Global Mental Health - 2.12 + 2.14

Question 1

What is the WHO definition of Mental Health?

Answer 1

A state of wellbeing in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community (WHO)

Question 2

What are the issues with the WHO definition of mental health?

Answer 2

Doesn’t have a timescale
‘Normal stresses’ is not applicable/realistic for all societies - individualistic, neglects poverty + conflict
Outcome hard to measure

Question 3

What are culture-bound syndromes?

Answer 3

Psychiatric syndromes closely related to culture or bound to cultural group or setting

Question 4

Describe the global burden of neuropsychiatric disorders

Answer 4

Neuropsychiatric disorders account for 28% of global burden (Prince et al, 2007) - Contribute more than CVD or cancer
1 in 10 people estimated to need mental health care at any one time (WHO, 2018)
3rd leading cause of death in young people - likely to be unreported
Interaction between mental health + physical health e.g. somatic symptoms e.g. newborn deaths + stillbirth is a driver in maternal health

Question 5

Name 3 neuropyschiatric disorders

Answer 5

Unipolar + bipolar affective disorders
Substance-use + alcohol-use disorders
Schizophrenia
Dementia
Neurological disorders

Question 6

What is the treatment gap?

Answer 6

Difference between the true prevalence of a disorder and the treated proportion of individuals affected by the disorder (Kohn, 2004)

Question 7

Why is there a treatment gap?

Answer 7

Lack of public health priorities, health policy + legislation - only 2/169 SDGs realted to mental health
Lack of financial + human resources
Inefficient resource allocations - WHO estimates shortage of 1.18 million mental health professionals worldwide

Question 8

Name 3 strategies for reducing treatment gap

Answer 8

Patel, 2010
Increasing number of psychiatrists + other mental health professionals
Increasing involvement of a range of appropriately trained non-specialist providers
Active involvement of people affected by mental disorders

Question 9

What are the consequences of the ‘treatment gap’?

Answer 9

Stigma + discrimination
Violation of basic human rights + freedoms - maltreatment of mentally ill widely reported
Physical, sexual + psychological abuse more prevalent among those with mental disorders

Question 10

Name 4 movements/programmes that aim to strengthen mental health systems

Answer 10

Movement for Global Mental Health
WHO MIND (Mental Health Improvements for Nations Development)
Mental Health Gap Action Programme (mhGAP)
WHO Report 2001: recommendations to strengthen mental health systems

Question 11

What are the 5 areas of action stated in WHO MIND?

Answer 11

Action in + support to countries to improve mental health
Mental health policy, planning + service development
Mental health human rights + legislation
Mental health as a core part of human development
The Quality Rights Project to unite + empower people to improve quality of care + promote human rights in mental health facilities + social care homes

Question 12

Name at least 3 recommendations from the WHO report 2001 to strengthen mental health systems

Answer 12

Provide treatment in primary care
Make psychotropic drugs available
Give care in community
Educate public
Involve communities, families + consumers
Establish national policies, programs + legislation
Develop human resources
Link with other sectors
Monitor community mental health
Support more research

Question 13

How valid is the Global Mental Health course?

Answer 13

Te presentation, attribution, classification, prevalence + prognosis of mental health disorders have been shown to vary greatly across cultures
In non-Western world there are high rates of structural poverty, conflict etc so Western diagnostic categories may not be applicable
From a public health perspective, is it more important to address the identification + treatment of mental illness in these settings or social determinants?
‘Medical imperialism’

Question 14

Why is there a need for cross-cultural mental health research + care?

Answer 14

Mental health + global burden of disease
Treatment gap
Human rights + mental health
Globalisation, conflict, climate change, natural disaster
Growing immigrant populations
Controversies around validity of understandings of distress and mental health disorders
Global populations require appropriate health disorders

Question 15

What must global mental health research be?

Answer 15

Representative of diverse communities

Community-based + contextualised within diverse languages + cultures

Question 16

What are the barriers to cross-cultural research?

Answer 16

Linguistic + cultural barriers

Result in lack of research and can lead to failure to provide adequate care + underrepresentation of minority groups

Question 17

What social + cultural factors are associated with increased risk of mental disorders?

Answer 17

Family history
Physical health
Stigmas
Gender
Social hierarchy
Social attitudes to emotional responses, grief and loss
Leadership + policy priorities

Question 18

What is primary prevention in terms of mental health?

Answer 18

Aims to prevent onset of mental health problems by addressing wider determinants of illness and using ‘upstream’ approaches that target the majority of population

Question 19

What is secondary prevention in terms of mental health?

Answer 19

Early identification of signs of mental health problems or suicide risk + early intervention to prevent their progression or the development of other health complications

Question 20

What is tertiary prevention in terms of mental health?

Answer 20

Involves working with people with established mental health problems to promote recovery + prevent (or reduce risk of) recurrence

Question 21

Name key factors that affect the interrelationship between mental health problems + social constructs

Answer 21

Community + individual assets, resilience + agency
Social inequality, social justice, class + status
Discrimination - individual + cumulative effects
Gender relationships, sexism + heterosexism
Ethnicity + racism
Societal violence, abuse + stress
Transcultural + societal stigmas