Session 2: Mike Davies

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Mike Davies: Mental health in low and middle income countries

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Session 2: Mike Davies

  1. 1. MENTAL HEALTH IN LOW- AND MIDDLE-INCOME COUNTRIES NEEDS, RESOURCES, ISSUES AND APPROACHES MIKE DAVIES OBE cbm
  2. 2. CBM <ul><li>Formerly the Christian Blind Mission or Christoffel Blindenmission </li></ul><ul><li>Founded 104 years ago </li></ul><ul><li>Today, providing technical and financial support to 740 disability-related programmes in 89 countries </li></ul><ul><li>Reaching > 23 million people in 2010 </li></ul><ul><li>Mostly funded by individual donations </li></ul>
  3. 3. NATURAL DISASTERS HAVE ACCELERATED CBM’S INVOLVEMENT IN COMMUNITY MENTAL HEALTH
  4. 4. NEEDS <ul><li>450 million people worldwide have psycho-social problems , including - </li></ul><ul><li>150 million with depression </li></ul><ul><li>90 million with substance abuse disorders </li></ul><ul><li>25 million with schizophrenia </li></ul><ul><li>(World Health Report 2001) </li></ul>
  5. 7. RESOURCES <ul><li>Europe : One psychiatrist for 10,000 people </li></ul><ul><li>Africa : One psychiatrist for 200,000 people </li></ul><ul><li>IN LOW- AND MIDDLE INCOME COUNTRIES </li></ul><ul><li>LESS THAN 1% OF THE HEALTH BUDGET IS </li></ul><ul><li>SPENT ON MENTAL HEALTH </li></ul><ul><li>(WHO Mental Health Atlas 2005) </li></ul>
  6. 8. MASS GRAVE - ACEH
  7. 9. TREATMENT RATE <ul><li>cbm estimates that in developing countries, between 80 and 90% of persons with psychosocial problems do not get treatment of any kind </li></ul><ul><li>For the vast majority, no accessible or affordable treatment option exists </li></ul>
  8. 10. HOW TO BRIDGE THE GAP BETWEEN NEEDS AND RESOURCES?
  9. 11. NCD SUMMIT (Sept 2011) <ul><li>Focused mainly on cancers, cardiovascular disease, chronic respiratory disease and diabetes. </li></ul><ul><li>By 2020, depression alone will be the second ranked disease burden, after cardiovascular disease </li></ul>
  10. 14. CBM’S RESPONSE <ul><li>A paradigm shift towards community mental health work, with treatment emphasis at primary and secondary levels </li></ul><ul><li>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. </li></ul>
  11. 15. UNCHAINING PEOPLE
  12. 17. DUAL MODELS <ul><li>Community mental health services, concentrating exclusively on people with psychosocial problems </li></ul><ul><li>Inclusion of persons with psychosocial problems in cross-disability, multi-intervention community-based rehabilitation (CBR) programmes </li></ul>
  13. 18. CBR guidelines January 27, 2012
  14. 19. IN 2010 cbm … <ul><li>Helped 101,000 people with psychosocial problems in 31 countries </li></ul><ul><li>Supported the work of 18 local mental health professionals </li></ul><ul><li>Met the training costs of 44 mental health professionals </li></ul>
  15. 20. The mayor’s solution? Put him on the bus to the next town…
  16. 21. STRENGTHS <ul><li>Strong network of partners at all levels (local, national, international) </li></ul><ul><li>Support for users groups and self-help groups </li></ul><ul><li>The move towards inclusive approaches </li></ul><ul><li>Cost-effective interventions at community level </li></ul>
  17. 22. WEAKNESSES <ul><li>Not enough ‘care for the carers’ </li></ul><ul><li>Preventive and promotional work remains weak </li></ul><ul><li>Partner overload </li></ul><ul><li>Not enough time to do training </li></ul><ul><li>Insufficient evidence that inclusive approaches work </li></ul>
  18. 23. OPPORTUNITIES <ul><li>Emergency relief work </li></ul><ul><li>Involving community and religious leaders </li></ul><ul><li>Advocacy to influence policy/funding support </li></ul><ul><li>More central roles for user groups </li></ul>
  19. 24. THREATS <ul><li>Biomedical orientation of government systems </li></ul><ul><li>Lack of public/private partnerships </li></ul><ul><li>Professional resistance to community-based MH approaches </li></ul><ul><li>Focus on 3ry care as first choice intervention </li></ul><ul><li>Many professionals don’t want to work where they are most needed </li></ul>
  20. 25. PEOPLE WITH PSYCHOSOCIAL PROBLEMS ARE INCREASINGLY INVOLVED IN PLANNING COMMUNITY MENTAL HEALTH PROGRAMMES
  21. 26. THE WAY FORWARD <ul><li>Empowering user organisations & SHGs </li></ul><ul><li>Promotion of positive mental health </li></ul><ul><li>Capacity-building at all professional levels </li></ul><ul><li>Balance between medical, social and livelihood interventions </li></ul><ul><li>Structured monitoring & evaluation leading to systematic improvements of services </li></ul><ul><li>Stronger advocacy with governments </li></ul><ul><li>Staff care/burn-out prevention </li></ul>
  22. 27. QUOTES FROM A ‘USER’ <ul><li>“ 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’” </li></ul>
  23. 28. QUOTES FROM A ‘USER’ <ul><li>“ 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” </li></ul>
  24. 29. QUOTES FROM A ‘USER’ <ul><li>“ 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” </li></ul><ul><li>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 </li></ul>
  25. 30. BEFORE Chained to a tree
  26. 31. AFTER Growing vanilla
  27. 32. THANK YOU <ul><li>cbm UK </li></ul><ul><li>www.cbmuk.org.uk </li></ul><ul><li>Tel – 1223 - 484700 </li></ul>
  28. 33. GLOBAL DISEASE BURDEN <ul><li>Of the 15 main types of disease affecting women in LOMICs, six are psychosocial – </li></ul><ul><li>depression (ranked 1), schizophrenia (4), bipolar disorder (7), self-inflicted injury (8), panic disorder and substance abuse </li></ul><ul><li>(WHO, Global Disease Burden, 2004) </li></ul>

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