Mental Health and Physical Health: The Role of Primary Care ‘ World Mental Health Day 2010 Dr Gabriel Ivbijaro  MBBS FRCGP...
<ul><li>http://www.globalfamilydoctor.com/ </li></ul>http://wwpomh.ning.com/ WMHD 2010
http://wwpomh.ning.com/ Thanks: Service users Speakers Sponsors WFMH Wonca Europe Wonca World Conference Organising  commi...
Wonca & WHO: A joint collaboration
World Mental Health Day
Current trends  (WHO 2008) <ul><li>Too much emphasis on centralization can lead to: </li></ul><ul><ul><li>Increased fragme...
World Health Assembly Report 2009
A European initiative
 
 
Evidence based summary –  health & primary care <ul><li>Countries with strong primary care have: </li></ul><ul><ul><li>Low...
 
Gap in human resources: Number of psychiatrists per 100,000 population
 
<ul><li>Primary care for mental health must be supported by other levels of care including : </li></ul><ul><ul><li>communi...
An example of what can be done through collaboration 43.58% of all older people in Waltham Forest (aged 65+)  have been se...
% of  patients diagnosed with dementia whose care has been reviewed in the previous 15M – WF ( without exceptions ) All pr...
 
 
 
Primary care for mental health Primary care for mental health forms an essential part of both: <ul><li>comprehensive menta...
<ul><li>Primary care for mental health must be supported by other levels of care including : </li></ul><ul><ul><li>communi...
UK Attitudes Survey 2008
More worldwide health indicators  <ul><li>More primary care access associated with better infant mortality and maternal mo...
mental health Gap Action Programme  Scaling up care for mental, neurological and substance use disorders   mhGAP
<ul><ul><li>(WHO World Mental Health Consortium, JAMA, June 2 nd  2004) </li></ul></ul>Gap in treatment: Serious cases rec...
Mobilizing a global response: Five barriers to implementation <ul><li>Political will to address mental health is low: </li...
Wonca Collaboration
World Mental Health Day
World Mental Health Day – An Opportunity for Change Thank you! [email_address]
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Ivbijaro: The Bridge of Primary Care

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Wonca Working Party on Mental Health
World mental Health Day

presentation Dr Gabriel Ivbijaro (UK)
The Bridge of Primary Care

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  • World Health Organization October 14, 2010 If it had been we would not be seeing the huge burden of mental disorders and the subsequent huge treatment gap that we have today. This does not mean to say that countries have not tried to integrate mh into phc. Indeed many countries have tried at different points of time, and many have not been successful. WHO therefore saw the important need to to provide countries with detailed and comprehensive guidance on what it takes to successfully integrate mental health into primary care. An effective response to the situation requires action on the part of policy makers right through to primary care workers, and this is why the partnership between the World Health Organisation and Wonca is so crucial.
  • World Health Organization October 14, 2010
  • World Health Organization 14 October 2010 However, the army to face all this is rather poor WHO&apos;s ATLAS has collected, for the first time, comparable data for mental health professionals within countries. These data show the extreme lack of professionals in the developing regions of the world.
  • The WHO Service Organization Pyramid for an Optimal Mix of Services for Mental Health describes different service levels within the mental health system, their relative costs and desirability in terms of need . The WHO model is based on the principle that no single service setting can meet all population mental health needs. Support, supervision, collaboration, information-sharing and education across the different levels of care are essential to any system. The model also emphasise that people with mental disability need to be involved in their own recovery and this must be reinforced at each level of care. Primary care services for mental health is the first level of care within the formal health system. Essential services at this level include early identification of mental disorders, treatment of common mental disorders, management of stable psychiatric patients, referral to other levels where required, attention to the mental health needs of people with physical health problems, and mental health promotion and prevention. In developed countries, primary care is provided mainly by medical doctors whereas in low- and middle-income countries, nurses provide most primary care. To be fully effective and efficient primary care servics for metal health must be complemented by additional levels of care – These include secondary care for example, services in general hospital settings and community mental health services to which primary care wokers can turn to referrals, support and supervision Psychiatric services in general hospitals District general hospitals provide an accessible and acceptable location for 24-hour medical care and supervision of people with acute worsening of mental disorders, in the same way that these facilities manage acute exacerbations of physical health disorders. Community mental health services are essentially specialized mental health services based in the community. They include day centres, rehabilitation services, hospital diversion programmes, mobile crisis teams, therapeutic and residential supervised services, group homes, home help, assistance to families, and other support services. Strong community mental health services are essential as part of any deinstitutionalization or community based programme, as well as to prevent unnecessary hospitalization. To maximize effectiveness, strong links are needed with other services up and down the pyramid of care. Linkages to informal community based services are also crucial Informal community care includes services provided by traditional healers, professionals in other sectors such as teachers, police, and village health workers, services provided by nongovernmental organizations, user and family associations, and lay people. This level of care plays an extremely important supportive role and can help prevent relapses among people who have been discharged from hospitals and is usually accessible and acceptable Self-care, is the foundation of the WHO service pyramid, upon which all other care is based. At the base of the pyramid, it refers to care without professional input. It means that p eople should be supported to manage their mental health problems themselves, or with the help from family or friends - health promotion programmes are useful. At the other levels, self care is also fundamental. The WHO model emphasizes health worker-patient partnerships and collaboration to promote an active role of people with mental disorders in their own care. Individuals’ roles may range from collaborative decision-making concerning their treatment, to actively adhering to prescribed medication, through to changing health-related behaviours such as drug and alcohol use or stress management. The emphasis on self-care in this model should not be confused with blaming affected individuals for having mental disorders, nor for shifting undue responsibility on people to “get themselves together”. Long stay facilities and specialist psychiatric services is the least needed form of care For a small minority of people with mental disorders (e.g. people with treatment-resistant or complex presentations), specialist care is required beyond that which can be provided in general hospitals. Forensic psychiatry is another type of specialist service that falls into this category. Understanding and appreciating these relationships is crucial to understanding the role of integrated primary care for mental health within the context of the overall health system. Edwige, Keep the 2 pyramid slides in big presentation
  • Primary care for mental health is an ESSENTIAL component of any well-functioning health system. As you can see on the diagram, primary care for mental health is at the intersection of (horizontal) primary care and (vertical) mental health care . It must not be considered in isolation but rather in context. To be fully effective and efficient, primary care for mental health must be complemented by additional levels of care . These include secondary care components to which primary care workers can turn for referrals, support, and supervision. Linkages to informal and community-based services are also necessary. Understanding and appreciating these relationships is crucial to understanding the role of integrated primary mental health care within the context of the overall health system.
  • The WHO Service Organization Pyramid for an Optimal Mix of Services for Mental Health describes different service levels within the mental health system, their relative costs and desirability in terms of need . The WHO model is based on the principle that no single service setting can meet all population mental health needs. Support, supervision, collaboration, information-sharing and education across the different levels of care are essential to any system. The model also emphasise that people with mental disability need to be involved in their own recovery and this must be reinforced at each level of care. Primary care services for mental health is the first level of care within the formal health system. Essential services at this level include early identification of mental disorders, treatment of common mental disorders, management of stable psychiatric patients, referral to other levels where required, attention to the mental health needs of people with physical health problems, and mental health promotion and prevention. In developed countries, primary care is provided mainly by medical doctors whereas in low- and middle-income countries, nurses provide most primary care. To be fully effective and efficient primary care servics for metal health must be complemented by additional levels of care – These include secondary care for example, services in general hospital settings and community mental health services to which primary care wokers can turn to referrals, support and supervision Psychiatric services in general hospitals District general hospitals provide an accessible and acceptable location for 24-hour medical care and supervision of people with acute worsening of mental disorders, in the same way that these facilities manage acute exacerbations of physical health disorders. Community mental health services are essentially specialized mental health services based in the community. They include day centres, rehabilitation services, hospital diversion programmes, mobile crisis teams, therapeutic and residential supervised services, group homes, home help, assistance to families, and other support services. Strong community mental health services are essential as part of any deinstitutionalization or community based programme, as well as to prevent unnecessary hospitalization. To maximize effectiveness, strong links are needed with other services up and down the pyramid of care. Linkages to informal community based services are also crucial Informal community care includes services provided by traditional healers, professionals in other sectors such as teachers, police, and village health workers, services provided by nongovernmental organizations, user and family associations, and lay people. This level of care plays an extremely important supportive role and can help prevent relapses among people who have been discharged from hospitals and is usually accessible and acceptable Self-care, is the foundation of the WHO service pyramid, upon which all other care is based. At the base of the pyramid, it refers to care without professional input. It means that p eople should be supported to manage their mental health problems themselves, or with the help from family or friends - health promotion programmes are useful. At the other levels, self care is also fundamental. The WHO model emphasizes health worker-patient partnerships and collaboration to promote an active role of people with mental disorders in their own care. Individuals’ roles may range from collaborative decision-making concerning their treatment, to actively adhering to prescribed medication, through to changing health-related behaviours such as drug and alcohol use or stress management. The emphasis on self-care in this model should not be confused with blaming affected individuals for having mental disorders, nor for shifting undue responsibility on people to “get themselves together”. Long stay facilities and specialist psychiatric services is the least needed form of care For a small minority of people with mental disorders (e.g. people with treatment-resistant or complex presentations), specialist care is required beyond that which can be provided in general hospitals. Forensic psychiatry is another type of specialist service that falls into this category. Understanding and appreciating these relationships is crucial to understanding the role of integrated primary care for mental health within the context of the overall health system. Edwige, Keep the 2 pyramid slides in big presentation
  • World Health Organization 14 October 2010
  • World Health Organization 14 October 2010 A recent WHO study in 14 countries has shown the extent of treatment gap. 35.5 to 50.3% of serious cases did not receive any treatment within the prior year in developed countries but the proportion of cases not receiving any treatment in developing countries was much higher- 76 to 85%. These figures should be an eye-opener to anybody who believes that mental health services are adequate in developed countries. They are not!
  • World Health Organization October 14, 2010
  • World Health Organization October 14, 2010
  • Ivbijaro: The Bridge of Primary Care

    1. 1. Mental Health and Physical Health: The Role of Primary Care ‘ World Mental Health Day 2010 Dr Gabriel Ivbijaro MBBS FRCGP FWACPsych MMedSci DFFP MA Chair Wonca Working Party on Mental Health Editor in Chief Mental Health in Family Medicine
    2. 2. <ul><li>http://www.globalfamilydoctor.com/ </li></ul>http://wwpomh.ning.com/ WMHD 2010
    3. 3. http://wwpomh.ning.com/ Thanks: Service users Speakers Sponsors WFMH Wonca Europe Wonca World Conference Organising committee All of you !
    4. 4. Wonca & WHO: A joint collaboration
    5. 5. World Mental Health Day
    6. 6. Current trends (WHO 2008) <ul><li>Too much emphasis on centralization can lead to: </li></ul><ul><ul><li>Increased fragmentation </li></ul></ul><ul><ul><li>Reduced access </li></ul></ul><ul><ul><li>Increased costs </li></ul></ul><ul><ul><li>Difficulty attaining holistic care </li></ul></ul><ul><li>This emphasizes the need for primary care reforms </li></ul>
    7. 7. World Health Assembly Report 2009
    8. 8. A European initiative
    9. 11. Evidence based summary – health & primary care <ul><li>Countries with strong primary care have: </li></ul><ul><ul><li>Lower overall costs </li></ul></ul><ul><ul><li>Generally healthier populations </li></ul></ul><ul><li>Within countries, areas with: </li></ul><ul><ul><li>Higher primary care physician (but NOT specialist) availability have healthier populations </li></ul></ul><ul><ul><li>Higher primary care physician availability have reduced adverse effects resulting from social inequality </li></ul></ul>
    10. 13. Gap in human resources: Number of psychiatrists per 100,000 population
    11. 15. <ul><li>Primary care for mental health must be supported by other levels of care including : </li></ul><ul><ul><li>community-based and hospital services </li></ul></ul><ul><ul><li>informal services </li></ul></ul><ul><ul><li>and self-care </li></ul></ul>Meet the full spectrum of needs
    12. 16. An example of what can be done through collaboration 43.58% of all older people in Waltham Forest (aged 65+) have been sent questionnaires and more than a quarter of those have been referred for Single Assessment Over 3000 older people received services following Single Assessment, over 70% of these were provided in the voluntary sector
    13. 17. % of patients diagnosed with dementia whose care has been reviewed in the previous 15M – WF ( without exceptions ) All practices have achieved the national target of 60% without exceptions
    14. 21. Primary care for mental health Primary care for mental health forms an essential part of both: <ul><li>comprehensive mental health care </li></ul><ul><li>general primary care. </li></ul>General health care Primary care Mental health care Primary care for mental health
    15. 22. <ul><li>Primary care for mental health must be supported by other levels of care including : </li></ul><ul><ul><li>community-based and hospital services </li></ul></ul><ul><ul><li>informal services </li></ul></ul><ul><ul><li>and self-care </li></ul></ul>Meet the full spectrum of needs
    16. 23. UK Attitudes Survey 2008
    17. 24. More worldwide health indicators <ul><li>More primary care access associated with better infant mortality and maternal mortality rates </li></ul>
    18. 25. mental health Gap Action Programme Scaling up care for mental, neurological and substance use disorders mhGAP
    19. 26. <ul><ul><li>(WHO World Mental Health Consortium, JAMA, June 2 nd 2004) </li></ul></ul>Gap in treatment: Serious cases receiving no treatment during the last 12 months 0 10 20 30 40 50 60 70 80 90 Developed countries Developing countries Lower range Upper range Lower range Upper range 35% 50% 76% 85% mhGAP 2009
    20. 27. Mobilizing a global response: Five barriers to implementation <ul><li>Political will to address mental health is low: </li></ul><ul><li>Incorrect belief that mental health care is cost-ineffective </li></ul><ul><li>Inconsistent and unclear advocacy between different groups of mental health advocates (professionals, users, families) and within each group </li></ul><ul><li>People with disorders are not organized in a powerful lobby in many countries </li></ul><ul><li>mhGAP 2009 </li></ul>
    21. 28. Wonca Collaboration
    22. 29. World Mental Health Day
    23. 30. World Mental Health Day – An Opportunity for Change Thank you! [email_address]
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