4. MH-GAP-
2016
Gaps highlighted by presenters
Focus on Integration
Human resources gaps
Stigma from healthcare workers and
community a REAL ISSUE.
Geneva Monday 10/10/2016
103 partners
18 WHO collaborating centers
40 member states
5 other UN agencies
250 total attendees
5. Ecological Frame
Macro/Policy:
• The majority of countries allocate less
than 2% of health budgets to mental
health4
• 76 - 85% of people with MH problems in
LMIC, do not receive treatment³
8. Mental Health and HIV:The
Missing Link?
↑ risk taking behaviors, ↑ ↓ self-care bx.
ART side effects can mimic depression symptoms
Stress of managing chronic illness
Stigma and Marginalization
Depression and non-adherence = 6 fold mortality risk²
Pregnant/post-partum, PLHIV in Option B+
experiencing drop off!!
¹ Endeshaw et al. 2014, ²Simoni et al. 2011
9. MH Gap in Zimbabwe
•Link between mental illness and traditional beliefs
•Dual stigma surrounding HIV and MH
•MH system uncoordinated with other health
systems, poor infrastructure
•Recognition that services should be integrated
•Shortage of trained professionals
1 Chibanda et al. 2011; Patel et al. 1997; Ministry of Health and Child Welfare 2012.
13. STEP 1: SCREEN
3. Wakambotanga nekumwa doro, kuputa kana kushandisa zvinodhaka uchangobva
mukumuka mangwanani kuti unzwe zvakanaka kana kuti upedze bhabharasi?
Have you ever had a drink or drug first thing in the morning to steady your nerves or
get rid of a hangover (an "eye-opener")
Ehe Yes Aiwa No
16. •Mental Health Screens
–Wellness Recovery Action Plan (WRAP)¹
–Helps the client to identify symptoms when they are mentally
healthy and when nearing a crisis
–A collaborative process to build a toolkit of actions to take
to maintain mental health and to prevent and address a crisis.
•Alcohol and Substance use Screens
–Readiness to Change Rulers
¹ Copeland, 2013
STEP 2: Brief Therapeutic
Interventions
19. Achievements
• Decreased MH stigma among health care providers
– 80% of respondents/trained staff (n=30) agreed that stigma was
reduced in facilities following the training (pilot 1)
• Developed a referral system between levels of care, including
traditional healers
– 100% of clients with positive SSQ were referred
• Standard Operating Procedures developed for integration at
the national level
• MOHCW is committed and seeking funding to scale-up efforts
20. Challenges
Addressing alcohol and substance use
Acceptance of referrals from Traditional Healers to sites
outside of pilot study
Local funding limitations to scale-up
21. Other JSI MH Focus
Examining Mobile Technology for MH interventions among
PLHIV
Integrating MH into ANC to examine Maternal and neonatal
MH and clinical outcomes
Ethiopia SEUHP – MH Curricula for UHE-p
MH and perinatal women living with HIV
22. JSI Next
Internal Steps
Test andTreat Gaps:
Focus on drop off in trx retention
of positive women post birth
Maximize skills of existing staff
Include MH in all proposals
Promote MH at all
opportunities as it is critical for
all PH programs
#MHIntegration
23. Global
upcoming
tools available:
Challenges:
• MH-GAP implementation
guidance (2.0) will soon be
available.
• Contextual adaptations
• Stigma-beliefs/attitudes of
HW
• MH Gap Intervention Guide
2.0
• A CHW version of the IG
guide
• Electronic IG guide via
mobile app.
• Training and Operations
Manual
• Global Action Plan for
Dementia
• Community Suicide Action
Plan