Henderson research in mental health policy


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Henderson research in mental health policy

  1. 1. The Chester M. Pierce, MD Division of Global PsychiatryThe Role of Research in Mental Health Policy<br />David Henderson, M.D.<br />Director<br />
  2. 2. Leading Causes of Years Lived with Disability<br />
  3. 3. Gender Differences in Mental Health Problems WorldwidePercentage of DALYs* Lost<br />
  4. 4. Burden vs. Budget<br />
  5. 5. Gap in treatment:<br />Serious cases receiving no treatment during the last 12 months<br />90<br />85%<br />80<br />76%<br />70<br />60<br />50<br />50%<br />40<br />35%<br />30<br />20<br />10<br />0<br />Lower range<br />Upper range<br />Lower range<br />Upper range<br />Developed countries<br />Developing countries<br />(WHO World Mental Health Consortium, JAMA, June 2nd 2004)<br />
  6. 6. ScarcityHuman Resources(N=157 to 183 countries)<br />Figure 2: Human resources for mental health in each income group of countries per 100 000 population<br />
  7. 7. Number of psychiatrists per 100,000 population<br />
  8. 8. Comparing Resources<br />
  9. 9. Mental Health systems in low and middle-income countries<br />
  10. 10. WHY IS MENTAL HEALTH NOT A PRIORITY?<br /><ul><li>We have not made the case in the language of policymakers or the general public, either in terms of cost-effectiveness or in terms of outcomes.
  11. 11. We do not have consensus on “model” interventions, especially for low-resource contexts.
  12. 12. We have not demonstrated that we can take successful programs and go to scale
  13. 13. We have not built consumer and family voice to garner political and public support</li></li></ul><li>Mental Health Policy<br />Mental heath policy and human protection laws are important<br />Strategic plan and coordination are even more important.<br />Research agenda should be designed to answer important questions and feeds back into policy and strategic plan<br />As data becomes available, policy and strategic plan should be updated.<br />
  14. 14. FACTORS AFFECTING INTERVENTION IMPLEMENTATION<br /><ul><li>System leadership
  15. 15. Organizational culture/consensus
  16. 16. IT capacity/outcomes measurement
  17. 17. Policies/procedures
  18. 18. Integration with performance/quality improvement
  19. 19. Human resource capacity/training
  20. 20. Funding methods</li></li></ul><li>Leadership Training<br /><ul><li>There is no sustained development without effective leadership
  21. 21. Leadership perspectives and skills are best taught alongside teaching on mental health system development / capacity building
  22. 22. Effective leadership is learned by doing, with continuing support and mentoring
  23. 23. Collaborative programs of activity (in policy development, service design and implementation, research – particularly mental health system research, education and training, and consumer, carer and civil society engagement) are the most effective way to develop effective leadership skills
  24. 24. Leadership training without sustained and productive engagement is probably of doubtful value</li></li></ul><li>MOHs <br />Should also be responsible for the coordination of all mental health activities by local and international non-governmental organizations (NGOs), UN agencies, and international donors. <br />MOHs can also develop and monitor a simple, scientifically valid and reliable national mental health data system capable of informing national public health policy. <br />This requires that the MOH, as the lead agency in mental health , has a national mental health action plan that can be fully supported and financed by the national government through mental health policy and legislation.<br />
  25. 25. Key Needs in Global Mental Health Research<br />Demonstration projects tied to rigorous external evaluation and funding for generalization of programs if outcomes are positive<br />Network of global mental health policy research centers in the developed and developing worlds<br />Networking Centers, Researchers, and Trainees<br />
  26. 26. Culture, Context and Western Imports<br />Concern about imposing western approaches to psychiatry on diverse cultures – undermining indigenous healing<br />Risk of bringing in the “worst”: old and riskier drugs, institutionalization, stigma<br />At same time, neglect of MI is major practical/HR issue in p-c environment (Lancet 2000)<br />Principle: High level of critical awareness in melding essentials of western psychiatry with local traditions and customs<br />Dilemma: Is this “marriage” always feasible. Unintended dangers (stigma, adverse effects, disruption of traditional care systems). <br />
  27. 27. Approaches<br />Global Mental Health Research Collaborations<br />Global Mental Health Research Centers<br />Research Training Programs<br />Population studies<br /><ul><li>Collaborative
  28. 28. Interdisciplinary
  29. 29. Basic
  30. 30. Applied
  31. 31. Surveillance
  32. 32. Local policy agendas
  33. 33. Intervention studies
  34. 34. Evaluation</li></li></ul><li>POTENTIAL GLOBAL MENTAL HEALTH RESEARCH AREAS<br /><ul><li>Intervention models
  35. 35. Implementation strategies
  36. 36. Uptake
  37. 37. Going to scale
  38. 38. Sustainability
  39. 39. Financing/economics
  40. 40. Advocacy
  41. 41. Evidence bas
  42. 42. Optimal strategies
  43. 43. Recovery outcomes
  44. 44. What works? What does not?</li></li></ul><li>INTERVENTION MODELS<br /><ul><li>Intervention models limited by over reliance on RCT as criteria.
  45. 45. We need explicit ways of building acceptable knowledge using different methodologies.
  46. 46. Research is limited to specific contexts or outcomes
  47. 47. Transferability and relevance of models across nations and cultures needs examination
  48. 48. Engagement of consumer and family voice in developing models and assessing outcomes has been uneven</li></li></ul><li>ADVOCACY ISSUES<br /><ul><li>Effective models for mental health advocacy
  49. 49. Building the evidence base for advocacy interventions
  50. 50. Optimizing consumer and family member involvement
  51. 51. Developing mutually beneficial partnerships</li></li></ul><li>RECOVERY OUTCOMES<br /><ul><li>Measuring recovery
  52. 52. Individual recovery process
  53. 53. System support for recovery
  54. 54. Relationship of recovery trajectory to treatment outcomes
  55. 55. Role of consumer and family member</li></li></ul><li>Community Research and Socio-Cultural Research<br />Poverty and Labor Conditions<br />Stigma<br />Substance Abuse<br />Gender<br />Infectious Disease<br />Political Violence and Refugee Populations<br />Epidemiology and Ethnography<br />Mental Health Services Research<br />
  56. 56. REASONS FOR OPTIMISM<br /><ul><li>Mental health is becoming part of the rhetoric of global health and development
  57. 57. Effective innovation is occurring at the local level in many countries
  58. 58. There are a few successful national-level programs related to prevention and promotion
  59. 59. There are opportunities on the horizon such as the UN Assembly on non-communicable diseases in 2011
  60. 60. The global mental health movement is becoming an engine for change</li></li></ul><li>Mental Health Policy<br />Mental heath policy and human protection laws are important<br />Strategic plan and coordination are even more important.<br />Research agenda should be designed to answer important questions and feeds back into policy and strategic plan<br />As data becomes available, policy and strategic plan should be updated.<br />
  61. 61. Thank You!<br />“You must be the change you want to see in the world.” <br />Mahatma Gandhi<br />