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Collins global mental health

Collins global mental health






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  • Worldwide, community-based epidemiological studies estimate that the lifetime prevalence of mental disorders in adults ranges from 12.2 percent to 48.6 percent, accounting for approximately 30 percent of the total burden of non-communicable diseases. In Sub-Saharan Africa, the disability-adjusted life years attributable to psychiatric conditions surpass the proportion attributable to nutritional deficiencies, tuberculosis, or maternal complications from childbirth. Yet, insufficient attention and resources address the diagnosis, treatment, and care of people with mental disorders in low- and middle-income countries (LMICs).

Collins global mental health Collins global mental health Presentation Transcript

  • Global Mental Health: A way forward
    Pamela Y. Collins, MD, MPH
    Office for Research on Disparities & Global Mental Health
    Associate Clinical Professor of Epidemiology & Psychiatry
    Columbia University
  • National Institutes of Health
    NIH is a part of the US Department of Health and Human Services and is the nation’s medical research agency
    Largest source of funding for medical research in the world
    NIH is made up of 27 institutes and centers, of which the National Institute of Mental Health is one
    Fogarty International Center is dedicated to facilitating global health research conducted by US and international investigators
  • NIMH Offices and Divisions
    Office of the Director
    NIMH Divisions
    Office on AIDS
    Office of Autism Research Coordination
    Office of Constituency Relations and Public Liaison
    Office for Research on Disparities and Global Mental Health
    Office of Rural Mental Health
    Office of Science Policy, Planning, and Communications
    Division of Intramural Research Programs
    Division of Neuroscience and Basic Behavioral Science
    Division of Adult Translational Research and Treatment Development
    Division of Developmental Translational Research
    Division of AIDS Research
    Division of Extramural Activities
  • “Resources for mental health are scarce and inequitably distributed between countries, between regions, and within local communities.” (Saxena et al., 2007)
  • The biological basis of mental disorders
    “…from the brain, and from the brain only, arise our pleasures, joy, laughter and jests, as well as our sorrows, pains, griefs, and tears.”
    “…all the most acute, most powerful, and most deadly diseases, and those which are most difficult to be understood by the inexperienced, fall upon the brain.”
    Adams, 1939, p.360 in Costello, 2010
  • Understanding Etiology of Mental Disorders
    WHO, 2000, Women’s Mental Health
  • Worldwide Distribution of DALYs Lost Among Young Women, By Age Group, 2002
    Ages 5-14
    Ages 15-29
    Notes: Numbers are rounded.
    Source: Disease Control Priorities in Developing Countries, second edition, 2006, Table 59.1
  • Worldwide Distribution of DALYs Lost Among Young Men, By Age Group, 2002
    Ages 5-14
    Ages 15-29
    Notes: Numbers are rounded.
    Source: Disease Control Priorities in Developing Countries, second edition, 2006, Table 59.1
  • Source: Global Burden of Disease, WHO 2004
  • Identifying Global Mental Health Research Priorities
  • Global Engagement in Mental Health Research Directions: Grand Challenges
    Grand Challenges Canada
    commits up to $20 million
    to combat stigma and
    to address Goal C:
    Improve treatment &
    Expand access to care
  • A Practical Goal for Services: Integrate mental health into primary care
    Long-standing goal globally
    Needs favorable political conditions
    Benefits from decentralized government
    Adequate training/supervision of primary care providers
    Grand Challenges
    Integrate screening and core packages of
    services into routine primary health care
    Strengthen the mental-health component in the training of all health-care personnel
  • Psychiatry NOS:What are we talking about??
    Diagnostic systems need improvement
    Think dimensionally
    Need valid, simplified diagnoses for use in primary care
    What are the real disorders?
    What language can we use?
    Grand Challenge
    Develop valid and reliable definitions, models and
    measurement tools for quantitative assessment at
    the individual and population levels for use across
    cultures and settings
  • No Health without Mental Health
    A human is a single organism, health should not be segmented into “mental” and “physical.”
    Mental disorders can increase risk, morbidity, and mortality associated with infectious and non-communicable disease
    Grand Challenge
    Redesign health systems to integrate MNS
    disorders with other chronic-disease care
  • The social context of mental health in
    Context of poverty/economic deprivation
    Internal displacement due to conflict
    Power of devastating traumatic experiences
    Exposure to chronic, daily stressors
    Grand Challenge
    Understand the impact of poverty,
    violence, war, migration and disaster
  • What care do we provide?Where does that care occur?
    Engage traditional sources of support in the community (religious leaders, teachers, traditional healers) in mental health
    Our treatment settings contribute to stigma
    Grand Challenge
    Provide effective and affordable community-based care and rehabilitation
    Develop culturally informed methods to eliminate the stigma, discrimination and social exclusion of patients and families across cultural settings
  • Using policy & implementing plans for mental health services
    Importance of integrating mental health into all levels of health system
    Translate research to policy
    Clinical experience informing policymakers
    Grand Challenge
    Establish and implement minimum health
    care standards for MNS disorders around
    the world
  • Task shifting for mental health
    Using providers with more abbreviated training to perform the tasks of specialists
    Good examples in many low- and middle-income countries
    India – MANAS trial (Patel et al., 2010)
    Pakistan – Lady Health Workers ( Rahman et al, 2008)
    Uganda – Group IPT for depression (Bolton et al, 2003)
    Chile – Treating depression in primary care (Araya et al, 2003)
  • Challenges for research
    In 1990 5% of the world’s research investment addressed 93% of the world’s population (Commission on Health Research for Development)
    By 2003 global health research expenditures quadrupled (Global Forum for Research, www.globalhealthforum.org)
    Critical questions cannot be answered with data from a limited portion of the world’s population
    Brain drain!
    Burden of clinical and administrative responsibilities
    Lack of demand for publication
    Few opportunities for research capacity-building
    Poorly accessible research findings
  • Opportunity #4: Encouraging a greater focus on global health
  • Focus on Equity:Reduce the treatment gap in LMICs
    On the Pulse of Global Mental Health Action:
    Identifying Strategic Research Opportunities
    2-3 March, 2010
    Hyatt Regency, Bethesda, MD
  • Scientific Opportunity: Human Heredity & Health in Africa (H3 Africa)
  • Build on global health programs
  • Anticipate global public health needs
  • Build Research Capacity
  • Opportune Time for Global Mental Health Activities
    Global Funding Opportunities
    Global Policy Opportunities
    UK-East Kilbride: HRPC10
    Improving Mental Health
    Services in Low Income
    DFID is seeking Expressions of
    Interest (EOIs) from suppliers
    to lead a consortium of
    organisations with multi-
    disciplinary skills in the theme
    "Improving Mental Health Services
    in Low Income Countries".
  • New Developments in Global Mental Health
    Meet criteria for vulnerability
    Merit targeting by development strategies and plans
    Different development stakeholders have roles to play in designing & implementing policies and programs for reaching people with mental disorders
    Development programs should protect the human rights of people with mental disorders and build capacity to participate in public affairs
    WHO, 2010