All in 2 Weeks

Recently I attended a two-week long training course on Leadership in Mental Health (MH) in Goa. Organized by Sangath, the NGO I currently intern for, and the London School of Hygiene and Tropical Medicine, the training course offered me a theoretical framework for advocating for the global MH agenda, a goal I will continue pursuing in the future. I have tried to give a synopsis of what global mental health is, why it matters, and how future leaders can expand services.

What is “Global Mental Health?”

According to Koplan et al., it is a field that prioritizes mental healthcare access to all people and emphasizes the equitable provision of services. The movement aims to provide care to those who need treatment the most, those who are the most vulnerable, and those who are most at risk.

Why does Mental Health even matter?

Bottom Line: No health without mental health.

Without treatment, mental disorders linger and fester in a person’s life, causing suffering that debilitates physical health and contributes to mortality. 14% of the global burden of disease is a result of neuropsychiatric disorders. Moreover, mental disorders are often linked to other conditions like HIV/ AIDS, heart disease, and childhood growth. The impact on co-morbidity bolsters the claim that MH must be made a priority.

But, in low and middle income settings, like India, scaling up coverage of services for mental disorders can be quite a challenge.

What are some of the barriers to scaling up MH programming?

  1. Low political will
  2. Resistance to decentralization
  3. Difficulties in integrating MH in primary health clinics
  4. MH leadership often lack public health skills
  5. Lack of skilled workers

So how is it possible to overcome these hindrances and create large-scale changes?

Mental Health is a RIGHT!

A rights-based perspective can be used to protect and argue for the human rights of people affected by mental disorders and their families. Most governments, including India, have signed resolutions and conventions like the UN Convention on the Rights of Persons with Disabilities. These polices establish standards that protect this vulnerable population against abuse and safeguard their rights. Moreover, adopting an equity-based argument mandates that the most vulnerable, at-risk groups have access to treatment they need. The people who need treatment the most should receive the care they need.

Examples of some Tools at our Disposal:

WHO’s mhGAP

Moreover, I learned that there are tools in existence that are at my disposal to scale up care. The tool currently being tested by Sangath through the PRIME project is the World Health Organization’s mhGAP, which aims to increase coverage with evidence-based interventions for priority mental, neurological, and substance use (MNS) conditions in resource-poor conditions. These guidelines aim to integrate MH within existing systems of care with a focus on primary care. This study opposes the current organization of MH care, which finances expensive, specialty care options (eg: long stay facilities, psychiatric services, etc.) and is utilized by the least number of people. Instead, the mhGAP proposes a change in the current scenarios of care and redirects funds to self-care and community-based services that can reach more people and are cheaper.

Task-sharing

Task-sharing aims to redistribute tasks from highly qualified professionals to more readily available, less qualified health worker teams wherever appropriate. This concept is widely present in the mhGAP. Moreover, through discussions, I also learned that psychiatrists are not the only resources available for MH. Tapping into out-of-the-box pools like pediatricians and college students is the key to raising the human power necessary for implementing a large scale program.

Personal Stories

People living with mental disorders can be a crucial resource while advocating and scaling up services. One such example is the Norwegian Prime Minister, Kjell Magne Bondevik, who temporarily left office after he admitted that he was suffering from depression. After he recovered, he returned to office and was positively received by the public. He made mental illness a more publicly acceptable event in a person’s life and brought awareness to the country. As seen from above, the human experience, when conveyed effectively, oftentimes has more weight than stats and figures.

Conclusion

I have tried to give a brief overview of some of the lessons I learned during the training course. In addition to gaining this knowledge, I met some amazing people who are just as passionate as I am about improving the lives of millions suffering from mental illness all around the world. Over the two weeks, we became a family of committed leaders, equipped with tools to fight for global mental health. Their personal stories and motivations have taught me that I am not alone in fighting for increased awareness and attention for MH. More than anything, I left the course feeling energized and inspired to tackle and overcome the obstacles that I undoubtedly will face!

As an undergraduate, Anusha cultivated an interest in connecting medical anthropology and global health, particularly in India. She is interested in understanding the Indian public health system using qualitative methodologies. Anusha has worked in the past with Sangath, an NGO that focuses on improving the provision of mental healthcare in India. Anusha will continue to work with Sangath to evaluate the PRIME study, an international study that aims to generate knowledge which can be used to improve access to care for priority mental disorders in primary and maternal health care contexts in low resource settings. In the future, she hopes to become a cultural broker in both the academic and health care realms.

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3 thoughts on “All in 2 Weeks

  1. Anusha
    Great summary. With mental health front and center as a result of the tragedy at Sandy Hook, I hope Governments take it more seriously .
    Sridar

  2. A very good summary on global mental health. A student myself of global health, this is one of those issues that is gaining more attention among academic and clinical circles worldwide. Stigma to access health services remains to be a bedrock challenge and especially in cultures with high emphasis on tradition and culture like those in East and South Asia. People will have to be educated that schizophrenia and clinical depression are neurological problems and not because of poor upbringing or evil spirits.

    Having said that, I also believe that mental health provision in developing cultures like in India cannot be isolated from discussions about religion, spirituality, and cultural values. And rightly so, these discussions must be had, but must be done so without ignoring those patients chained up in some psychiatric ward and mistreated by communities due to their poor mental health status.

  3. An excellent summary….. I did want to understand what exactly is mhGAP’s approach. Would love to learn more from you… maybe midpoint….

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