Mental Health Flashcards
Mental health and human resources paper
“At the heart of each and every health system, the workforce is central to advancing health”
The world health report 2006 focused on shortage of healthcare workers
Kakuma et al
- Worldwide shortage of HR for MH, particularly LMIC
- evidence suggests MH can be delivered efficiently through community bases programmes (1) and task shifting (2)
(1) – education for MH HCW and recruitment:
Training programmes for psychiatrists only present in 55% of LIC: Nigeria has had a specialist programme for 25 years yet only half of countries tertiary facilities has enough psychiatrists
Only 14% Kenya med students consider psych despite 75% thinking of it favourably
No national programme in Ethiopia
Brain drain: 9k psychiatrists left Africa and Asia.
(2) – task shifting:
non specialist HCW with brief training under supervision able to tx monitor diagnose DECR CAREGIVER BURDEN
Examples:
mid level MH workers** (e.g. Medical officers) helped reach rural areas where psychiatrists are unavailable
Psychosocial workers** provided psychoeducation in Chile - increase attitudes of caregivers and decrease caregiver burden
India - led support groups showing decrease in severity amongst women with post natal depression
– the need for psychiatrists and neurologists will continue even if task shifting is implemented successfully
Integration of mental health services (depression) into primary healthcare in Chile
In particular, stepped up programmes
Nb. Integration for depression in primary facility is as cost effective as ARVs for HIV/AiDS
Patel et al,
- Depression common amongst poor and women
- integrated into primary health care
- low rate of referrals to secondary facilities despite 80% present with moderate-severe depression
- 2005, new initiative by government Universal Access and Explicit Guarantees
- ensures all depressed people entitled to basic treatment package irrespective of health insurance
Araya et al,
Integration of stepped up programmes in LMICs into primary care systems e.g. Chile. Also shown success in HIC (Simon et al)
Bower et al model:
New case -* agreement to stepped care - step 1 tx - outcome monitoring and analysis
-* step 2 tx or -successful tx
Nb. Refused care**
