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Global Mental Health

McGill Summer School 2nd July 2016

Ross White

on 27 February 2017

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Transcript of Global Mental Health

Leading causes of disease burden caused by mental health difficulties
Mental health difficulties are set to become a leading global cause of disability (Mathers & Loncar, 2005).
4 out of 5 people in low and middle-income countries who need services for mental, neurological and/or substance use disorders do not receive them (MH-Gap, 2008).

Greater than 90% of global mental health resources are located in high-income countries (WHO, 2005).

Globally, spending on mental health is less than $2 (US) per person, per year. It is 25 cents in low income countries. (WHO, 2011)

Only 36% of people living in low income countries are covered by mental health legislation vs. 92% in HIC (WHO, 2011).
The Brain Drain

The UK, the USA, New Zealand, and Australia employ almost 9000 psychiatrists from India, the Philippines, Pakistan, Bangladesh, Nigeria, Egypt, and Sri Lanka (Kakuma et al., 2011).

Without this migration, many source countries would have more than double (in some cases five to eight times) the number of psychiatrists per 100 000 population (Kakuma et al., 2011).
The mhGAP-IG presents integrated management of priority conditions using protocols for clinical decision-making.

The priority conditions included are: depression, psychosis, bipolar disorders, epilepsy, developmental and behavioural disorders in children and adolescents, dementia, alcohol use disorders, drug use disorders, self-harm/suicide and other significant emotional or medically unexplained complaints (WHO, 2010).
Fifty-seven per cent of the 114 LMICs were found to contribute fewer than five
articles to the international mental health indexed literature for a 10-year period
By 2030 Unipolar depression will be the No. 2 contributor to total years lived with disability globally.
Task Shifting/Sharing

The transfer of specific tasks from highly qualified health workers to health workers that have received less training and have fewer qualifications, in order to make more efficient use of the available resources for health in LMIC (Lewin et al., 2007).

What do we scale up/task shift?

Even when available, the interventions in low income countries are often neither evidence-based nor of high quality. (MH-Gap, 2008).

How valid are treatments developed in HIC?

Although > 80% of the global population lives in LAMIC, over 90% of papers published in a 3-year period in six leading psychiatric journals came from Euro-American countries (Patel & Sumathipala, 2001).

Stepped Care

Intervention programme for depression in Goa reduces suicide and increases adherence (Patel, 2008).
Group IPT for depression in Uganda (Bolton et al., 2007)
Community-based intervention for schizophrenia in rural India increases adherence and outcomes (Chaterjee et al., 2003).
70% of a group of patients treated for depression using a stepped care programme in Santiago, Chile, recovered, compared to 30% of a patient group treated as usual (Araya et al., 2003).
The WHO Service Organization pyramid for optimal mix of services in developing countries (Funk et al., 2004)
Human resources for mental health per 100 000 population, by country income group (Income groups defined by the World Bank, 2010) (Kakuma et al., 2011)
WHO Mental Health Atlas (2005) - data received from all 192 WHO Member States.

Aggregate results (region/income group) and country profile information provided.
WHO Mental Health Atlas (2011). It presents data from 184 WHO Member States: covering 98% of the world’s population.

Divided into 6 sections:
•Mental Health care delivery
•Medicines for mental and behavioural disorders
•Information systems
Median change from Atlas 2005 to Atlas 2011 in number of psychiatrists per 100 000 population, by country income group (Income groups defined by the World Bank, 2004) (Kakuma et al., 2011).
The Lancet series on Global Mental Health:

•No health without mental health (Prince et al., 2007)
•Resources for mental health: scarcity, inequity, and inefficiency (Markandya & Wilkinson, 2007)
•Treatment and prevention of mental disorders in low-income and middle-income countries (Patel, et al., 2007)
•Mental health systems in countries: where are we now? (Jacob et al., 2007)
•Scale up services for mental disorders: a call for action (Lancet Global Mental Health Group).

Barriers to improvement of mental health services in low-income and middle-income countries (Saraceno et al., 2007)
The 2nd Lancet series on Global Mental Health:

•Poverty and mental disorders: breaking the cycle in low-income and middle-income countries (Lund et al., 2011)
•Child and adolescent mental health worldwide: evidence for action (Kieling et al., 2011)
•Mental health and psychosocial support in humanitarian settings: linking practice and research (Tol et al., 2011)
•Scale up of services for mental health in low-income and middle-income countries (Eaton et al., 2011)
•Human resources for mental health care: current situation and strategies for action (Kakuma et al., 2011)
•Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis (Drew et al., 2011)
Barriers to the development of mental health services:

1)The absence of mental health from the public health priority agenda.
2) The organization of services. Mental health resources are centralized in and near big cities and in large institutions
3) The complexity of integrating mental health care effectively with primary care services.
4) The lack of effective public health leadership for mental health in most countries
(Saraceno et al., 2007)
The Global Burden of Disease - 2004 Update
Steps for addressing the mh-GAP (mh-GAP, 2008):
•Political commitment
•Assessment of needs and resources
•Development of a policy and legislative infrastructure
•Delivery of the intervention package
•Strengthening of human resources
•Mobilization of financial resources
•Monitoring and evaluation
Stepped care:
Depression/anxiety, substance use disorders, and psychoses were identified as the top three priority disorders.

Prioritized population groups were children and adolescents, women, and persons exposed to violence/trauma.

Connecting with information networks in health research to ensure the sharing and utilization of mental health information by researchers, policy-makers, and the general population.
The term ‘Global Mental Health’ was first coined in 2001 by, the then US Surgeon General, David Satcher.

Global Mental Health is the area of study, research, and practice concerned with addressing inequalities in mental health provision across the globe (Patel & Prince, 2010).

Global Mental Health is ‘a failure of humanity’ (Kleinman, 2009): “The fundamental truth of global mental health is moral: individuals with mental illness exist under the worst of moral conditions”.

In 2010, mental and substance use disorders accounted for 183·9 million DALYs, or 7·4% of all DALYs worldwide.

Of the DALYs caused by mental and substance use disorders:
Depressive disorders accounted for 40·5%.
Anxiety disorders accounting for 14·6%,
Illicit drug use disorders for 10·9%
Alcohol use disorders for 9·6%
Schizophrenia for 7·4%
Bipolar disorder for 7·0%,
Global reporting on core mental health indicators
Mental health systems governance
Financial and human resources for mental health
Mental health service availability and uptake of mental health promotion and prevention
Comparison with mental health atlas 2011 results
"Global Mental Health: Bridging the Perspectives of Cultural Psychiatry and Public Health.” McGill University Montreal (July 5-7 2012)
Global Mental Health: Addressing Inequities in Mental Health Provision Across the Globe

Dr Ross White, University of Liverpool,
ross.white@liverpool.ac.uk - @RossGWhite
Routine follow-up community care provided by a majority of mental health facilities by World Bank income group (WHO, 2011).
Provision of psychosocial interventions by a majority of mental health facilities by World Bank income group (WHO, 2011).
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