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Global Mental Health > Global Mental Health: Scope and limitations > Flashcards

Global Mental Health: Scope and limitations Flashcards

1
Q

What is the consequence of the lack of mental health services in low and middle income country (LMIC) settings?

A

Disability and low quality of life

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2
Q

What is the recognition of mental health around the globe?

A
  • Mental health is neglected globally

- particularly salient in LMICs

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3
Q

What is the principle of equity based on?

A

Recognition of inequity

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4
Q

What are the two roots of global mental health?

A
  1. Medical anthropology

2. Transcultural psychiatry

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5
Q

How and when did the current global mental health movement start?

A

With a Lancet series in 2007:
- led by researchers from KCL and London School of Hygiene and Tropical Medicine
(professors Patel and Prince)

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6
Q

Which evidence was reviewed in the 2007 Lancet series led by Pr Vikram Patel and Pr Martin Prince, which started the global mental health movement?

A

Evidence for:

  • barriers to delivering effective treatment
  • ressources available in LMIC settings

-> call for action

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7
Q

What shaped early research on global mental health?

A
  1. Scientific racism
  2. View that people were on a linear pathway
  3. View that mental disorders were a product of modernity
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8
Q

What was the perception of global mental health in early research?

A

View that mental illness in LMICs was lower than that in the West

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9
Q

What does evidence suggest on the levels of mental illness in the world?

A

Mental illness is quite similar across the world

  • distress may be expressed differently, but no evidence of different prevalence
  • similar debilitating effects
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10
Q

Which evidence suggests that mental illness is an increasing proportion of disease burden?

A

The proportion of disease attributable to non-communicable diseases, including mental disorders, is increasing
- across regions and countries, at macro and micro level

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11
Q

What is the defining goal of global mental health?

A

Closing the treatment gap

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12
Q

What constitutes the global mental health treatment gap?

A

Around the world, mental disorders are under-diagnosed and under-treated

  • treatment gap is at its widest in LMICs
  • sometimes only 10% of people (or less) receive treatment
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13
Q

What do many people do in the absence of treatment in biomedical system?

A

They seek treatment from traditional and faith healers

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14
Q

What are the advantages of traditional and faith healers?

A
  • Cultural appropriateness

- Services are community-based

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15
Q

What are the disadvantages of traditional and faith healers?

A
  • Lack of regulation and training
  • Expense of these kinds of treatments
  • Lack of evidence of effectiveness
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16
Q

What makes the most effective mental health systems?

A

Balance of

  • community-based services
  • AND inpatient facilities consisting of multi-disciplinary teams
  • Psychiatric hospitals and specialists
  • Psychiatric services in general hospitals
  • Community mental health services
  • Mental health services in primary care or other community-based care services
  • Informal community care
  • Self-care
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17
Q

Why are there large geographical areas and populations without mental health services in LMICs?

A

In LMICs, mental health services tend to be concentrated in large psychiatric hospitals in urban areas

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18
Q

What is the state of mental health in stretched health budgets and LMICs?

A

> Mental health has been low priority for stretched health budgets
- small number of beds, majority concentrated in psychiatric hospitals

> Lack of specialist mental health professionals in LMICs

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19
Q

What does the Emerald programme implementation suggest? (Semrau et al., 2015)?

A

Growing recognition of importance of mental health

  • number of countries are beginning to develop infrastructures and policies needed for development of systems and services
  • it will take time to impact the treatment gap
  • in the absence of specialists, there’s a growing interest in developing the workforce capacity to rapidly scale up mental health services
20
Q

What is task-sharing in mental health care?

A

A means by which the treatment gap may be rapidly addressed

21
Q

What is a key contribution of the academic field of global mental heath for task-sharing?

A

To bring evidence about the effectiveness of task-sharing interventions

22
Q

How did task-sharing emerge?

A

Recognition that given constraints on budgets, introduction and delivery of new mental health services needs to be done using existing infrastructures
- minimal additional inputs and costs

  • community-based care is currently lacking from LMIC systems
23
Q

Which elements make task-sharing more feasible in LMIC systems?

A

Existing, well-developed primary care systems dealing with infectious disease, maternal and child death

24
Q

Who can deliver care in task-sharing?

A

Non-specialist healthcare workers
- involved in diagnosis, treatment, management

  • with the support of specialists
25
Q

What is the current effectiveness of task-sharing?

A
  • Good evidence from RCTs of effectiveness of task-sharing for mental healthcare in LMICs
  • BUT, there are still gaps in feasibility and acceptability
26
Q

What is the role of specialists in task-shared services?

A

Using limited resources in the most efficient way possible

27
Q

What did the MANAS trial carried out in Goa consist of (Patel et al., 2010)?

A

Graduates were trained to deliver psychological interventions for common mental disorders, working alongside primary care doctors with supervision from psychiatrists

28
Q

What did the MANAS trial carried out in Goa demonstrate (Patel et al., 2010)?

A

Evidence of effectiveness and some challenges in the feasibility and acceptability of task-shared services

29
Q

What is the collaborative care model developed for quality of care in LMIC settings?

A

A type of task-sharing between specialists and primary healthcare workers that can deliver the highest quality of care

30
Q

What did the Federal Democratic Republic of Ethiopia Ministry of Health propose in their National mental health strategy 2012/13 - 2015/16?

A

Development and revision of national policies and plans

  • provides the impetus, funding and frameworks necessary for the successful implementation of health services and systems
31
Q

What is the WHO Mental Health Gap Action Program (mhGAP)?

A

A task-shared intervention programme providing

  • manualised training for primary healthcare workers
  • with the aim of enabling them to treat and manage priority mental disorders in a community setting
32
Q

What does the WHO Mental Health Gap Action Program (mhGAP) aims to do?

A

Focus attention on mental health in order to close the treatment gap in LMIC settings

33
Q

What is the current application state of the Mental Health Gap Action Program (mhGAP)?

A

It is currently being rolled out by national governments in LMIC settings
- research is underway to evaluate its effectiveness

34
Q

What is the PRIME research programme (2014)?

A
  • Includes researchers from KCL

- Uses a combination of methods to evaluate the effectiveness of the implementation of mhGAP

35
Q

What are the necessary factors for the successful scale-up of mental health services?

A
  • Assessment of needs and resources
  • Political commitment
  • Supportive policy environment
  • Development of intervention package
  • Establishment of plan for monitoring and evaluation
  • Strengthen Human Resources
  • Mobilisation of financial resources
36
Q

What are the challenges to the scale-up of mental health care, found by the PRIME research programme (2016)?

A
  • Lack of prioritisation
  • Poverty
  • Cultural diversity
  • Health system challenges
  • Medication supply
  • Health info systems
  • Burden on healthcare workers
  • Shortage of Human Resources
  • Bureaucracy
  • Lack of accountability
  • Lack of community awareness
  • Stigma and discrimination
37
Q

How do proponents of global mental health view this field?

A

As a means for improving mental health and reducing inequity

38
Q

What is the central view of the critics of global mental health?

A

Global mental health as cultural imperialism of Western ideas

39
Q

What is the key argument from the critics of global mental health?

A

It imposes biomedical categories upon other cultures when these are not necessarily appropriate

40
Q

What is the consensus between proponents and critics on global mental health?

A

Consensus on the expression of distress

- even though mental disorders manifestations vary, there are identifiable shared underlying constructs across cultures

41
Q

What would most proponents of global mental health agree on?

A

The need for awareness of culture

- particularly for measurement, design and delivery of interventions and services

42
Q

What does the early work on the difference of prevalence between LMICs and high income countries suggest?

A

> LMICs
- low prevalence and impact of mental disorders

> High income countries

  • high prevalence and impact of mental disorders
  • due to labelling and separation within family and community systems (absent in LMICs)
43
Q

What does the recent work on the difference of prevalence between LMICs and high income countries suggest?

A

High levels of social isolation and low levels of participation in those with mental disorders in LMIC settings

44
Q

What does recent evidence suggest on the level of satisfaction with existing traditional modalities of dealing with mental illness?

A

Without biomedical services -> lack of choice

- it does not imply satisfaction

45
Q

What is a limit of global mental health?

How is it countered?

A

It ignores elephant-in-the-room issues (e.g. poverty, social adversity)

  • > many global mental health interventions go beyond the clinical issues
  • > examine social capital, social conditions and improve community resources
46
Q

What are the typical partnerships in global mental health?

A

Western partners often from powerful universities

- which have originally created concepts of global mental health and categories of mental disorders

47
Q

What seem to be the factors leading to an equal platform in global mental health?

A
  • Long-term partnerships

- Capacity-building activities

Global Mental Health (14 decks)

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