Session 2: Mike Davies
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Session 2: Mike Davies

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Mike Davies: Mental health in low and middle income countries

Mike Davies: Mental health in low and middle income countries

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Session 2: Mike Davies Session 2: Mike Davies Presentation Transcript

  • MENTAL HEALTH IN LOW- AND MIDDLE-INCOME COUNTRIES NEEDS, RESOURCES, ISSUES AND APPROACHES MIKE DAVIES OBE cbm
  • CBM
    • Formerly the Christian Blind Mission or Christoffel Blindenmission
    • Founded 104 years ago
    • Today, providing technical and financial support to 740 disability-related programmes in 89 countries
    • Reaching > 23 million people in 2010
    • Mostly funded by individual donations
  • NATURAL DISASTERS HAVE ACCELERATED CBM’S INVOLVEMENT IN COMMUNITY MENTAL HEALTH
  • NEEDS
    • 450 million people worldwide have psycho-social problems , including -
    • 150 million with depression
    • 90 million with substance abuse disorders
    • 25 million with schizophrenia
    • (World Health Report 2001)
  •  
  •  
  • RESOURCES
    • Europe : One psychiatrist for 10,000 people
    • Africa : One psychiatrist for 200,000 people
    • IN LOW- AND MIDDLE INCOME COUNTRIES
    • LESS THAN 1% OF THE HEALTH BUDGET IS
    • SPENT ON MENTAL HEALTH
    • (WHO Mental Health Atlas 2005)
  • MASS GRAVE - ACEH
  • TREATMENT RATE
    • cbm estimates that in developing countries, between 80 and 90% of persons with psychosocial problems do not get treatment of any kind
    • For the vast majority, no accessible or affordable treatment option exists
  • HOW TO BRIDGE THE GAP BETWEEN NEEDS AND RESOURCES?
  • NCD SUMMIT (Sept 2011)
    • Focused mainly on cancers, cardiovascular disease, chronic respiratory disease and diabetes.
    • By 2020, depression alone will be the second ranked disease burden, after cardiovascular disease
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  •  
  • CBM’S RESPONSE
    • A paradigm shift towards community mental health work, with treatment emphasis at primary and secondary levels
    • Multi-tiered intervention strategy focused on local capacity development, access to appropriate treatment, social integration, family counselling & support, livelihood development, advocacy to reduce stigma and prejudice, and empowerment of users and carers groups.
  • UNCHAINING PEOPLE
  •  
  • DUAL MODELS
    • Community mental health services, concentrating exclusively on people with psychosocial problems
    • Inclusion of persons with psychosocial problems in cross-disability, multi-intervention community-based rehabilitation (CBR) programmes
  • CBR guidelines January 27, 2012
  • IN 2010 cbm …
    • Helped 101,000 people with psychosocial problems in 31 countries
    • Supported the work of 18 local mental health professionals
    • Met the training costs of 44 mental health professionals
  • The mayor’s solution? Put him on the bus to the next town…
  • STRENGTHS
    • Strong network of partners at all levels (local, national, international)
    • Support for users groups and self-help groups
    • The move towards inclusive approaches
    • Cost-effective interventions at community level
  • WEAKNESSES
    • Not enough ‘care for the carers’
    • Preventive and promotional work remains weak
    • Partner overload
    • Not enough time to do training
    • Insufficient evidence that inclusive approaches work
  • OPPORTUNITIES
    • Emergency relief work
    • Involving community and religious leaders
    • Advocacy to influence policy/funding support
    • More central roles for user groups
  • THREATS
    • Biomedical orientation of government systems
    • Lack of public/private partnerships
    • Professional resistance to community-based MH approaches
    • Focus on 3ry care as first choice intervention
    • Many professionals don’t want to work where they are most needed
  • PEOPLE WITH PSYCHOSOCIAL PROBLEMS ARE INCREASINGLY INVOLVED IN PLANNING COMMUNITY MENTAL HEALTH PROGRAMMES
  • THE WAY FORWARD
    • Empowering user organisations & SHGs
    • Promotion of positive mental health
    • Capacity-building at all professional levels
    • Balance between medical, social and livelihood interventions
    • Structured monitoring & evaluation leading to systematic improvements of services
    • Stronger advocacy with governments
    • Staff care/burn-out prevention
  • QUOTES FROM A ‘USER’
    • “ There are two critical issues in mental health today – a) the excessive medicalisation of human suffering and distress, and b) the widespread human rights abuses of people society labels as ‘mad’, ‘disturbed’ or ‘mentally ill’”
  • QUOTES FROM A ‘USER’
    • “ The primary crisis in mental health is not the lack of economic resources or the need for better technologies… the crisis is a social, cultural and political one that requires changing how we think about madness, suffering and emotional pain”
  • QUOTES FROM A ‘USER’
    • “ The UN Convention on the Rights of Persons with Disabilities is a clear and comprehensive blueprint … a human rights and social inclusion framework that represents a shift away from the medical model to a social model of disability. This is precisely what is needed in mental health”
    • In 2006, David Webb completed his PhD on suicide – the first thesis of its kind by someone who has attempted suicide. David has been a board member of the World Network of Users and Survivors of Psychiatry. His book ‘Thinking About Suicide’ was published in the UK in 2010, by PCCS Books
  • BEFORE Chained to a tree
  • AFTER Growing vanilla
  • THANK YOU
    • cbm UK
    • www.cbmuk.org.uk
    • Tel – 1223 - 484700
  • GLOBAL DISEASE BURDEN
    • Of the 15 main types of disease affecting women in LOMICs, six are psychosocial –
    • depression (ranked 1), schizophrenia (4), bipolar disorder (7), self-inflicted injury (8), panic disorder and substance abuse
    • (WHO, Global Disease Burden, 2004)