Turning the world upside down event 27.11.2013
Chaired by Lord Nigel Crisp
Introduction Peter Piet London School of Tropical Medicine
2012 Burden of disease report
Huge burden of mental illness
Neglected area
Significant human rights abuses
HIV remains huge issue
Ministry of Health Indonesia report that there are 18,000 people in chain in
Indonesia with mental illness.
Abuses occur even in Europe
Budgets in Low-income countries run around 0.5% for mental health.
May 2013 World Health Action plan established
Dec 2013 World innovations summit in Durban
Dementia summit soon G8 –so mental health on political agenda
Development of Mental Health Innovation Network
Most important are empowering people with mental health
Advocacy most important role in health
Development of service users as expert and involved from beginning in
developments. Co creating projects
Aim of event is to showcase how innovations in low-income countries can
benefit NHS
Also website http://www.ttwud.org/ 34 shortlisted examples listed and 4 top
Winner
Jamaica- Dream-A-World (DAW) Cultural Therapy is a multimodal
intervention for high-risk primary school children living in
impoverished, disadvantaged, inner-city communities, selected
for severe disruptive disorders and academic underachievement.
Frederick Hickling
Considered 40% unhealthy in Jamaica
Children lot of abuse and adversity
High rate of teenage pregnancies, violence
Primary mental health prevention programme
Focus on children in schools under 8.
Involves educational interventions and fantasy
Presented at meeting
Kerala- Using Mobile Telepsychiatry to Bridge the Mental Health Gap
Providing telepsychiatry consultations onboard a bus by using
low cost solutions such as free video conferencing software and
wireless 3G for connectivity
- Schizophrenia Research Foundation India
- Feasible, effective and users confortable with technology
- Low cost
- Also train lay workers to support clinicians-case
identification, referral and rehab
- Redistributes resources
- Secondary advantages e.g. employment
But not for acutely unwell or for intense psychological
interventions
Can be applied to remote areas
Presented at meeting
BASIC NEEDS By placing affected people firmly at the centre of
an economic and social approach to mental health, Basic Needs
has had a significant impact in LMIC and is beginning to see
what it can offer to the challenges faced by high income
countries.
Economic and social approach to mental health
Component of
-Livelihoods
-Resources
-Collaboration
-Capacity building
-Community mental health
Arises out of poverty being associated with mental health
difficulties
Research and evaluation based on users of projects
Are in 12 countries
Benefited 589,000 people since 2000
-Increased access to treatment
-Improved family and quality of life
-Improved work opportunities
-Reduction of symptoms
Key is use of user and self help groups
Advocacy comes from users and policy makers
20,000 in 628 peer self-help groups
90,000 reentered workforce
-People at centre
- Proven model
-Community orientated
- Maximize resource use and task shifting
-Self help groups hold power and sustainability
Model is same in each country but local adaptations
Starts with initial capacity building meeting
Largest in this specialized are
Budget of 2.3 million turnover per year
Presented at meeting
GOA SUNDAR: mental health for all by all
SUNDAR describes the ingredients of Sangath’s approach to
improve access to evidence based interventions for mental
health problems through lay people as the front line mental
health care providers.
-3,500 psychiatrists in India
MANAS trial showed can use lay health counselors effectively
for treatment of depression and anxiety. Improves reduction of
suicide
Home care for Schizophrenia
Lay workers for dementia
Lay counselors in school
Autism care
-Simplify language
-Unpack treatments
-Deliver where people are
-Affordable
-Quality human resources
-Specialists take on training and supervision role
-Importance of evidence and needs based
-Deliver through existing systems and support of government –
sustainability
Lay workers are paid and supervised
No peer workers yet
Now 3 mental health workers in every primary care centre in
India
The following are other entrants which are on website in more
detail
- Brazil's 250,000 lay Community Health Workers, each with
responsibility for up to 150 households, lead to
remarkable impact on individual and population health
-
Jamaica-Admissions of the acutely mentally ill to open
wards of general medical hospitals have had a profound
impact on the assimilation of psychiatry into general
medical practice.
- Jamaica-Mental Health Officers have served as the ‘glue’
holding together all the elements of community mental
health integration in Jamaica over 50 years
- Jamaica - Psychiatry’s traditional geographic separation
from medicine has been significantly challenged by the
integration of culturally appropriate affordable mental
health care into Jamaica’s public health system, accessible
to the entire population.
- Jamaica- Independence from British colonialism catalyzed
the gradual deinstitutionalization process of the century
old custodial Lunatic Asylum leading to an 80% gradual
decline in the resident population over 5 decades.
- Haiti- A community-based outreach program in mental
wellness was organized among local volunteers and
children at an earthquake field hospital in Leogane, Haiti;
January 2010.
- Saint Vincent We have piloted self-help groups in Saint
Vincent/Grenadines as a cost-effective way to address
alcohol problems and have learned that, contrary to
Western models, they need not and should not be
anonymous to succeed.
- UK –Southwest London
- Co Producing Mental Health and Well Being Early
Intervention and Prevention in Black Communities:
unlocking social capital to add public value
- Jamaica- Introducing a Community Mental Health Team in
the Public Health primary and secondary service of the
Kingston Metropolitan area portends an impending Mental
Hospital deinstitutional end game metamorphosis
- Uganda - The Aim of the Partnership is to enable
sustainable improvements in mental health services and
support in the Statutory and Voluntary Sector in both Gulu
and Sheffield.
- South America - We are a voluntary organisation
established in 2012 seeking to improve mental health care
by collaborating with mental health services and related
organisations in Latin America and Europe.
- Greece- Event in a busy metro concourse to encourage
citizens to change their perception of mental health
problems: also to offer people with psychosocial
difficulties and their families free support
- Nigeria- A mental health service within the Juvenile Justice
System, sustained by partnerships and existing
programmes is an initiative of a multidisciplinary Child
Mental Health Team in the University of Ibadan.
- Zimbabwe- HIV positive teenagers from Zimbabwe have
developed their own books, films, photos, music and art as
therapeutic interventions for themselves and their HIV
positive peers around the world
- Kerala- An awareness cum screening project conducted
among school children in Attappady,the largest tribal
block in Kerala State Of India ,aimed at
detection,prevention and remedial measures regarding
substance abuse.
- Chile- National roll-out of a collaborative care model for
depression in Chile, integrating detection and treatment of
depression into primary care.
- Ghana - Through the network of self-help groups
surrounding Sandema in northern Ghana, members
challenge discrimination, share support and advice, and
attain financial security in a very poor setting.
- Kerala- Delirium is a syndrome characterized by the acute
onset of fluctuating cognition, inattention and disturbed
consciousness. We are reporting a very cost effective
Indian Indigenous way of treating Delirium.
- Ghana- We tested the evidence that creative arts can
facilitate mental health promotion by organising a public
exhibition of artwork produced by mentally ill individuals,
artists and researchers, in Accra, Ghana.
- South Africa - The PMHP envisions integration of mental
health care for pregnant and perinatal women at primary
level. Four inter-related programmes aim towards scale up:
service delivery, training, research and advocacy.
- Ghana-Involving patient’s family in the care of the patient
has proved very useful because it seeks to eradicate the
stigma attached to mental illness.
- Indonesia - Integrating mental health in a national health
survey has made mental health studies become more
readily acceptable. The impact is that the survey can be
run continuously.
- Pakistan- SHARE-THPP equips lay women (i.e. peer
volunteers) to deliver evidence-based psychological
treatment to mothers in their communities, in order to
reduce the burden of maternal depression in Goa, India
and Rawalpindi, Pakistan.
- Canada-India- Canadian Mental Health Centre develops
Parent Education Resource shared in International
Partnership with Indian NGO which adapts, universalizes
resource removing limitations of a standardized kit, shared
back with Canada .
- Andes region- A study of the genetics of movement
disorders amongst unmedicated Kolla indgenous people in
the Andes mountains opens the door for prediction of risk
and primary prevention of schizophrenia.
- Uganda- The Butabika Link- East London NHS Foundation
Trust in consultation with The Uganda Diaspora health
Foundation, has managed to successfully plan and develop
health projects in Uganda.
-
Uganda -UK and Ugandan mental health service users met
in 2008 leading eventually to a user led organisation and
innovative solutions to the lack of resources.