Global Mental Health

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Global Mental Health
Community Psychiatry in Rural Southern
India
1
Presented by: Geetha Jayaram M.D.,M.B.A.

Disclosures: none
Objectives:
To identify global concerns in community
psychiatry in mental health care provision
To desig...

Definition of mental health
The World Health Organization describes
it as “a state of well-being in which the
individual r...

WHO initiativesWHO initiatives

Global burden of mental disorders
• The burden of mental disorders is likely to
have been underestimated because of
inadeq...

Global burden of mental disorders-2
• Health services are not provided equitably to
people with mental disorders, and the ...

Global burden of mental disorders -3
• Millennium Development Goals such as
promotion of gender equality and
empowerment o...

Global burden of mental health-4
• Disturbances of mental health remain not only
neglected but also deeply stigmatized acr...

Global burden of mental health-5
They suggest that successful strategies can be adopted
to overcome barriers to scaling up...

Maanasi project objectivesMaanasi project objectives
• To bring mental health care to villages in rural
Southern India
• I...

Cooperative work byCooperative work by
• Rotary Club of Howard West, Maryland, USA
• Rotary Club of Bangalore Midtown, Ind...

How was this accomplished?How was this accomplished?
• Raising funds through creative means
• Establishing a local link
• ...

Work doneWork done
• Epidemiological survey
• Evaluation of integrated model of care
• Stepwise goals to accomplish tasks:...

Surveys conducted across the worldSurveys conducted across the world
• Lifetime prevalence of depression may be around
25%...

Phase 1 and 2Phase 1 and 2
• Identifying and training HS educated community
health workers
• A door to door survey of a po...

Global burden of mental disorders
Rank
Worldwide High-income countries†
Low- and middle-
income countries
Cause DALYs‡
(mi...

Results of the Maanasi projectResults of the Maanasi project
• Majority of patients were between the ages of
21 and 50 (21...

Results of the Maanasi project-2
• Major Depression and Dysthymia were the
predominant diagnoses
• Majority of patients we...

Aspects of care in villagesAspects of care in villages
• A sliding fee scale is offered or care is free
• Care is accessib...

Outcomes are influenced byOutcomes are influenced by
• Cultural identity of the providers
• The environment in which they ...

What Are The Costs Of NotWhat Are The Costs Of Not
Treating Depression?Treating Depression?
Treatment
• Direct medical cos...

Outcomes- phase 1Outcomes- phase 1
• Initial screening by trained health care
workers who administered the ‘symptoms in
ot...

Outcomes -2Outcomes -2
• A cohort of 300 patients treated at the clinic for Major
Depression were consecutively selected t...

Preliminary results -1Preliminary results -1
• Of the 300 patients interviewed, 99 did not meet
criteria for MDD either cu...

Preliminary results-2Preliminary results-2
• The two groups were compared across a host
of clinical and socio-demographic ...

Other goals reachedOther goals reached
– Services have been offered through outreach to
187 villages
– Dedicated female ca...

Key drivers for successKey drivers for success
• Culturally congruent care with local
caseworkers who have intimate knowle...

Where do we go from here?Where do we go from here?
• We must sustain care that is being provided
• We must emphasize the i...

Future goalsFuture goals
Use IT support for efficiency and better outcomes as
follows:
1. Cell phone appointment and medic...

Discrimination studyDiscrimination study
Depression is the third leading contributor to the
worldwide burden of disease. W...

MethodsMethods
In a cross-sectional survey, people with a diagnosis of
Major Depressive Disorder were interviewed in 39 si...

FindingsFindings
• 1082 people with depression completed the DISC-12.
Of these, 855 (79%) reported experiencing
discrimina...

Higher levels of discrimination wereHigher levels of discrimination were
foundfound
• With poorer levels of social functio...

InterpretationInterpretation
• Discrimination related to depression acts as a barrier
to social participation and successf...

Future Goals-2Future Goals-2
• Develop a corpus fund to continue the project
• Develop employment opportunities for treate...

Papers publishedPapers published
• Isaacs AN, Srinivasan K, Neerakkal I, Jayaram G. Initiating a community Mental Health p...

Anti Stigma Program European
Network (ASPEN)
• The INDIGO (International Study of Discrimination
and Stigma for Depression...

DISC 12
• Is a structured interview containing 32 questions
about aspects of everyday life including work,
marriage, paren...

DISC- 12 (2)
• Participants responses were rated with a 4
point Likert scale (0= no difference, 1= a little
difference, 2=...

Discrimination and depression
• 79% of people with depression reported experienced
discrimination in at least one domain o...

Cross-national variations in reported discrimination among
people with major depression
Participating countries were class...

Findings on cross cultural differences
• Both levels of experienced and anticipated
discrimination widely differed across ...

Findings on cross cultural differences-2
• People living in developed countries however
reported higher levels of anticipa...

The HDI report 2013
Notes that by 2020, Brazil, China and India—
will surpass the aggregate production of
Canada, France, ...

The 2013 HDI
Identifies 4 specific areas for sustaining
development momentum:
1.Enhancing equity, including with regard to...

Interpretation
Anticipated discrimination is less likely to be the
case for patients returning to traditional
communal set...

Interpretation-2
• Another possible reason for lower levels of
discrimination in less developed countries is
the nature of...

Interpretation-3
The broader social context may also make the
difference for people with depression to
perceive the ‘other...

Work enabled byWork enabled by
• Carl P. Miller Discovery Grant
• RI Matching Grant 20954
• Rotary University Teachers’ Gr...

Presentation of the Maanasi
project
https://vimeo.com/76316516
May 13, 2015 52

Work enabled by
• Carl P. Miller Discovery Grant
• RI Matching Grant 20954
• Rotary University Teachers’ Grant
• Support f...

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