Depression and anxiety are linked to happiness and there’s plenty that can be done from a young age

In the last blog, I talked about the World Happiness Report 2013 and began to explore the links between mental health and happiness. I want to explore this in further detail here, to examine the issues which effect happiness in an individual’s life and the implications of positive mental health on these indicators. As I mentioned in the earlier post, and as the Happiness Report 2013 clarifies, mental illness is the “single biggest determinant of misery.” While the prevalence of the problems varies between countries, at any given time, around 10 percent of the world’s population suffers from some kind of mental illness. Among all the mental illnesses, depression and anxiety are most common—accounting for about a fifth of all disability globally. Naturally, this has an incredible effect on the output of individuals, societies, countries and globally! And as we’ve heard so many times before, people are not receiving treatment for these illnesses for which cost-effective treatments exist—not even in the richest of countries!

 

For depression and anxiety disorders, evidence-based treatments can have low or zero net cost, according to not only the latest Happiness Report, but a host of professionals working in the field. They can and should be made far more universally available. However, these are all post-illness measures and the majority of interventions have focused too heavily on tackling the issues surrounding mental ill health at a later stage in life, when illnesses have been brewing and developing for years.

 

But in order to successfully make the case for childhood intervention, a paradigm shift is required which would look to establish mental health as intrinsically linked to personal happiness and not just a medical illness. That is what the World Happiness Report seeks to do precisely, by pointing out that “schools and workplaces need to be much more mental health-conscious” and “directed to the improvement of happiness” in order to prevent mental illness and promote mental health.

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The importance of good mental health to individual well-being can be demonstrated, in fact, by reference to values, according to the World Happiness Report 2013, which sit “at the very heart of the human condition.” Here, the Report, for example, says that if the ultimate goal in life and the truest measure of well-being is happiness, it’s “hard if not impossible” to flourish and feel fulfilled in life when individuals are beset by health problems such as depression and anxiety. This couldn’t be truer. Further, an individual’s self-identity and ability to flourish are often influenced by their social surrounding, relationships and engagement with those around them, but with mental illness, these become increasing difficult to maintain and manage. Importantly, the other issue identified by the report is that once an individual loses the ability to manage thoughts, feelings and behavior, then happiness becomes a distant dream to them.

 

The focus then should be at promoting happiness in all spheres of life, at home, school, work, and, in effect, promote mental health too. This would mean fostering an environment, for example, where young people and young professionals would not be personally, professionally or socially pushed to be isolated, over-stressed, keep feelings bottled up and be accepted and nurtured to grow and develop on their strengths and manage their weaknesses.

 

Further, there is plenty of scientific evidence that links happiness (thus equating to the absence of mental illness) to healthy lifestyles, including getting plenty of exercise which releases endorphins – aka happy hormones – and eating right. Personally, meditation and yoga I believe are also great techniques which can be developed as a lifestyle to promote well-being overall. Teaching these kinds of lifestyle choices from a young age can also prove to be extremely fruitful in the long run to fight unhappiness and mental illness simultaneously. After all, while it’s necessary to further develop medical and social interventions – as is most popular today – to address mental illness, nipping the bud at the root would undoubtedly be the most effective approach!

 

Having said all of this, I am thrilled to say that iFred is already well on its way to adopting this model of intervention, through all of its work. From developing a positive image of depression globally, to educating children about the value of hope in schools, iFred’s work deserves not only praise on this account, but some serious up-scaling through global partnerships!.

 

A new article written by:

Jagannath Lamichhane

 

The Path to Happiness is Sound Mental Health

In July 2011 the UN General Assembly passed a historic resolution:  It invited member countries to measure the happiness of their people and to use this to help guide their public policies. Bhutan topped the first report published in 2012 as the ‘happiest’ country, in a shocking revelation. According to the report, “the word ‘happiness’ is not used lightly. Happiness is an aspiration of every human being, and can also be a measure of social progress.” It further goes on to take the example of the US to explain: “America’s founding fathers declared the inalienable right to pursue happiness. Yet are Americans, or citizens of other countries, happy? If they are not, what if anything can be done about it?”

Undoubtedly, this “happiness” discourse is intrinsically linked to the mental health of individuals, communities and countries. One has to wonder: Why are Mexico and Costa Rica “happier” than the US, even in the event of massive income, development and freedom deficits in the former countries? This then leads us to the idea that perhaps — just perhaps — happiness cannot be measured by wealth or external development, but rather by other factors like peace of mind, social cohesion, satisfaction, inclusion in the community and personal integrity: all factors associated with good mental health. Unsurprisingly, the 2013 World Happiness Report reveals in chapter three that mental illness is, in fact, the “single most important cause of unhappiness, but it is largely ignored by policy makers”.

The 2013 report shows that mental health is the “single most important determinant of individual happiness” (in every case where this has been studied). About 10 percent of the world’s population suffers from clinical depression or crippling anxiety disorders going by UN data.  And accordingly, that makes depression and anxiety the biggest causes of disability and absenteeism, with huge costs in terms of misery and economic waste. Most cases of depression and anxiety are easily treatable—medically and socially.

Cost-effective treatments exist as I have discussed in previous blogs, but even in advancedcountries, only a third of those who need it are in treatment according to the report. The incredibly frustrating part is that the available treatments ranging from psychotherapy (CBT, Mindfulness) to medication produce recovery rates of 50% or more, which means that effectively, fifty percent of the world’s ‘unhappy’ people could be happier and be living far more fulfilling lives!

That means that there are indeed objective benefits of subjective well-being. The Happiness Report 2013 shows a broad range of evidence showing that people who are emotionally happier, who have more satisfying lives, and who live in happier communities, are more likely both now and later to be healthy, productive, and socially connected. These benefits in turn flow more broadly to their families, workplaces, and communities, to the advantage of all.

But it seems not enough that human rights require that treatment should be as available for mental illness as it is for physical illness. The policy priority in much of the world for mental health, especially in developing countries, is incredibly low. Even politicians are marked by the terror of the stigma associated with mental illness such that mental illness is rarely expressed or internalized as a leading cause for the misery of any state’s population.

What I found particularly useful in the 2013 World Happiness Report are the solutions suggested to overcome these barriers to sound mental health and thus a happier global population. It suggests two main strategies: to provide better healthcare and social support for adults who are mentally ill. But a second is to intervene earlier — since half of adults who are mentally ill experienced the onset of their mental health problems by the age of 15, say the writers of the report. This, I suppose, would mean starting to talk about mental health as a real and substantial issue from a young age within schools and local communities. The research done on the mental health variable with regards to happiness shows the contribution of a child’s development to his/her resulting life satisfaction as a child. Basically, the emotional development of children is crucial to determining their mental health later in life. According to the research, “if you are interested in well-being, intellectual development needs to be balanced by much more interest in emotional and social development”.

Having read this report, I am even more enthused about the work that iFred is doing through the Schools for Hope program! While the notion of providing better mental health services at the adult stage will forever be crucial to the well-being of society, measures to incorporate the ideas of hope into school curriculums could well go a long way in preventing common mental disorders like depression and anxiety in the first place by nipping the bud at the root. And that is exactly what the World Happiness Report 2013 has clarified – that preventative care is possible, through education and services for young people!

A new article written by:

Jagannath Lamichhane

(with support from Bidushi Dhungel)

#happiness #teachhope #mentalhealth #shinelight

Artwork Inspires a Message of Hope Among Students

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April 4th, 2014 was a day of true celebration.  Students gathered in the heart of campus at the University of North Carolina in Charlotte to witness the dedication of a beautiful piece of artwork.  But it is the powerful and inspiring message that the sunflower sculpture displays that will continue to touch the lives of all who view it.

The sunflowers stand to honor the 350 million who suffer worldwide from depression and other forms of mental illness.  With that honor, it serves as a reminder that no one student or person should ever have to stand alone.  Help and Hope are always available in our greatest time of need.  A plaque reads:

This sunflower sculpture is donated to the University in recognition for those suffering from depression and other mental illnesses.  The sunflower is yellow, the color of joy; it naturally grows toward the sunlight and likewise, this sunflower sculpture symbolizes turning away from the darkness and embracing the light.  Embrace the light that surrounds us, as no amount of darkness can overpower the light that is available to all.

The Graduate Team and the Inspiring Story Behind Their Project

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 Pictured from left to right:  Bhargavi Golluru, Chris Yoder, Paul Franklin, Samantha Howie, and Tim Seckler

Their passion came from the heart with each student having known someone or been impacted in their life in some way by mental illness.  When learning about iFred’s Field for Hope project, the team initially wanted to do a sunflower planting on campus to help raise awareness and reduce the stigma of depression.

Early into their project, they were met with their first obstacle.  A viable location did not exist for the planting or care of sunflowers.  The team did not give up hope!  Instead, they decided to engineer and construct a sculpture in the form of a sunflower.  This course of action opened up the opportunity for creating awareness and sharing the message with campus inhabitants, faculty and visitors year round.

They put in an incredible amount of time and effort to see the sculpture come to life in a matter of weeks.  The team posted fliers announcing the unveiling, as well as creating an event on social media to invite the student body, faculty, and visitors.  Please visit Artwork for Hope for a visual display of their creative process.

The Dedication

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 The entire team was present to welcome attendees and share the story of their project.  Sunflower pins and brochures were distributed near a bright colored sign displaying the message “Help Bring Sunshine Into The Lives of Others”.  Samantha Howie stated, “Our ultimate goal is to let those with depression know that they are not alone.  There is help available.”

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Melissa Marshburn from Cardinal Innovations and Penny Tate from iFred were proud to attend, speak, and personally thank the students.
Cindy Ballaro was so inspired by the event, she has plans to carry on the message with her own sunflower sculpture displayCindy-Ballaro at The Respite: A Centre for Grief and Hope.  What a beautiful way to deliver hope through the creative process of art.

iFred extends a heartfelt thank you to the following students on the “To Give Them A Choice” Team.  These individuals deserve the highest recognition for all of their hard work in shining their light.  Their vision was brought to a reality and will impact the lives of students, faculty, and visitors to come.

A new article written by Penny Tate

#sharehope #endstigma #shinelight

Shining a Light for Depression: An Invitation to Plant Hope

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Many of us recognize the unfortunate stigma that remains in society when it comes to openly discussing our own or our loved ones depression and/or mental health.  Yet, as Paolo del Vecchio, M.S.W and Director of Mental Health at SAMHSA shares on his recent blog, less than 1/3 of those with mental health challenges receive treatment.  This must change.

Many of the images we are bombarded with in the media depict colorless and isolating scenes of those with depression, full of silent expressions of shame, hopelessness, and grief.  While this may be a key symptom of someone in the middle of a major depressive episode, the fact remains that depression is treatable and many find this experience their greatest gift.  All that is needed is for them to make it through the pain and find their way to light.

iFredBlogLogoToday on this Mental Health Blog Day, I would like to share my journey out of isolation.  It all started with planting a sunflower.

In 2009, I lost my mom to suicide.  She fell into a clinical depression in 2008 after undergoing some medication changes.  She suffered silently and lived in great fear of anyone finding out.  My dad and I knew of her struggle and did our best with the information we had at the time to help her.  But we also lived in isolation.

She begged for us not to ever share her suffering.  She saw herself as damaged goods and less than others.  As family members, we honored her request for privacy.  We only spoke to her doctors.  No one else in our family knew of her struggle.  She hid it from her siblings, extended family, and dear friends; the people who truly loved and cared for her happiness and well-being.  The stigma of depression had robbed our family of much needed guidance and support.

In my time of healing, I came across iFred’s message to “Shine a Light on Depression”.  When researching the topic, this was something I had never seen.  Seeing the beautiful sunflowers accompanied by the inspirational message that there is hope was very welcoming.  All around the world, sunflowers were being planted to honor the World Health Organization’s most recent statistic of the 350 million who experience depression.  I read about their Field for Hope project and knew I wanted to be a part of it.  I initially donated one dollar to have a sunflower planted in my mom’s honor, and it spiraled from there.

Next, I decided to plant my own garden which inspired Gardens for Hope. The sight of the sunflowers outside my window I knew would help cheer me.  I printed a sign from the website and posted it in my yard that I was “Shining a Light of Hope on Depression.”  What happened next came as a wonderful surprise.  Conversations were started in regards to my sunflower planting with my family and friends…and then neighbors.  People wanted to know about the project and its message.  Having the opportunity to open up the subject in such a positive way connected me to others in a way I never thought possible.  I was amazed at the response I received.  It truly opened the door for sharing experiences.

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From my backyard, I saw my own pathway to continue the conversation.  A farm located behind my home grows sunflowers in their field each season.  So I decided to approach the farmer and ask if they would be interested in donating their sunflowers to the cause by displaying a Field for Hope sign.  She immediately agreed and had her own stories to share.  With every visitor to her local farm stand, another community member was reached.

Once the conversations got started, I found it easier to share.  After posting on Facebook and Twitter, I received hundreds of messages.  People thanked me for talking about it.  Many then shared their stories with me.  I began to see that by shining my light on depression, it encouraged others to shine theirs.  I believe as we continue to have the conversation, we will indeed reduce the stigma by creating awareness and knowledge…and that all of us are most definitely not alone.

iFred saw the work I was doing, and asked me to come on their team to help #teachhope to kids dealing with depression and talk to celebrities like Rick Springfield to help end stigma with #famousfaces.  When I learned that research suggests HOPE is teachable, I got on board.  So we are now creating a curriculum that is being tested in schools across the country called Schools for Hope.

For me, it started with planting a sunflower and sharing my story.  Now I am no longer isolated.  My fear has dissipated.  I talk about depression.  I talk about available treatment.  I am the voice for my mom.  I am proud to talk about the wonderful human being she was and I do not define her life by her death.  She was an amazing mother, wife, sister, friend, and the list goes on.  And she had depression.  She lost her life to an illness that we are afraid to talk about.  This needs to change.

Never underestimate the power of your own voice and your own story.  Someone will be listening.  Just begin the conversation and plant your seed.  Shine Your Light for Hope.

A new article written by Penny Tate

#mhblogday #planthope #shinelight #endstigma #teachhope

 

 

The Concept of “Mental (In)capacity” can never be a basis to deprive people with psychosocial disabilities and mental health problems of “legal capacity”

by Jagannath Lamichhane

Last week, I came across a Facebook post of a dear friend, which moved me to tears. Gabor Gombos, a former United Nations member of the Committee on the Rights of Persons with Disabilities (CRPD) — and a man whom I always looked at with high esteem as a source of knowledge and inspiration for the millions of people in the mental health and psychosocial disability rights movement across the world — was in a state of utter despair.

Gabor had written on his wall page: “Doctors say there is no hope for Kati, my only wife in my life, my co-worker, the mother of our child, who survived three days. We jointly did what I became famous of. We had hard times recently as well. Now she is slowly dying. I am dying too. Life is meaningless and impossible”.

His message affected me deeply and I felt depressed the entire day. I never thought I’d have to read such words of despair coming from a man of such strength and accomplishment in the field. Gabor had even gone as far as to indicate he was most inclined to hang himself. In response, there were hundreds of comments on his Facebook page praying for the good health of his wife and his own strength. I also wrote a few words: “My prayers Gabor, stay strong’.

A few days passed through which time and again I would think of Gabor and the loss to the movement and myself were he to really take his own life. I was quite worried actually.

A couple of days later, I heard about the United Nations Committee on the CRPD General Comment on article 12 ie legal equality (legal capacity) of people with disabilities, including psychosocial and mental health problems.  Although article 12 of the disability convention was already a revolutionary article giving equal legal recognition of people with disabilities — including mental health problems and psychosocial disabilities — in absence of the United Nations CRPD Committee’s authoritative interpretation of the article, its interpretation remained controversial since the adoption of the CRPD in 2006.

However, this general comment brought an end to the ongoing controversy, endorsing equal rights and equal recognition of people with disabilities before the law. The general comment has explicitly interpreted that legal discrimination on the basis of disability or in the name of mental (in)capacity is clearly a violation of human rights and against international human rights principles. The general comment has highlighted that there has been a general failure to understand that the human rights-based model of disability implies a shift from the substitute decision-making paradigm to one that is based on supported decision-making.

The general comment discards the concept of “mental capacity” as a social and political construct lacking an objective, scientific and naturally occurring phenomenon. The CRPD Committee explicitly recommends the state parties to guarantee civil and political rights for people with disabilities, even if they might require support in decision-making. While developing a policy framework in the country level, the Committee clearly recommends that support in decision-making must not be used as a justification for limiting other fundamental rights of persons with disabilities, especially the right to vote, the right to marry (or establish a civil partnership) and found a family, reproductive rights, parental rights, medical treatment and the right to liberty.

Most importantly, the interpretation heralds an end to the era of forced psychiatry, a long and much-awaited battle in the fields of psychiatry and human rights. Following this committee report, involuntary detention in psychiatric or mental health facilities without consent is now considered a violation of human rights and punishment can be sought.

It was great news. I had not expected such a bold and clear interpretation of the article 12 of the CRPD so early. And it is because of people like Gabor and so many others, who fought their whole lives to establish equal rights and stop the practice of involuntary detention, that the interpretation has been possible. This general comment is the greatest victory yet for the thousands of millions of people living with psychosocial disabilities and mental health problems across the world.

But while the community was celebrating this this historical moment, I couldn’t help but think of Gabor’s tragic situation. All of the sudden, I saw a thank you message from Gabor on his Facebook page–full of emotion, hope and victory. He wrote: “thank you all for your empathy, love and support. That means a lot. Kati’s health is slightly improved. No immediate danger. This morning, she was much more attentive than before. I spoke to her about the General Comment on the CRPD article 12. I can’t know how much she understood. Once I heard about the general comment I felt some peace. Pain is very much there and sorrow, but also peace”.

It was upon reading this that my eyes filled with tears. I reminded myself how indispensable liberty and freedom is in an individual’s life.  We do not have control over our future and destiny and at any time, we might suffer from disease, disability, mental illness, tragedy and the like. However, no misery can be a cause to take away an individual’s right to live as he/she pleases. Now a new era has begun where mental illness cannot be the reason or justification to deprive people of equal legal and human rights. I salute Gabor and the countless others who made it possible.

 

 

 

Why the Global Movement for Mental Health? Time to Join.

Countries in crisis are a breeding ground for ill health. The social, political and economic conditions harbored by crises – from Tsunamis and earthquakes to conflicts – make countries ripe for disease. That’s why we see figures related to infant and maternal mortality, life expectancy and most communicable and non-communicable diseases posing a real threat to the livelihoods of a good chunk of the population in countries like the Sudan, Afghanistan or Iraq.

These factors of instability, destruction and violence have a huge impact on the mental health of a population as well. In fact, it has been proven that in countries where conflict is present the rate of mental health problems are higher. Take Afghanistan for example: it is estimated that 73% of Afghan women show symptoms of depression, 84% suffer from anxiety, and 48% from post-traumatic stress disorder. Of course, the figures are not much better for men either, but, women being the most vulnerable group, suffer most.

In many African countries, the situation concerning mental health is simply diabolical. Decades of conflict and violence matched by extreme poverty and destitution have left huge populations in a mental crisis. However, as dire as the situation is, these populations are the “forgotten,” “condemned” to a life of “misery and abuse,” according to photographer and journalist Robin Hammond, who recently published a collection of revealing photographs depicting the suffering of those with mental health problems in African countries which are most in crisis.

The images are telling in themselves and speak volumes about the unthinkable extent to which men, women and children are being treated as sub-human – caged, locked-up, chained, abused, beaten and bruised – within their own communities. In many instances, as the photos describe, there seems to be no alternative available in the context of abject poverty, lack of awareness and access.

One photograph which stands out is of a 13 year- old Ahmed Adan Ahmed, who “spends his days walking in circles, or sitting running his hands through the sand at his feet,” as “for 10 years, he has been tied to a stick under the tarpaulin of a tent in a camp for Internally Displaced People in Galkayo, Somalia.” What is painstakingly hard to digest is that his mother Fawzia “sees no other option – if she doesn’t tie him he will run away,” she told the photographer.

Ahmed Adan Ahmed

In another photograph from Nigeria, the image is perhaps even more distressing: a “patient” is tied to a tree with his hands joined as if begging. The caption for the image reads: “Native Doctor Lekwe Deezia claims to heal mental illness through the power of prayer and traditional herbal medicines. While receiving treatment, which can sometimes take months, his patients are chained to trees in his courtyard. They begged the photographer for food – they say they are only fed once a day, sometimes only once every 3 days. The Niger Delta, Nigeria.”

Nigerian Man Chained to Tree

These photos and the collection by Robin Hammond is perhaps one of the most comprehensive collections of images which portray the devastating reality of the negligence of mental health issues and of those who suffer on the ground in some of the world’s most marginalized countries in communities. In the midst of upheaval, they are left to suffer in silence.

In countries like Somalia, ravaged by over two decades of civil conflict, the World Health organization says that at least one in three people have some kind of mental health problem. And yet, the way in which such a major problem is being dealt with is by not dealing with it at all. The victims of disaster are being made to bear the brunt of their countries’ crisis — well demonstrated in the way in which those who suffer from mental illness are living across Africa.

But I have to admit that when I saw these photographs, I couldn’t help but think about the situation in my own country, Nepal. Centuries of exploitation and poverty, followed by a brutal civil conflict and social, political and economic instability has left the country ravaged. In many ways, those who suffer from mental health problems in Nepal share a similar fate to those as shown in Robin’s photographs. One image, in particular, of a 12-year old boy, Prabin, whom I came across years ago, keeps coming to mind. He was chained and locked up for seven years because he “lost his mind”. His father had to leave his job as a policeman during the Maoist insurgency because of the fear of violence. And when Prabin was two and half years old, his father went to Malaysia for work and returned home only after four years. Since then, no one had been employed in the family and one family member needed always to be around to look after Prabin.

There were many cross-cutting issues I saw in Prabin’s family which are symptomatic of all countries in crisis— poverty, disability, mental illness, trauma from the conflict, lack of healthcare, migration and unemployment — all of which collectively pushed the whole family into a predicament, with Prabin at the centre of the suffering. Prabin is no longer in chains thanks to a few well-wishers, but thousands like him, young boys and girls across Asia and Africa, are still being chained, locked up and abused. Prabin’s photo is pasted below.

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If the simple fact that massive human rights abuses and violations don’t inspire you to act, consider this.

If the simple fact that massive human rights abuses and violations don’t inspire you to act, consider this:  Some of the most famous people in the world, contributing the most to our global prosperity, had mental health issues they faced.  The only difference is they were treated with respect, had access to quality social and health care services, and used their mental anguish to fuel their trade .  Some of the greats include Thomas Jefferson, Winston Churchill, Oprah Winfrey, and others mentioned on our Famous Faces page.  Imagine a world where all those with mental health issues received timely support and treatment, and used their emotional depth as a force for good?

Today’s blog post is just a reminder, to myself and others who are working towards achieving the goals of the Movement for Global Mental Health, of why we need to pool our efforts to address this immediate crisis. Sometimes, it’s easy to forget why we do what we do. I hope this serves as a reminder to us all.

by Jagannath Lamichhane

With support from Bidushi Dhungel

Global Mental Health: Medical versus Social Approaches to Treatment and Social Change

It has been just six years since the Movement for Global Mental Health took off on October 8, 2008. In that time, the Movement has sought to create a platform that connects the global network of the stakeholders in the field of mental health. While the movement has made much progress in the past few years, it has not been without controversy and criticism.

The most common allegation being that the Movement represents a bio-medical approach to mental health, where psychiatrists rule the roost and the discipline is defined in terms of medical, as opposed to social, parameters. Naturally, such allegations have come from the stakeholders within the field who work within the human rights framework and define mental health within socio-economic parameters. A recent book written by China Mills at Oxford University entitled Decolonising global mental health: The psychiatrization of the majority world (Concepts for Critical Psychology), examines this critique of global mental health well. Mills argues that there is a continued colonial mindset in the field of mental health global mental health.

However, there seems to be a misunderstanding among social-model advocates of mental health regarding the aims and methods of global mental health and in particular the Movement for Global Mental Health.

In this context, iFred wants to draw your attention to a recent interview taken of Professor Vikram Patel, a leading intellectual in vikram patelthe field of Global Mental Health, with Bio Medical Central.

Here, Patel talks about the impact of global mental health on traditional concepts of psychiatry and discusses the initiatives and platforms being developed to promote capacity building, research, policy, advocacy and human rights within the established Centre for Global Mental Health at the London School of Hygiene and Tropical Medicine in London. The anticipated challenges, controversies, and future directions of the global mental health are also highlighted as well. You can also listen to the audio version of this interview here.

 

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Interview with Vikram Patel, reproduced via Bio-Medical Central

What is global mental health and how will it impact the field of medicine?

Global mental health is a discipline of global health and, as with the mission of global health, its primary goal is to improve the health of people worldwide, with a strong focus on equity and access. There is no health without mental health. I think we know, through a large body of evidence, that mental health and physical health interact with each other in very diverse and intimate ways. Therefore, any attempt that we make to improve the mental health of individuals and populations will inevitably have a positive impact on the physical health of those individuals and populations. Therefore, investing in global mental health is, ultimately, an investment in global health.

How was the Centre for Global Mental Health established?

The Centre for Global Mental Health is a partnership between the London School of Hygiene and Tropical Medicine, which is Europe’s leading school of public health, and the Institute of Psychiatry at Kings Health Partners, which is Britain’s leading school of psychiatry and neurosciences. It’s a perfect marriage between academics who have strengths in the various disciplines of global health, and academics who have strengths in the various disciplines of clinical sciences related to mental health. The centre was founded in 2008 to bring these two complementary sets of disciplines on to the same platform to further the science of global mental health. The goal was to promote research, capacity building, and advocacy for policy to improve access to care for people living with mental disorders around the world, with a particular focus on those countries where the treatment gaps were the largest; that is, the low- and middle-income countries of the world.

Can you describe the initiatives and platforms that are involved with this collaboration?

Let me give you examples from each of the three broad themes of work that the Centre for Global Mental health pursues. Firstly, with capacity building, we are delighted that, after many years of plotting and planning, we were able to launch our full-time Masters in Global Mental Health last year. This year, we have had more than 20 applicants successfully admitted and beginning the MSc program. The MSc is, to my knowledge, the only face-to-face residential MSc in this discipline in the world today.

In the area of research, we are currently involved with dozens of research projects in more than 20 countries within sub-Saharan Africa, Latin America and Asia. Some of this research focuses on randomized controlled trials of innovative new interventions to improve access to evidence-based treatments, but we are also engaged in some exciting health systems work that examines how these evidence-based packages of care can be integrated into routine healthcare systems. Our portfolio also includes social science and epidemiological research on mental health problems.

Finally, in the realm of policy and advocacy, we have recently embarked on a number of exciting developments. The first is that we led the Mental Health Forum for the World Innovation Summit for Health, which was held in Qatar in December 2013. Along with Shekhar Saxena of the World Health Organization, I co-chaired this forum, which produced a report specifically directed at ministers of health and other policymakers, to recommend policy actions based on the research evidence in global mental health. Another exciting development is the Mental Health Innovations Network, supported by Grand Challenges Canada, whose goal is to synthesize the rapidly growing evidence base in the field into products that can be useful to a variety of different audiences, from researchers and practitioners to civil society and policymakers.

This is very exciting in terms of all the initiatives and platforms. What do you think are the current anticipated challenges?

There are a number of different challenges. The key is limited resources. There has actually been a fantastic increase in the amount of resources available for research, and of course the Centre for Global Mental Health has been a great beneficiary of that largesse. However, there has not been a similar increase in resources for mental health for ministries of health, particularly in the poorest countries of the world, which rely, to a large extent, on development assistance for their health programs. Thus there has not been the needed increase in resources to scale up mental health services in these countries. So the first important challenge is to mobilize development agencies to finance mental health services in the poorest countries of the world.

The second important challenge is a continuing concern among some communities about the validity of some of the mental health problems that the field is grappling with, in particular the common mental health problems like depression and anxiety. The concern is really whether these conditions are biomedical categories that have universal validity in all cultures, and whether the biomedical approaches that are being utilized in medicine and psychiatry in particular, are relevant and appropriate to all cultures of the world.

Can you indicate also the controversies such as the debate against global mental health?

In fact, my second point is at the heart of the critique that certain mental illness categories, such as depression in particular, do not travel well across cultures. The critique is that the use of such labels represents a medicalization of a social condition where the solutions lie not within a medical approach but more likely within the social or political sphere. And related to this is the concern of exporting psychiatric paradigms of treatment and care which have been at the heart of the mental healthcare systems of the developed world to developing countries where there is very little formal psychiatric care.

Do you also think that global mental health will be influenced by DSM-5 with its recent launch, and ICD-11, which will be launched in the future?

The honest truth is that global mental health is a completely different animal from its predecessor, which comprised cultural psychiatry and international psychiatry. First of all, global mental health is not simply psychiatry. Like global health, it is an interdisciplinary endeavor, and is firmly grounded in the South (that is, in the developing world). Most of the leading practitioners of global mental health live and work in developing countries, not in the developed world. Global mental health is completely contextualized to the cultural and social circumstances of the country in which this work is being carried out, and is action-oriented, seeking to improve the lives of people affected by mental health problems.

An important implication of this reality, in relation to your question, is the replacement of rigid diagnostic systems, which are much more suited to psychiatry and the specialized mental healthcare systems you might encounter in developed countries, with broader, more public health-oriented and contextually appropriate labels and diagnostic systems that communicate better to local policymakers, primary care workers and most importantly, to local communities. Global mental health barely uses DSM-4 or ICD-10 in any concrete way, and I think it is unlikely that DSM-5 or ICD-11 will have much traction either.

What do you think are the future directions for global mental health?

The future directions of global mental health lie in three big areas. The first is to mobilize resources by advocating to policymakers, especially in middle-income countries which have more resources, to finance scaling up of mental health care. This is particularly important in the context of universal health care to advocate for mental health to be given at least parity with physical health in resource allocation and service provision in middle income countries. For low income countries that continue to be dependent on development assistance, we need to be similarly advocating with donors to increase their resources specifically for mental health.

The second is to build capacity. It has to be admitted that there is a great shortage of every kind of mental healthcare provider in the developing world, from specialists like psychiatrists and psychologists all the way through to community-based workers who can provide frontline mental healthcare. There is a great need for investing both in programs that can build capacity that is scalable, and in curricula and other kinds of tools that can be utilized in these sorts of settings for these diverse professional groups.

The third, of course, is research. We clearly need to continue to build evidence which focuses on addressing questions about how we can integrate evidence-based packages for care within routine healthcare systems, so that we can inform governments on how they can make their mental health programs more effective and efficient.

What are you most excited about in relation to the recent developments in global mental health?

What I am really most excited about is that mental health has come out of the closet. I remember 15 years ago when I began working in this field, it was usually embarrassing in India to say that you were a psychiatrist because, if they did not walk away from you, they would look at you perplexed and ask, “Is this really relevant in our country?” I think there has been a dramatic change in the attitudes towards mental health in every sector of society in India, which is the country I know best, whether it is in the community, in the media in terms of the amount and the quality of the reporting on mental health issues, and of course at the level of policymakers. Today, it is so straightforward for me to sit with a Secretary of Health and talk about mental health issues; they are much more receptive, and indeed, more importantly, are much more willing to back their interest with resources.

 

There is a strong need to transform the Movement for Global Mental Health into an inclusive movement

-Jagannath Lamichhane

Although some claim that The Movement for Global Mental Health (MGMH) is, essentially, the brainchild of the Western medical framework, a closer look at the work being done under the MGMH banner would prove contrary. I know that less powerful and low income countries and their citizenry are making important strides to define the problems and solutions related to mental health because of the work of the Movement.

against mental violence The MGMH is the first cross-continental effort to bring diverse expertise, resources and perspectives on to one platform with a common goal of addressing mental health both at the global and local level. Their representation of a global movement, rather than western brainchild, is particularly evident in the recent shift of the global secretariat of the movement from the West (Sydney, Australia) to New Delhi, India, as well as the transfer of the movement’s leadership from medical professionals to those with expertise in social and community based fields. These changes are working to accommodate the diverse concerns of civil society groups regarding the rights of the persons with psychosocial disability and mental health problems.

Contrary to traditional approaches of addressing mental health, in which ‘professionals’ thrust ‘treatment’ onto ‘patients’, the MGMH promotes the role of people with psychosocial disabilities and mental health problems as equal partners in every endeavor from the health care setting, to the community and in efforts to promote human rights, fighting stigma and discriminations. Also, the MGMH advocates greater human rights along with affordable and accessible mental health care for all by putting greater emphasis on the UN Convention on the Rights of Persons with Disabilities (CRPD).

The MGMH believes in building an international civil society that can speak out and stand for the cause, and mobilise direct actions in order to overcome mental health challenges ranging from stigma, inequitable health services, social discrimination and others. This international community looks like a consolidated effort among the various stakeholder and creative partnerships among stakeholders around the world.

There are already some effective examples of partnership in promoting human rights and mental health. For example, the EMPOWER project brought together civil society groups representing all kinds of professionals working in the fields of medicine, research and human rights and together they worked not only to generate a new knowledge, but have set an example to advocate mental health in low and middle-income countries.

Towards creating a leadership community across the globe, the movement offers training and short courses like the Leadership in Mental Health, which is an annual two-week leadership course in mental health for all kinds of people interested and affected by mental health issues. The tutors in the course range from activists to researchers and psychosocial disabilities.

However, the future of MGMH is not straightforward. The divide among the stakeholders in the mental health community — some of whom prioritize the human rights elements over the medical elements and vice versa — is the greatest obstacle to fulfilling the goals of the movement.

The tussle over where the emphasis needs to be within the mental health domain has been at the centre of this divide. In fact, there is a misconstrued understanding among some stakeholders– largely non-professional groups– that the MGMH is a banner through which the medical model of psychiatry and mental health is being promoted. On the other hand, many professional groups believe that the non-professional activists and their associated movements in the realm of mental health reject the very idea of the possibilities of modern medicine in addressing mental health concerns. Some individuals and opinion makers have even labeled the MGMH as a neo-colonial project.

But these polarized views are untrue to the genuine efforts and initiatives being made across the board — by professionals and activists, and civil society groups in the field. That’s why although the major barrier for the Movement is this divide among stakeholders, I believe that these initial days of the Movement’s efforts can in fact be used to create a sense of belonging among all of those concerned. We can also hammer out the differences –among professionals, activists, researchers and psychosocial disability community – in order to come to a consensus which would benefit the hundreds of thousands of people living with mental health problems and psychosocial disability globally today.

There is no doubt in my mind that all groups are working tirelessly to find sustainable ways through which the needs of one of the most vulnerable groups in the world can be met –medically, socially, politically and economically. While making an effort to find solution, it is urgent among stakeholders to understand each other’s work and promote respect for each other.

(With support from Bidushi Dhungel)

 

INTERNATONAL COMMUNITY MUST SHOW MORAL SOLIDARITY TO ADDRESS MENTAL HEALTH SUFFERING IN DEVELOPING COUNTRIES

Jagannath Lamichhane

In my last blog post, I had briefly mentioned the need for international moral solidarity as a first step in addressing mental health related suffering in developing countries. Here, I will elaborate why international moral solidarity is important in the field of mental health and psychosocial disability.

Let me begin with a short description of a video aired on Channel4 (UK) a few months ago called life in chains: the plight of Somalia’s mentally ill. This film features Abdullahi, who was chained up by his kin for the past 17 years. The story of Abdullahi imbibes the viewer in his pain, his suffering. According to a BBC news report, Somalia has the highest rate of mental illness in the world. In a country where social order and the health care system have been devastated by decades of war, people with mental health problems are the forgotten people.

" It is on this humanitarian and human rights ground that I argue the international community must show moral solidarity in addressing mental health-related suffering of people with mental health problems in developing countries. That means we start to value people with mental health problems as equals to care about; as worthy as others to pay attention to, and their suffering as real as others’ to address. "

” It is on this humanitarian and human rights ground that I argue the international community must show moral solidarity in addressing mental health-related suffering of people with mental health problems in developing countries. That means we start to value people with mental health problems as equals to care about; as worthy as others to pay attention to, and their suffering as real as others’ to address. “

They cannot enjoy human status. They cannot enjoy the freedoms that even animals can. They are unseen everywhere in society and its social order, all the while physically and mentally in chains in front of our eyes in public spaces. Just like Abdullahi. In Somalia alone, over one hundred thousand people with mental health problems are living their lives in chains.

Somalia is not a stand-alone case. Take Indonesia for another example where over 30,000 people with mental health problems are still inhumanly chained across the country today. No matter — rich or poor — people with mental health problems are the worst victims of abuse, discrimination and social exclusion globally. The nature and degree of the problems are different in different countries but very much there and of their own local nature. While over-medicalization, forced treatment, torture and institutionalization are the major mental health-related problems of developed countries, lack of access to basic social services, medical treatment, chaining, abuse and discrimination are the widespread mental health related problems of low and middle income countries.

Despite the above mentioned evidence of abuse, neglect, discrimination, torture, cruelty, inhuman and degrading treatment of people with mental health problems, the international community, actively involved in the low and middle income countries, is completely overlooking these issues. It is both a shame and surprise to me.  Why is the international community failing to show moral solidarity (at the very least) on mental health and psychosocial disability issues in developing countries?

Its answer is not simple. In my observation, it seems ignoring mental health problems in developing countries is a kind of hypocrisy being practiced by the international community. Their failure to notice such widespread mental health related human rights violations in poor countries is a challenge to the moral foundation of their work where they stand and what they preach.

The inhuman and degrading treatment of people with mental health problems are among the most disgraceful acts of our time. On the basis of superstitious beliefs; traditional, social and cultural practice; ignorance about the nature of  problems; lack of adequate social and family support; that those suffering are dangerous to self and other, people with mental health problems are being chained, locked up years in jails, and denied basic social and medical care.

After being labeled mentally ill, people loose their social status, community network, and kinship, which is equal to a social death, as explained in this article from The Lancet, ‘Global Mental Health: a failure of humanity’. This label creates permanent inequality in the society.  People with mental health problems cannot imagine enjoying their civil and political rights. They are shamed and demoralized. They turn into unequal and forgotten citizen. The suffering of these people however do not get any space at the global or local levels of discourse on human rights, development, social security, health, and others.

In the absence of moral solidarity, moral exclusion takes place. As described by Susan Opotow in her essay, Moral Exclusion and Injustice: An Introduction, “Moral exclusion occurs when individuals or groups are perceived as outside the boundary in which moral values, rules, and considerations of fairness apply. Those who are morally excluded are perceived as nonentities, expendable, or underserving. Consequently, harming or exploiting them appears to be appropriate, acceptable, or just”.

In this context, my point is that the silence of the international community on mental health related problems endorses all kinds of atrocities against people with mental health problems, like Abdullahi. In a battle to challenge and stop such inhuman actions, first, it is important for everyone, including the international community, to acknowledge the prevalent tragedies faced by people with mental health problems in developing countries as unacceptable on humanitarian and human rights grounds.

It is on this humanitarian and human rights ground that I argue the international community must show moral solidarity in addressing mental health-related suffering of people with mental health problems in developing countries. That means we start to value people with mental health problems as equals to care about; as worthy as others to pay attention to, and their suffering as real as others’ to address.

(With support from Bidushi Dhungel)

Hidden Pictures and the World Health Organization: A Journey to Uncover Global Stories of Mental Health

Hidden Pictures Film

Here is a video we are all about right now at iFred. It’s a summary of the film Hidden Pictures by filmmaker and physician Delaney Ruston. Ruston’s work highlights both the serious need for global mental health resources and the power our personal stories can have

iFred joined global leaders to support the World Health Organization in crafting the Mental Health Global Action Plan by in 2012, that was then adopted by the United Nations in 2013.  Countries around the world convened to discuss implementation of the action plan for Global Mental Health Day in October, 2013, and, with policy highlighted in Ruston’s film. Have you browsed the document yet? You can read an mhGAP summery here or the entire document here. on creating social change.

Watch the WHO and Ruston’s video here and tell us what you think:

Hidden Pictures