Driving Change is a report based on interviews with mental health Non-Governmental Organisations (NGOs) around the world written by the McPin Foundation in partnership with Mind. The focus was on mental health organisations that were user- or carer-led in countries across the globe working locally to raise awareness and improve services for people living with mental illness.
It has been widely documented that the legal, social and financial impacts of being a refugee can be complex and deleterious. It is now coming to the fore that much the same can be said for the psychological impact of being a refugee or internally displaced person. This evaluation reports on how well UNHCR considers and provides for the well-being and mental health of the Persons of Concern to this agency. A perspective on the Mental Health and Psycho-Social Support (MHPSS) to Persons of Concern offers a new way to look at humanitarian assistance. It calls into question the appropriateness, sensitivity, and empathy of humanitarian interventions and demands that humanitarian agencies support avenues for displaced people to address and heal their own trauma. These demands pose a significant challenge for humanitarian organizations since many of the countries we work in do not have well developed mental health infrastructures and therapeutic solutions need to be resourced or developed within the displaced community. In some cases, addressing mental health also requires a technical expertise that has not always been present in the usual roster of humanitarian responders. Yet despite these challenges, the field based staff surveyed for this evaluation overwhelmingly agreed that “MHPSS programs contribute toward the protection of Persons of Concern”.
Nevertheless, MHPSS is an emerging and sometimes ambiguous perspective for UNHCR as well as for many other humanitarian actors. Thus, the evaluation begins with definitions of psycho-social support and examples. As this evaluation discovered, MHPSS activities in UNHCR may exist as an adjunct to other programmes or by another name. Many thanks to Sarah Meyer, the author of this global review, for her expertise and up to date overview on the field of MHPSS in humanitarian interventions. Through her knowledge, sensitivity and persistence she was able to discern UNHCR’s level of engagement in providing MHPSS programmes to Persons of Concern. Sarah was also assisted by Nora McGann, Research Assistant from the School of Foreign Service at Georgetown University. Sincere thanks to the Steering Committee members of this review: Sabine Rakotomalala of Terre des Hommes - Switzerland, Dr. Mark Van Ommeren from the World Health Organization, and Marian Schilperoord and Stefanie Krause of UNHCR. Their advice and guidance were invaluable to this document. Most generous thanks to field based colleagues who informed the review by reporting on the importance and realities of providing MHPSS activities to Persons of Concern. For it stands to reason that a truly durable solution can only be present for an individual who has found a way to cope and create a viable support network in displacement.
Senior Policy & Evaluation Officer
© United Nations High Commissioner for Refugees Policy Development & Evaluation Service
Geneve, June 2013
Just Posted: Currently there are at least five GMH edited volumes, full of materials useful for practice, policy, health systems, advocacy, training, etc. These are: GMH: Trauma and Recovery (2011, edited by Richard Mollica); 21st Century GMH (2012, edited by Eliot Sorel); and GMH: Principles and Practice (2013, edited by Vikram Patel, Harry Minas, Alex Cohen, and Martin Prince), Public Mental Health: Global Perspectives (2013, edited by Lee Knifton and Neil Quinn), and Improving Mental Health Care: The Global Challenge (2013, edited by Graham Thornicroft, Mirella Rugeri, and David Goldberg)
Two important questions:
1. If you are aware of additional GMH compilations--texts, please let me/us know.
2. If you have any ideas for how people can access more affordable versions of these texts, please let us all know.
Kelly O'Donnell, PsyD; Consulting Psychologist; GMH-Map Project
Acrodile in conjunction with Africa Mental Health Foundation (AMHF) wish to announce a new book (African editions) :‘Contemporary Psychiatry in Africa’ by David Musyimi Ndetei and Christopher Paul Szabo .
This book is recommended for
1.Researchers and practitioners in different areas of mental health
3.Postgraduate students pursuing various aspects of mental health
4.undergraduate medical students
5.Diploma medical students
A large Wagnerian grandmother. A great-aunt known as 'the Buchenwald chicken'. Shame and misery on the sports field. A club-footed father who disappeared to the golf course every weekend. How do these experiences lead to a career in psychology? Able-Bodied is a unique account of how being the son of a disabled man and the product of an eccentric family brought Leslie Swartz to a professional life working with disability issues. At the heart of this tale is a moving account of a complex, troubled, but loving father-son relationship, a relationship that spurred a lifetime of trying to understand and come to grips with what different bodies and different abilities mean for us all. With wit, compassion, frankness and irreverence, Swartz considers the challenges faced by families, academics, institutions and everyone trying to make a positive difference to society. Poignant and often hilarious, Able-Bodied is a tale of conflict, achievement, pain and triumph. It is a fascinating blend of personal narrative, anecdote and reflection on society, medicine and ethics.
For more information, or to attain a copy, please contact the author at: email@example.com
Introduction: The psychological and social impacts of disasters can undermine the long term well-being of the affected population. Well integrated and community-based mental health / psychosocial support (MHPSS) interventions can improve emotional, social and mental aspects of well-being. Professional understanding of effects of disasters, paired with post-emergency mental health (MH) awareness, can provide opportunity for improving community MH services. Problem statement: This prospective, semi-quantitative study evaluated the effectiveness of a community-based integrated MHPSS intervention by the Dutch international non-governmental organization (INGO) Cordaid in post-earthquake Haiti. Methods: Training on MHPSS issues was delivered to 115 non-specialized healthcare providers and 190 community psychosocial workers. The community-based MHPSS intervention was delivered to 115,191 direct beneficiaries. Data collection methods included quantitative community surveys with well-being, distress and resilience scales; a survey on satisfaction of training participants and multiple-choice knowledge tests. Results: MHPSS training reinforced the knowledge base of community psychosocial workers and non-specialized healthcare providers; a necessary prerequisite to the delivery of the community-based MHPSS intervention. The community-based MHPSS intervention resulted in improved well-being and resilience and reduced distress in targeted communities. Conclusions: The community based and integrated MHPSS intervention in Haiti was a feasible and much appreciated intervention that was relatively effective in a difficult disaster context. The intervention improved access to community MH care; psychosocial services; and general well-being of the affected population. This type of intervention may be reproducible in other post disaster environments, especially resource poor settings with neglected MH sectors.
Assessing the impact of group counseling intervention on depression, post-traumatic stress and function outcomes among adults attending the Peter C. Alderman Foundation (PCAF) trauma clinics in northern Uganda.
A case-study of the Peter C. Alderman Foundation's public-private partnership in northern Uganda
The Global Burden of Disease 2010 (GBD2010) Study reported that mental and substance use disorders were responsible for 184 million disability-adjusted life years (DALYs) worldwide in 2010 and were the leading cause of disability, in terms of years of life-lived with disability (YLDs) (Whiteford et al, 2013: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61611-6/fulltext).
Whilst these estimates were based on the best available epidemiological data, there were substantial gaps in the available information (see Baxter et al, 2013: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0065514) particularly for populations in Central and Eastern Europe, and many parts of Asia and Sub-Saharan Africa.
Lack of information resulted in considerable uncertainty around population burden estimates.
Prof Whiteford's team are currently revising these burden estimates for the next GBD report and are seeking epidemiological data to inform new calculations.
If you or your group have data for mental or illicit substance use disorders for your country we encourage you to contact Harvey Whiteford (firstname.lastname@example.org) or Amanda Baxter (email@example.com).
Disorders and inclusion criteria for GBD 2013 will be posted on the Burden of Disease section of the QCMHR website (http://qcmhr.uq.edu.au/research/policy-and-epidemiology/peabod/burden-of-disease/)
Kratzmann Professor of Psychiatry and Population Health
The University of Queensland, Australia
When the World Health Organization (WHO) European Ministerial Conference on Mental Health endorsed the statement “No health without mental health” in 2005, it spoke to the intrinsic — and indispensable — role of mental health care in health care writ large. Yet mental health has long been treated in ways that reflect the opposite of that sentiment. This historical divide — in practice and in policy — between physical health and mental health has in turn perpetuated large gaps in resources across economic, social, and scientific domains. The upshot is a global tragedy: a legacy of the neglect and marginalization of mental health. The scale of the global impact of mental illness is substantial, with mental illness constituting an estimated 7.4% of the world's measurable burden of disease. The lack of access to mental health services of good quality is profound in populations with limited resources, for whom numerous social hazards exacerbate vulnerability to poor health. The human toll of mental disorders is further compounded by collateral adverse effects on health and social well-being, including exposure to stigma and human rights abuses, forestallment of educational and social opportunities, and entry into a pernicious cycle of social disenfranchisement and poverty. Advances in efforts to alleviate the human and social costs of mental disorders have been both too slow and too few.
Background: Mental disorders such as depression, anxiety and suicide represent an important public health problem in India. Elsewhere in the world a high prevalence of symptoms of common mental disorders have been found among people who inject drugs (PWID). Research in India has largely overlooked symptoms of common mental disorders among this high risk group. This paper reports on the results of a survey examining quality of life, depression, anxiety and suicidal ideation among adult males who inject drugs living in Delhi.
Methods: Participants (n = 420) were recruited from needle and syringe programs using time location sampling and were interviewed using an interviewer-administered questionnaire. Self-report symptom scales were used to measure the severity of symptoms of depression (PHQ-9) and anxiety (GAD-2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts and attempts within the past 12 months.
Results: The mean length of injecting career was 20.9 years indicating a sample of chronic injecting drug users, of whom only one-third (38%) were born in Delhi. The level of illiteracy was very high (62%), and just 2% had completed class 12. Scavenging / rag picking was the main form of income for 48%, and many were homeless (69%). One-third (33%) had been beaten up at least twice during the preceding 6 months, and many either never (45%) or rarely (27%) attended family events. We found a high prevalence of depressive (84%, cut-off ≥10) and anxiety (71%, cut-off score of ≥3) symptoms. Fifty-three percent thought about killing themselves in the past 12 months, and 36% had attempted to kill themselves.
Conclusions: Our findings revealed a socially excluded population of PWID in Delhi who have minimal education and are often homeless, leaving them vulnerable to physical violence, poverty, poor health, imprisonment and disconnection from family. The high prevalence of psychological distress found in this study has implications for programmes seeking to engage, treat and rehabilitate PWID in India.
Research misconduct is a global problem as research is a global activity. Wherever there is human activity there is misconduct. But we lack reliable data on the extent and distribution of research misconduct, and few countries have mounted a comprehensive response to misconduct that includes programmes of prevention, investigation, punishment, and correction. The United States, the Scandinavian countries, and Germany have formal programmes , but even a country like the United Kingdom that has a long research tradition and has for years been debating research misconduct has failed to mount an adequate response . But what of low- and middle-income countries (LMICs), many of which are investing heavily in research? There are some high profile cases of misconduct from these countries, but little has been published on research misconduct in LMICs. This article provides what might best be described as an initial sketch of research misconduct in LMICs. (Research misconduct has a specific definition, in the United States [see below], but we, like many others, use the term broadly in this paper to cover every kind of misconduct—major or minor and intentional or not.)
All human activity is associated with misconduct, and as scientific research is a global activity, research misconduct is a global problem.
Studies conducted mostly in high-income countries suggest that 2%–14% of scientists may have fabricated or falsified data and that a third to three-quarters may be guilty of “questionable research practices.”
The few data available from low- and middle-income countries (LMICs) suggest that research misconduct is as common there as in high-income countries, and there have been high profile cases of misconduct from LMICs.
A comprehensive response to misconduct should include programmes of prevention, investigation, punishment, and correction, and arguably no country has a comprehensive response, although the US, the Scandinavian Countries, and Germany have formal programmes.
China has created an Office of Scientific Research Integrity Construction and begun a comprehensive response to research misconduct, but most LMICs have yet to mount a response.
Citation: Ana J, Koehlmoos T, Smith R, Yan LL (2013) Research Misconduct in Low- and Middle-Income Countries. PLoS Med 10(3): e1001315. doi:10.1371/journal.pmed.1001315
Published: March 26, 2013
Copyright: © 2013 Ana et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: No specific funding was received for writing this article.
Competing interests: RS was, as described in the article, much involved in the Singh case. He is also a trustee of the UK Research Integrity Office. All other authors have declared that no competing interests exist.
Abbreviations: LMIC, low- and middle-income country
Provenance: Commissioned; externally peer reviewed.
Global mental health intervention research and mass trauma
Open Access Journal of Clinical Trials 2013:5 61–69
Susan Meffert, Solvig Ekblad
The impact of mass trauma on mental health and the treatment of resulting disorders has been a major focus of global mental health work since the inauguration of the field. Descriptive studies in the 1990s provided convincing evidence of the importance of addressing global mental health needs in the aftermath of mass trauma. Nonetheless, despite calls to move ahead with interventional research, few studies have tested the effectiveness of the treatments for survivors of mass trauma. In this study, we use a translational science model to review the status of intervention research for adult survivors of mass trauma with the goal of identifying promising treatments, and presenting a logic model for using available data in a manner that is sensitive to community needs, and integrating with existing systems for capacity building.
An article consisting of five cogent paragrpahs on MH and NCDs,
Bulletin of the World Health Organization, January 2013--91: 3-3A
CEO of Member Care Associates and Coordinator of the Mental Health and Psychosocial Working Group of the Geneva-based NGO Forum for Health, Kelly O’Donnell, has recently written three resource articles on global mental health (GMH). The purpose of these articles is to provide user-friendly overviews of the field of global mental health, helping to orient people to this domain, especially students and practitioners in the mental health and overall health fields.
Resource 1. Global Mental Health: A Resource Map for Connecting and Contributing (Psychology International, July 2011).
This brief article provides a 60 minute overview of GMH via links to 10 written/multimedia resources on the web. It’s a great way to quickly see the big picture.
Click on this link to access the article: http://www.apa.org/international/pi/2011/07/global-health.aspx
Resource 2. Global Mental Health: Finding Your Niches and Networks (Psychology International, March 2012).
This brief article builds upon the first article. It identifies 10 overlapping areas of GMH (niche-nets) with links to current web resources for each area.
Click on this link to access the article: http://www.apa.org/international/pi/2012/03/global-health.aspx
Resource 3. Global Mental Health: A Resource Primer for Exploring the Domain (International Perspectives in Psychology: Research, Practice, Consultation, July 2012).
This is a major research article with an extensive listing of GMH resources, prioritizing those from the last 10 years. The resources are categorized into six areas: organizations, publications, conferences, training, human rights, and humanitarian. It is also foundational for the previous two articles as well as the new web site, GMH-Map—part of a collaborative project to identify and share GMH resources widely.
Click on this link to access the article: https://docs.google.com/viewer?a=v&pid=sites&srcid=ZGVmYXVsdGRvbWFpbnxnbWhtYXB8Z3g6ZjBmYTI4MTFmMDNhZWU4
Young Researchers Award
Young researchers are invited to join in the competition of the
Best article on a transcultural subject 2013
The winning article will be awarded by the honour of the young researchers award and a prize of €1,000. Articles have to be written on original research, whether based on clinical research, anthropological research, or literature review.
Researchers from LAMIC countries are specially invited.
Young researchers are defined as researchers who did not publish a peer reviewed article before 1.1.2009.
The six best articles will be offered publication, after peer review, in a 2014 special issue of Transcultural Psychiatry. There are also possibilities to publish a podcast.
The articles will be reviewed for the award by the board members of the WPA-TPS.
Responsible editors: Kamaldeep Bhui, M.D, Ph.D., Hans Rohlof, M.D.
If you are interested, contact: Hans Rohlof, +31715191500, firstname.lastname@example.org
Deadline for first draft: October, 15th, 2013
All MGMH Members should have an opportunity to contribute to decisions about the organisation and governance of the Movement. At the 3rd Global Mental Health Summit we will discuss the need to clarify the purpose, structure, and organisation of MGMH to ensure its viability and sustainability. We request that you please take a few minutes to complete the survey we've linked to below. The aggregate responses will be published, however any identifying information will be kept strictly confidential.
Deadline: 21 July 2013
The future of the Movement is up to you, so let us know how it can better serve you!
The July Newsletter from MGMH has been released! Please click this link to view the July newsletter.
If you didn't receive the newsletter and want to be subscribed, please send us an email at email@example.com.
A randomized controlled trial to evaluate Cognitive Processing Therapy (CPT) for survivors of sexual violence in conflict-affected DRC
Giuseppe "Bepi" Raviola is a psychiatrist with Partners In Health, Harvard Medical School and Boston Children's Hospital, working to integrate mental health services into global health care efforts.
"Did you know that in 15 years depression alone will be the number one cause of disability globally, above heart disease, cancer and HIV?"
A new film, “Our Stories: Living and Coping with Schizophrenia” describes the CGMH Community care for people with schizophrenia in India (COPSI) project. Funded by the Wellcome Trust and led by CGMH co-director Vikram Patel and staff member Graham Thornicroft, COPSI is a randomized controlled trial comparing the clinical and cost effectiveness of facility based (usual) care and a collaborative community based care intervention for people with schizophrenia in three sites in India. The community intervention is developed by a team comprising the treating Psychiatrist, the Intervention Coordinator and lay community health workers and the majority of the service is delivered in home settings. A package of evidence based treatments has been selected for the community intervention that can be delivered by CHW’s with adequate training and close supervision.
The film provides a personal and moving account of people with schizophrenia who are taking part in this project.
Click here to view the film.
In response to the realization that between 16% and 49% of people in the world have psychiatric and neurological disorders and that most of these individuals live in low- and middle-income countries, the World Health Organization (WHO) launched the Mental Health Gap Action Programme to provide services for priority mental health disorders in 2008. This focus on services is essential, but the WHO ran into a significant problem when confronting mental health disorders in the developing world: lack of research made it difficult to understand which mental health disorders should be prioritized and how best to reach individuals in need of care...
Transforming Mental Health is a major new initiative focused on identifying and funding research key to solving global issues in mental health.
List of 30 funding or grant organizations, from the very small funding initiatives to the big global donors, from conventional funding to innovative online fundraising and loans.
It is a challenge for all sectors in Global Mental Health to get or safeguard finance. Think of anti-stigma campaigns, advocacy agencies, rehabilitation/housing projects, mental health care facilities, educations and research.
This list is a attempt to help people and organizations in the field to 'see the wood for the trees'.
Comments and additions are welcome.
PLOS Medicine Policy Forum
articles provide a platform for health policy makers from around the world to discuss the challenges and opportunities in improving health care to their constituencies.
Grand Challenges in Global Mental Health: Integration in Research, Policy, and Practice
Citation: Collins PY, Insel TR, Chockalingam A, Daar A, Maddox YT (2013) Grand Challenges in Global Mental Health: Integration in Research, Policy, and Practice. PLoS Med 10(4): e1001434. doi:10.1371/journal.pmed.1001434
Published: April 30, 2013
Mental illnesses frequently co-occur with peripartum conditions, HIV-related disease, and non-communicable diseases. Care for mental disorders should be integrated into primary care and other global health priority programs.
Integration of care for mental, neurological, and substance use (MNS) disorders should (1) occur through intersectoral collaboration and health system-wide approaches; (2) use evidence-based interventions; (3) be implemented with sensitivity to environmental influences; and (4) attend to prevention and treatment across the life course.
Integration of care for MNS disorders with care for other conditions can occur through assimilation of activities, policies, or organizational structures at local, national, and global levels.
Plans for health-related development targets post-2015 should consider the tremendous burden of disability associated with MNS disorders and co-morbid conditions.
This paper is the first in a series of five articles providing a global perspective on integrating mental health.
This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Funding: No funding sources were used for preparation of this manuscript.
Competing interests: The authors have declared that no competing interests exist.
Abbreviations: DALY, disability adjusted life year; GBD, global burden of disease; GCGMH, Grand Challenges in Global Mental Health; LMIC, low- and middle-income country; MNS, mental, neurological, and substance use; mhGAP, Mental Health Gap Action Programme; MDG, Millennium Development Goal; NCD, non-communicable disease; NIMH, National Institute of Mental Health; NGO, non-governmental organization; WHO, World Health Organization
Provenance: Not commissioned; externally peer reviewed.
At the time of the first Lancet series on global mental health in 2007, only 1% of all clinical trials in mental health came from low- or middle-income countries, despite that these areas represent 80% of the world’s population. Moreover, three-quarters of this research was of limited generalizability because the samples studied were fewer than 100 people in size.
This section of the website describes important new research -- both qualitative and quantiative, and not only clinical trials -- about mental health in low- and middle-income countries.