10 years of #GrandChallenges, #innovativesolutions and its significance for #globalmentalhealth

Last week, from the 6th to the 10th of October, I got the opportunity to attend the #GrandChallenges in #globalhealth annual meeting in Seattle. This year’s anniversary event, attended by over 1000 scientists and researchers, celebrated a decade of progress since the Bill and Melinda Gates Foundation launched the initiative in 2003. It was exciting to be part of this celebration, especially because, for a change, #mentalhealth was on the agenda—albeit still woefully on the fringe.

 

Coinciding with the 10th anniversary of #GrandChallenges, a group of international partners announced three new initiatives aimed at creating breakthroughs in science and #innovativesolutions. A consortium of partners including Brazil, Canada, India, Norway, South Africa, the United Kingdom and the United States will fund a new phase of Grand Challenge initiatives. The three new initiatives announced in Seattle are: 1. All Children Thriving, 2. Putting Women and Girls at the Centre of Development, and 3. Creating New Interventions for Global Health.

 

In 2002, when Bill Gates first heard about the Grand Challenges in Mathematics to solve complex global issues on mathematics, it sparked something in him to apply the notion of #GrandChallenges to Global Health, with the aim to bring together the world’s most talented scientists and researchers to find solutions to serious health problems in developing countries — ranging from HIV/AIDS, tuberculosis, malaria, and neuroscience to maternal and child health. The use of science and technology to #innovatesolutions to the global health crisis has remained at the heart of #GrandChallenges since then. In the span of a decade, the #GrandChallengesmovement is evolving into a leading global platform fostering innovation to solve key global health and development agendas.

 

The announcement of the new initiative “Putting Women and girls at the Center of Development” by Melinda Gates is evidence that the goals of the #GrandChallenges have transformed over a decade. Addressing the Grand Challenges meeting, Melinda said, “Development needs to be more serious about gender inequities and women’s empowerment. By ignoring gender inequities, many development projects fail to achieve their objective. And when development organizations do not focus on women’s empowerment, they neglect the fact that empowered women have the potential to transform their societies”. According to Gates, if we really want to transform societies, there is no other alternative to women empowerment. This got me thinking about mental health and its role in global development.

 

Before going to take part in this grand consortium, I was pretty confident that mental health was going to feature predominantly, as a signal that change was in the air, and in the same way that women and girls were being brought to the centre, so would mental health. I envisioned a consortium where mental health was a leading public health and development challenge for the world’s best minds to recognize and work hard to solve this challenge in tandem with other health and development issues. However, the reality was quite the opposite. In fact, the ignorance of mental health in the #GrandChallenges consortium undermines its own central mission, which is to improve lives and spread #hope in developing countries. The reality is that mental illness kills more people globally than heart disease. Suicide is a leading cause of death among women of a reproductive age in the developing world. The World Health Organisation has already established that one-third of the global population suffers from a mental health problem. But even as this is the case, it is puzzling to see mental health not included as a “grand challenge” in health.

 

It would, nonetheless, be unjust to claim that all partners of the Grand Challenges have overlooked this global challenge. The Global Mental Health initiative of Grand Challenges Canada has continuously championed the issue on the international platform as a #lonelywarrior. While announcing the new Grand Challenges Canada initiatives at the #Grand Challenge meeting, the Chief Executive Officer of the GCC, Peter A. Singer reaffirmed its commitment to continue support to find #innovativesolutions in #globalmentalhealth. The growing #globalmentalhealth scientific and civil society community cheered Dr. Singer’s announcement. While it is already urgently necessary for #globalmentalhealth to be recognized as a priority development agenda across the #grandchallenges consortium, there is #hope that the coming years will bear good news. In the same way that the role of women and girls has slowly been recognized as a core issue in development, I am sure that sometime in the not-to-distant future, we will be hearing Melinda Gates talking about the core role that mental health plays in global development as well.

Bill & Melinda

A new article written by:  Jagannath Lamichhane

 

 

 

Health and Hope Can Prevent Suicide

SuicidePrevention#stopsuicide #globalcrisis #hope #suicideprevention

Every 40 seconds, an individual life is lost to suicide. The World Health Organization (WHO) calls it a #globalcrisis and estimates that the global suicide figure reaches almost one million every year. In every corner of the world, the number of people taking their own life is increasing. It is a known fact that suicidal thoughts are usually linked to mental disorders and the feeling of helplessness. Experts say that the expression of hopelessness in conjunction with a mental disorder — such as depression — represents a very dangerous warning sign.

September is Suicide Prevention Month. We must continue to shed light on the importance of talking about this link between mental health, hopelessness and suicide; and develop and discuss innovative ways to #stopsuicide and #preventsuicide globally.

Fundamentally, hopelessness is a feeling that life’s conditions can’t improve and that there is simply no solution to a problem. For many, that means that dying by suicide would indeed be better than living. But the fact is that most people who feel hopeless have depression, and untreated depression is the number one cause for suicide. In fact, numerous studies have shown that feelings of hopelessness, in conjunction with a mental disorder, can lead to suicide.

At the University of Pennsylvania’s School of Medicine, two separate studies were conducted– one which tracked close to 200 psychiatric outpatients deemed to be at risk for suicide, and another which tracked about 168 hospitalized psychiatric patients deemed to be at risk for suicide – both found that significantly more suicides occurred in the group of individuals who exhibited the highest levels of hopelessness. Researcher Jager- Hyman stated, “To prevent suicides, therapists would benefit from directly targeting patients’ thoughts of hopelessness in clinical interventions.”

What is often left out of public access, and often even advocacy, is that there is indeed #hope and #suicideprevention is possible. In fact, effective treatment of mental disorders, most often depression, can eliminate or substantially reduce feelings of hopelessness, and as a result, reduce the occurrence of suicide. Depression is highly treatable and the vast majority of people who receive treatment get better.

And yet, suicide rates are increasing globally. This means that this #globalcrisis persists because we are failing to educate on treatment and instill hope in the lives of the millions of people who are lost each year to suicide. Not only are we failing to educate and ensure access to healthcare and treatment for various mental illnesses, but we are also failing in providing hope to the millions of people who feel isolated and alone—to the extent that they choose death over life.

If suicide is to be prevented, we need to address the treatment gap in mental health globally and also stress the importance of promoting mental health and well-being throughout life. It is known that global suicide rates are highest in people aged 70 years and above. But suicide also is amongst our youth. Suicide is already the second leading cause of death in 15 to 29 year-olds globally.

A study by Professor Vikram Patel at the London School of Hygiene and Tropical Medicine shows that by promoting access to health care services, mental health education and addressing the social determinants of mental disorders, up to 80 percent of mental illness and risk to suicidal factors can be addressed amongst those under 29 years of age. This percentage does not even account for the health interventions put into place later in life should serious mental illnesses develop. Therefore, the evidence supports we must care for mental health at every stage of life.

It is in this spirit that the WHO has published its most recent report entitled, “Preventing suicide: A global imperative”, in conjunction with this year’s International Suicide Prevention Day. The WHO report claims that suicide is largely preventable. WHO recommends that “countries involve a range of government departments in developing a comprehensive coordinated response. High-level commitment is needed not just within the health sector, but also within education, employment, social welfare and judicial departments”. In summary, a multi-sectoral approach which seeks to address the healthcare concerns linked to suicide, alongside a rigorous social intervention programme which seeks to #teachhope, is the best strategy for reducing the fast-growing rates of suicide globally.

The good news is that in the WHO Mental Health Action Plan 2013-2020, WHO Member States have committed themselves to work toward the global target of reducing suicide rate in countries by 10% by 2020. Putting in place a new global advocacy strategy that examines and seeks to address suicide as a systemic health and social crisis will indeed give our nations and people #hope.

A new blog written by Bidushi Dhungel

Take Global Action Today for World Suicide Prevention Day – #FundamentalSDG

No Health Without Mental Health

Photo Credit: MHaPP-UCT

The International Foundation for Research and Education on Depression (iFred) announces today, World Suicide Prevention Day, it joins to support the #FundaMentalSDG initiative to advocate adding clear, measurable mental health targets to the United Nations’ Post-2015 Sustainable Development Goals about to be negotiated by the UN member states following the UN High-level Stocktaking Event on the Post-2015 Development Agenda in New York on 11 – 12 September 2014. The initiative takes up on the Preventing Suicide, A Global Imperative report, which was publicly released by the World Health Organization (WHO) last week at a mental health leaders and advocates gathering in Geneva, Switzerland, just a year after the WHO launched implementation discussions of the Global Mental Health Action Plan adopted by the United Nations 66th assembly.  Ifred asks you to take action by joining the global movement at http://www.fundamentalsdg.org/act-now.html.

According to the report by WHO, suicide is preventable, mental health disorders are treatable, and yet because we don’t significantly address it we lose over 800,000 lives annually, it is the second leading cause of death globally for youth ages 15-29, and is estimated to cost the United States alone over 100 billion dollars every year. iFred invites other organizations to support #FundaMentalSDG to join in the effort, asking the United Nations to include a specific mental health target and two indicators in this critical post-millennium agenda.

FundaMentalSDG (www.fundamentalsdg.org) needs your help and is asking you to join in solidarity for mental health on an issue we all must support.  Mental health is not covered in the 2015 Post Millennium Development Goals, and as we all know there really can be no sustainable development unless we include mental health and its inclusion impacts all of our organizations work.  There is a very important meeting this week discussing these goals, so please act quickly and join in this unified global coalition to advocate positive change.

Below are action steps for your organization and please pass / share as the more voices, the better:

  1. Send a letter on your organization’s letterhead in support of this initiative to leaders in the United Nations by downloading the template here:  http://www.fundamentalsdg.org/act-now.html.
  2. Show your support on our website: http://www.fundamentalsdg.org/show-your-support.html and / or end an e-mail to fundamentalsdg@gmail.com letting us know your organization is on board.
  3. Like the Facebook page, share with friends and family at www.facebook.com/fundamentalsdg.
  4. Tweet: “We must include mental health in United Nations Post Millennium Development Goals.  There is no #health without #mentalhealth @FundamentalSDG @UN #FundaMentalSDG  (note – if on September 10th, add #WSPD).”
  5. Send out your own organization’s release declaring your support of the initiative.

Kathryn Goetzke, Founder of iFred, is a strong supporter and encourages others to get on board. “Suicide is preventable, and depression is treatable. iFred stands in solidarity with #FundaMentalSDG, in support of the 450 million around the world needing mental health treatment today. There is no sustainable development without both mental and physical health, so we ask the United Nations to recognize this, to add relevant language in the new post-millennium goals, and for other organizations around the world to join us and unite for this global movement for mental health”.

To support the initiative, visit www.fundamentalsdg.org/show-your-support and take action today.

For more information, see www.fundamentalsdg.org, www.facebook.com/fundamentalsdg, and twitter.com/FundaMentalSDG and be sure to use hashtag #FundaMentalSDG in communication efforts.

 

 

Mental health is a worthwhile goal for United Nations Sustainable Development Agenda

 

no-health-without-mental-health

The post-2015 development goals will, as we know, set out the world’s development agenda for the foreseeable future—in the same way that the Millennium Development Goals provided a framework for global development over the past couple of decades. The United Nations is now preparing to choose its new set of sustainable development goals and the Global Mental Health community must work hard to ensure these goals include mental health.

Professors Vikram Patel and Graham Thornicroft have recently published an article in the British Medical Journal, which outlines why the case for including mental health in the UN’s new development agenda is a compelling one.

Indeed their case is compelling. When we think about it logically, it makes sense: poor mental health is a precursor to reduced resilience to conflict, they argue. In the midst of conflict, hope is a scarce resource and instead of teaching hope, “in the aftermath of war people with mental illness are often accorded the lowest priority”. If we think about the seemingly intractable global conflicts of today, from Syria and Iraq to the massacre in Gaza, the call to address mental health concerns as a priority development agenda, and as a result, rebrand mental illness and teach hope to thousands, is most pertinent.

Including mental health in the new global development agenda will also go a long way towards ending the paralyzing stigma associated with all kinds of mental illness. Not least, the most common mental disorders like depression and anxiety would be well on their way to receiving a more hopeful image globally, recognized as issues which affect us all personally and as communities, cities and countries.

Thornicroft and Patel in fact argue that if mental health is included in the new development agenda and mental health systems are globally improved, that would also “have a decisive role in making cities and human settlements inclusive, safe, resilient, and sustainable”. For addressing mental health concerns of an individual is not only beneficial to the person suffering, but when the problems associated with mental illness are given importance by society and a collective effort to address them is taken, it will inevitably create a sense of common belonging, hope, equality and indeed resilience among communities.

This would then also require addressing the income and economic inequalities faced by people who suffer from mental health problems. They have far lower rates of employment, but also, in times of economic recession, a population’s mental health is worse, argue the two professors. If we can thus promote a principle of ‘sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all,” again this too would benefit wider society as a whole.

The narrative which is understood by these arguments is that mental health problems are a global issue that impacts not only those who suffer, but wider society and large populations of human settlements. It is thus, for our collective benefit that we make treatment available to people who are suffering and in turn spread the message of hope globally.

The reasons that we need to push for the inclusion of mental health in the global development agenda are of course many, and only a few have been mentioned here.  But what is important to remember is that the proliferation of mental health problems is the result of collective ignorance of these issues over a long period of time. When we can talk freely about depression, anxiety and other mental illnesses, we can find and develop ways to tackle these issues whether it’s through modern medicine, community-building or teaching hope to young people. What we do know is that the conversation can become truly global if we can secure mental health in the Post-2015 development agenda. The BMG editorial rightly highlights that mental health is a worthwhile goal for sustainable development.

A new article written by Bidushi Dhungel

Young and Vulnerable: The biggest tragedy regarding youth mental illness is collective inaction

This year, United Nations International Youth Day (IYD), on August 12, has been designated to celebrate the importance of youth mental health with the slogan ‘Mental Health Matters’. This is an opportunity, particularly for low and middle-income countries, to highlight a vitally important—but utterly neglected—aspect of youth life. The neglect has occurred on many levels by both state and society. In a statement, UN Secretary-General Ban Ki-moon rightly highlighted the global urgency to address the stigma and discrimination of youth with mental health conditions.

For the majority of youth who suffer from mental illness, they are forced to live a life of rejection from friends, society and relatives. They are denied the status of ‘citizen’, social membership and basic human needs, robbing them of a dignified life. Around the world, mental illnesses play a significantly negative role in the development of hundreds of millions of youth and their social and economic inclusion and empowerment. In poor countries like Nepal, the young population with mental illness is in a particularly vulnerable position because of the lack of a public health approach in dealing with mental illness, the absence of basic support for their recovery from the state and the deeply entrenched stigma of their illness.

More at risk

Coinciding with the IYD 2014, the United Nations Division for Social Policy and Development, the Department of Economic and Social Affairs has published an insightful report, ‘Social Inclusion of Youth with Mental Health Conditions,’ targeting global actors involved in the field of youth empowerment. I would recommend that youth activists and development workers in Nepal and abroad read this report seriously.

While the young years of life are usually considered to be the most physically active, healthy and energetic of one’s life, this phase is also one when people are most susceptible to mental health problems. However, in many low and middle-income settings, the latter risk is entirely ignored. I do hope that the exposure the issue is getting this year will be instrumental in changing the outlook of mental health, particularly of youth mental health, across the globe.

Nearly one fifth of the global population is comprised of youth aged 14 to 24 years. Almost 90 percent of these live in low and middle-income countries. In a study carried out by Professor Vikram Patel and his team, it is estimated that approximately 20 percent of youth experience a mental health condition each year around the world. Because the youth years are a phase of emotional transition and a time to nurture and pursue childhood dreams, the pressure to study well, find jobs and opportunities is also high.

Drug use, emotional and learning difficulties and disappointment are common. In countries like Nepal, socio-economic disparities and practices of early marriage and strenuous labour can make the situation worse, leaving young people more at risk of experiencing mental health problems than anyone else. Many studies suggest that over 70 percent of mental disorders start before the age of 16. One in nine children attempt suicide before high school graduation and 40 percent of those are in grade school.This is clear evidence that mental health services must be developed to target young age groups.

Educating and collective action

OPRF School Planting, 2013

The prevention and promotion of mental health issues is the way to deal with the growth in mental health problems amongst the youth. Integrating mental health issues into school education is the most effective approach to prevent and promote mental well-being. With an ambition to institutionalise mental health education at the school level and teach hope from an early age, US-based entrepreneur Kathryn Goetzke and her team have just started a pioneering programme, Schools for Hope. This team strongly believes that we can teach our kids how to find pathways to hope, no matter what they experience and that ultimately, we can prevent suicide in youth and adulthood. If this programme is successful, it will be a revolutionary step forward in promoting and institutionalising emotional health and mental well-being.

The biggest tragedy regarding mental illness is collective inaction, which has perpetuated tremendous fear, uncertainty, helplessness, segregation, and hopelessness in the lives of those who suffer. Rather than the illness itself, a fear of social rejection and segregation leads almost a million people to commit suicide every year, with the majority of them young people. By promoting greater social inclusion and empowerment of youth living with mental illness in society, we can change this reality.

It is also vitally important to spread the message that effective services (both social and clinical) exist to manage all kinds of mental health problems. We need to build capacity and a knowledge base to address them. Now, we have to start demanding equitable investment for the mental well-being of the population by asking that the state make holistic mental health services available and accessible for all.

 A new article written by Jagannath Lamichhane

Lamichhane is global coordinator of the Movement for Global Mental Health

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.

Ifred blog photo

 

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

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.

 

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

A Touching Message from a South African Sacred Activist; Her Thoughts on Mandela, Healing, and Hope

Dear fellow Sacred Activists:
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I have a heavy heart and many tears I am shedding this morning.  I am crying for my beloved country.  My heart is aching for all those who sacrificed so much in service to a just and civil society, and continue to do so. I pray that those who are currently in power in South Africa will pause as they mourn our beloved Madiba, and remember that he transformed from freedom fighter and enemy to a revered leader who sought reconciliation. Mandela was arrested after being found by a CIA agent.  My great-uncle (by marriage) Bram Fischer, was Mandela’s attorney during his trial. I remember as a child seeing Robben Island and learning of the prison that held many who are now famous and a number who have died.  During my political activism I came to know people who had served at “the university” as it was called. Colleagues and friends would just disappear without explanation. When they ended up on Robben Island they would be part of conversations orchestrated by the leaders incarcerated there.  And then, on being released, would teach those of us working in townships and squatter camps, trade unions and community organizations, giving us word of what the leadership’s plans were.  Each and every one of their legacies lives on. In South Africa during that time we were not allowed to have images of Nelson Mandela.  Possession of the Freedom Charter that became the most progressive constitution on the planet was grounds for being imprisoned without trial.  We were all imprisoned by the draconian system, even the most privileged, even those who never saw the inside of a cell. When I left South Africa in 1986 during a State of Emergency, and into political exile, I never imagined that in my lifetime Mandela would be released. I never imagined I would ever be able to return to South Africa.  I never imagined that my mixed race daughter would have children who could be friends with children of different colors and cultures.  I never imagined that South Africa would ever be embraced by the rest of Africa because it had always been such a pariah in the eyes of the rest of the continent.  I never imagined that the world would support the change we all fought for and made huge sacrifices for – my imagination was limited by the oppression I grew up in. One never knows how the tides of change will shift the sands.  One never knows how orchestrated insignificant acts can create a crescendo of change such as was experienced in my homeland.   There have been rare moments in my life, as a 5th generation white South African, that I have felt proud to have that legacy.  Today, my pride is mixed with a depth of grief because I am not there on South African soil, to be caught up in the crowds of mourners honoring and remembering. As South Africa moves towards a presidential election, may we all pray that the current  leaders remember that power is to be shared, not hoarded and used to corrupt. In solidarity with all around the globe who mourn with me. Lyndall Hare