Teaching Hope: A Powerful Lesson

IMG_0958iFred’s recent project, Schools for Hope, launched this fall with fifth graders in the Chicagoland area. The curriculum aims to teach hope to students as a result of the disheartening statistic suggesting that one out of nine students attempt suicide before graduating high school, with forty percent of those being in grade school (Journal of Adolescent Health, 2011).iFred learned that research suggests that hope is a teachable skill and created the program with the intention of instructing each and every ten year old around the world useful tools for finding and maintaining hope.

Hopelessness is the number one symptom of depression and leading predictor to suicide (Association of Physicians, 2004) and suicide is the 3rd leading cause of death among 10-24 year olds according to the Center for Disease Control and Prevention (CDC). This is an issue that must receive our attention and action.

Our society has created a stigma surrounding mental illness and as a result individuals become isolated, feel ashamed, and do not seek treatment. This is no different with our children. It is evident we must educate on the importance of caring for our minds as we do for our bodies, and by doing so, we will encourage new generations to embrace mental health, provide people with the support and care that is currently lacking, and lead individuals to effective treatment.

According to the World Health Organization, prevention programs have been shown to reduce depression including school-based programs focused on enhancing cognitive, problem-solving, and social skills of children and adolescents. The Schools for Hope curriculum is designed to provide children with the tools to always find hope and promote the importance of caring for an individual’s emotional well-being.

It is important and necessary to understand the research, statistics, and learn about what we can do to create change and improve on in mental health education. However, after having the opportunity to observe firsthand the discussions that formulated in the classroom, I must add that the true gift and lesson was also given by the children. Hearing their thoughts, ideas, and insight on the importance of hope, was nothing short of inspiring, heartwarming, and a reminder of the impression we can make on young open minds.

By giving them hope, we empower new generations to enact change for the better. Scholastic agrees, and recently released an article written by teens in their Choices Magazine, educating teens on depression and offering treatment and support options. Editor Eva Rosenfield stated, “The stigma surrounding depression makes people feel like they can’t talk about it openly-or at all.  And in turn, these people are not getting the help they need.”

We can make a difference and save lives. Let us listen to the voices of our children and bring them a world where they always have love, support, compassion, and HOPE.

#teachhope #sharehope

A new article written by Penny Tate

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

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

 

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.

 

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

-Jagannath Lamichhane

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

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

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

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

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

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

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

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

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

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

(With support from Bidushi Dhungel)

 

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

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. 

Schools for Hope; New Campaign to Prevent Suicide in Youth

High School Teens at Oak Park River Forest High School Planting Hope, 2013

Did you know 1 in 9 kids attempt suicide prior to graduating high school, and that 40% of those kids are in grade school?  (Journal of Adolescent Health via Family Matters, 2011).  And that the number one autofill on google is ‘Hope makes me…  depressed’?  We don’t know exactly why, but what we do know is that the primary predictors of suicide include hopelessness and depression.  (Association of Physicians, 2004).

The Good news?  HOPE is teachable and depression is treatable? (Rand and Cheavens, 2008),  It is true.  Research suggests that Hope can be taught  and that the greater the hope, the greater the level of well-being (Scioli, 2009).  Hope is defined as the perceived ability to create pathways to a desired result, and the motivation to follow those pathways through to the desired result (Rand and Cheavens, 2008).  Higher Hope corresponds to greater emotional and psychological well-being, greater academic performance, and enhanced personal relationships (Snyder, 2005).

With your help, we can bring a lesson plan of HOPE with activities to the classroom.  Our goal is to raise $85,000 throughout December for this project through our Indiegogo campaign, and then to spend January and February creating the research-based curriculum to launch in ten test schools in April of 2014.  Our goal is then to take the finalized curriculum global in 2015.

Our Overall Vision for Schools for Hope:

Our aim is to expand on our Field for Hope project that cultivates Hope through seeing through a planting of sunflowers; from seed to flower and back to seed.  With your help we aim to take this project further and share messages and symbols of hope with others; creating curriculum around the planting specifically to teach Hope to children.  And then to nurture Hope and through peer to peer support to teach this to the next classroom.

  • Engaging children through a 360° support and wisdom sharing system—peer-to-peer, teachers, counselors/psychologists and parents.
  • Partnering with mental health education experts, curriculum will be targeted, self-paced and ready to implement into school systems.
  • Leverage online and new social mobile application technology to implement the program. Content will be engaging and inspirational and delivered on a relevant youth-oriented platform.
  • Integrate a yearly sunflower planting symbolic of HOPE in the Spring, writing messages of Hope to those that then harvest the seeds in the fall, starting the infinite spiral for Hope.
  • Garner research through metrics analysis, evaluation and optimization.
  • Pilot in Chicago schools; adapt to deploy tailored program focused in PTSD and tragedy to those areas as needed. (i.e. Sandy Hook, Columbine, Oklahoma, etc.)

Please help us make this campaign a success!  With your generous donation of time, brain power, and/or contacts we can get this moving.  Hope is teachable, depression is treatable. Let’s help make ALL kids feel value and like there is always a way to resolve problems in a positive, productive way.

Please visit www.schoolsforhope.org and help us make this project a reality.