According to human rights groups, Russian security services routinely monitored prayers at mosques for any mention that Crimea remained part of Ukraine. Russian security forces also monitored mosques for anti-Russian sentiment and as a means of recruiting police informants.

The Mejlis of the Crimean Tatar People remained banned for purported “extremism” despite an order by the International Court of Justice requiring occupation authorities to “refrain from maintaining or imposing limitations on the ability of the Crimean Tatar community to conserve its representative institutions, including the Mejlis.” Following the 2016 ban on the Crimean Tatar Mejlis as an “extremist organization,” occupation authorities banned gatherings by Mejlis members and prosecuted individuals for discussing the Mejlis on social media.

• c. Freedom of Religion

See the Department of State’s International Religious Freedom Report at https://www.state.gov/religiousfreedomreport /.

• d. Freedom of Movement

Occupation authorities did not respect the right to freedom of movement.

In-country Movement : Occupation authorities maintained a state border at the administrative boundary between mainland Ukraine and Crimea. According to the HRMMU, the boundary and the absence of public transportation between Crimea and mainland Ukraine continued to undermine freedom of movement to and from the peninsula, affecting mainly the elderly, individuals with limited mobility, and young children.

There were reports occupation authorities selectively detained and at times abused persons attempting to enter or leave Crimea. According to human rights groups, occupation authorities routinely detained adult men at the administrative boundary for additional questioning, threatened to seize passports and documents, seized telephones and memory cards, and questioned them for hours. For example, on June 11, the FSB detained activist Gulsum Alieva at the administrative borderline when she was entering the peninsula. They brought the activist to the police station in the nearby town of Armyansk. According to her lawyer, authorities charged Alieva with extremism and released her later the same day.

In other cases, authorities issued entry bans to Crimean Tatars attempting to cross the administrative boundary from mainland Ukraine. For example, according to the Crimean Human Rights Group, on February 5, occupation authorities at the administrative boundary detained Crimean Tatar Rustem Rashydov, who was seeking to visit his family in Crimea. He was released after being interrogated for 12 hours and given a document stating he was banned from entering the “Russian Federation.”

Occupation authorities launched criminal cases against numerous high-profile Crimean Tatar leaders, including member of the parliament Mustafa Jemilev and Refat Chubarov, the current chairmen of the Crimean Tatar Mejlis; by Crimean Tatar activist Sinaver Kadyrov; and by Ismet Yuksel, the general director of the Crimean News Agency.

According to the HRMMU, Ukrainian legislation restricts access to Crimea to three designated crossing points and imposes penalties, including long-term entry bans, for noncompliance. Crimean residents lacking Ukrainian passports, who only possessed Russian-issued Crimean travel documents not recognized by Ukrainian authorities, often faced difficulties when crossing into mainland Ukraine.

Citizenship : Russian occupation authorities required all residents of Crimea to be Russian citizens. Those who refused Russian citizenship could be subjected to arbitrary expulsion. According to the Crimean Human Rights Group, during the five years of Russia’s occupation, more than 1,500 Ukrainians were prosecuted for not having Russian documents, and 450 persons were ordered to be deported.

According to the HRMMU, in 2018 “courts” in Crimea ordered deportation of 231 Ukrainian nationals, many of whom were Crimean residents with Ukrainian citizenship, whose residence rights in Crimea were not recognized.

Residents of Crimea who chose not to adopt Russian citizenship were considered foreigners. In some cases they could obtain a residency permit. Persons holding a residency permit without Russian citizenship were deprived of key rights and could not own agricultural land, vote or run for office, register a religious congregation, or register a vehicle. Authorities denied those who refused Russian citizenship access to “government” employment, education, and health care, as well as the ability to open bank accounts and buy insurance, among other limitations.

According to the Crimean Human Rights Group, Russian authorities prosecuted private employers who continued to employ Ukrainians. Fines could be imposed on employers for every recorded case of employing a Ukrainian citizen without a labor license. Fines in such cases amounted to several million dollars.

In some cases authorities compelled Crimean residents to surrender their Ukrainian passports, complicating international travel, because many countries did not recognize “passports” issued by Russian occupation authorities.

• Internally Displaced Persons

Approximately 33,000 residents of Crimea registered as IDPs on the mainland, according to the Ministry of Social Policy. The Mejlis and local NGOs, such as Krym SOS, believed the actual number could be as high as 100,000, as most IDPs remained unregistered. Many individuals fled due to fear that occupation authorities would target them for abuse because of their work as political activists or journalists. Muslims, Greek Catholics, and Evangelical Christians who left Crimea said they feared discrimination due to their religious beliefs.

Crimean Tatars, who made up the largest number of IDPs, said they left because pressure on their community, including an increasing number of arbitrary searches of their homes, surveillance, and discrimination. In addition, many professionals left Crimea because Russian occupation authorities required them to apply for Russian professional licenses and adopt Russian procedures in their work.

Freedom to Participate in the Political Process

Recent Elections : Russian occupation authorities prevented residents from voting in Ukrainian national and local elections since Crimea’s occupation began in 2014.

Corruption and Lack of Transparency in Government

Corruption : There were multiple reports during the year of systemic rampant corruption among Crimean “officeholders,” including through embezzlement of Russian state funds allocated to support the occupation. For example, on April 3, de facto Crimean law enforcement authorities detained the mayor of the city of Yevpatoriya, Andrey Filonov. He was charged with abuse of power that entailed losses for the municipal budget in the amount of 35 million Russian rubles ($5.5 million).

Governmental Attitude Regarding International and Nongovernmental Investigation of Alleged Abuses of Human Rights

Most independent human rights organizations ceased activities in Crimea following Russia’s occupation. Occupation authorities refused to cooperate with independent human rights NGOs, ignored their views, and harassed human rights monitors and threatened them with fines and imprisonment.

Russia continued to deny access to the peninsula to international human rights monitors from the OSCE and the United Nations.

Discrimination, Societal Abuses, and Trafficking in Persons

Birth Registration : Under both Ukrainian law and laws imposed by Russian occupation authorities, either birthplace or parentage determines citizenship. Russia’s occupation and purported annexation of Crimea complicated the question of citizenship for children born after February 2014, since it was difficult for parents to register a child as a citizen with Ukrainian authorities. Registration in the country requires a hospital certificate, which is retained when a birth certificate is issued. Under the occupation regime, new parents could only obtain a Russian birth certificate and did not have access to a hospital certificate. In 2016 the Ukrainian government instituted a process whereby births in Crimea could be recognized with documents issued by occupation authorities.

Institutionalized Children : There were reports occupation authorities continued to permit kidnapping of orphans in Crimea and transporting them across the border into Russia for adoption. Ukraine’s government did not know the whereabouts of the children.

• Anti-Semitism

According to Jewish groups, an estimated 10,000 to 15,000 Jews lived in Crimea, primarily in Simferopol. There were no reports of anti-Semitic acts.

• National/Racial/Ethnic Minorities

Since the beginning of the occupation, authorities singled out Crimean Tatars and Ukrainians for discrimination, abuse, deprivation of civil liberties and religious and economic rights, and violence, including killings and abductions (also see sections 1.a.-1.d., 1.f., 2.a., 2.b., and 2.d.). The August UN secretary-general’s special report noted a “narrowing of space for manifestations of Ukrainian and Crimean Tatar identities and enjoyment of the respective cultures in Crimea. The restrictions have reportedly been closely connected to the suppression of political dissent and alternative political opinion.”

There were reports that government officials openly advocated discrimination against Crimean Tatars. Occupation authorities harassed Crimean Tatars for speaking their language in public and forbade speaking it in the workplace. There were reports teachers prohibited schoolchildren from speaking Crimean Tatar to one another. Crimean Tatars were prohibited from celebrating their national holidays and commemorating victims of previous abuses. For example, on June 26, occupation authorities denied a request by the residents of the town of Oktyabrske to hold a car rally for Crimean Tatar Flag Day. Police arrived at the gathering, informed them the event was unauthorized, and video-recorded those present. According to press reports, as the cars proceeded anyway, they were pulled over four times by police for “document checks.”

Occupation authorities also restricted the use of Crimean Tatar flags and symbols (see section 2.a.).

By the end of 2014, Ukrainian as a language of instruction was removed from university-level education in Crimea. According to the HRMMU, in the 2017-2018 academic year no school provided instruction in Ukrainian, and there were eight available Ukrainian language classes in Russian schools that were attended by 318 children. In 2017 the International Court of Justice ruled on provisional measures in proceedings brought by Ukraine against the Russian Federation, concluding unanimously that the Russian Federation must “ensure the availability of education in the Ukrainian language.”

Occupation authorities have not permitted churches linked to ethnic Ukrainians, in particular the Orthodox Church of Ukraine (OCU) and the Ukrainian Greek Catholic Church, to register under Russian law. Occupation authorities harassed and intimidated members of the churches and used court proceedings to force the OCU in particular to leave properties it had rented for years. The largest OCU congregation in Crimea closed on September 23 following a ruling by occupation authorities that the cathedral located in Simferopol must be “returned to the state.” The church was shut down after repeated refusals by the authorities to allow it to register.

Occupation authorities allegedly selectively seized property belonging to ethnic Ukrainians and Crimean Tatars. According to the August UN secretary-general’s special report, during the year the HRMMU “received information about numerous cases of allocation of land plots to formerly displaced persons in Crimea, including Crimean Tatars, free of charge, as part of plans to legalize the unauthorized appropriation of land or allocation of alternative land plots.”

Russian occupation authorities prohibited Crimean Tatars affiliated with the Mejlis from registering businesses or properties as a matter of policy.

• Acts of Violence, Discrimination, and other Abuses Based on Sexual Orientation and Gender Identity

Human rights groups and local LGBTI activists reported that most LGBTI individuals fled Crimea after the Russian occupation began. Those who remained lived in fear of abuse due to their sexual orientation or gender identity.

According to the HRMMU, NGOs working on access to health care among vulnerable groups have found it impossible to advocate for better access to healthcare for LGBTI persons due to fear of retaliation by occupation authorities.

Occupation authorities prohibited any LGBTI group from holding public events in Crimea. According to the HRMMU, LGBTI residents of Crimea faced difficulties in finding a safe environment for gatherings because of occupation authorities’ encouragement of an overall hostile attitude towards the manifestation of LGBTI identity. LGBTI individuals faced increasing restrictions on their right to free expression and assembly peacefully, because occupation authorities enforced a Russian law that criminalizes the so-called propaganda of nontraditional sexual relations to minors (see section 6 of the Country Reports on Human Rights for Russia). For example, on June 29, the organizers of the theater company Territoria apologized for producing a play that showed two women kissing during a state-sponsored theater festival. High-ranking members of the Russian government called for the company to be prosecuted under the Russian law that prohibits the “propaganda” of “nontraditional sexual relations” to minors.

Worker Rights

Occupation authorities announced the labor laws of Ukraine would not be in effect after 2016 and that only the laws of the Russian Federation would apply.

Occupation authorities imposed the labor laws and regulations of the Russian Federation on Crimean workers, limited worker rights, and created barriers to freedom of association, collective bargaining, and the ability to strike. Trade unions are formally protected under Russian law but limited in practice. As in both Ukraine and Russia, employers were often able to engage in antiunion discrimination and violate collective bargaining rights. The pro-Russian authorities threatened to nationalize property owned by Ukrainian labor unions in Crimea. Ukrainians who did not accept Russian citizenship faced job discrimination in all sectors of the economy. Only holders of Russian national identification cards were allowed to work in “government” and municipal positions. Labor activists believed that unions were threatened in Crimea to accept “government” policy without question and faced considerable restrictions on advocating for their members.

Although no official data were available, experts estimated there was growing participation in the underground economy in Crimea.

Read a Section

On this page.

• Section 3. Freedom to Participate in the Political Process
• Section 4. Corruption and Lack of Transparency in Government
• Section 5. Governmental Attitude Regarding International and Nongovernmental Investigation of Alleged Abuses of Human Rights
• Section 7. Worker Rights

U.S. Department of State

The lessons of 1989: freedom and our future.

Simferopol, Autonomous Republic of Crimea, Ukraine

Simferopol is the capital and largest city of the Autonomous Republic of Crimea in Ukraine, with a population of approximately 332,317 as of 2021. It is located in the central part of the Crimean Peninsula and is a significant economic and cultural center of the region. The city is situated at an altitude of 150 meters above sea level and covers an area of 108.7 square kilometers. Simferopol has a moderate continental climate with hot summers and relatively mild winters.

The happiness of the inhabitants of Simferopol depends on various factors, including the availability of opportunities for employment, access to housing, air quality, traffic and commuting, noise and stress, and the weather. Additionally, things to do, comfort, and quality of life also play a significant role in the happiness of the city's inhabitants.

One of the things that make Simferopol's inhabitants happy is the city's rich cultural heritage. The city boasts several historical and cultural attractions, including the Taurida State Museum, the Simferopol Art Museum, and the Central Museum of Tavrida. These museums showcase the region's history, culture, and art, and attract tourists from all over the world.

Another factor that affects the happiness of the city's inhabitants is the availability of comfortable housing. Simferopol has a wide range of housing options, including apartments, townhouses, and single-family homes. The cost of living in Simferopol is relatively affordable, which makes it easier for residents to afford comfortable housing. Additionally, the city's central location and excellent public transportation make it easy for residents to commute to work and other activities.

The quality of life in Simferopol is also affected by the city's air quality and pollution levels. The city is located in a valley, which can sometimes trap pollutants and decrease air quality. However, the city has taken steps to improve air quality by implementing regulations on industrial emissions and promoting the use of public transportation.

Employment opportunities are also a crucial factor in the happiness of Simferopol's inhabitants. The city has a diverse economy with industries such as tourism, agriculture, and manufacturing. Additionally, Simferopol is home to several universities and research institutions, which provide opportunities for education and employment in the academic field.

Traffic and commuting can be a significant source of stress for Simferopol's inhabitants. The city has a relatively high population density, which can lead to traffic congestion during peak hours. However, the city has a well-developed public transportation system, including buses, trams, and trolleybuses, which can help alleviate some of the stress of commuting.

Noise and stress are also factors that can affect the happiness of Simferopol's inhabitants. The city can be noisy at times, especially during peak hours when traffic and public transportation are at their busiest. However, the city has several parks and green spaces, which provide a peaceful escape from the noise and stress of city life.

The weather can also impact the happiness of Simferopol's inhabitants. The city has a moderate continental climate with hot summers and relatively mild winters. While the city experiences occasional extreme weather events, such as heavy snowfall and heatwaves, overall, the weather in Simferopol is relatively mild and pleasant.

The happiness of Simferopol's inhabitants is affected by a variety of factors, including the availability of opportunities for employment, access to housing, air quality, traffic and commuting, noise and stress, and the weather. Additionally, things to do, comfort, and quality of life also play a significant role in the happiness of the city's inhabitants. Despite some challenges, Simferopol is a city with a rich cultural heritage, diverse economy, and excellent quality of life, which makes it a desirable place to live for many Ukrainians.