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

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

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