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Session 2: Mike Davies
 

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
    •  
    •  
    • 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)