NO HEALTH WITHOUT MENTAL HEALTH
When it comes to mental health, all countries are developing countries. Mental disorders are the leading cause of disability worldwide. To bring this enormous disease burden to the center of the global development agenda, last month the World Bank Group (WGB) and the World Health Organization (WHO) co-hosted a high-level event in Washington, D.C., Out of the Shadows: Making Mental Health a Global Development Priority.
This two-day event brought together global leaders, advocates, and experts to highlight the need to scale-up mental health services in primary care and community settings as a key issue in the global health and development agenda. Furthermore, this meeting engaged finance ministers, the business community, and technology innovators on the economic and social benefits of investing in mental health. What’s the economic consequence of ignoring mental health? According to WHO, not treating depression and anxiety disorders costs the world $1 trillion a year. For every $1 spent on mental health treatment, governments could receive a $4 return on their investment.
The event also included an Innovations Fair organized by the Mental Heath Innovation Network (MHIN) and supported by the Wellcome Trust . At the fair, innovators representing countries from all over the world showcased effective, generalizable, replicable, and sustainable interventions for improving access to mental health care at the community level. At the fair, the National Institute of Mental Health’s (NIMH) young investigators in global mental health presented new research, and the event also featured the Institute’s Collaborative Hubs for International Research on Mental Health (CHIRMH). The Hubs were established to increase the research base for mental health interventions in low-and middle-income countries through integration of findings from translational, clinical, epidemiological, and/or policy research. NIMH’s network of Collaborative Hubs spans Africa, Asia, and Latin America.
Following the Innovations Fair, World Bank President Jim Yong Kim, M.D. introduced the keynote panel featuring WHO Director-General Margaret Chan, M.D. and other global leaders. During his keynote statement, Dr. Kim compared the challenges with mental health and stigma to the HIV/AIDS movement. “We demanded action and it happened,” said Dr. Kim. “We need to put the same kind of energy and activism into mental health.”
On the second day of the event, speakers focused on how to achieve mental health parity globally. The Honorable Patrick Kennedy, former member of the U.S. House of Representatives, founder of the Kennedy Forum and co-founder of One Mind presented the keynote presentation and shared his own personal health challenges, as well as his experience leading the sponsorship of the Mental Health Parity and Addition Equity Act of 2008. “It’s against the law to discriminate against someone who has a brain illness,” said Kennedy. “Mental health parity is a medical civil rights issue.”
In order to achieve mental health parity globally, Bernice Dahn, Minister of Health of Liberia, advocated for an integrated health care system where mental health is included with other competing priorities such as HIV and maternal and child health.
After the WHO and WBG’s two-day event concluded, the NIMH and Grand Challenges Canada (GCC) co-hosted a workshop entitled, Solving the Grand Challenges in Global Mental Health: Maintaining Momentum on the Road to Scale Up on April 15, 2016 at the George Washington University in Washington, D.C. The workshop engaged mental health innovators, investigators, policymakers, and other key stakeholders to discuss new research findings and strategies for maintaining a worldwide spotlight on the growing evidence base that supports the scale-up of mental health interventions in low-resource settings—one of the priorities identified in the Grand Challenges in Global Mental Health initiative.
Throughout the workshop NIMH and GCC grantees representing countries such as the United Kingdom, Ethiopia, Brazil, Pakistan, and many more shared effective mental health care delivery interventions for diverse populations, as well as lessons learned that are generalizable to other settings. Policy makers and innovators also shared challenges and approaches to overcoming barriers to implementing quality mental health care.
One of the biggest challenges that low-and middle-income countries face is the lack of trained local providers that specialize in mental health care. The NIMH-supported Collaborative Hub SHARE (South Asian Hub for Advocacy Research and Education on Mental Health), aims to reduce this treatment gap in South Asia by incorporating a task-shifting approach in the intervention. Task-shifting involves the use of less-specialized providers with a shorter duration of training to deliver health care interventions. Peer health workers with no prior mental health care experience are trained to deliver psychological treatment such as cognitive behavioral therapy (CBT) for maternal depression. AFFIRM (Africa Focus on Intervention Research for Mental Health), another NIMH-supported Collaborative Hub, also focuses on task-shifting to reduce the treatment gap in Africa.
The task shifting approach also prompted discussion around how to ensure high quality care in low-and middle-income countries. Do lay health workers provide a lower standard of care? Stanley Kutcher, M.D., Sun Life Financial Chair in Adolescent Mental Health and Director of WHO’s Collaborating Care in Mental Health Policy Center at Dalhousie University, explained that competency is more important than professional title when providing mental health treatment. Experts participating in the workshop also shared that using lay providers with a deep understanding of the local community context--one form of task-shifting--can help with establishing trust, especially with torture survivors and indigenous populations. People are more likely to seek treatment and help from their peers rather than mental health professionals who come into their communities only to leave later.
As this landmark global gathering of NIMH, GCC, WHO, and WBG concluded last month, the U.S. is now focusing its attention on mental health during May, which is National Mental Health Awareness Month. In President Obama’s proclamation of the health observance month, he echoes the same sentiments that global leaders emphasized throughout both the WHO and WBG meeting, as well as the NIMH and GCC meeting. "Mental health should be treated as part of a person's overall health, and we must ensure individuals living with mental health conditions can get the treatment they need." There is no health without mental health.
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1. National Institute of Mental Health, NIH, USA.