Community care in mental health

#communitycare

#communitymentalhealth

#globalinnovations2014

If ever there was a need for innovation in mental health, it is now. Perhaps that is why we see growing global commitment to develop, evaluate, and scale up promotion, prevention and treatment innovations for mental disorders around the world. Under that premise, the idea of #communitycare in mental health is also gaining momentum. After centuries of the institutionalization of those who suffer from mental health problems, #communitycare in mental health is a refreshing change in the right direction, based on the notion that mental health problems can be dealt with at the community level. In fact, in many ways, the work that iFred does, with projects such as Schools for Hope and Fields for Hope, are also based on the fundamental belief of #communitycare in mental health.

MH innovation

A few months ago, at the London School of Hygiene and Tropical Medicine with support from the Grand Challenge Canada, the Mental Health Innovation Network was created comprising of a global community of mental health innovators: researchers, practitioners, policy-makers, service user advocates. The central aim of this network is to share innovative resources and ideas to promote mental health and improve the lives of people with mental, neurological and substance use disorders. Fundamentally, the network promotes the idea of #communitycare interventions by enabling learning, building partnerships, synthesizing and disseminating knowledge and crucially, by leveraging resources. There are other major initiatives as well like Grand Challenges in Global Mental Health, the World Innovation Summit on Health 2013 (WISH) and the Movement for Global Mental Health which champion the idea of the #communitycare model of intervention.

In February this year, an article appeared in the New England Journal of Medicine, called Transforming Lives, Enhancing Communities – Innovations in Global Mental Health, which highlights not only the need for innovation in global mental health at the community level, but the potential that exists for #collaborativecare and #communitymentalhealth. The article highlights that “despite the robust evidence testifying to the effectiveness of a range of pharmacologic, psychological, and social interventions that can transform lives and enhance communities, the majority of the world’s population has no access to these interventions.” Further, the authors, Vikram Patel and Shekhar Saxena, show that the human rights abuses faced by those who suffer from mental health problems are the worst of modern times. Yet the resource allocation for global mental health remains staggeringly low.

They point to new and innovative measures to tackle the global mental health crisis, in which community care is at the heart of all interventions. In fact, through the Mental Health Innovation Network, these up and coming innovative interventions which can be scaled-up, are being chronicled and discussed and made available for public access. Among some of these innovative interventions, we see the appearance of prevention programs targeted toward youth such as iFred’s Schools for Hope program.

According to the authors of a report drafted (upon which the article is based) in the wake of the World Innovation Summit on Health, on mental health, “at the heart of these innovations lies the health care delivery model of integrated collaborative care. Collaborative care must incorporate an active role for patients and their families and must integrate mental health care with social and economic interventions.”

The authors go on to argue that such care models must focus on the detection and treatment of mental disorders as early in the course of life as possible, since most mental disorders begin before adulthood. They say that “mental health care should be delivered in diverse settings; indeed, most care would be expected to occur outside traditional specialist delivery venues — for instance, in schools, primary health care facilities, the workplace, and patients’ homes.” This is why the focus on #communitymentalhealth is so vital, and also a wonderful example of the importance of iFred’s work in implementing innovative measures to tackle what is a truly global crisis.

A new blog 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

 

Artwork Inspires a Message of Hope Among Students

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

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

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

The Graduate Team and the Inspiring Story Behind Their Project

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

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

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

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

The Dedication

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

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

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

A new article written by Penny Tate

#sharehope #endstigma #shinelight

Shining a Light for Depression: An Invitation to Plant Hope

Penny_Tate_Pinning_Rick_Springfield

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

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

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

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

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

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

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

Penny_Gardens_For_Hope

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

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

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

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

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

A new article written by Penny Tate

#mhblogday #planthope #shinelight #endstigma #teachhope

 

 

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

The British Parliament Inquiry for Disability and Development is a lesson for governments around the world

-Jagannath Lamichhane

Recently, the British Government conducted a parliamentary inquiry on disability and development. As part of the inquiry, leading academic institutions, researchers, disabled peoples organizations (DPOs) and civil society organizations representatives were invited to the parliament committee

"Sometimes, moral solidarity can be more important than the value of money. For millions of people with psychosocial disabilities in developing countries who are invisible and unheard in the society, moral solidarity from the donor community to protect and promote their human rights should be the first concern"

“Sometimes, moral solidarity can be more important than the value of money. For millions of people with psychosocial disabilities in developing countries who are invisible and unheard in the society, moral solidarity from the donor community to protect and promote their human rights should be the first concern”

meeting to present evidences based on research and lived experiences that highlight strong links between disability and development.

All participants at the inquiry univocally emphasized the need to mainstream disability issues as part of a strong international development program. Despite the presence of the UN Convention on the Rights of Persons with Disabilities-2006 (CRPD) and the international obligations to support disability communities under the Convention, many DPO representatives expressed their dissatisfaction over the grave international inaction on addressing disability issues in developing countries.

According to the World Report on Disability 2011 , over one billion people – 15% of the world’s population- are disabled. Around 80% of people with disabilities (PWDs) live in developing countries. Out of them, 98% are unemployed. Over 90% PWDs are out of school. The majority of PWDs are trapped in the vicious cycle of social exclusion, poverty, disease, malnutrition and death. During conflicts and disasters, PWDs are the worst victims of neglect and damage. Of the many disability categories, the situation of people with mental health problems and psychosocial disabilities, and intellectual disabilities is the most neglected. Those with mental health problems and psychosocial disabilities are marginalized within the disability groups.

In this context, the Center for Global Mental Health, CBM International and the Nepal Mental Health Foundation had submitted a joint inquiry submission to persuade the Inquiry Committee to include mental health and psychosocial disability issues in DFID’s future development programs. Prof. Graham Thornicroft was invited from our group. He presented mental health as a strong case for international development.

While the inquiry was underway, I was also invited by the chair of the International Development Committee Rt Hon Sir Malcolm Bruce for an informal meeting to discuss the experiences and situation of mental health issues in developing countries, mainly of Nepal. It was a great opportunity for me to share the ordinary ground experiences of psychosocial disability and mental health in the hopes that DFID might take international leadership to address these issues.

Dr. Mary DeSilva from the Centre for Global Mental Health made my meeting possible with the Chair and, in fact, Mary herself has been playing a lead role in an effort to sensitize British parliamentarians about the tragedy of mental health issues and the routine human rights violations of people with psychosocial disabilities in developing countries.

My meeting with the Chair went well. He seemed quite concerned about the lack of educational, economic, social, health and livelihood opportunities of people with mental health problems and psychosocial disabilities in developing countries. The protection and promotion of human rights, quality health care and social inclusion were the main issues discussed with the Chair.

As I informed the Chair, in international development, money isn’t the only factor. Sometimes, moral solidarity can be more important than the value of money. For millions of people with psychosocial disabilities in developing countries who are invisible and unheard in the society, moral solidarity from the donor community to protect and promote their human rights should be the first concern. There are so many “No Cost” interventions where donor agencies can provide genuine moral support and solidarity. If the donors begin by allocating small resources matched by moral solidarity, it would go a long way to transform the millions of lives of people with mental health and psychosocial disabilities in poor countries.

I hope DFID will take both “No Cost” and “Low Cost” international leadership in this sector.

 

(With support from Bidushi Dhungel)

 

 

 

In order to address the suffering of those with mental health problems, there needs to be a radical shift in the understanding of mental illness

-Jagannath Lamichanne

I have always believed that the challenge of dealing with mental health problems is their invisibility. Anyone who suffers from mental illness repeatedly questions: Does it exist? Do other people also suffer the same problem? Do people believe that my mental suffering is real? Does it make me different? It is to provide answers to such complex questions, to promote the visibility of mental health, promote their acceptance and find ways to address the problems related to them that I have been working.

I learned early on that mental health problems were of serious concern to many people around the world. For example, depression, — the most common of mental illnesses — if left untreated, can lead to disastrous personal, social and even economic costs. Further, the lack of treatment and right to live with integrity as an

"...our big challenge is the legitimacy of civil society voices who have been struggling for years demanding the recognition of human rights and the social condition of people with mental health problems."

“…our big challenge is the legitimacy of civil society voices who have been struggling for years demanding the recognition of human rights and the social condition of people with mental health problems.”

equal member of society for those who suffer is an infringement on their human rights. This is especially true in under developed and developing countries where resources are scarce and access to any kind of treatment is bogged down with stigma alongside financial burdens.

In 2010, the World Health Organization (WHO) released a report titled “Mental Health and Development”. It focused on the civil, economic, human, and health rights of people with mental health conditions. According to the report, “the majority of development and poverty alleviation programmes do not reach persons with mental or psychosocial disabilities.” It goes on to say that between 75 percent and 85 percent of people who suffer from a variety of mental health problems do not have access to any form of mental health treatment.

But what is most crucial is the impact that such problems can have on society and on personal well-being of those who suffer. The report suggests that those with “mental and psychosocial disabilities are associated with rates of unemployment as high as 90 percent” and that they are “not provided with educational and vocational opportunities to meet their full potential”.

The lack of treatment and the stigma associated with mental illness has pushed those who suffer to the extreme margins. However, the relevance of mental health as a global issue is further established when one examines the link between chronic physical illness and mental illness, for mental illness is not an isolated occurrence.

According to WHO, four chronic illnesses—cardiovascular, diabetes, cancer and respiratory illnesses— are responsible for 60 percent of the world’s deaths. Further, The Lancet series on Global Mental Health suggests that persons with these chronic illnesses have much higher rates of depression and anxiety than the general population. Major depression among persons experiencing chronic medical conditions increases the burden of their physical illness and somatic symptoms. More importantly, it increases medical costs and mortality.

The bottom line is that mental illnesses occur with chronic physical illnesses in many patients, causing significant role impairment, loss of productive hours and disability. They also worsen prognosis for heart disease, stroke, diabetes, HIV/AIDS, cancer and other chronic illnesses. But the majority of factors responsible for mental illnesses — like depression among those suffering from chronic illnesses — are not being adequately addressed.

It has been a hard job for us to educate people that mental illnesses are a result of both social and medical conditions. While improving the quality of mental health services in coordination with physical health services, we also need social attention, care and support to ensure the recovery of people with mental health problems.

For this, the WHO report suggests two development paradigms: the need to improve aid effectiveness in poor countries; and the use of a human rights approach (universally) that ensures there are sufficient resources to provide quality services for people with mental health problems as well as their inclusion in development programmes.

Still our big challenge is the legitimacy of civil society voices who have been struggling for years demanding the recognition of human rights and the social condition of people with mental health problems. There is a need to create a strong social force for radical changes in the mental health area.

(With support from Bidushi Dhungel)

 

Seeds for Hope

Lamichhane and Goetzke at the first Global Mental Health Summit

I still remember the first day I met Kathryn Goetze, founder of the International Foundation for Research and Education on Depression (iFred). It was in Greece on the 2nd of September, 2009, during the first ever global mental health summit; the early days of my entry into the then-newly emerging field of global mental health. I guess you could say that until then, when it came to issues of mental health, my understanding was traditional and shaped by negative public perceptions.

However, it was upon hearing Kathryn speak at the summit about the need to rebrand depression and her endeavor to give depression a positive brand with the help of the image of sunflowers, that I began to understand how we can work to re-construct social understandings of mental illness and depression. I began too slowly realize that societal perceptions of mental health are constructed with negative images and that with effective campaigning, could well be re-constructed with the use of positive imagery like that of the sunflower.

Since 2009, I have remained in constant communication with Kathryn, keenly observing her work. It was in 2011 that I finally got a chance to actually work with her on her global initiative — the Field for Hope campaign, where fields of sunflowers are planted to shed light on depression and simultaneously work to give the mental health related problems a more positive image. It was, however, only recently that I thought about exactly what the motivations for Kathryn’s involvement in the sector were. I knew that she was doing wonderful and innovative work to tackle stigma against depression but didn’t know why she was doing it. I caught up with her and what I learned was telling.

Kathryn had lost her father to suicide at the tender age of 19. “It was very devastating to me. He was a brilliant businessman, very close to me, and I knew there was something ‘wrong’ with him from an early age, but had no idea what it was,” she recalled. It was only after several years of study in her 20’s that she realized it was untreated depression.

By the time she was in her 30’s Kathryn began to apprehend that she too was struggling with depression, “a chemical imbalance of the brain that manifests itself in different ways through different people,” in her words. She had developed addictions – to food, alcohol and could not understand why for a long time.

That’s why when Kathryn launched her company she wanted to donate her time and resources to help educate people about depression. However, in order to do so, she would have to start a new movement herself.

The sad reality of the global context of depression is that even the non-profits and organizations working on depression are by and large straggled themselves by the negative stigmas and imageries surrounding depression. Kathryn found that “the nonprofits doing work in this area were often, ironically, depressing.” According to her, these non-profits focused more “on symptoms rather than the impact of treatment,” and fail to recognize the fact that depression is the “most hopeful disease there is — depression is treatable.” That fact is one that many societies across the world, even the most developed, are yet to come to terms with.

The majority of images of depression are depressing people–sad men and women, head bowing down, arms wrapped around the knees and almost crying, in dreadful black and white gloom. As an expert in marketing and branding, Kathryn set out to challenge and, thus, change the stigma surrounding depression. by creating an organization to help rebrand the disease through “educating other NGOs about branding and stigma, engaging celebrities and role models to talk about the disease, and teach the public about the biology of the brain.”

 

For Kathryn, it is this biology of the brain that is central to being mentally fit. “We must learn about creating and maintaining a healthy brain. Everything they think, eat, feel, and do affects the health of their brain.” According to her, the world is going to be based more and more on human intelligence, so creativity, brain health, and ability to solve problems is increasing ever more in importance. That is why Kathryn has begun this new movement to “Learn about and feed the brain in positive ways.”

 

This is not the first time such a rebranding of a disease is taking place. A major rebranding success was seen in fighting the stigma surrounding breast cancer some decades ago. Iconic symbols like the pink ribbon and the ownership of the cause by celebrities helped to quickly bring the disease to the mainstream and strip it of its negative stigma. Kathryn hopes to help enable the same for depression.

When asked what she would like to see accomplished in her life, she replied that she’d like to see an “event similar to ‘Stand Up to Cancer’, engaging celebrities from all walks of life to raise money and awareness for depression by speaking out on how to find hope when all else is going wrong.”  Further, Kathryn wants to be able to “live in a world where there are no suicides and people feel fine about getting treatment for their depression.” Her advocacy is undoubtedly on the right track to make this a reality.

In addition, Kathryn is working with companies to implement depression awareness and prevention programs in the workplace. She is also working on her Schools for Hope, “a curriculum we are developing to teach kids about how they can create Hope,” she said. Towards this end, she is also seeking support from consumer products companies.

Having been a part of the Field for Hope campaign, I can see its positive effects in encouraging communities to gather and talk about healthy brains and as a way to “honour those with depression,” as Kathryn told me. Overtime, the image of the sunflower will drown out the negative images of depression we see all-too-prevalent today. What Kathryn hopes for the future is to “have people think of a sunflower when they hear the word depression.”

Her work has been exemplary and encouraging in every way for the millions who are suffering. She vows to continue encouraging others to find the beauty in their darkness, and use the powerful force to create something full of light and inspiration for others.

I am proud to continue to be a part of her noble endeavor through my weekly blog beginning as of January 2014. I urge all to join hands to combat the greatest tragedy of the 21st century–depression.

-Jagannath Lamichhane

(With support from Bidushi Dhungel)

Jagannath Lamichhane is a mental health and human rights activist from Nepal. Currently, he is doing an MSC in global mental health, a program jointly run by Kings College London and the London School of Hygiene and Tropical Medicine, UK. 

World Health Organization Adopts Mental Health Action Plan

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We recently learned that the 66th World Health Assembly has adopted the World Health Organization’s comprehensive mental health action plan (2013-2020). The action plan is the outcome of extensive global and regional consultations over the last year with a broad array of stakeholders including: 135 Member States; 60 WHO CCs and other academic centers; 76 NGOs and 17 other stakeholders and experts.

As one of the 76 contributing nonprofit organizations at the forum, we are proud to have played a role in the development of this Action Plan as we feel it is a critical step in the right direction of eradicating the stigma of depression and meeting the needs of the 350 million worldwide living with the disease.

As part of our ongoing efforts to be leaders and advocates for the disease, we plan to have International Foundation for Research and Education on Depression (iFred) representatives once again at the mhGAP Forum in October to discuss the launch of the plan and its implementation.

The four major objectives of the action plan are to:

  • Strengthen effective leadership and governance for mental health.
  • Provide comprehensive, integrated and responsive mental health and social care services in community-based settings.
  • Implement strategies for promotion and prevention in mental health.
  • Strengthen information systems, evidence and research for mental health.

We look forward to continuing collaboration with WHO representatives and working towards solutions that will give hope to millions living with depression.

For more information about the Action Plan click here.