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

Bridging the Mental Health Treatment Gap Must Be a Global Priority

 

 equal_treatment_closing_the_gap

Every year, the World Health Organization (WHO) organizes the mhGAP Forum as part of its annual partnership event on mental health. The mhGAP Forum is an informal group of Member States, intergovernmental and nongovernmental organizations, including UN agencies, international development agencies, philanthropic foundations, research institutes, universities and WHO collaborating centres, for coordinated action on the implementation of mhGAP. The mhGap is WHO’s flagship publication aimed at scaling up care for mental, neurological and substance use disorders.

 

WHO’s first global report on suicide prevention will be launched at this year’s annual event. This report will be the first of its kind with in-depth information about the global scenario of suicide, groups at risk of suicide and the ways in which the number of deaths from suicide can be prevented by action from the individual and collective levels. Along with the report, this year’s event is examining the ways to communicate mental health issues effectively and global strategies to advocate the implementation of WHO’s Comprehensive Mental Health Action Plan 2013 to 2020 through partnership.

 

Suicide is a leading global public health issue. Around the world, in every 40 seconds, there is one death because of suicide. In the last 45 years suicide rates have increased by 60% worldwide. According to WHO, “Suicide is now among the three leading causes of death among those aged 15 to 44 (male and female). Suicide attempts are up to 20 times more frequent than completed suicides”. Globally each year approximately one million people die from suicide. Although suicide rates have traditionally been highest amongst elderly males, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of all countries.

 

Mental health disorders (particularly depression and substance abuse) are associated with more than 90% of all cases of suicide. Kathryn Goetzke, the founder of the International Foundation for Research and Education on Depression (iFred) says, “over 350 million people around the world have depression, a treatable disease, yet less than 50% of those with depression are currently receiving treatment”. Ms. Goetzke stresses the importance of this year’s WHO mhGAP forum as being critical to draw global attention to the urgency in bridging the mental health treatment gap. Her organization iFred works to #endstigma, to ensure all those needing treatment feel comfortable getting help. She says, “iFred also believes that by rebranding with a focus on hope, business and individuals are going to be more inspired to donate and fund solutions for this debilitating disease”. With the goal of rebranding depression, iFred has started global campaigning using hashtags like #sharehope #rebranddepression #endstigma.

 

 

According to WHO research, the mental health treatment gap is unacceptably high across the world ranging from 50% to 98%. In rich countries as well, 50% to 60% of people who are believed to be in need of support do not seek any kind of help for their problem. This is a global shame that world governments must give attention. Right to quality mental health services is a fundamental human right. In this context, much work lies ahead for us towards creating #innovative mental health services which will attract and build the trust of users.

 

I believe this mhGAP Forum will build some #hope in this direction. As a participant at the Forum, Ms. Goetzke says that “iFred is thrilled to be participating in this year’s event at the World Health Organization, as this year’s focus directly fits to our new Schools for Hope program. We are inspired by the amount of work occurring globally in mental health, and admire Dr. Shekhar Saxena and his team in creation of the Global Mental Health Action Plan and its implementation advocacy around the world”. She further adds, “we are looking forward to hearing more from the WHO Director General Dr. Margaret Chan who plans to speak at the event this year.”

 

Mental health services are highly stigmatized—regardless of whether the country or society is rich or poor. As a result, people are demonized, and alienated from the entire social process. This is a major factor that discourages people from seeking help. We must aim to overcome this barrier, through shared learning, and move toward bridging the shocking mental health treatment gap.

 

A new article written by Jagannath Lamichhane

 

 

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 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.

Youngboylookingup

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.