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?
- Low political will
- Resistance to decentralization
- Difficulties in integrating MH in primary health clinics
- MH leadership often lack public health skills
- 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:
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 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.
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.
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!