Mental Health for Sustainable Development€¦ · Yet mental health is generally given a very low...
Transcript of Mental Health for Sustainable Development€¦ · Yet mental health is generally given a very low...
1Mental Health for Sustainable Development
All-Party Parliamentary Group on Global Health All-Party Parliamentary Group on Mental Health
Mental Health forSustainable Development
Dr Mary De Silva & Jonty Roland, on behalf of the Global Health and Mental Health All-Party Parliamentary Groups
2 Mental Health for Sustainable Development
Abbreviations
APPG All-PartyParliamentaryGroup
BME BlackandEthnicMinority
DALY DisabilityAdjustedLifeYear
DFID DepartmentforInternationalDevelopment
EMERALD Emergingmentalhealthsystemsinlow-andmiddle-incomecountries
MDG MillenniumDevelopmentGoal
mhGAP MentalHealthGapActionProgramme
NGO Non-GovernmentalOrganisation
NHS NationalHealthService
PCAF PeterC.AldermanFoundation
PRIME PRogrammeforImprovingMentalhealthcarE
THET TropicalHealthandEducationTrust
SDGs SustainableDevelopmentGoals
WHO WorldHealthOrganization
YLD YearLivedwithDisability
ThisisnotanofficialpublicationoftheHouseofCommonsortheHouseofLords.All-PartyGroupsareinformalgroupsofmemberswithacommoninterestinparticularissues.ThisreportisfundedbythesponsorsoftheAll-PartyParliamentaryGrouponGlobalHealth
Alloftheprojectsandorganisationshighlightedinthisreportandonthemaponpage20areprofiledontheMentalHealthInnovationNetworkinagrowingdatabasewhichcurrentlyhostsmorethan85innovativeexamplesofbestpracticeinmentalhealthpromotion,preventionandtreatmentfromaroundtheworld.
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Contents
Preface 4
Executivesummary 5
Recommendations 7
1.Whymentalhealthmattersglobally 8
2.Whatsolutionsexist? 14
Improvingmentalhealthglobally 20
3.TheUK’scurrentcontributiontoglobalmentalhealth 22
4.Doingmoreandactingdifferently 24
References 27
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Thesimplemessageofthisreportisthatprogressindevelopmentwillnotbemadewithoutimprovementsinmentalhealth.
Thereasonsareequallystraightforward.Mentalillnessescausemoredisabilitythananyotherhealthcondition;bringenormouspainandsufferingtoindividualsandtheirfamiliesandcommunities;andcanleadtoearlydeath,humanrightsabusesanddamagetotheeconomy.Improvingmentalhealthisthereforeavitalpartofasuccessfuldevelopmentprogramme.
Yetmentalhealthisgenerallygivenaverylowpriority–andoftenneglectedaltogether-inbothnationalandinternationalpolicy.
TheUKgovernmentcangiveapowerfulleadtocorrectthisthroughDFIDanditsworkwithotherinternationalbodies;however,italsoneedstodevelopitsownpoliciesandpracticestogivementalhealthgreaterpriorityand,crucially,paritywithphysicalhealth.Mentalhealthneedstomovefrombeinganafterthoughttoanessentialpartofsocialpolicy,healthsystemstrengtheningandhealthimprovement.
ChangeisalsoneededintheUK’svibrantvoluntarysectorwhich,withafewnotableexceptions,doeslittleinthisarea.Moreover,thenegotiationsontheforthcomingSustainableDevelopmentGoalspresenttheopportunityforrealchange.Asthereportsays,weknowwhatneedstobedone.Whatisneedednowisachangeinmindsetaswellasinpolicyandpractice.
Wewouldliketothankallthosewhocontributedideas,evidenceandcasestudies.Inparticular,wewouldliketothankthereport’stwoauthors,DrMaryDeSilvaandJontyRoland,aswellastheteamwhichsupportedthemconsistingofVanessaHalipi,LisaTownsend,GraceRyan,LucyLee,CatherineRushworthandWillBurch.
Lord Crisp APPG on Global Health
Meg Hillier MP APPG on Global Health
James Morris MP APPG Mental Health
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Preface
5Mental Health for Sustainable Development 5
The scale of the problem is better understood than ever. Cost-effective solutions for addressing it exist. It is becoming increasingly apparent that successful development will not take place without addressing mental health. The time is right to consider what the UK is currently doing to improve mental health globally and whether UK expertise and resources could be more effectively used to meet this challenge.
Mentalhealthproblemsaccountforalmost13percentoftheworld’stotaldiseaseburden,affectupto10percentofpeopleacrossthelifecourseatanyonetime,andmakeupoveraquarteroftheyearspeoplelivewithdisabilityglobally.1ThiscoststheworldsomeUS$2.5trillionperyear,2yettheamountinvestedintreatingmentalhealthproblemsisbarelyafractionofthis–lessthantwopercentofthehealthspendinginmostlowandlower-middleincomecountries.3
Depression,substanceabuse,schizophrenia,learningdisabilitiesandothercommonconditionsarenotsimply‘Westernissues’.Almostthreequartersofpeoplewithmentalhealthproblemsliveinlowandmiddleincomecountries4andreceivelittleornoevidence-basedtreatment.Thisreportsetsoutthreeimportantargumentswhymentalhealthmattersgloballyandwhydevelopmentactivitywillnotbetrulysuccessfulwithouttacklingmentalhealthissues:
The health case Peoplewithmentalhealthproblemshaveshorterlivesandworsehealththanothers.Thisisduetosuicide,mentalhealthproblemsworseningthecourseandinterferingwithappropriatecareandself-managementofphysicalhealthproblems,andpoorertreatmentofthoseproblemsbythehealthsystem
The social and economic case Mentalhealthproblemsareabrakeondevelopmentastheycause(andarecausedby)poverty.Thisfuelssocialfailuresincludingpoorparentingandschoolfailure,domesticviolence,andtoxicstress,preventingpeoplewithproblemsandtheirfamiliesfromearningaliving
The human rights case Peoplewithmentalhealthproblemsareoftensubjectedtoseriousabuse,suchaschaining,andinmanycountriesaredeniedfundamentalhumanrightsandprotectionsthroughdiscriminatorylaws.
Despitestrongeconomic,social,humanitarianandepidemiologicalargumentsfortacklingmentalhealthinlowandmiddleincomecounties,mentalhealthisdisproportionatelypoorlyfundedaroundtheworld.Inlowincomecountries,asfewasonein50peoplewithaseriousmentalhealthproblemeverreceivestreatment.
“���Mental�illnesses�are�killer�diseases.�They�need�to�take�their�place�among�the�other�killer�diseases�for�investment�and�priority”
Graham Thornicroft, Professor of Community Psychiatry, King’s College London
Executive summary
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Fortunately,agrowingbodyofresearchisshowingthat–eveninthepoorestcountries–cost-effectivesolutionstothisglobalchallengeexist.Theseinclude:
Improvingsocialandeconomicenvironmentsaspartofsustainabledevelopmentsothatmentalhealthproblemsarelesslikelytooccur Integratingmentalhealthintogenericprimaryhealthcare Usingtrainedandsupervisedcommunityandnon-specialisthealthworkers
toprovideculturallyappropriatecareandtreatmentinthecommunity Harnessingtechnologytobuildworkforcecapacity,connectpeople
withspecialisthelp,andincreaseaccesstoself-help Empoweringpeoplewithmentalhealthproblemstosupport
andadvocateforthemselvesandforeachother Improvingthephysicalhealthcareofpeoplewithmentalhealthproblems Advocatingforgreaterrightsandrepresentationforpeoplewithmentalhealthproblems
Thisreportcontainspracticalexamplesofalloftheseapproaches,manyofwhichholdlessonsforhighlydevelopedhealthsystemsaswell–suchashowtointegratementalhealthintoexistingphysicalhealthservicesandhowtoadaptmentalhealthinterventionstoworkacrossdifferentcultures.
Thesesolutionsarebeginningtoraiseglobalmentalhealthuptheinternationalagenda.Ayearago,memberstatesoftheWorldHealthOrganization(WHO)unanimouslysupportedtheadoptionoftheComprehensiveMentalHealthActionPlan2013–2020.Thisrecognisestheimportanceofmentalhealthasaglobalhealthpriority,andcommitstofourkeyobjectivesby2020:
Strengtheneffectiveleadershipandgovernanceformentalhealth Providecomprehensive,integratedandresponsivementalhealth
andsocialcareservicesincommunity-basedsettings Implementstrategiesforpromotionandpreventioninmentalhealth Strengtheninformationsystems,evidenceandresearchformentalhealth
TheUKwasanimportantsupporterofthisglobalagreementandhasmuchtocontributebutasyetdoesnothaveaclearstrategyforwhatitsroleinachievingtheActionPlanwillbe.
AlthoughtheBritishGovernmentandotherinstitutionsaredoingmorethanmosttoimprovementalhealthinlowandmiddleincomecountries,theseinitiativesarefewinnumberandareoftenisolated.Thisreportgivesanumberofpracticalrecommendationsfor‘doingmore’and‘doingdifferently’.
“��We�have�such�good�cost-effective�interventions.�Treatments�for�mental�disorders�are�as�cost-effective�as�those�for�other�chronic�diseases�like�diabetes”
Vikram Patel, Wellcome Trust Senior Research Fellow, London School of Hygiene & Tropical Medicine
“��The�challenge�is�we�have�in�the�order�of�a�billion�people�on�the�planet�who�will�have�a�mental�health�problem�in�their�lifetime�and�not�get�evidence-based�care�for�it.�A�response�to�that�sort�of�problem�needs�action�at�a�global�level.�It�needs�the�sorts�of�global�structures�we’ve�created�for�malaria�and�HIV�to�be�created�for�mental�health�as�well”
Gary Belkin, Executive Deputy Commissioner, New York City Department of Health and Mental Hygiene
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Recommendation 1
TheDepartmentforInternationalDevelopment(DFID)to‘integrate’,‘evaluate’and‘replicate’globalmentalhealthinitsprogrammesinordertosupportcountriestoimplementtheWHOActionPlan:
‘Integrate’byconductinga‘mentalhealthinallpolicies’reviewtostrategicallyconsideritsroleinachievingtheWHOMentalHealthActionPlanobjectives ‘Evaluate’byincorporatingmentalhealthimpactmetricsintoitsexistingprogrammes ‘Replicate’bycommittingtoprogrammefundingtoscaleupmentalhealth
projectsthatprovesuccessfulaspartofDFID-fundedresearch
Recommendation 2
NGOsandothersworkingininternationaldevelopmentshouldsupportstafftounderstandtheneedsandcapacitiesofpeoplewithmentalhealthproblems,encouragetheinclusionofpeoplewithmentaldisordersintheirgeneraldevelopmentprogrammes,setupnewmentalhealthspecificprogrammes,andmeasuretheimpactoftheirprogrammesonmentalhealth
Recommendation 3
Professionalbodiesandmentalhealthproviders,withthesupportofgovernment,shouldestablishandexpandtrainingandresearchpartnershipswithlowandmiddleincomecountries–seekingtoteachandtolearnaboutprofessionalskills,tacklingdiscriminationandpolicyreform
Recommendation 4
TheUKshouldlobbyfortheinclusionofthefollowingmentalhealthtargetwithintheHealth Goalin the SustainableDevelopmentGoals
“Theprovisionofmentalandphysicalhealthandsocialcareservicesforpeoplewithmentaldisorders,inparitywithresourcesforservicesaddressingphysicalhealthandworkingtowardsuniversalcoverage”
Recommendations
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There are powerful reasons why improving mental health in low and middle income countries should be a key global concern. Mental disorders are responsible for a significant proportion of the disease burden in developing countries. They impede social and economic development. They impair community fabric and impair crucial collective needs such as parenting, child development, and school success.5 They are also associated with some of the world’s most pervasive human rights abuses. Despite a compelling case, mental health is disproportionately poorly funded around the world - especially in low and middle income countries.
Mentalhealthisanindispensablecomponentofhealth,definedbytheWHOas“astateofwell-beinginwhicheveryindividualrealizeshisorherownpotential,cancopewiththenormalstressesoflife,canworkproductivelyandfruitfully,andisabletomakeacontributiontoherorhiscommunity.”6‘Mentalhealthproblems’isatermthatreferstoasetofmedicalconditionsthataffectaperson’sthinking,feeling,mood,abilitytorelatetoothers,anddailyfunctioning.Thisincludesawiderangeofconditionssuchasdepressionandanxiety,drugandalcoholabuse,andschizophrenia.
Inthisreport,andinlinewithguidancefromtheWHO,theneurologicalconditionsdementiaandepilepsyarealsoincluded,asinlowandmiddleincomecountriestheirtreatmentissimilartomentalhealthproblemssuchasschizophrenia.7Table1presentsdefinitionsforthementalhealthandneurologicalproblemsincludedinthisreport,allofwhichcauseasignificantdiseaseburdeninlowandmiddleincomecountries.
Therearethreecompellingargumentswhyimprovingmentalhealthshouldbeconsideredavitalcomponentofglobalhealthanddevelopment:thehealthcase,thehumanrightscaseandthesocialeconomiccase.
The health case: mental health problems cause more disability than any other health problem, as well as high levels of premature mortality
Mentalhealthproblemsareextremelycommoninallcountriesoftheworld.Atanypointintime,morethanonein10peoplehaveamentalhealthproblem:1nearlythreequartersofthesepeopleliveinlowandmiddleincomecountries.4
Mentalhealthproblemsarethemostdisablingofallhealthconditions,contributingnearlyonequarterofallYearsLivedwithDisability(YLDs)globally(Figure1).Importantly,thoughthereisvariabilitybetweencountriesintheburdenofsomedisorders(particularlyalcoholuse),mostdonotdiffersignificantlyfromtheglobalaverage.Ratesofmentaldisordersinlowandmiddleincomecountriesareverysimilartothoseinhighincomecountries.1Theburdenisgreatestinpeopleaged10-29years,reflectingtheearlyageofonsetofmanysubstanceuseandcommonmentaldisorders.1ThisisparticularlyimportantforregionslikeAfrica,whereupto40percentofthepopulationarechildren.8
1. Why mental health matters globally
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Table1:Theglobalburdenofmental,neurological,andsubstanceuseanddisorders
Mentalandsubstanceusedisorders:7.4percentofglobaldiseaseburden(DALYs*)
Developmentaldisorders Agroupofconditionswhichdevelopfrombirthonwards,characterisedbyimpairmentsinintellectual,movement,sensory,social,orcommunicationabilities(e.g.autism,intellectualdisabilityandcerebralpalsy)
Childbehaviouraldisorders
Agroupofconditionscharacterizedbyimpairmentsofattentionanddisruptivebehaviour(e.g.attentiondeficithyperactivitydisorderandconductdisorder)
Drugandalcoholuseproblems
Agroupofconditionscharacterisedbyregularuseofdrugsandalcoholtothelevelofcausingharmtotheperson’shealthandsocial/personalrelationships
Commonmentaldisorders
Agroupofconditionsincludingdepressivedisorders(lowmood,lossofinterestandenjoyment,andfatigue)andanxietydisorders(excessiveworrying,tensionandfear,andphysicalsymptomssuchaspalpitations,headachesandsleepdisturbances)
Psychosis Agroupofconditionscharacterizedbydistortionsofthinkingandperception(e.g.hallucinationsanddelusions),behaviouralabnormalitiesandemotionaldisturbance,includingschizophrenia
Self-harmandsuicide:1.5percentofglobaldiseaseburden(DALYs)
Self-harmandsuicide Intentionalself-inflictedpoisoningorinjurywhichmayleadtodeath.
DementiaandEpilepsy:1.15percentofglobaldiseaseburden(DALYs)
Dementia Organicbraindiseasescharacterizedbyaprogressivedeteriorationinmentalfunctions,suchasmemoryandorientation,leadingtobehaviouralproblemsandlossoftheabilitytocareforoneselfandultimatelydeath
Epilepsy Neurologicalconditionwherethereisatendencytohaveseizuresthatstartinthebrain.Repeatedseizureswithouttreatmentcanresultinpermanentbraindamage
* Disability Adjusted Life Years: A measure of the number of years lost due to death, disability and ill health. Source: 2010 Global Burden of Disease estimates9
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0 5 10 15 20 25
Cardiovascular and circulatory diseases
Diarrhea, lower respiratory infections, meningitis and other common infectious
diseases
Neonatal disorders
Cancers
Mental health problems
Figure1:Topfivecontributorstotheglobalhealthburden(DALYsandYLDs)
Reproduced from Patel V, Saxena S, De Silva M, & Samele C. Transforming Lives, Enhancing Communities: Innovations in Mental Health (2013) Report for the World Innovation Summit for Health10
Source: Global Burden of Disease study 20101
Theheavyhealthburdenofmentalhealthproblemsisalsotheresultoftheirdamagingimpactonphysicalhealth.Inhighincomecountries,menwithseverementalhealthproblemsdieupto20yearsandwomen15yearsearlierthanpeoplewithoutmentalhealthproblems.11Inthepoorestcountriesthislifeexpectancygapislesswelldocumented,butislikelytobemuchwider.12Thisexcessmortalityisduetosuicide,unhealthylifestyles(suchashighsmokingrates)andpoorerphysicalhealthcareforpeoplewithmentalhealthproblems.11,13Globally,nearly1millionpeopletaketheirownliveseveryyear,14nearlydoublethosewhoarekilledasaresultofconflictorcriminalviolence.15Betweenhalfandthree-quartersofsuicidescouldbeavertedifmentalhealthproblemsweretreated.16Thisexcessandavoidablemortalityhasbeendescribedasaformof“lethaldiscrimination”.17Inaddition,mentalhealthproblemscorrodesociallife,lifelongdevelopment,andoverallhealth.Forexample,theeffectsofmaternaldepressiononchildren,andexposureinearlylifetotoxicstress,castsalongshadowonlifetimementalandphysicalhealth,andsocialsuccess.18
% of total Years Lived with Disability (YLDs)
% of total Disability Adjusted Life Years (DALYs)
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The social and economic case: mental health problems impose a tremendous economic and social cost to society that places a brake on development efforts
Thecostsofmentalhealthproblemsarestaggering.TheWorldEconomicForumestimatesthattheglobalcostofmentalhealthproblemswasUS$2.5trillionin2010,andwillrisetoUS$6.0trillionby2030.2Aroundtwo-thirdsofthesesocietalcostsareduetoreducedeconomicproductivity,highratesofunemployment,andunder-performanceatwork.2Attheindividuallevel,thesecostscomefromlossofproductivityfromtheaffectedpersonandtheircaregivers,andfromoftencatastrophicoutofpocketexpenditureonhealthservices.19
Povertyandmentalhealthproblemsareintimatelyrelatedtooneother,withthoselivinginpovertymorelikelytodevelopmentalhealthproblems,andmentalhealthproblemsleadingtoadownwardspiralofeconomicdisenfranchisement.2,20Thisisparticularlytrueinpoorercountries,wheretheabsenceofawelfaresafetynetandlackofaccesstoeffectivetreatmentsacceleratethecycleofdisadvantage.Breakingthisviciouscyclebytacklingbothcausesandconsequencesofmentalhealthproblemsiskeytoensuringsustainabledevelopmentinallregionsoftheworld.
The human rights case: people with mental health problems are subject to some of the world’s worst human rights abuses
Peoplewithmentalhealthproblemsfrequentlyexperiencestigmaanddiscriminationwhichactasabarriertoparticipationinsocialandeconomicactivitiesandmaypreventthemseekingtreatment.21Ratesofbothanticipatedandexperienceddiscriminationareconsistentlyhighacrosscountriesfrommanyregionsoftheworld,andactasabarriertoseekinghelp,receivingsuccessfultreatment,andsocialandvocationalintegration.21,22Inmanycountriesthecivilandpoliticalrightsofpeoplewithmentalhealthproblemsareviolated,suchasinNepalwherementalillnessislegalgroundsfordivorceresultinginmanywomenbeingabandonedonthestreetsbytheirhusbands(seemaponpage20),orinLithuaniawheresomepeoplewithlongtermmentalhealthproblemsareunabletoowntheirownhome.23AreviewofmentalhealthlegislationinCommonwealthcountriesfoundthatmostlegislationwasoutdated,wasnotcompliantwiththeConventionontheRightsofPersonswithDisabilities,usedstigmatisingtermssuchas‘lunatic’,anddidnotinvolvepeoplewithmentaldisordersinthedevelopmentandimplementationofthelegislation.24
Asaresultofoutdatedlawsleadingtodiscrimination,stigma,andpooraccesstoservices,peoplewithmentalhealthproblemsaremorelikelythanotherstoexperiencesocialexclusion,violentvictimizationandhumanrightsabuse.25Thisincludesbeingchainedtotheirbedsorkeptinisolationinpsychiatricinstitutions,beingincarceratedinprisons,beingchainedandcagedinsmallcellsinthecommunityandbeingabusedbytraditionalhealingpractices.25,26Evenwherepsychiatricwardsareincludedingeneralhospitalstheyaregenerallyinmuchworseconditionthanthegeneralmedicalandsurgicalwards.InIndonesiaforexample,theMinistryofHealthestimatesthat18,800peoplewithmentalhealthproblemsarecurrentlyshackledinthecommunity,apracticesocommonithasitsownname,‘pasung’(seemaponpage20).27Thesehumanrightsabuseshavebeendescribedas“afailureofhumanity”.25
“��When�countries�are�setting�out�their�health�agendas,�very�rarely�are�mental�health�experts�involved,�and�consequently�very�rarely�are�governments�finding�that�mental�health�is�a�priority”
Ken Grant, Director, HLSP Institute
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Global under-investment in mental health
Lackofpublicawareness,highlevelsofstigmaandinadequatepoliticalattentionhaveledtoachronicunderinvestmentinmentalhealthcare.Middleincomecountriesallocatelessthantwopercentoftheiralreadysmallhealthbudgetstothetreatmentandpreventionofmentalhealthproblems,andlowincomecountrieslessthanhalfofonepercent3(Figure2).Morethanhalftheworld’spopulationliveinacountrywithfewerthanonepsychiatristper200,000people,3withanestimatedshortageof1.18millionmentalhealthworkersinlowandmiddleincomecountries.28Mostofthesescarceresourcesareallocatedtoasmallnumberofpsychiatrichospitalslocatedinmajorcities,leavingthevastmajorityofthepopulationwithnoaccesstoanymentalhealthcare.
Thislackofinvestmenthasresultedinasituationwheremostpeopleindevelopingcountriesreceivenotreatmentwhatsoeverfortheirmentalhealthproblems.Lessthanonein10willgettreatmentfordepression,29whileinlowincomecountriesandformoreseveredisorderssuchasschizophrenia,thisfiguresfallstoonein50.30
Figure2:Percentageoftotalhealthspendingonmentalhealthcomparedtotheburdenofdisease(DALYsandYLDs)forallmentalhealthandneurologicalconditions
Reproduced from Patel V, Saxena S, De Silva M, & Samele C. Transforming Lives, Enhancing Communities: Innovations in Mental Health (2013) Report for the World Innovation Summit for Health10
Source: Global Disease Burden data 2010 (DALYs and YLDs)31 and WHO Atlas 2011 (mental health spending).3
Low-income countries
Lower middle- income countries
Upper middle-income countries
High-income countries
30
25
20
15
10
5
0
% of total health spending on mental health
Disability Adjusted Life Years (DALYs)
Years Lived with Disability (YLDs)
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Huzeima’s story Reproduced with the kind permission of BasicNeeds
WhilepursuingherstudiesatateachingtrainingcollegeinGhana,25yearoldHuzeimabecameill.Asisfrequentlythecase,shewasadmittedtoatraditionalhealer’shomebyherfamilyandremainedthereforsixmonths.However,afewmonthsafterreturninghomeshebecameunwellagainandherparentstookhertohospitalwhereshewasreferredtotheNGOBasicNeeds.
AspartoftheBasicNeedscommunitybasedtreatment,Huzeimaattendedanoutreachclinicwhereshewasdiagnosedwithpsychosisandprescribedmedicationwhichhelpedimprovehercondition,bolsteredbythesupportHuzeimaandherfamilyreceivedfromaself-helpgroup.Huzeimasaid:“The group loaned me a small amount of money and with this I was able to buy food grains during the harvest season and sell it during the lean season. I was able to repay the loan and even made a small profit. I am back to life again”.
Theself-helpgroupalsoapproachedtheDistrictEducationDirectorrequestinghimtofindasuitableteachingpositionforHuzeima.AfterhearingthatHuzeimahaddroppedoutofteachertrainingduetoherillnessandwasdependentonherparents,theDirectorwasabletoofferheranon–professionalteachingpositionatalocalprimaryschool.
Today,HuzeimahasrecoveredandapartfromteachingsheisalsoSecretaryoftheNanumbaNorthDistrictAssociationofmentallyillpeopleandcarersinGhana,whosemainobjectiveistocoordinatetheactivitiesofself-helpgroupsintheNorthofGhanaandchampionissuesofmentalhealthandepilepsyinthedistrict.
Huzeima at a self-help group meeting in Ghana
Photo: BasicNeeds Ghana
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Despite the scale of the global mental health challenge, there is much that can be done to address it. Good evidence exists for a range of cost-effective, feasible interventions to improve the health and well-being of people affected by mental health problems, even in low and middle income countries.32 Many of these solutions are capable of ‘turning the world upside down’ - ideas developed in resource poor settings from which the UK could learn. The problem is not what to do, but mobilising the political will, finance and human resources needed to do it.
Theinternationalcommunityhasalreadyagreedthewayforwardforglobalmentalhealth.InMay2013,all194memberstatesoftheWHOratifiedtheMentalHealthActionPlan2013-2020.33Thiscommittedtheworldtoachievingfourobjectives,eachwithcorrespondingglobaltargetstobereachedby2020:
1. Tostrengtheneffectiveleadershipandgovernanceformentalhealth2. Toprovidecomprehensive,integratedandresponsivementalhealth
andsocialcareservicesincommunity-basedsettings3. Toimplementstrategiesforpromotionandpreventioninmentalhealth4. Tostrengtheninformationsystems,evidenceandresearchformentalhealth
TheWHOActionPlan,alongwiththeConventionoftheRightsofPersonswithDisabilities,representsahistoricopportunityforGovernmentstoactonmentalhealth.Asasignatory,theUKneedstoconsiderwhatitsroleinmeetingtheActionPlan’sgoalsshouldbe,andhowitcanequipitsconsiderableglobalhealthanddevelopmentsectorstomeettheseends.OnecriticalapproachwheretheUKisalreadyhavinganimpactisworkingdirectlywithgovernmentstosupportthemtodevelopeffectivenationallevelmentalhealthpoliciesandplans.34,35PerhapsthesinglemostimportantthinginensuringthatnationalgovernmentsandinternationaldonorsprioritisementalhealthforinvestmentwouldbetoincorporateatargetformentalhealthintotheHealthGoaloftheforthcomingSustainableDevelopmentGoals(SDGs).Aninternationalcampaigntoachievethisisalreadyunderway.36
Threebroadsolutionshavebeensuccessfullyimplementedinlowandmiddleincomecountries:preventingmentalhealthproblemsfromdeveloping;treatingthemthroughcareandsupport;andpromotingtherightsandrepresentationofpeoplewithmentalhealthproblems.Examplesofthesearedescribedbelow,althoughmanyprogrammesuseacombinationofallthreesolutions.
2. What solutions exist?
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Solution 1 Foster social and economic environments that promote mental wellbeing and prevent mental disorders from developing
Actioncanbetakentoimprovetheconditionsofdailylife,topromotementalwellbeingandpreventmentaldisordersdeveloping.Thisrequiresbroadinterventionsacrossmultiplesectors(e.g.environment,health,education,socialpolicy)andatmultiplelevels(family,community,national).37Examplesincludenationallevelpolicychangestorestricttheavailabilityofalcohol,suchasthosecurrentlybeingconsideredinMalawiandZambia,38andregulatorycontrolsontheimportandsaleoftoxicpesticidesinSriLankawhichresultedthenumberofsuicideshalvingovera10yearperiod.39
SomeofthisworkisalreadyhappeningthroughtheMillenniumDevelopmentGoals(MDGs).AlthoughmentalhealthisnotexplicitlymentionedintheMDGs,progresstowardsallofthesegoals(includingnon-healthgoalssuchasreducingextremepovertyandhunger,improvingeducation,andpromotinggenderequality)willhavepowerfuleffectsonpromotinggoodmentalhealthbyactingonthesocialdeterminantsofpoormentalhealth.37
Impactsofpovertyreductionprogrammesonmentalhealthcanbehardtopredictwithoutpurposefullymeasuringthem.Forexample,whilecashtransferstoparentsconditionalontheirchildattendingschoolhavebeenshowntoreducebehaviouralproblemsinchildren,somemicrocreditschemeshaveshownanegativeeffectonmentalhealth.40Trackingtheimpactofdevelopmentprogrammesonmentalhealthshouldberoutinepracticetoensuretheseimportanteffectsaretakenintoaccount,butthisisrarelydone.
ThereisanimportantopportunitytochangethisthroughthedraftingoftheSDGs,currentlyunderintensediscussionatagloballevelandexpectedtobefinalizedthroughtheUNin2015.Inadditiontoadvancingaglobalagendaofaccesstobasicmentalhealthserviceswithinhealthsystems,theSDGspresentarareandimportantopportunitytoalignactionaroundmetricsthatcapturewellbeingingeneral,aswellasspecificmentalhealthprioritiesforwhichcross-culturalmeasuresarewelldeveloped,suchasfordepression.
Promotionandpreventionstartswiththeearlyyears.Thereisrobustevidencefromhighincomecountriesthatgivingeverychildthebestpossiblestartwillgeneratethegreatestsocietalandmentalhealthbenefits.37Thereisgrowingevidencethatthesameistrueinlowandmiddleincomecounties,withsuccessfultrialsofinterventionsbycommunityhealthworkerspromotinggoodparenting,childnutritionandmaternalmentalhealthincountriessuchasJamaicaandPakistan.41Thereisalsogoodevidencethatschoolandcommunitybasedinterventionscanpromotementalwellbeingamongchildrenaged6-16yearsindevelopingcountries.42
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Solution 2 Expand access to community based treatment and care for people who do develop mental health problems
Despitethecommonlyheldbeliefthatimprovementsinmentalhealthrequiresophisticatedandexpensivetechnologiesandhighlyspecialisedstaff,therealityisthatmostmentaldisorderscanbetreatedbynon-specialiststaffwithoutanymedicalequipment.ThetreatmentofmentalhealthproblemshasbeenshowntobeascosteffectiveasotherhealthtreatmentssuchasantiretroviraldrugsforHIV/AIDS,andthereturnsoninvestmentsinmentalhealthareconsiderable.43Thesetreatmentsarealsoaffordable:ascaleduppackageofcareforepilepsy,depression,psychosisandharmfulalcoholuseinsub-SaharanAfricaandSouthAsiaisestimatedtocostUS$3-4percapita.44
In2008theWHOlauncheditsflagshipmhGAPprogramme.TheaimofmhGAPistoexpandaccesstoservicesinlowresourcesettingsbyprovidingevidencebasedguidelinesforthetreatmentofarangeofmentalhealthproblemsbynon-specialistsinprimarycareinlowresourcesettings.7mhGAPnowformsthebasisofmanycountriesnationaleffortstoscaleupmentalhealthservices,supportedbytheWHOandamplifiedbyspecialistsworkingdirectlywithgovernmentsandotherstakeholdersonsituationappraisalandpolicysupport.34
Projectsinlowresourcesettingshaveusedthreebroadstrategiestosuccessfullyintegratementalhealthintocommunitycare.Allthesestrategiessharethecommonthreadoflocallyadaptingsolutionstobeculturallyappropriate.Thefirstovercomestheshortageofmentalhealthspecialistsbytask-sharingwithothercadres:thesecanbegenericprimaryhealthcareworkers,dedicatedmentalhealthcommunityworkers,speciallytrainedlaypeople,orotherhealthprofessionalsequippedwithmentalhealthcareskills.Forexample,theKenyanMedicalTrainingCollegehastrainedover2000frontlinenursesandclinicalofficerswitha5daymentalhealthcontinuingprofessionaldevelopmentcourse.ThisamountstonearlyhalfofKenya’sprimarycarepublicsectorworkforce.Ithasalsorunsimilartrainingforsomeprivatesectorworkers,faithbasedorganisationsandprisonnurses.45TheKintampoProjectisaUKNon-GovernmentalOrganisation(NGO)whichworksinpartnershipwiththeGhanaianMinistryofHealthtotraintwonewcadresofcommunitymentalhealthworkerswhoprovideservicesinallregionsinGhana.46Theprojecthasincreasedthetrainednationalmentalhealthworkforcebyover90percent,resultinginatriplingofthenumberofpeopleinGhanareceivingtreatment.47
Thereisanestablishedbodyofevidencefromtrialsinlowandmiddleincomecountriesthatdemonstratestheeffectivenessoflayhealthworkerdeliveredpsychologicaltherapies.48Thesestrategiesarenowbeingadoptedbygovernments,suchasinthenewDistrictMentalHealthProgrammeinIndiawhichrecommendsanewcadreofcommunity-based,non-specialistmentalhealthworker.49Task-sharingisonlysuccessfulifdeliveredthroughahealthsystemsapproachincludingon-goingtrainingandprofessionaldevelopment,supportivesupervision,clearreferralpathwaystospecialistcare,andaclearroleforthenon-specialistwithinthehealthsystem.
HealthsystemstrengtheningformentalhealthiscurrentlybeinginvestigatedintheEmergingmentalhealthsystemsinlow-andmiddle-incomecountries(EMERALD)project,fundedbytheEuropeanCommission.EMERALDaimstoidentifykeyhealthsystembarriersto,andsolutionsfor,thescaled-updeliveryofmentalhealthservicesinlow-andmiddle-incomecountries,andbydoingsoenhancehealthsystemperformanceandimprovementalhealthoutcomesinafairandefficientway.50
17Mental Health for Sustainable Development
Thesecondstrategyinvolvesempoweringpeoplewithmentalhealthproblemstobeagentsofchange.Thereisnowglobalexperienceinthevalueofhavingpeoplewithmentalhealthproblemsinvolvedindevelopingservicesthatmeettheirneeds,andtobeinvolvedindeliveringthoseservices.HeartSoundsinUgandaengagespeersupportworkerswhoare‘expertsbyexperience’tosupportfellowserviceusersthroughengagingfamiliesandprovidingpsycho-education(seemaponpage20).51OtherexamplesincludeClubhouseInternationalwhichruns330communitycentresrunbyserviceusersin33countries,includinganumberoflowandmiddleincomecountries.52Theselean,service-userledmodelshavebeenshowntoworkequallywellinhighincomecountriessuchastheUSAandUK.
Healthservicemanagersmustalsobeempoweredtodefine,scale,andimprovecare,andtherehavebeenimportantadvancesinmakingavailableandapplyingQualityImprovement(QI)toolsforthispurpose.TheuseandspreadofgoodideasforhowtodelivercareoftenfailintheabsenceofgoodimplementationtoolsandQIhasbeenshowntobeeffectiveinfillingthatneedinthesesettingsforotherhealthconditions.53ThepotentialimpactofQImethodstohelpaccelerateadoptionofmhGAP-basedcareinverylowresourcedsettingsisbeingexploredthroughtheABillionMindsandLivesEarlyAdopterNetworkwhichlinksfundedprojectsscalingupprimarycareintegrationofmhGAP-basedcareacross5Sub-SaharancountrieswiththeInstituteforHealthcareImprovement,agloballeaderintheapplicationofQItohealthsystemsimprovement.54
Thethirdstrategyharnessesdevelopmentsin‘mHealth’:usingtechnologytoimproveaccesstocare.Telemedicineisaneffectivewaytoconnectpeoplewithscarcementalhealthspecialists,toincreaseaccesstoself-helptreatments,andtobuildthecapacityofthementalhealthworkforce.UseoftelemedicineisbeingsuccessfullyimplementedinTamilNaduinIndiawhereabuswithatele-psychiatryconsultationroomandamobilepharmacyvisitsruralareas.Atacostof£7perperson,theprojecthastreated1500peoplewithseverementaldisorders,70percentofwhomhavebeenreceivingtreatmentforoveroneyear.55Therearenumerouslow-cost,automatedpsychologicaltreatmentsforanxietyanddepressivedisordersdeliveredviatheinternetsuchasTHISWAYUP56whichhaveagrowingevidencebaseandhavegreatpotentialforincreasingaccesstopsychologicaltherapiesparticularlyinmiddleincomecountries.Technologyisalsobeingusedforcapacitybuilding,suchasintheeDataKprojectwhichusesfreelyavailablecomputer-basedcoursestotrainlargenumbersofprimaryhealthcareworkerstoidentifyandtreatalcoholusedisordersinKenya.57
“��Mental�health�needs�to�become�an�essential�part�of�our�approach�to�improving�primary�care,�strengthening�health�systems�and�achieving�universal�health�coverage”
Rachel Jenkins, Emeritus Professor of Epidemiology and International Mental Health, King’s College London
18 Mental Health for Sustainable Development
Solution 3 Advocate for the rights and representation of people with mental health problems, and for greater investment to improve access and services
Promotingmentallyhealthyenvironmentsandprovidingeffectiveandculturallyappropriatetreatmentandcarewillnothappenonthescaleneededtoaddressthecurrentcrisis,withoutincreasedinvestmentinmentalhealthindevelopingcountries.Forthistohappen,mentalhealthneedstobemorewidelyrecognisedasahumanrightandaneconomicandsocialpriority.58Thereisasmallbutgrowingnumberofservice-userledadvocacygroupsworkingincountriestoadvocateforimprovedservicesandcampaigningforchangestodiscriminatorylawsandpractices.ExamplesincludeKOSHISHinNepal59(seemaponpage20),andtheCentralGautengMentalHealthSocietyinSouthAfrica.60However,suchinitiativesarenotyetthenorminlowresourcesettings,andtheireffortsmustbeamplifiedthroughlinkageswithothersimilarinitiativesandbypolicysupportfromthehighestlevelwithinthecountrieswheretheyareworking.
Is global mental health culturally imperialist? Anon-goingdebateexistsoverwhetherimprovingaccesstomentalhealthinterventionsusedinhighincomecountriesmightdomoreharmthangood.Globalmentalhealthhasbeenlikenedto‘culturalimperialism’bysome-imposingWesterndiagnosesandtreatmentsontosocietieswithconflictingconceptionsofmentalhealth.Theseexternalinfluences,itissuggested,medicaliseandmedicatepeoplewithoutregardtoexistingsupportstructuresandlocalperspectives.61
Culturalappropriatenessisavitalpartoftheeffectivenessofmentalhealthinterventions,aspresentationofproblems,aswellaswhathelps,canvarybycontext.Thisisasharedproblemrelevanttomentalhealtheverywhere–betweendifferentlocalboroughsinonecity,asmuchasbetweendifferentcountries.
Thisdebatethereforeprovidesahelpfultensioninthefieldofglobalmentalhealth–challengingthoseworkinginlowandmiddleincomecountriestothinkdeeplyabouttheculturalappropriatenessofservices,theinvolvementofcommunities,wherelocalknowledgeandresourcesworkbest,andwhereoutsidesupportisneeded,andtocollaboratewithlocalexpertisetoresearchrelevantprotectiveandharmfulpsychosocialfactors.
Thechallengetowellmeaning,butill-consideredattemptstohelpiswelcome,butshouldnotleadtoinaction.Theexamplesquotedinthisreportshowhowknowledgeandskillsfromhighincomecontextsaredrawnuponandadaptedtomeetlocalneeds,consideringthecultureandresourcesofparticularlowincomecontextsthroughpartnershipswithlocalstakeholdersincludingserviceusers–andthatindoingsothereisequalopportunityformutuallearning.Someoftheseprogrammeshavethepotentialto‘turntheworldupsidedown’byprovidingimportantlessonsonhowtoaddressthelargeunmetneedformentalhealthcareintheUK.
19Mental Health for Sustainable Development
James’ story Reproduced with the kind permission of the Peter C. Alderman Foundation (PCAF).
JamesresidesintheKitgumdistrictinnorthernUganda.Helosthisfatherbeforehewasborn,andhismothersufferedfromguineaworm
infection.HewasabductedbytheLord’sResistanceArmyatage14,wherehewastrainedasasoldierandsenttoSudan.Hewasbeaten,starvedandforcedtokill,andescapedmanyhelicoptergunshipattacksandbombs.
AfterhisescapefromtheLRA,JameswasregisteredataPCAFclinicwherethesocialworkernoticedthathewouldnottalkorsmile.Hesufferedfromnightmares,lossofappetiteandhopelessnessaboutthefuture.Thesocialworkernoticedthathelikedtodrawandgavehimcrayonsandapapertotellhisstory.HeproduceddozensofextraordinarydrawingsofhisexperienceinthebushasasoldierwiththeLRA.
Inmonthsofintensivetreatment,Jamesopenedupandbegantoregainhislife.HehasbeenmakingartworkforPCAFeversince.Henowworksforagraphicdesignstudio,hasasafeplacetolivewithhiswifeandchild,andthroughananonymousdonor,hasafullrangeofartsupplies.
YoucanseeavideoofJamestalkingabouthisexperience,andseeagalleryofhiswork,onthePCAFwebsite
Photo: Cynthia MacDonald
20 Mental Health for Sustainable Development
Improving mental health globally
All of the projects and organisations highlighted in this report and on this map are profiled on the Mental Health Innovation Network in a growing database which currently hosts more than 85 innovative examples of best practice in mental health promotion, prevention and treatment from around the world.
TheCanadian Governmentis
fundingtheworld’slargestbodyofglobalmentalhealthresearchprojectsthroughGrand Challenges Canada.Theyhaveinvestedover£17millionin49projectsacrossthedevelopingworldsince2011,withprojectsincludingestablishingfamilynetworksforchilddevelopmentaldisordersinPakistan 62,expandingandstrengtheningmentalhealthservicesinprimarycareinHaitifollowingtheearthquake,63andusingindigenousnetworksforcasedetection,referralandfollow-upinUganda.64
TheIndonesian Ministry of Health
hasimplementedaprogrammeforthenation-wideeliminationoftheuseofphysicalrestraintstoprotectthehumanrightsofpeoplewithseverementalillness.Theyestimatethat18,800peopleinthecountryarecurrentlyrestrainedinthisway.Amulti-prongedapproachincludingensuringallocationofsufficientmentalhealthbudgets,providingcommunity-basedmentalhealthservicesandintensiveeducationcampaignshasresultedin3500peoplebeingreleasedfromchainssince2012.65
TheUKNGOBasicNeeds worksin
11countriesinAfricaandAsiatoempowerpeoplewithmentalhealthproblemslivinginpovertythroughcommunity-orientedtreatmentandself-helpsupport,addressingtheirmedical,socialandeconomicneeds.AsofJune2014,BasicNeedshasreachedover120,000peoplewithmentalillnessandover496,000carersandfamilymembers,atacostofapproximately£20peraffectedindividual.66
ThePRogramme for Improving Mental
health carE (PRIME)isapartnershipofresearchersandMinistriesofHealthfundedbyDFIDtodevelop,evaluateandscaleupdistrictlevelmentalhealthcareplansintegratingmentalhealthintoprimarycareinNepal,India,Ethiopia,UgandaandSouth Africa.Finalresultsareduein2017,butsofartheprojecthasinformednationallevelpolicychangesinfourofthefivecountries.67
21Mental Health for Sustainable Development
TheEthiopian Ministry of Health
hasmadesignificantprogresstowardsdevelopinganationalmentalhealthworkforcethroughtrainingprogrammesforallcadresofhealthworkersfrompsychiatrists,psychiatricnursesandcommunityhealthworkerstoPhDlevelmentalhealthresearchers.Todate115psychiatricpractitioners(MSclevel)and491psychiatricnurseshavebeentrained,andthenumberofpsychiatristshasincreasedfrom12to40withallbutthreeremaininginthecountry.68
ThePeter C. Alderman
Foundation (PCAF)workswithgovernmentsinUganda,KenyaandCambodiatoestablishtraumaclinicsdeliveredthroughpublic-privatepartnershipsinpost-conflictsettingsusingtrainedlayhealthworkersandoutreachservices.PCAF alsoopened thefirstmentalhealthWellnessClinicinLiberia.Morethan100,000survivorsofterrorismandmassviolencehavesofarbeentreatedbyPCAFatacostof£26perpatientperyear,withevaluationsshowingsignificantreductionsinsymptomsanddisabilityinindividualswhoreceivetreatment.69
InNepal,mentalillnessislegalgroundsfordivorce.
Asaresult,womenlivingwithmentalillnessarecommonlyabandonedonthestreetsbytheirhusbands.The National Mental Health Service User Organization KOSHISH,whichisrunbyserviceusers,providesemergencysupportforabandonedwomen,whilefightingdiscriminatorylawstoensurethattheirrightsareprotected.AfternearlyadecadeofadvocacybyKOSHISHandpartners,in2014thegovernmentcommittedtoestablishamentalhealthunittoaddressthementalhealthcareneedsofallpeoplelivingwithmentalillnessinNepal.59
TheButabika East London Linkisa
partnershipbetweenEastLondonNHSFoundationTrustandButabikaPsychiatricHospitalinUganda,fundedbytheTropicalHealthEducationTrustandDFID.70TheyhavedevelopedanumberofprogrammestoimprovementalhealthcareinUganda,includinghelpingtodevelopchildandadolescentmentalhealthservicesatthehospital,trainingPsychiatricClinicalOfficerswhoprovidemuchofthementalhealthservicesinruralUganda,andapartnershipwithHeartSoundsUgandatrainingpeer-supportworkerstoprovidecommunityoutreachservicestopeopledischargedfromthehospital.51
Improving mental health globally
22 Mental Health for Sustainable Development
UK government is doing more than most to address the challenge of global mental health and British institutions are slowly beginning to recognise the importance of this field. Still, mental health remains an afterthought in most of the UK’s global health and development work. Many excellent programmes exist, but they are isolated. The impact of the UK’s wider international development efforts to create stable, sustainable communities on mental health goes unmeasured.
Department for International Development
DFIDstandsoutasoneoftheonlynationalaidagenciestohaveaportfolioofworkfocussedonmentalhealth.71However,theseprojectsarelimitedinnumberandscope,comprisinglessthanonepercentofitsoverallhealthbudget.
DFID’smostnotableprogrammeisthe£6millionPRIMEresearchstudytodevelopandevaluatedistrictlevelmentalhealthcareplansinfivecountriesinAfricaandAsia(seemaponpage20).Inaddition,DFIDisfundinganumberofprojectsinindividualcountries,suchasinGhanawhere£7millionhasbeenallocatedoverfiveyearstosupportamixofdirectserviceimprovements(aBasicNeedsprogrammetoestablishcommunitymentalhealthcareandafaith-basedreferralsystemsprojectwiththeChristianHealthAssociationofGhana)andpolicydevelopment(assistingGhana’snewlyestablishedMentalHealthAuthority).DFIDisalsoleadingworkonmentalhealthincrisissituations,forexampledevelopingtechnicalguidanceforadviserstoprovidepsychosocialsupportfollowinghumanitariandisasters.
NGOs and others working in international development
MentalhealthisconspicuouslyabsentfromtheUK’svibrantglobalhealthNGOsector,potentiallylimitingtheimpactoftheirdevelopmentprogrammesthroughignoringthecriticalmissingpieceofsustainabledevelopment:mentalhealth.Fewofthemajorhealthcharitiescontactedcouldnameanyprojectswhichaimedtoimprovementalhealthinlowandmiddleincomecountries,orwherementalhealthimpactsofdevelopmentprogrammeswerebeingmeasured.Thislackwaslargelyseenasfunding-driven–mentalhealthwasnotsomethingthatdonorswouldreadilysupportoverotherdiseaseareas.ItisalsopossiblethatpublicstigmaintheUKmeansfundraisingformentalhealthismorechallenging.
ExceptionsexistintheformofasmallnumberofUKNGOswhodoincludementalhealthaspartoftheirwiderwork,includingVSO,InternationalMedicalCorpsandtheTropicalHealthEducationPartnership.ThereisanevensmallernumberofrelativelysmallbuthighlyregardedUKNGOswhoworkexclusivelyonmentalhealth,includingBasicNeedsandMindsforHealth.MindsforHealthformspartnershipswithexistingorganisationsindevelopingcountriestoimproveaccesstomentalhealthcareandtacklethesocialcausesandconsequencesofmentalhealth.BasicNeeds’lean,communitybasedapproachtoimprovingthelivesandlivelihoodsofpeoplewithmentalhealthproblemsacross11countriesisfeaturedonthemap(page20).
3. The UK’s current contribution to global mental health
23Mental Health for Sustainable Development
Academic institutions
UKuniversitiesandresearchfundingbodiesaremakingsomesignificantcontributionstoourunderstandingofglobalmentalhealth.Inparticular,theUKhostsoneoftheworld’sleadingresearchhubsinthefield:theCentreforGlobalMentalHealth,acollaborationbetweentheLondonSchoolofHygiene&TropicalMedicineandKing’sHealthPartnersAcademicHealthScienceCentre.
Intermsofresearchfunding,mostofthemajorUKresearchfunderscannameasmallnumberofglobalmentalhealthprojectstheysupport.TheMedicalResearchCouncil,theWellcomeTrustandtheEconomicandSocialResearchCouncilfundavarietyofresearchprojectsinlowandmiddleincomecountries,includingthesocialdeterminantsofmaternalmentalhealth,trialsformentalhealthinterventions,andstudiestounderstandthementalhealthofHIVpositivechildren.ThereisapromisingdevelopmentintheformationanewUKcharity,MQ:TransformingMentalHealth,thoughtodatetheyhavenotfundedanyresearchinlowandmiddleincomecountries.
NeuroscienceisamajorareaofinvestmentforseverallargeUKresearchfundinginstitutions.Althoughthisworkcouldultimatelyleadtobreakthroughsinmentalhealthtreatments,littleofthisresearchisalignedwiththeprioritiesoflowandmiddleincomecountries,andthetreatmentsthatresultarelikelytobeoutofreachformanyhealthsystems.
NHS
TheNHShasalsobeencontributingtoimprovingglobalmentalhealththroughanumberofpartnershipswithgovernmentsandprovidersinlowandmiddleincomecountries.NHSmentalhealthtrustsoperatelinksthroughtheDFID-fundedHealthPartnershipsScheme.Thesepartnershipslargelyfocusontrainingspecialist,non-specialistandlaymentalhealthworkersinordertoexpandaccesstocareinthepartnercountry.Onesuchlink,betweentheEastLondonNHSFoundationTrustandtheButabikaPsychiatricHospitalinUganda(seemaponpage20)hasdemonstratedthemutualvalueofthesepartnerships:Butabikanowhasmanymoretrainedmentalhealthworkerstodelivercare,whiletheNHSstaffinvolvedhavehelpedtoexperienceandadaptnewapproaches–suchasnarrativetherapy–thatarenowsuccessfullybeingusedwithlocalcommunitiesinEastLondon.
UK’s biggest contributions go unnoticed
TheprogrammesnotedabovegiveasnapshotofthecurrentUKactivitiesthatexplicitlyaimtoimprovementalhealthindevelopingcountries.Thegreatestcontributionstothisfieldwillnothoweverbethesededicatedprojects,butthemuchlargerglobalhealthanddevelopmentworkofBritishgovernment,charities,companiesandinstitutions.Assection1outlined,economicempowerment,goodphysicalhealth,security,equalityandhumanrightscanallhaveahugelybeneficialimpactonmentalhealth.ThereareamultitudeofsuchprogrammesacrossallsectorsoftheUK,butthementalhealthimpactsoftheseprojectscurrentlygounmeasured–despitesimple,cheapandwellvalidatedtoolstocapturethis.Thismeanswedonotknowwhatworks,orhowtofactormentalhealthbenefitsintoresourceallocationdecisions.Incorporatingthesetoolsintoon-goingandfutureprojectsrunbyDFID,NGOsandUKresearchwouldbeasimplechangethatwillprovideawealthofinformationaboutthetypesofprojectsthatarehavingpositivementalhealthoutcomes.
“��Frankly,�mental�health�is�not�an�attractive�subject�to�many�funders:�it’s�complex�and�there’s�a�lack�of�knowledge�about�the�extent�and�urgency�of�the�problem”
Chris Underhill, Founder Director, BasicNeeds
24 Mental Health for Sustainable Development
Mental health problems must be tackled to achieve sustainable development. This report recommends four key steps to achieve this. Our major health and development institutions must do more and act differently: thinking about mental health in all that they do, measuring mental health impacts of existing programmes and showing global leadership.
Recommendation 1
TheDepartmentforInternationalDevelopment(DFID)to‘integrate’‘evaluate’and‘replicate’globalmentalhealthinitsprogrammesinordertosupportcountriestoimplementtheWHOActionPlan
IntegrateDFIDshouldconducta‘mentalhealthinallpolicies’reviewtoassesswhereandhowmentalhealthcouldbeintegratedintoitsexistingwork.Inparticular,itshouldseektocometoaclearanddetailedviewofitsroleinhelpingcountriesachievetheWHOMentalHealthActionPlanobjectives.Itshouldalsoconsidercost-effectiveinvestmentsthataimatbroadersystemsstrengtheningalongthekeyareasemphasizedheresuchason-goinginfrastructuresfortrainingandmaintainingatask-sharingandcommunity-basedworkforce,capabilitiesforsmartuseofmobilehealthtechnologies,qualityimprovementmethods,empowermentandcommunitymobilization
EvaluateAsafirststep,DFIDshouldincorporatementalhealthimpactmetricsintoitsexistingprogrammesthatarelikelytobehavingasignificantimpactonmentalhealth(suchaspovertyreductionandgenderequalityprojects).ValidatedmeasuresarenowwidelyavailableandwouldbeaminimaladditionalburdenforrelevantDFIDfundedprojectstoadopt.ThiswillallowDFIDtobuildupamuchbetterpictureofwhereitisalreadymakingadifference
ReplicateAsDFID’sexistingmentalhealthinitiativesmatureandshowsuccessfuloutcomes,itshouldcommittoscalingupandadaptingtheseevidence-basedapproachestomuchlargergeographicareas.Thisshouldbedeliveredwithanappropriateincreaseinfundingforbothcivilsocietyandgovernments
TheUKhasrecognisedtheneedforacomprehensiveglobalstepchangeinthesupportformentalhealthavailableinlowandmiddleincomecountries.Thisincludesscale-upofcommunitybasedservices,strengthenedleadershipandgovernance,moreresearch,andsystemsforpromotionandpreventioninmentalhealth.
AlthoughDFIDisalreadydoingmorethanmostdevelopmentagenciesonthesepriorities,theinitiativesoutlinedintheprevioussectionappeartobeisolatedwithintheDepartment’sportfolio.ThisreviewfoundtheretobenocoherentorstrategicunderstandingofhowmentalhealthshouldfactorintoDFID’swiderhealthanddevelopmentwork.
4. Doing more and acting differently
25Mental Health for Sustainable Development
Thisreportisnotthefirsttomakethisobservation.TherecentInternationalDevelopmentCommitteeinquiryintodisabilityanddevelopmentnotedthedisproportionatelylowlevelofDFIDspendingonmentalhealth,andthelimitedgeographicalcoverageofthiswork.71
ItrecommendedthatDFID“thoroughlyappraisethecase”forspendingmoreonmentalhealthandexplainitsreasonsifitdecidesagainstincreasingfunding.TheDepartment’sresponsetothiswasinsufficient,statingthatits“focusisonensuringthatthisisincludedinourworkonhealthsystemsstrengthening”withoutgivingdetailastohow.71ThethreespecificactionsrecommendedbythisreportwouldimproveDFID’sunderstandingandstrategicresponsetotheglobalmentalhealthchallenge.
Recommendation 2
NGOsandothersworkingininternationaldevelopmentshouldsupportstafftounderstandtheneedsandcapacitiesofpeoplewithmentalhealthproblems,encouragetheinclusionofpeoplewithmentaldisordersintheirgeneraldevelopmentprogrammes,setupnewmentalhealthspecificprogrammes,andmeasuretheimpactoftheirprogrammesonmentalhealth
Sustainabledevelopmentwillnotbeachievedifthehugechallengeofmentalhealthisnotaddressed.ThisrequiresexistingNGOsandothersworkingininternationaldevelopmentwhodonotcurrentlyaddressmentalhealthtoincorporatementalhealthpreventionandpromotionprogrammesintotheirwork,andmeasurethementalhealthimpactsofexistingprogrammestounderstandtheireffectondevelopment.AsignificantbarriertoachievingthisisthelackofspecialistexpertiseinmentalhealthwithintheNGOsectorwhichmeansthatpeoplewithmentalhealthproblemsareeitherexcludedfromprogrammesorincludedunderthedisabilitybannerinonlyacursoryway.InternationalinitiativessuchastheMentalHealthandPsychosocialSupportnetworkandtheMentalHealthInnovationNetworkwhichprovideexpertsupport,informationsharingandcapacitybuildingmaterials,alongwithexistingmentalhealthNGOssuchasBasicNeeds,canbetappedtoincreasetheexpertiseofNGOstaff.
Recommendation 3
Professionalbodiesandmentalhealthproviders,withthesupportofgovernment,shouldestablishandexpandtrainingandresearchpartnershipswithlowandmiddleincomecountries–seekingtoteachandtolearnprofessionalandimplementationskills,tacklingdiscriminationandpolicyreform
TheUKcanmakealargecontributiontomentalhealthinlowandmiddleincomecountriesbysharingitsknowledgeandskills.Conversationswithmentalhealthleadersinresource-constrainedsettingsrevealedacriticalshortageoftrainingresourcestodevelopskilledspecialist,non-specialistandlaymentalhealthworkers.Britishassistancewouldbehighlyvaluedin:
Trainingofexistingprimarycareworkersinmentalhealth Continuingprofessionaldevelopmentofmentalhealthstaff Communicationsexpertisetoincreasepublicawareness,promote
self-helpstrategies,andtacklediscrimination Legalandpolicyreforms IntegrationofmentaldisordersintoHealthManagementInformationSystems
“��It�is�important�not�to�have�a�situation�where�different�health�issues�are�simply�competing�for�the�same�finite�resources.�Building�strong�health�systems�that�see�the�person�as�a�whole,�recognising�mental�and�physical�health�is�really�important.”
Jane Edmondson, Health of Human Development, Department for International Development
26 Mental Health for Sustainable Development
NotonlydoestheUKhavestrengthintheseareas,butcruciallyitalsohasthelinkstomakethesepartnershipshappen.MentalhealthstaffintheUKareevenmoreinternationalinbackgroundthanthegeneralNHSworkforce.Psychiatry,forexample,isthethirdmostinternationalmedicalspecialtyintheNHS.72Forthreecountries(allrecipientsofDFIDfunds)theUKemploysmorepsychiatristsfromthatcountrythanremainthere–Nigeria(214-114),Zambia(9-2)andMalawi(1-0).73TheseDiasporalinksofferanimportantuntappedresourcetheUKcouldusetogivebacksomeofwhatwehavegained.
Astheprevioussectionhighlighted,theUKalsobenefitsfrommentalhealthpartnerships.TherecentTurningtheWorldUpsideDown(www.ttwud.org)awardsshowstheNHShasmuchtolearnfromlowandmiddleincomecountriesaboutimprovingthehealthandlivesofpeoplewithmentaldisorders.The34projectsshowhowinnovativeapproachesbeingtakeninlowresourcesettingsofferideasandinitiativesthatBritaincouldadoptandadapt.ParticularattentionshouldbegiventopartnershipswithpartsoftheworldwheretheUKhassignificantDiasporacommunities,sinceoutcomesforblackandethnicminoritieswithmentalhealthproblemsinBritainaresignificantlyworsethanforwhiteBritishserviceusers.Developingandlearningfrominnovativesolutionsincommunities’culturesoforiginmaybeonewayofachievingthis.
Recommendation 4
TheUKshouldlobbyfortheinclusionofthefollowingmentalhealthtargetwithintheHealth Goalin the SustainableDevelopmentGoals.
“Theprovisionofmentalandphysicalhealthandsocialcareservicesforpeoplewithmentaldisorders,inparitywithresourcesforservicesaddressingphysicalhealthandworkingtowardsuniversalcoverage.”
Theworldlacksaneffectivearchitecturetosupportglobalactiononmentalhealth,partlyduetotheexclusionofmentalhealthfromtheMDGs.TheWHOhasgiveninvaluablesupporttomanylowandmiddleincomecountriesinrecentyears,includingtheMentalHealthActionPlan.However,thiscommitmentisnotattachedtoanysignificantlevelsoffundingforexpandedservices.
Anumberofsignificantopportunitiestoaddressthisgapexistinthenearfuture.TheseincludetheWorldBankandWHOhighlevelmeetingondepressioninAutumn2015,andfurthermilestonesinthedevelopmentandimplementationoftheSustainableDevelopmentGoals.TheUKwillhaveakeyroleinbothofthesesummits,andshouldcallinternalmeetingswithingovernmentwellinadvancetocometoaclearUKpositiononwhatshouldbedonetostrengthentheglobalarchitecturesupportingmentalhealth.TheUKshouldnotmissthisopportunitytoleadthesechanges,andinparticulartoensurethananynewinitiativesareprincipallygovernedbyandforlowandmiddleincomecountries.
PerhapsthesinglemostimportantthinginensuringthatnationalgovernmentsandinternationaldonorsprioritisementalhealthforinvestmentwouldbetoincorporateanadditionaltargetformentalhealthintotheHealthGoaloftheforthcomingSustainableDevelopmentGoals(SDGs).Thistargetmustexplicitlyseekparityofesteembetweenphysicalandmentalhealth,workingtowardstheultimategoalofuniversalcoverage.Toachievethis,countrieswillneedtosetthemselvesatransitionplantoincreasecoverageoverarealistictimeframe,includingthecollectionofrelevantlocaloutcomeindicatorssuchasmentalhealthdiagnosesrecordedinprimaryhealthcare,whichcanbeusedtotrackprogressovertime.
27Mental Health for Sustainable Development
1. Whiteford,H.A.,L.Degenhardt,J.Rehm,etal.,Globalburdenofdiseaseattributabletomentalandsubstanceusedisorders:findingsfromtheGlobalBurdenofDiseaseStudy2010.Lancet,2013.382(9904):p.1575-1586.
2. Bloom,D.E.,E.T.Cafiero,E.Jane-Llopis,etal.,Theglobaleconomicburdenofnon-communicablediseases.2011,WorldEconomicForum:Geneva.
3. WHO,MentalHealthAtlas.2011,WorldHealthOrganization:Geneva.
4. WHO,MentalHealthandDevelopment:Targetingpeoplewithmentalhealthconditionsasavulnerablegroup.2010,WorldHealthOrganization:Geneva.
5. ForesightMentalCapitalandWellbeingProject,MentalCapitalandWellbeing:Makingthemostofourselvesinthe21stcentury.2008,TheGovernmentOfficeforScience:London.
6. WHO,Mentalhealth:strengtheningourresponse.2014,WorldHealthOrganization:Geneva.
7. WHO,mhGAPMentalHealthGapActionProgramme:Scalingupcareformental,neurologicalandsubstanceusedisorders.2008,WorldHealthOrganization:Geneva.
8. UnitedNations,Worldpopulationprospects–the2010revision.2011,UnitedNations:NewYork.
9. Murray,C.,T.Vos,R.Lozano,etal.,Disability-adjustedlifeyears(DALYs)for291diseasesandinjuriesin21regions,1990-2010:asystematicanalysisfortheGlobalBurdenofDiseaseStudy2010.TheLancet,2012.380:p.2197-223.
10. Patel,V.,SaxenaS,M.DeSilva,etal.,TransformingLives,EnhancingCommunities:InnovationsinMentalHealth,inWorldInnovationSummitforHealth.2013,QatarFoundation:Qatar.
11. Thornicroft,G.,Physicalhealthdisparitiesandmentalillness:thescandalofprematuremortality.BrJPsychiatry,2011.199(6):p.441-442.
12. Teferra,S.,T.Shibre,A.Fekadu,etal.,Five-yearmortalityinacohortofpeoplewithschizophreniainEthiopia.BMCPsychiatry,2011.11:p.165.
13. Wahlbeck,K.,J.Westman,M.Nordentoft,etal.,OutcomesofNordicmentalhealthsystems:lifeexpectancyofpatientswithmentaldisorders.BrJPsychiatry,2011.199:p.453–8.
14. WHO.SuicidePrevention.2013Availablefrom:http://www.who.int/mental_health/prevention/en/.
15. GenevaDeclarationSecretariat,GlobalBurdenofArmedViolence2011:LethalEncounters.2011,Cambridge:CambridgeUniversityPress.
16. Cavanagh,J.,A.Carson,M.Sharpe,etal.,Psychologicalautopsystudiesofsuicide:asystematicreview.PsycholMed,2003.33(3):p.395-405.
17. Thornicroft,G.,Prematuredeathamongpeoplewithmentalillness.BritishMedicalJournal,2013.346.
18. Shonkoff,J.,T.Boyce,andB.McEwen,Neuroscience,molecularbiology,andthechildhoodrootsofhealthdisparities:buildinganewframeworkforhealthpromotionanddiseaseprevention.JAMA,2009.301(21):p.2252-2259.
19. WHO,Investinginmentalhealth:evidenceforaction.2013,WorldHealthOrganization:Geneva.
20. WHO,Promotingmentalhealth:concepts,emergingevidence,practice.2005,WorldHealthOrganization:Geneva.
21. Lasalvia,A.,S.Zoppei,T.VanBortel,etal.,Globalpatternofexperiencedandanticipateddiscriminationreportedbypeoplewithmajordepressivedisorder:across-sectionalsurvey.TheLancet,2013.381(9860):p.55-62.
22. Thornicroft,G.,E.Brohan,D.Rose,etal.,Globalpatternofexperiencedandanticipateddiscriminationagainstpeoplewithschizophrenia:across-sectionalsurvey.TheLancet,2009.373(9661):p.408-15.
23. TimetoChange.MentalHealthStigmaMap.Availablefrom:https://www.time-to-change.org.uk/sites/default/files/imce_uploads/mental-health-stigma-map.PNG.
24. Pathare,S.andJ.Sagade,Mentalhealth:alegislativeframeworktopower,protectandcare.AreviewofmentalhealthlegislationinCommonwealthMemberStates.2013,CentreforMentalHealthLaw&Policy,IndianLawSociety:Pune,India.
25. Kleinman,A.,Afailureofhumanity.TheLancet,2009.374:p.603-604.
26. Hammond,R.Condemned:MentalhealthinAfricancountriesincrisis.2013.Availablefrom:http://www.robinhammond.co.uk/condemned-mental-health-in-african-countries-in-crisis/.
27. Utami,D.,IndinesiaBebasPasung(FreeFromRestraints)program,inMovementforGlobalMentalHealth:3rdSummit.2013:Bangkok,Thailand.
References
28 Mental Health for Sustainable Development
28. Kakuma,R.,H.Minas,N.vanGinneken,etal.,Humanresourcesformentalhealthcare:currentsituationandstrategiesforaction.Lancet,2011.378(9803):p.1654-63.
29. Ormel,J.,M.Petukhova,S.Chatterji,etal.,Disabilityandtreatmentofspecificmentalandphysicaldisordersacrosstheworld.BritishJournalofPsychiatry,2008.192:p.368-375.
30. Wang,P.S.,S.Aguilar-Gaxiola,J.Alonso,etal.,Useofmentalhealthservicesforanxiety,mood,andsubstancedisordersin17countriesintheWHOworldmentalhealthsurveys.TheLancet,2007.370(9590):p.841-850.
31. GlobalBurdenofDiseaseData2010.Availablefrom:http://www.healthmetricsandevaluation.org/search-gbd-data.
32. Patel,V.,R.Araya,S.Chatterjee,etal.,Treatingandpreventingmentaldisordersinlowandmiddleincomecountries-isthereevidencetoscaleup?TheLancet,2007.370(9591):p.991-1005.
33. WHO,ComprehensiveMentalHealthActionPlan2013-2020.Sixty-SixthWorldHealthAssembly.ResolutionWHA66/8.2013,WorldHealthOrganization.
34. Mbatia,J.andR.Jenkins,DevelopmentofamentalhealthpolicyandsysteminTanzania:anintegratedapproachtoachieveequity.PsychiatricServices2010.61(10):p.1028-1031.
35. Jenkins,R.,A.Heshmat,A.Loza,etal.,ResearchMentalhealthpolicyanddevelopmentinEgypt-integratingmentalhealthintohealthsectorreforms2001-9.IntJMentHealthSyst.,2010.4(17).
36. Thornicroft,G.andV.Patel(2ndSept2014)WhyismentalhealthsuchalowpriorityfortheUN?TheGuardian
37. WorldHealthOrganizationandCalousteGulbenkianFoundation,Socialdeterminantsofmentalhealth.2014,WorldHealthOrganization:Geneva.
38. UnitedNationsDevelopmentProgramme,Addressingthesocialdeterminantsofnon-communicablediseases.2013:NewYork.
39. PesticideregulationtopreventsuicidesinSriLanka.Availablefrom:http://mhinnovation.net/innovations/pesticide-regulation-suicide-prevention.
40. Lund,C.,M.J.DeSilva,S.Plagerson,etal.,Povertyandmentaldisorders:breakingthecycleinlow-incomeandmiddle-incomecountries.TheLancet,2011.378(9801):p.1502-1514.
41. Rahman,A.,J.Fisher,P.Bower,etal.,Interventionsforcommonperinatalmentaldisordersinwomeninlowandmiddleincomecountries:asystematicreviewandmeta-analysis.BullWorldHealthOrgan.,2013.1;91(8):p.593-601.
42. Barry,M.,A.Clarke,R.Jenkins,etal.,Asystematicreviewoftheeffectivenessofmentalhealthpromotioninterventionsforyoungpeopleinlowandmiddleincomecountries.BMCPublicHealth,2013.13(1):p.835.
43. Hyman,S.,D.Chisholm,R.Kessler,etal.,MentalDisorders,inDiseaseControlPrioritiesinDevelopingCountries,T.Jamison,Editor.2006,OxfordUniversityPress:NewYork.
44. Chisholm,D.andS.Saxena,Costeffectivenessofstrategiestocombatneuropsychiatricconditionsinsub-SaharanAfricaandSouthEastAsia:mathematicalmodellingstudy.BritishMedicalJournal,2012.344:p.e609.
45. Jenkins,R.,D.Kiima,F.Njenga,etal.,IntegrationofmentalhealthintoprimarycareinKenya.WorldPsychiatry,2010.9(2):p.118-120.
46. TheKintampoProject,Ghana.Availablefrom:http://mhinnovation.net/innovations/kintampo-project.
47. Roberts,M.,J.Asare,B,C.Mogan,etal.,ThementalhealthsysteminGhana:WHOAIMSreport.2013,TheKintampoProject&MinistryofHealth,RepublicofGhana.
48. vanGinneken,N.,P.Tharyan,S.Lewin,etal.,Non-specialisthealthworkerinterventionsforthecareofmental,neurologicalandsubstance-abusedisordersinlowandmiddle-incomecountries.CochraneDatabaseofSystematicReviews,2013.11.
49. Patel,V.,Legistlatingtherighttomentalhealthcare.EconomicandPoliticalWeekly,2013.48(9):p.73-77.
50. Emergingmentalhealthsystemsinlow-andmiddle-incomecountries(EMERALD)project.Availablefrom:http://mhinnovation.net/innovations/emerald.
51. HeartSoundsUganda.Availablefrom:http://mhinnovation.net/innovations/heartsounds-peer-support.
52. ClubhouseInternational.Availablefrom:http://mhinnovation.net/innovations/clubhouse.
53. Franco,L.andL.Marquez,Effectivenessofcollaborativeimprovement:evidencefrom27applicationsin12less-developedandmiddle-incomecountries.BMJQuality&Safety,2011.20(8):p.658-65.
54. Belkin,G.,J.Unutzer,R.Kessler,etal.,Scalingupforthe“bottombillion”:“5x5”implementationofcommunitymentalhealthcareinlow-incomeregions.PsychiatrServ.,2011.62:p.1494-1502.
55. Tele-psychiatryinPuddukottai(STEP).Availablefrom:http://mhinnovation.net/innovations/scarf-tele-psychiatry-puddukottai-step.
56. THISWAYUP.Availablefrom:http://mhinnovation.net/innovations/way.
29Mental Health for Sustainable Development
57. eDataK.Availablefrom:http://mhinnovation.net/innovations/e-data-k.
58. DeSilvaM,J.,C.Samele,V.Patel,etal.,Policyactionstoachieveintegratedcommunity-basedmentalhealthservices.HealthAffairs,2014.33(9).
59. KOSHISH,Nationalmentalhealthselfhelporganization,Nepal.Availablefrom:http://mhinnovation.net/organisations/koshish-national-mental-health-self-help-organization.
60. CentralGautengMentalHealthSociety,SouthAfrica.Availablefrom:http://mhinnovation.net/organisations/central-gauteng-mental-health-society.
61. Summerfield,D.,HowScientificallyvalidistheknowledgebaseofglobalmentalhealth.BMJ,2008.336:p.992-4.
62. FANSforkids,Pakistan.Availablefrom:http://mhinnovation.net/innovations/fans-kids-project.
63. Expansionofanewimplementationmodelforseverementaldisorders.Availablefrom:http://mhinnovation.net/innovations/expansion-new-implementation-model-severe-mental-disorders.
64. WayoNeroStrategy,Uganda.Availablefrom:http://mhinnovation.net/innovations/wayo-nero-strategy.
65. ChainFreePasungprogramme,Indonesia.Availablefrom:http://mhinnovation.net/innovations/chain-free-pasung-program.
66. BasicNeeds.Availablefrom:http://mhinnovation.net/innovations/basic-needs.
67. PRIME:PRogrammeforImprovingMentalHealthcarE.Availablefrom:http://mhinnovation.net/innovations/prime-programme-improving-mental-health-care.
68. NationalCapacityBuildingProgrammeEthiopia.Availablefrom:http://mhinnovation.net/innovations/national-capacity-building-program-ethiopia.
69. PeterC.AldermanFoundationTraumaClinics.Availablefrom:http://mhinnovation.net/innovations/peter-c-alderman-trauma-clinics.
70. ButabikaEastLondonLink.Availablefrom:http://mhinnovation.net/organisations/butabika-east-london-link.
71. HouseofCommonsInternationalDevelopmentCommittee,DisabilityandDevelopment.2014,StationaryOffice:London.
72. GeneralMedicalCouncil,ThestateofmedicaleducationandpracticeintheUK.2014:London.
73. JenkinsR,KyddR,M.MullenP,etal.,AnInternationalmigrationofdoctors,anditsimpactonavailabilityofpsychiatristsinlowandmiddleincomecountries.PLoSONE,2010.5(2).
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Those who gave oral evidence to the review:
GaryBelkin NewYorkCityDepartmentofHealthandMentalHygieneJaneEdmondson DepartmentforInternationalDevelopmentKenGrant HLSPRachelJenkins King’sCollegeLondonVikramPatel LondonSchoolofHygiene&TropicalMedicineGrahamThornicroft King’sCollegeLondonChrisUnderhill BasicNeeds
Those who submitted written evidence or were interviewed individually:
NatashaAbrahams BasicNeedsDaveBaillie EastLondonNHSFoundationTrustDineshBhugra WorldPsychiatricAssociationPatBracken WestCorkMentalHealthServiceCatherineCampbell LondonSchoolofEconomicsMaryChambers KingstonUniversitySarahCotton InternationalCommitteeoftheRedCrossBhargaviDavar CentreforAdvocacyandMentalHealth,IndiaSubodhDave BritishAssociationofPhysiciansofIndianOriginMatrikaDevkota KOSHISH,NepalHervitaDiatri UniversityofIndonesiaVictorDoku MentalHealthEducatorsintheDiasporaRowanEl-Bialy MemorialUniversityofNewfoundlandConorFarrington UniversityofCambridgeSumanFernando LondonMetropolitanUniversityMichelleFunk WorldHealthOrganizationJaneGilbert DepartmentforInternationalDevelopmentRexHaigh BerkshireHealthcareNHSFoundationTrustCharlotteHanlon AddisAbabaUniversity,EthiopiaGregHarrison SheffieldTeachingHospitalsNHSFoundationTrustPeterHughes RoyalCollegeofPsychiatristsJillIllife CommonwealthNursesFederationDavidIngleby UniversityofAmsterdamSumeetJain UniversityofEdinburghJanakaJayawickrama UniversityofYorkIanB.Kerr CoathillHospital,ScotlandJayasreeKalathil SurvivorResearchValentinaLemmi LondonSchoolofEconomicsBlakeleyLowry PeterC.AldermanFoundationJohnMayeya MinistryofHealth,ZambiaPollyMeeks NationalAuditOfficeHughMiddleton UniversityofNottinghamAkimMogaji NewMediaNetworksMatthewMuijen WorldHealthOrganizationEuropeMahmoudMussa MinistryofHealth,ZanzibarSamuelOkpaku CentreforHealth,CultureandSociety,USAMilenaOsorio InternationalCommitteeoftheRedCrossNimishaPatel UniversityofEastLondonSoumitraPathare CentreforMentalHealthLawandPolicy,IndiaAlisonPavia PeterC.AldermanFoundationAlbertPersaud CareIfMargreetPeutz CentralandNorthWestLondonNHSFoundationTrustSabahSadik MinistryofHealth,IraqAbegailSchwarz ProgrammeforImprovingMentalHealth(PRIME)MortenSkovdal UniversityofCopenhagenR.Srivatsan AnveshiResearchCentreforWomen’sStudies,IndiaDerekSummerfield King’sCollegeLondonPhilThomas UniversityofBradford
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SamiTimimi UniversityofLincolnRossWhite UniversityofGlasgowMaureenWilkinson CheshireandWirralPartnershipNHSFoundationTrustTedlaWolde-Giorgis MinistryofHealth,EthiopiaAdrianWorrall RoyalCollegeofPsychiatrists
Parliamentarians who took part in this review:
PeterBottomleyMPLordCrisp(Reviewco-chair)ViscountEcclesMegHillierMPBaronessMashamJamesMorrisMP(Reviewco-chair)LordPatelLordRibeiro
This review was funded by the All-Party Parliamentary Group on Global Health, who would like to thank their supporting organisations:
Bill&MelindaGatesFoundationCambridgeUniversityHealthPartnersImperialCollegeLondonInstituteforGlobalHealthInnovationKing’sHealthPartnersTheLancetLondonSchoolofHygiene&TropicalMedicineManchesterAcademicHealthScienceCentreUniversityCollegeLondonGrandChallengeofGlobalHealthUniversityofOxford
Des
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32 Mental Health for Sustainable Development
All-PartyParliamentaryGroup(APPG)onGlobalHealthOfficeofLordCrisp,FieldenHouse,13LittleCollegeSt,London,SW1P3SH
+44(0)[email protected]
www.appg-globalhealth.org.uk
All-PartyParliamentaryGroup(APPG)onMentalHealthMrJamesMorrisMP,HouseofCommons,LondonSW1A0AA.
+44(0)[email protected]
November2014