session 2: mike davies
DESCRIPTION
Mike Davies: Mental health in low and middle income countriesTRANSCRIPT
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MENTAL HEALTH IN LOW- AND MIDDLE-INCOME COUNTRIES
NEEDS, RESOURCES, ISSUES AND APPROACHES
MIKE DAVIES OBE
cbm
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CBM
• Formerly the Christian Blind Mission or Christoffel Blindenmission
• Founded 104 years ago• Today, providing technical and financial
support to 740 disability-related programmes in 89 countries
• Reaching > 23 million people in 2010• Mostly funded by individual donations
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NATURAL DISASTERS HAVE ACCELERATED CBM’S INVOLVEMENT IN COMMUNITYMENTAL HEALTH
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NEEDS
• 450 million people worldwide have psycho-social problems , including -
• 150 million with depression• 90 million with substance abuse disorders• 25 million with schizophrenia
(World Health Report 2001)
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RESOURCES
• Europe : One psychiatrist for 10,000 people• Africa : One psychiatrist for 200,000 people
IN LOW- AND MIDDLE INCOME COUNTRIESLESS THAN 1% OF THE HEALTH BUDGET IS
SPENT ON MENTAL HEALTH (WHO Mental Health Atlas 2005)
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MASS GRAVE- ACEH
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TREATMENT RATE
• cbm estimates that in developing countries, between 80 and 90% of persons with psychosocial problems do not get treatment of any kind
• For the vast majority, no accessible or affordable treatment option exists
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HOW TO BRIDGE THEGAP BETWEEN NEEDSAND RESOURCES?
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NCD SUMMIT (Sept 2011)
• Focused mainly on cancers, cardiovascular disease, chronic respiratory disease and diabetes.
By 2020, depression alone will be the second ranked disease burden, after cardiovascular disease
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CBM’S RESPONSE
• A paradigm shift towards community mental health work, with treatment emphasis at primary and secondary levels
• Multi-tiered intervention strategy focused on local capacity development, access to appropriate treatment, social integration, family counselling & support, livelihood development, advocacy to reduce stigma and prejudice, and empowerment of users and carers groups.
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UNCHAININGPEOPLE
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DUAL MODELS
1. Community mental health services, concentrating exclusively on people with psychosocial problems
2. Inclusion of persons with psychosocial problems in cross-disability, multi-intervention community-based rehabilitation (CBR) programmes
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CBM UK 5th January 2012 18CBR guidelines April 13, 2023 18
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IN 2010 cbm…
• Helped 101,000 people with psychosocial problems in 31 countries
• Supported the work of 18 local mental health professionals
• Met the training costs of 44 mental health professionals
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The mayor’s solution?Put him on the bus to the next town…
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STRENGTHS
• Strong network of partners at all levels (local, national, international)
• Support for users groups and self-help groups
• The move towards inclusive approaches• Cost-effective interventions at community
level
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WEAKNESSES
• Not enough ‘care for the carers’• Preventive and promotional work remains
weak• Partner overload• Not enough time to do training• Insufficient evidence that inclusive
approaches work
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OPPORTUNITIES
• Emergency relief work• Involving community and religious leaders• Advocacy to influence policy/funding support• More central roles for user groups
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THREATS
• Biomedical orientation of government systems
• Lack of public/private partnerships• Professional resistance to community-based
MH approaches• Focus on 3ry care as first choice intervention• Many professionals don’t want to work where
they are most needed
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PEOPLE WITH PSYCHOSOCIAL PROBLEMS ARE INCREASINGLY INVOLVED IN PLANNINGCOMMUNITY MENTAL HEALTH PROGRAMMES
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THE WAY FORWARD
• Empowering user organisations & SHGs• Promotion of positive mental health• Capacity-building at all professional levels• Balance between medical, social and livelihood
interventions• Structured monitoring & evaluation leading to
systematic improvements of services• Stronger advocacy with governments• Staff care/burn-out prevention
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QUOTES FROM A ‘USER’
• “There are two critical issues in mental health today – a) the excessive medicalisation of human suffering and distress, and b) the widespread human rights abuses of people society labels as ‘mad’, ‘disturbed’ or ‘mentally ill’”
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QUOTES FROM A ‘USER’
• “The primary crisis in mental health is not the lack of economic resources or the need for better technologies… the crisis is a social, cultural and political one that requires changing how we think about madness, suffering and emotional pain”
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QUOTES FROM A ‘USER’
• “The UN Convention on the Rights of Persons with Disabilities is a clear and comprehensive blueprint … a human rights and social inclusion framework that represents a shift away from the medical model to a social model of disability. This is precisely what is needed in mental health”
In 2006, David Webb completed his PhD on suicide – the first thesis of its kind by someone who has attempted suicide. David has been a board member of the World Network of Users and Survivors of Psychiatry. His book ‘Thinking About Suicide’ was published in the UK in 2010, by PCCS Books
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BEFOREChained toa tree
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AFTERGrowing vanilla
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THANK YOU
cbm UKwww.cbmuk.org.uk
Tel – 1223 - 484700
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GLOBAL DISEASE BURDEN
• Of the 15 main types of disease affecting women in LOMICs, six are psychosocial –
depression (ranked 1), schizophrenia (4), bipolar disorder (7), self-inflicted injury (8), panic disorder and substance abuse
(WHO, Global Disease Burden, 2004)