Global Mental Health: Scope and limitations Flashcards
What is the consequence of the lack of mental health services in low and middle income country (LMIC) settings?
Disability and low quality of life
What is the recognition of mental health around the globe?
- Mental health is neglected globally
- particularly salient in LMICs
What is the principle of equity based on?
Recognition of inequity
What are the two roots of global mental health?
- Medical anthropology
2. Transcultural psychiatry
How and when did the current global mental health movement start?
With a Lancet series in 2007:
- led by researchers from KCL and London School of Hygiene and Tropical Medicine
(professors Patel and Prince)
Which evidence was reviewed in the 2007 Lancet series led by Pr Vikram Patel and Pr Martin Prince, which started the global mental health movement?
Evidence for:
- barriers to delivering effective treatment
- ressources available in LMIC settings
-> call for action
What shaped early research on global mental health?
- Scientific racism
- View that people were on a linear pathway
- View that mental disorders were a product of modernity
What was the perception of global mental health in early research?
View that mental illness in LMICs was lower than that in the West
What does evidence suggest on the levels of mental illness in the world?
Mental illness is quite similar across the world
- distress may be expressed differently, but no evidence of different prevalence
- similar debilitating effects
Which evidence suggests that mental illness is an increasing proportion of disease burden?
The proportion of disease attributable to non-communicable diseases, including mental disorders, is increasing
- across regions and countries, at macro and micro level
What is the defining goal of global mental health?
Closing the treatment gap
What constitutes the global mental health treatment gap?
Around the world, mental disorders are under-diagnosed and under-treated
- treatment gap is at its widest in LMICs
- sometimes only 10% of people (or less) receive treatment
What do many people do in the absence of treatment in biomedical system?
They seek treatment from traditional and faith healers
What are the advantages of traditional and faith healers?
- Cultural appropriateness
- Services are community-based
What are the disadvantages of traditional and faith healers?
- Lack of regulation and training
- Expense of these kinds of treatments
- Lack of evidence of effectiveness
What makes the most effective mental health systems?
Balance of
- community-based services
- AND inpatient facilities consisting of multi-disciplinary teams
- Psychiatric hospitals and specialists
- Psychiatric services in general hospitals
- Community mental health services
- Mental health services in primary care or other community-based care services
- Informal community care
- Self-care
Why are there large geographical areas and populations without mental health services in LMICs?
In LMICs, mental health services tend to be concentrated in large psychiatric hospitals in urban areas
What is the state of mental health in stretched health budgets and LMICs?
> Mental health has been low priority for stretched health budgets
- small number of beds, majority concentrated in psychiatric hospitals
> Lack of specialist mental health professionals in LMICs
What does the Emerald programme implementation suggest? (Semrau et al., 2015)?
Growing recognition of importance of mental health
- number of countries are beginning to develop infrastructures and policies needed for development of systems and services
- it will take time to impact the treatment gap
- in the absence of specialists, there’s a growing interest in developing the workforce capacity to rapidly scale up mental health services
What is task-sharing in mental health care?
A means by which the treatment gap may be rapidly addressed
What is a key contribution of the academic field of global mental heath for task-sharing?
To bring evidence about the effectiveness of task-sharing interventions
How did task-sharing emerge?
Recognition that given constraints on budgets, introduction and delivery of new mental health services needs to be done using existing infrastructures
- minimal additional inputs and costs
- community-based care is currently lacking from LMIC systems
Which elements make task-sharing more feasible in LMIC systems?
Existing, well-developed primary care systems dealing with infectious disease, maternal and child death
Who can deliver care in task-sharing?
Non-specialist healthcare workers
- involved in diagnosis, treatment, management
- with the support of specialists
What is the current effectiveness of task-sharing?
- Good evidence from RCTs of effectiveness of task-sharing for mental healthcare in LMICs
- BUT, there are still gaps in feasibility and acceptability
What is the role of specialists in task-shared services?
Using limited resources in the most efficient way possible
What did the MANAS trial carried out in Goa consist of (Patel et al., 2010)?
Graduates were trained to deliver psychological interventions for common mental disorders, working alongside primary care doctors with supervision from psychiatrists
What did the MANAS trial carried out in Goa demonstrate (Patel et al., 2010)?
Evidence of effectiveness and some challenges in the feasibility and acceptability of task-shared services
What is the collaborative care model developed for quality of care in LMIC settings?
A type of task-sharing between specialists and primary healthcare workers that can deliver the highest quality of care
What did the Federal Democratic Republic of Ethiopia Ministry of Health propose in their National mental health strategy 2012/13 - 2015/16?
Development and revision of national policies and plans
- provides the impetus, funding and frameworks necessary for the successful implementation of health services and systems
What is the WHO Mental Health Gap Action Program (mhGAP)?
A task-shared intervention programme providing
- manualised training for primary healthcare workers
- with the aim of enabling them to treat and manage priority mental disorders in a community setting
What does the WHO Mental Health Gap Action Program (mhGAP) aims to do?
Focus attention on mental health in order to close the treatment gap in LMIC settings
What is the current application state of the Mental Health Gap Action Program (mhGAP)?
It is currently being rolled out by national governments in LMIC settings
- research is underway to evaluate its effectiveness
What is the PRIME research programme (2014)?
- Includes researchers from KCL
- Uses a combination of methods to evaluate the effectiveness of the implementation of mhGAP
What are the necessary factors for the successful scale-up of mental health services?
- Assessment of needs and resources
- Political commitment
- Supportive policy environment
- Development of intervention package
- Establishment of plan for monitoring and evaluation
- Strengthen Human Resources
- Mobilisation of financial resources
What are the challenges to the scale-up of mental health care, found by the PRIME research programme (2016)?
- Lack of prioritisation
- Poverty
- Cultural diversity
- Health system challenges
- Medication supply
- Health info systems
- Burden on healthcare workers
- Shortage of Human Resources
- Bureaucracy
- Lack of accountability
- Lack of community awareness
- Stigma and discrimination
How do proponents of global mental health view this field?
As a means for improving mental health and reducing inequity
What is the central view of the critics of global mental health?
Global mental health as cultural imperialism of Western ideas
What is the key argument from the critics of global mental health?
It imposes biomedical categories upon other cultures when these are not necessarily appropriate
What is the consensus between proponents and critics on global mental health?
Consensus on the expression of distress
- even though mental disorders manifestations vary, there are identifiable shared underlying constructs across cultures
What would most proponents of global mental health agree on?
The need for awareness of culture
- particularly for measurement, design and delivery of interventions and services
What does the early work on the difference of prevalence between LMICs and high income countries suggest?
> LMICs
- low prevalence and impact of mental disorders
> High income countries
- high prevalence and impact of mental disorders
- due to labelling and separation within family and community systems (absent in LMICs)
What does the recent work on the difference of prevalence between LMICs and high income countries suggest?
High levels of social isolation and low levels of participation in those with mental disorders in LMIC settings
What does recent evidence suggest on the level of satisfaction with existing traditional modalities of dealing with mental illness?
Without biomedical services -> lack of choice
- it does not imply satisfaction
What is a limit of global mental health?
How is it countered?
It ignores elephant-in-the-room issues (e.g. poverty, social adversity)
- > many global mental health interventions go beyond the clinical issues
- > examine social capital, social conditions and improve community resources
What are the typical partnerships in global mental health?
Western partners often from powerful universities
- which have originally created concepts of global mental health and categories of mental disorders
What seem to be the factors leading to an equal platform in global mental health?
- Long-term partnerships
- Capacity-building activities
