Mental Health in low & middle income countries

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Mike Davies OBE (Head of Programme Development, CBM UK) was one of the key speakers at The Cambridge Post-UN Summit Conference on Noncommunicable Diseases and Mental Health in Developing Countries.

The outcomes from the Conference (held on 20th January 2012) were translated into key messages and brought to the attention of MPs, Parliamentarians, civil servants, and other policy-makers, researchers, activists and practitioners, at a reception in the House of Commons at the end of January 2012.

Conference sessions included:
- Critical reviews of the outcomes of the UN Summit on Noncommunicable Diseases
- Short- and long-term strategies for addressing gaps in prevention, treatment, policy and 'public awareness' on noncommunicable diseases and mental health (NMH) in developing countries
- Highlights from a growing number of successful 'linking' and 'capacity-building' programmes, which assist individuals and organisation in the developing world to strengthen their own sustainable NMH research, treatment and care programmes.
- Different models of partnership to advance best practices and policies on NMH research, interventions, treatment and care - including multidisciplinary, multisectoral and multinational partnerships.

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Mental Health in low & middle income countries

  1. 1. MENTAL HEALTH IN LOW- AND MIDDLE-INCOME COUNTRIES NEEDS, RESOURCES, ISSUES AND APPROACHES MIKE DAVIES OBE cbmCBM UK 5th January 2012 1
  2. 2. 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 donationsCBM UK 5th January 2012 2
  3. 3. NATURAL DISASTERS HAVE ACCELERATED CBM’S INVOLVEMENT IN COMMUNITY MENTAL HEALTHCBM UK 5th January 2012 3
  4. 4. 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)CBM UK 5th January 2012 4
  5. 5. CBM UK 5th January 2012 5
  6. 6. CBM UK 5th January 2012 6
  7. 7. 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)CBM UK 5th January 2012 7
  8. 8. MASS GRAVE - ACEHCBM UK 5th January 2012 8
  9. 9. 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 existsCBM UK 5th January 2012 9
  10. 10. HOW TO BRIDGE THE GAP BETWEEN NEEDS AND RESOURCES?CBM UK 5th January 2012 10
  11. 11. 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 diseaseCBM UK 5th January 2012 11
  12. 12. CBM UK 5th January 2012 12
  13. 13. CBM UK 5th January 2012 13
  14. 14. 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.CBM UK 5th January 2012 14
  15. 15. UNCHAINING PEOPLECBM UK 5th January 2012 15
  16. 16. CBM UK 5th January 2012 16
  17. 17. DUAL MODELS 1. Community mental health services, concentrating exclusively on people with psychosocial problems 2. Inclusion of persons with psychosocial problems in cross-disability, multi- intervention community-based rehabilitation (CBR) programmesCBM UK 5th January 2012 17
  18. 18. CBM UK 5th January 2012 18 CBR guidelines April 16, 2012
  19. 19. 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 professionalsCBM UK 5th January 2012 19
  20. 20. The mayor’s solution? Put him on the bus to the next town…CBM UK 5th January 2012 20
  21. 21. 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 levelCBM UK 5th January 2012 21
  22. 22. 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 workCBM UK 5th January 2012 22
  23. 23. OPPORTUNITIES • Emergency relief work • Involving community and religious leaders • Advocacy to influence policy/funding support • More central roles for user groupsCBM UK 5th January 2012 23
  24. 24. 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 neededCBM UK 5th January 2012 24
  25. 25. PEOPLE WITH PSYCHOSOCIAL PROBLEMS ARE INCREASINGLY INVOLVED IN PLANNING COMMUNITY MENTAL HEALTH PROGRAMMESCBM UK 5th January 2012 25
  26. 26. 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 preventionCBM UK 5th January 2012 26
  27. 27. 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’”CBM UK 5th January 2012 27
  28. 28. 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”CBM UK 5th January 2012 28
  29. 29. 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 BooksCBM UK 5th January 2012 29
  30. 30. BEFORE Chained to a treeCBM UK 5th January 2012 30
  31. 31. AFTER Growing vanillaCBM UK 5th January 2012 31
  32. 32. THANK YOU cbm UK www.cbmuk.org.uk Tel – 1223 - 484700CBM UK 5th January 2012 32
  33. 33. 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)CBM UK 5th January 2012 33

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