Global Mental Health: A way forward<br />Pamela Y. Collins, MD, MPH<br />Office for Research on Disparities & Global Menta...
National Institutes of Health<br />NIH is a part of the US Department of Health and Human Services and is the nation’s med...
NIMH Offices and Divisions<br />Office of the Director<br />NIMH Divisions<br />Office on AIDS<br />Office of Autism Resea...
“Resources for mental health are scarce and inequitably distributed between countries, between regions, and within local c...
The biological basis of mental disorders<br /> “…from the brain, and from the brain only, arise our pleasures, joy, laught...
Understanding Etiology of Mental Disorders<br />WHO, 2000, Women’s Mental Health<br />
Worldwide Distribution of DALYs Lost Among Young Women, By Age Group, 2002<br />Ages 5-14<br />Ages 15-29<br />Notes: Numb...
Worldwide Distribution of DALYs Lost Among Young Men, By Age Group, 2002<br />Ages 5-14<br />Ages 15-29<br />Notes: Number...
Source: Global Burden of Disease, WHO 2004<br />
Identifying Global Mental Health Research Priorities<br />http://grandchallengesgmh.nimh.nih.gov<br />
Global Engagement in Mental Health Research Directions: Grand Challenges<br />Responses:<br />Grand Challenges Canada<br /...
A Practical Goal for Services: Integrate mental health into primary care<br />Long-standing goal globally<br />Needs favor...
Psychiatry NOS:What are we talking about??<br />Diagnostic systems need improvement<br />Think dimensionally<br />Need val...
No Health without Mental Health<br />A human is a single organism, health should not be segmented into “mental” and “physi...
The social context of mental health in <br />Context of poverty/economic deprivation<br />Internal displacement due to con...
What care do we provide?Where does that care occur?<br />Engage traditional sources of support in the community (religious...
Using policy & implementing plans for mental health services<br />Importance of integrating mental health into all levels ...
Task shifting for mental health<br />Using  providers with more abbreviated training to perform the tasks of specialists<b...
Challenges for research<br />In 1990 5% of the world’s research investment addressed 93% of the world’s population (Commis...
Opportunity #4: Encouraging a greater focus on global health<br />
Focus on Equity:Reduce the treatment gap in LMICs<br />On the Pulse of Global Mental Health Action:<br />Identifying Strat...
Scientific Opportunity: Human Heredity & Health in Africa (H3 Africa)<br />
Build on global health programs<br />
Anticipate global public health needs<br />
Build Research Capacity<br />
Opportune Time for Global Mental Health Activities <br />Global Funding Opportunities<br />Global Policy Opportunities<br ...
New Developments in Global Mental Health<br />Meet criteria for vulnerability<br />Merit targeting by development strategi...
Collins global mental health
Upcoming SlideShare
Loading in …5
×

Collins global mental health

687 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
687
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
18
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • 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

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

    ×