MENTAL HEALTH GAP ACTION PROGRAMME (mhGAP) 2nd meeting of the

MENTAL HEALTH GAP ACTION PROGRAMME (mhGAP)
2nd meeting of the mhGAP Forum
ANNEX
F
Submissions from the participating organizations
ADI Submission for mhGAP
Geneva, 7 October 2010
64 Great Suffolk Street
London SE1 0BL
United Kingdom
Tel:
+44 (0)20 7981 0880
Fax: +44 (0)20 7928 2357
Email: info@alz.co.uk
Web: www.alz.co.uk
Alzheimer’s Disease International (ADI) is the worldwide federation of 73 Alzheimer associations.
ADI’s mission is to strengthen and support Alzheimer associations and raise awareness about
dementia worldwide, to improve the knowledge of and information on risk factors, and to make
dementia a global health priority. Our vision is an improved quality of life for people with dementia
and their families throughout the world.
ADI has recently commissioned two reports on global dementia, the World Alzheimer Report 2009,
with the latest prevalence data and information about the impact of the disease, and the World
Alzheimer Report 2010 with the global economic impact of Alzheimer’s disease and related
dementias.
We welcome the priority that is given to dementia in the Mental Health GAP programme. and offer
our assistance with its implementation. There are still governments in the world who – wrongly –
think that dementia does not occur in their country. This programme gives a unique opportunity to
improve the quality of life of people with dementia and their families. It brings together the most
effective interventions that can be used from today on.
The national Alzheimer associations are well positioned to assist in the implementation of this plan.
A list of countries where we have a member association can be found below. ADI can do the
following things to promote mhGAP:
1. Publish an article in our newsletter Global Perspective
2. Put an article and all available information on our website, in as many languages as are
possible
3. Inform the ADI-members in countries that are prioritised in the programme and recommend
working with the local WHO-office and the Health Ministry.
4. Put the mhGAP programme on the agenda of our regional meetings with the Latin
American and Asia-Pacific members, both in October 2010.
5. Consider looking for a pilot country for mhGAP to carry out our Global Improvement in
Dementia Care (GIDE) project, that we have developed together with the International
Psychogeriatric Association. At the moment, Alzheimer Pakistan and the Alzheimer and
Related Disorders Society of India have shown interest in this project.
We are very interested to hear more about the programme during the World Health Organization
meeting on 7 October and to meet with others who are working towards similar goals.
Marc Wortmann
Executive Director
Alzheimer’s Disease International
Alzheimer’s Disease International, The International Federation of Alzheimer’s Disease and Related Disorders Societies, Inc.
In official relations with the World Health Organization
List of members of ADI 2010-2011
Argentina
Armenia
Aruba
Australia
Austria
Bangladesh
Barbados
Belgium
Bermuda
Brazil
Bulgaria
Canada
Chile
Chinese Taipei (Taiwan)
Colombia
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Dominican Republic
Egypt
El Salvador
Finland
France
Germany
Greece
Guatemala
Honduras
Hong Kong SAR
Hungary
India
Indonesia
Iran
Ireland
Israel
Italy
Jamaica
Japan
Korea, Republic of
Lebanon
Malaysia
Malta
Mauritius
Mexico
Netherlands
New Zealand
Nigeria
Pakistan
Panama
Peru
Philippines
Poland
PR China
Puerto Rico
Romania
Scotland
Singapore
South Africa
Spain
Sri Lanka
Sweden
Switzerland
Syria
Thailand
Trinidad and Tobago
Turkey
UK
USA
Uruguay
Venezuela
Zimbabwe
Important publications:
World Alzheimer Report 2009 (overview of dementia and global prevalence)
World Alzheimer Report 2010 (economic impact of dementia)
Http://www.alz.co.uk/worldreport
Association for Regional Development and Mental Health (EPAPSY)
Est. 1988
EPAPSY is a nongovernmental, non profit organization that has founded and operates 11
community-based mental health services (residential care units, mobile units, day centers). It
operates under the supervision of the Greek Ministry of Health, but functions under private
law as a public body. It is funded by national funds as well as the E.U.. EPAPSY employs 188
mental health professionals. Scientific Director is professor Stelios Stylianidis, Ass. Prof. of
Social Psychiatry at the University of Panteion, vice president of World Association for
Psychosocial Rehabilitation, an NGO in official status with WHO. Professor Stylianidis is the
national counterpart for mental health to WHO. EPAPSY is governed by 5-member Board of
Directors.
The aims of the Association are: the implementation of mental health programmes promoting
local development and social inclusion, the promotion of the rights of people with mental
disorders, their families and other vulnerable or high-risk groups, the provision of know-how,
training and applied research for the implementation of mental health and psychosocial
rehabilitation services in Greece and abroad, the development of initiatives and innovative
working methods in close cooperation with public health and non-health services and other
local voluntary organizations and non-profit associations. EPAPSY has implemented 9 projects
funded by the EU and conducted three large scale psychiatric surveys. EPAPSY was part of the
multi-centered study "Primary Health Care and Psychiatry" run by the “Mario Negri Health
Research Institute” (Italy) and the WHO.
EPAPSY operates two Mobile Mental Health Units in NE and W Cycladic islands providing
psychiatric services for 11 islands with a population of 87000 people. The staff is constituted
by 24 professionals (psychologists, psychiatrists, social workers, administrative staff, and
supervisors). Angelo Barbato, Senior Scientist at the Epidemiology and Social Psychiatry Unit of
Mario Negri Institute and Benedetto Saraceno, professor of Social Psychiatry at the University
of Geneva, are consultant of EPAPSY for policy, training and research issues.
The objectives of the Mobile Mental Health Units are:
Mental Health needs assessment of the population of each sector
Assessment and management of mental health problems and disorders of children,
adolescents and adults through the integration with Primary Health Care System
Mental Health Promotion actions (fighting stigma, raising awareness and educating the
general population etc)
Concerning the collaboration with primary health care services of the islands, 7 islands have a
public Health Centre with specialized staff, the others rely mainly on GPs or ‘unskilled’ doctors
(“agrotikoi” in Greek) working in local and smaller locations. As stigma is an important barrier
to seeking help in the remote and introverted communities of the islands, people generally
trust GPs when seeking care. Therefore, GPs are the health professionals that first are in
contact with people with mental health problems. Over 50% of patients treated by the Mobile
Units are referred by PHC. There are no other mental health services in the eleven islands
except the mobile units and one child-psychiatrist in the General Hospital of Syros. Reduction
of the huge number of compulsory hospitalizations from the islands can only be achieved in
collaboration with PHC professionals.
As mental health care in these islands is provided through the PHC system with the supervision
of the EPAPSY Mobile Units we consider these areas as suitable for the piloting of the mhGap
programme. We intend to do that through:
Step 1. Translating the package into Greek. A census group of experts will validate
the translation which will be used for the training of Greek professionals (1 month).
Step 2. Training of the mental health professionals working for the Mobile Units.
Training will last approximately 1 week (in Athens). From this group 5 mental
health professionals will be the trainers for the GPs.
Step 3. Training of the selected PHC workers in a one-to-one basis at the local
health centers (1 month). 4 GPs and 2 pediatricians in Kithnos, Paros, Antiparos
and Andros island. Selection criteria: working experience in PHC setting, previous
systematic collaboration with the Mobile Units, workplace steadiness, motivation.
Step 4. Implementation of the programme by PHC workers with the supervision of
mental health professionals of the Mobile Units (3 months)
Step 5. Focus group with the participation of academics from the Psychiatric Clinics
of Athens, Ioannina, Thrace and the Greek Association of General Practitioners.
Final report to WHO with suggestions about mhGAP package.
Coordinator: St. Stylianidis, Scientific Director of EPAPSY.
Suggestions for further support:
Identifying other Greek sites for training and use of the package
Promoting the integration of the final package to the official curriculum of
training GPs (by the Greek Association of GPs) and the continuous training
sessions for GPs and training psychiatrists
Relevant Publications
Stylianidis S., Pantelidou S., Chondros P. (2007). Unités mobiles de santé mentale dans le
Cyclades. L’ Information Psychiatrique 83: 682-688
S. Stylianidis, P. Skapinakis, S. Pantelidou, P. Chondros, A. Avgoustaki, M. Ziakoulis (2010).
Prevalence of common psychiatric disorders in an island region. Archives of Hellenic Medicine,
27(4):675–683
Autism Speaks Global Autism Public Health Initiative
Autism Speaks is the world’s largest autism science and advocacy organization. Its mission is to
fund research into the causes, prevention, treatments and a cure for autism; increase awareness
of autism spectrum disorders; and advocate for the needs of individuals with autism and their
families. Officially designated a non-governmental organization associated with the United
Nations Department of Public Information, the first and only such organization devoted to
autism, Autism Speaks is able to reach a global audience in its efforts to promote the dignity,
equal rights, social progress and better standards of life for individuals with autism. In 2008,
Autism Speaks launched the Global Autism Public Health Initiative (GAPH), an ambitious
international advocacy effort designed to help countries around the world: (1) enhance public
and professional awareness of autism; (2) facilitate scientific research, including research that
informs public health policy; and (3) build capacity for autism services, especially in early
detection and intervention. Through GAPH, Autism Speaks has already established or is
exploring partnerships with local governments, professionals, and parent advocates in over 20
countries across Central and South America, the Middle East, Eastern and Western Europe,
South Asia, Africa, and the Pacific Rim.
A major barrier to improving the health and wellbeing of children and families touched by
autism around the world is the paucity of expertise and subsequent lack of capacity for autism
services and research. Capacity-building is a core component of GAPH development and closing
the treatment gap requires development of community-based intervention that is feasible, costeffective, and can be delivered with fidelity by professionals and non-professionals alike. GAPH
implements strategies developed in the field of global mental health where experts
acknowledge the need for innovative solutions to scaling up services, especially in countries
struggling with many public health priorities outside of autism and developmental disabilities.
Furthermore, collaboration and partnership are essential for the success of GAPH programs.
Autism Speaks aims to serve as a catalyst for meaningful change, but we recognize that
committed local and international leadership and support is essential for achieving our goals.
Successful partnerships allow us to leverage shared investments, speed development, enhance
impact, and facilitate dissemination of program activities and outcomes to communities in need.
As the priorities and approaches of GAPH are well aligned with those of the World Health
Organization’s (WHO) Mental Health GAP Action Program in reducing the global burden of
mental health issues, in April of 2010 Autism Speaks and WHO announced an official
partnership. The Autism Speaks-WHO partnership aims to build upon the synergy between the
GAPH and mhGAP to have the greatest impact and broadest reach in rapidly delivering
meaningful, impactful, and sustainable solutions to families struggling with autism and other
mental health disorders around the world.
No Health without Mental Health
The Shirley Foundation and Autistica welcome the opportunity to
contribute to the Mental Health Forum in partnership with the WHO and its
other partners.
The Shirley Foundation is the leading funder of autism projects in the
UK having donated over £40 million to research and service development
in the past decade. It continues to fund strategically significant projects
including:
the mhGAP initiative,
a WHO Europe project,
Supporting the work of Autistica.
Academy of medical Science to do expert report on autism
research
History of Autism (published by Wiley/Blackwell
Autistica is the UKs leading charity funding autism research, in the UK. It
seeks to use biomedical research to bring benefits to individuals and
families affected by autism. It is dedicated to raising and investing funds
to support high quality peer reviewed research focussing on determining
the causes and biological basis of autistic spectrum disorders and
advancing and evaluating new treatments and evidence based
interventions.
Autism is one of the most significant but least researched developmental
disorders. Autistica has set itself the task of achieving major
breakthroughs within 10 years.
Its main focus in support of the mhGAP initiative is, and will, be to support
capacity building in areas of low to middle income or areas where
diagnosis is at a low level. Currently Autistica is in the process of funding
and facilitating 12 Saudi fellows to study in the UK and first of 2 of 6
fellows from India. This is part of an initiative to ensure involvement at an
international level in research into autism and developmental disorders,
ultimately leading to an improvement in services and evidence
interventions.
It is expected that the Saudi initiative will be widened to include the whole
Gulf region over the next years.
Support in the future:
By supporting capacity building in areas such as these Autistica will
enhance knowledge, support evidence based interventions, practice
and research thus ensuring an improvement in the quality of life for
individuals and families.
One of Autisticas mission aims and continuing responsibilities is the
dissemination of information on autism and major research
initiatives and outcomes. It will continue to promote evidence
based intervention as described in the mhGAP reports.
Personnel involved in The Shirley Foundation and Autistica will
continue to contribute to mhGAP and its aims and objectives
Eileen Hopkins – eileen.hopkins@autistica.org.uk
Project Manager -The Shirley Foundation
Director of International Development - Autistica
www.autistica.org.uk
CBM – Building an inclusive society
CBM is an international Christian development organisation, committed to improving
the quality of life of persons with disabilities in the poorest countries of the world.
Based on over 100 years of professional expertise, CBM addresses poverty as a cause
and a consequence of disability, and works in partnership to create a society for all.
CBM’s vision is: “an inclusive world in which all persons with disabilities enjoy their
human rights and can achieve their full potential”.
CBM’s work is founded on the core values of Christianity, Internationalism,
Professionalism, Stewardship, respectful and honest Communication and Inclusion.
CBM’s goals are:
to improve the quality of life of persons with disabilities through health care,
education, rehabilitation and livelihood services;
to advocate for the inclusion and rights of persons with disabilities in all aspects
of development and societal life (mainstreaming);
to build capacity in national Partners to provide services for persons with
disabilities.
In order to achieve this, CBM follows a twin track approach, consisting of:
Improving access to healthcare,
education, livelihood and social
activities and political influence so
as to enable and empower persons
with disabilities and their families.
Overcoming the barriers in society
that people with disability face e.g.
attitude, physical accessibility,
communication, legislation, so that
persons with disabilities are
included in all aspects of society.
Mental health care in Sri Lanka, after the Tsunami
Picture: CBM/Lohnes
CBM promotes service developments which are accessible to all people, particularly
the poorest. Therefore CBM works proactively with its Partners to break down barriers
which prevent people accessing services. These barriers include poverty, lack of education, gender, religion, age, social stigma and geographic isolation. CBM prioritises
services that improve the lives of children and women, and takes into account environmental issues.
Together we can do more…
Together with its Partner organisations, CBM reaches over 20 million persons annually. CBM Member Associations support a joint programme of development work with
over 60 million Euros annually. Currently, CBM supports more than 900 projects in
over 90 countries in Africa, Asia, Latin America and Eastern Europe through 12 Regional Offices. Local and expatriate professionals (nurses, special educators, doctors,
physiotherapists, rehabilitation experts and project managers) offer their skills
through approximately 750 Partner organisations. CBM emphasises sustainable,
community-based approaches which encourage self-reliance and contribute to poverty
alleviation and community development. Building local capacity is a priority and CBM
invests significantly in personnel development.
International Cooperation, Advocacy and networking
CBM works with like-minded local and international organisations to build alliances
and create global initiatives in order to improve the quality of life of persons with
disabilities.
CBM is working in cooperation with United Nations (UN) agencies, including the World
Health Organization (WHO), NGOs and Disabled Peoples’ Organisations (DPOs) to
develop networks and programmes.
CBM, the WHO and the International Agency for the Prevention of Blindness (IAPB)
were founding members of “VISION 2020: the Right to Sight,” a programme to
eliminate avoidable blindness by the year 2020. CBM is a pioneer in Community Based
Rehabilitation (CBR), and is involved in the development of the new WHO-ILOUNESCO CBR guidelines (to be launched in October 2010).
CBM and Community Mental Health
CBM has been involved in Community
Mental Health (CMH) work through its
partners for many years. Activities in
CMH are particularly strong in West Africa
and Indonesia.
CBM supports both standalone CMH
programmes and CMH activities as an
integral part of many of the 210 CBM
supported CBR programmes worldwide.
Awareness raising exercise by community volunteers in Nigeria
Picture: CBM
In 2009, around 96,000 persons accessed CMH services supported by CBM.
CBM has an Advisory Working Group in Community Mental Health, composed of five
Mental Health experts who advise and build capacity in CBM Regional Offices and
Partners for the implementation of CMH. They also participate in global forums and
networks to scale up CMH services worldwide.
CBM and mhGAP
CBM is proud to be an active participant in mhGAP, having been involved in reviewing
the mhGAP materials, and being already actively involved in its implementation. The
WHO’s goal of closing the gap between need and services in the area of mental health
is shared by CBM. In line with the core value of professionalism, it is important to CBM
that the Programme is built on a strong evidence-base. The practical and culturally
sensitive nature of the materials lend themselves to use in low-income settings where
CBM conducts its work. CBM will support its partners in collaborating with mhGAP as
part of the process of scaling up quality services and ensuring that rights of people
with psychosocial disabilities are promoted. This collaboration is already active in
some countries of Africa and Asia. Joint NGO/Government/local partner programmes
are using mhGAP as a platform to build services, and training curriculums are
increasingly using mhGAP materials as resources.
CBM is strongly committed to working with the WHO to ensure that mental health care
is available to those who need it, so that together we can build an inclusive society.
CBM
www.cbm.org
contact@cbm.org
Nibelungenstr. 124, 64625 Bensheim, Germany
The U.S. Centers for Disease Control and Prevention (CDC) is a government agency
that promotes prevention and public health. CDC’s Internet web site is located at
www.cdc.gov.
CDC Vis io n fo r th e 2 1s t Ce ntu ry
“Health Protection…Health Equity”
CDC Mis s io n
Collaborating to create the expertise, information, and tools that people and
communities need to protect their health – through health promotion, prevention of
disease, injury and disability, and preparedness for new health threats.
CDC seeks to accomplish its mission by working with partners throughout the nation
and the world to
•
monitor health,
•
detect and investigate health problems,
•
conduct research to enhance prevention,
•
develop and advocate sound public health policies,
•
implement prevention strategies,
•
promote healthy behaviors,
•
foster safe and healthful environments,
•
provide leadership and training.
Historically, CDC did not consider mental health as part of its mission, but this has
changed over the past decade, and now CDC is engaged in a variety of activities
related to mental health.1,2
References:
1. Safran MA. Achieving recognition that mental health is part of the mission of CDC.
Psychiatric Services. 2009; 60(11): 1532-1534.
2. Safran MA, Mays RA; Huang LN, McCuan R, Pham PK, Fisher SK, McDuffie KY,
Trachtenberg A. Mental Health Disparities. American Journal of Public Health. 2009; 99(11):
1962-1966.
The Centre Saint Martin : transferring knowledge from specialized centers to general practice
health services
The Centre Saint Martin which is part of the Community Psychiatry Service of the Centre Hospitalier
Universitaire Vaudois (CHUV), is a specialized out-patient clinic situated in down-town Lausanne
(Switzerland). The center provides special care for severely affected illicit drug users. Mental and
general health assessment, counseling for social problems, supportive follow-up and Methadone
substitution treatment are amid its commonly used interventions. The staff is composed of
psychiatrists, physicians specialized for internal medicine and infectious diseases, psychologists,
psychiatric nurses and social workers. Beside the interdisciplinary approach in assessing, treating and
orienting every patient, there are many collaborative ventures with other regional institutions that
have to deal with problems associated with the use of illicit substances, e.g. the maternity wards, the
prisons, the general psychiatric services, etc. Another particular interest of the Centre Saint Martin is
to train general practitioners and other mental health professionals enabling them to treat
adequately and efficaciously their patients presenting a comorbidity of substance abuse. The main
objective of this policy is to create a common culture of knowledge and network collaboration
allowing the majority of drug abusing patients to be treated by non-specialized health care
professionals, and only the most severely affected patients to be treated in a specialized treatment
setting.
Ansgar Rougemont-Bücking ; MD, psychiatrist
Centre Saint Martin
7, Rue Saint Martin
1003 Lausanne
Switzerland
CITTADINANZA ONLUS
Cittadinanza is a non-profit organization founded in Rimini (Emilia Romagna-Italy) in 1999,
with a clear focus on people who suffer from mental illness and living in poor or
disadvantaged countries.
Cittadinanza is an Italian word: its translation in English is
Citizenship. We chose this name to emphasize that we
want to remove, from persons with mental illness, the
mask of shame and give them back their identity as
‘citizens’.
1 - Best New Life Shelter, Vellore
2 - Community Mental Health Programme, Thiropurur
3 - Day Care Centre, Smedrevska Palanka, Serbia
Practically, we develop and support mental health projects for low income populations.
Cittadinanza provides care for adults (like in our project in Thiropurur, India) and for
children
and
adolescents
with
neuropsychiatric
disabilities (as in the projects we implemented in
Serbia, Vellore-India and Albania), using a Community
approach that includes the involvement of all local
stakeholders (families, schools, social services, local
authorities etc.) and considering the beneficiaries as
active partners of our projects.
4 - Day Care Centre, Berat, Albania
CITTADINANZA onlus
Via Briolini 48/E · 47921 Rimini (RN) · tel/fax 0541 412091
info@cittadinanza.org
www.cittadinanza.org
Cittadinanza’s activities have been always based on two strategic points:
I) International Exchange of Experience - We are convinced that exchange of experience
in this field, in mental health, is very important. The exchange of experience is not oneway - from rich to poor countries. Poor countries suffer of course from a huge lack of
resources, both financial and technical. But this lack sometimes can become an
opportunity to develop creative solutions, new ideas, new projects and social cooperation.
From which also western countries can benefit.
II) Cooperation with WHO – From the beginning we had a strong relationship with the
World Health Organization, that helped Cittadinanza with its institutional frame and
scientific support. Cittadinanza supported and assisted low and middle income countries,
which have already accomplished the WHO-AIMS, in the transition from the analysis to the
real implementation of the mental health reforms. Cittadinanza, in collaboration with
WHO, has organized two international meetings (2008, 2009) in Rimini, where 36 low
and medium income countries met to present and discuss their projects aimed to develop
and improve their mental health systems. The countries representatives had also the
opportunity to meet International and Italian NGOs, International Health and Development
Agencies, Italian Mental Health Services with whom create collaboration and partnerships.
Continuing with the tradition of successful collaboration with WHO, Cittadinanza will
actively support the implementation of mhGAP, helping to organize a mhGAP follow-up
Meeting in 2011 in Rimini. The meeting is designed as an
opportunity for the countries to meet again and to reflect
about
opportunities
and
constraints
of
the
mhGAP
implementation. There will be also the possibility to meet
other organizations, NGOs, working on mental health in low
and middle income countries. Cittadinanza is also going to
contribute to the implementation of the mhGAP in Panama.
5 - International Meeting, Rimini 2009
CITTADINANZA onlus
Via Briolini 48/E · 47921 Rimini (RN) · tel/fax 0541 412091
info@cittadinanza.org
www.cittadinanza.org
Who we are
We are a private, non-profit, grantmaking Swiss foundation, created in Geneva in 1964 upon the
initiative of the d’Harcourt family. Our mission was to provide assistance to people in situations of
material and moral difficulties, by ensuring the fulfilment of their primary and basic life needs.
Lessons learnt from the long-standing practice of financial individual aid encouraged the
Foundation Board to redefine our approach to giving. Starting in 2007, we enlarged the scope of
our philanthropic activities in favour of those experiencing poverty and harsh living conditions.
Our vision
Our work is inspired by the following principles:
• The human being, in all material and spiritual dimensions, is the main agent of any possible path
out of poverty or development process
• Poverty and primary life needs can’t be defined only as economic issues: the fulfilment of a
variety of immaterial needs, including psychosocial needs, is essential to the promotion of the
well-being of the person, also of the poorest one
• People living in disadvantaged socio-economic conditions and who are most vulnerable have
needs; however, they also have internal resources and potentials which come along with
shortcomings
• Philanthropic projects to be sustainable should have the capacity to recognize those assets and
support people most in need to mobilize their personal and social capital.
Mission and Strategy
Based on these premises, our Foundation invests in programs aimed at enhancing the human
capital of most vulnerable groups, at individual and community level.
We specifically sustain and intend to promote pilot interventions which integrate a psycho-social
approach and address critical sectors of human development - i.e. health services; education;
vocational training and social inclusion; access to income-generating activities.
In our current programming we didn’t set geographic priorities. At present, we sustain
psychosocial support and mental health projects in Switzerland, Lebanon, Benin and Ivory Coast.
In the pursuit of our objectives, we seek productive partnerships with other non profit organisations
- NGOs, international bodies, private foundations - which have extended expertise in our areas of
interest and that share our main goals.
Commitment to WHO mental health Gap Action Program
We are committing to WHO mhGAP by providing financial support for the implementation of the
pilot project in Ethiopia for the next two years.
Being an intervention at the system level, developed in key partnership with Government’s
Ministry of Health, we estimate this action to have outstanding potential of sustainability and local
ownership.
Contacts:
Maddalena Occhetta - Program Manager
Maddalena@fondationdharcourt.ch
Fondation d’Harcourt, 12 rue François-Bonivard – 1201 GENEVA
Introduction HealthNet TPO for the mhGAP Forum
Introduction
HealthNet TPO, an international NGO based in the Netherlands, develops evidence-based
interventions to reach better health for all. Our mission is to enhance the ability of communities in
fragile states to better manage their own health. We build health systems with communities that are
excluded from functioning healthcare by combining international public health expertise with local
tradition. One of the core foci concerns mental health and psychosocial wellbeing.
With the regards to the ultimate goal of the mhGAP program to scale up care for mental,
neurological and substance abuse disorders, HealthNet TPO has a track record in the development
and evaluation of low-cost and community-integrated psychosocial and mental health programs. For
example, HealthNet TPO has developed and pilot-tested a multi-level care package for children,
ready to be replicated to overcome the treatment gap for children with mental health problems.
Furthermore, HealthNet TPO has worked on the integration of mental health care into primary
health care within complex emergency settings.
HealthNet TPO stresses the importance of both operational and academic research in order to reach
the set goals. We aim to gain in-depth understanding of local resources, capacities, beliefs and needs
through action research, and by monitoring the effect and applying academic research, we build the
evidence base to disseminate successful models. Accordingly, HealthNet TPO has lead and
participated in multidisciplinary academic research projects and has performed research within
service-oriented projects and programs. See below for a selection of publications.
Selection of HealthNet TPO related publications since 2007
Jordans, M.J.D., Komproe, I.H., Tol, W.A., Susanty, D., Vallipuram, A., Ntamutumba, P., Lasuba, A.C. & de Jong,
J.T.V.M. (2010). Practice-driven evaluation of a multi-layered psychosocial care package for children in areas of
armed conflict. Community Mental Health Journal, DOI 10.1007/s10597-010-9301-9.
Tol, W.A., Komproe, I.K., Jordans, M.J.D., Gross, A., Susanty, D., de Jong, J.T.V.M. (In press). Mediators and
Moderators of a Psychosocial Intervention for Children Affected by Political Violence. Journal of Clinical and
Consulting Psychology.
Jordans, M.J.D., Komproe, I.H., Tol, W.A., Kohrt, B., Luitel, N., Macy, R.D.M. & de Jong, J.T.V.M. (2010).
Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: A cluster randomized
controlled trial. Journal of Child Psychology and Psychiatry, 51, 818-826.
Jordans, M.J.D., Komproe, I.H., Tol, W.A., & de Jong, J.T.V.M. (2009). Screening for psychosocial distress
amongst war affected children: Crosscultural construct validity of the CPDS. The Journal of Child Psychology
and Psychiatry. 50:4: 514-52.3
Tol, W.A., Komproe, I.H., Jordans, M.J. Thapa, S.B., Sharma, B. & de Jong, J.T.V.M. (2009). Brief multidisciplinary treatment for torture survivors in Nepal: a naturalistic comparative study. The International
Journal of Social Psychiatry, 55,1: 39-56.
HealthNet TPO
Tolstraat 127, 1074 VJ Amsterdam, The Netherlands
Reception +31 (0)20 6200005
+31 (0)20 6201503
www.healthnettpo.org
Sonis, J., Gibson, J.L., de Jong, J.T.V.M, Field, N.P., Hean, S., & Komproe, I.H. (2009). Probable Posttraumatic
Stress Disorder and Disability in Cambodia: Associations with Perceived Justice, Desire for Revenge and
Attitudes Toward the Khmer Rouge Trials. JAMA, 302(5):527-536.
Laban, C.J., Komproe, I.H., Gernaat, H.P.E., & de Jong, J.T.V.M. (2008). The impact of a long asylum procedure
on quality of life, disability and physical health in Iraqi asylum seekers in the Netherlands. Social Psychiatry and
Psychiatric Epidemiology, 43: 507-515.
Kohrt, B.A., Jordans, M.J.D., Tol, W.A., Speckman, R.A., Maharjan, S.M., Worthman,C.M., & Komproe, I.H.
(2008). Comparison of Mental Health Between Former Child Soldiers and Children Never Conscripted by
Armed Groups in Nepal. JAMA, 300(6):691-702.
Tol, W.A., Komproe, I.H., Susanty, D., Jordans, M.J.D., Macy, R.D., & de Jong, J.T.V.M. (2008). School-Based
Mental Health Intervention for Children Affected by Political Violence in Indonesia: A Cluster Randomized Trial.
JAMA ,300(6):655-662.
Punamäki, R.L., Salo, J., Komproe, I.H., Qouta, S., El-Masri, M., & de Jong, J.T.V.M. (2008). Dispositional and
situational coping and mental health among Palestinian political ex-prisoners. .Anxiety, Stress & Coping, 21,4:
337-358.
De Wit, M.A.S., Tuinebreijer, W.C., Dekker J., Beekman, A.J.T.F., Gorissen, W.H.M., Schrier, A.C., Penninx,
B.W.J.H, Komproe, I.H., & Verhoeff A.P. (2008). Depressieve and anxiety disorders in different ethnic groups: A
population based study among native Dutch, and Turkish, Moroccan and Surinamese migrants in Amsterdam.
Social Psychiatry and Psychiatric Epidemiology, 43: 905–912.
Jordans, M.J.D., Komproe, I.H., Ventevogel, P., Tol, W.A., & de Jong, J.T.V.M.(2008). Development and
Validation of the Child Psychosocial Distress Screener in Burundi. American Journal of Orthopsychiatry,78,3:
290-299.
Ventevogel, P., de Vries, G.J., Scholte, W.F., Shinwari, N.R., Faiz, H., Nassery, R., & Olff, M. (2007) Properties of
the Hopkins Symptom Checklist-25 (HSCL-25) and the Self Reporting Questionnaire (SRQ-20) as screening
instruments used in primary care in Afghanistan. Social Psychiatry and Psychiatric Epidemiology 42: 328–335.
Tol, W.A., Komproe, I.H., Thapa, S.B., Jordans, J.D., Sharma, B. & de Jong, J.T.V.M. (2007). Disability associated
with psychiatric symptoms among torture survivors in rural Nepal. Journal of Nervous and Mental Disease,
195: 463-469.
Laban, C.J., Gernaat, H.P.E., Komproe, I.H., & de Jong, J.T.V.M. (2007). Prevalence and predictors of health
service use among Iraqi asylum seekers in the Netherlands. Social Psychiatry and Psychiatric Epidemiology, 42:
837-844.
Araya, M., Chotai, J., Komproe, I.H., & de Jong, J.T.V.M. (2007) Gender differences in traumatic life events,
coping strategies, perceived social support and socio demographics among post-conflict displaced persons in
Ethiopia. Social Psychiatry and Psychiatric Epidemiology, 42: 307-315.
Dobricki, M., Komproe, I.H., de Jong, J.T.V.M., & Maercker, A. (2010). Adjustment disorders after severe lifeevents in four post conflict settings. Social Psychiatry and Psychiatric Epidemiology, 45: 39-46.
Tol, W.A., Kohrt, B.A., Jordans, M.J.D., Thapa, S.B., Pettigrew, J., Upadhayad, N., & de Jong, J.T.V.M. (2010).
Political violence and mental health: A multi-disciplinary review of the literature on Nepal. Social, Science and
Medicine, 70, 35-44.
HealthNet TPO
Tolstraat 127, 1074 VJ Amsterdam, The Netherlands
Reception +31 (0)20 6200005
+31 (0)20 6201503
www.healthnettpo.org
Institute of Psychiatry, King’s College London
Professor Graham Thornicroft, Professor Martin Prince & Professor Martin Knapp
Fundamentally transforming the mental health of people in low income countries:
dementia and depression population level intervention strategies
1. Translational capacity at King’s Health Partners/King’s College London in Global Mental Health
The Health Service and Population Research Department at the Institute of Psychiatry, KCL was awarded
the 2009 Queen’s Anniversary Prize for Further and Higher Education, denoting the quality and social
impact of our research and teaching. Together with the London School of Hygiene and Tropical Medicine
we have established the Centre for Global Mental Health. In terms of our global mental health portfolio
we have a particular focus upon LAMICs, and at present we have active collaborations with 84 countries
worldwide. We also host the Centre for Economics in Mental Health, led by Professor Martin Knapp, to
lead and collaborate in cost-effectiveness studies of health related interventions. Our Research Group is a
multi-disciplinary team of 120 researchers with backgrounds and skills in anthropology, epidemiology,
general practice, health economics, history of medicine, nursing, psychiatry, psychology, people with
experience of mental ill health, social work, sociology, statistics and systematic reviews. We are
committed to research that understands the implications of mental health problems across the whole
spectrum of health, and to identifying better treatments that improve physical and mental wellbeing19.
In global terms, very little research about the evidence for effective treatments takes places in low or
medium resource settings20. We are contributing to remedying this by making direct contributions to the
evidence in studies in such countries, for example in relation to the support needed by carers of people
with dementia in Russia21 and India22. Further we are providing support to policy makers in these settings
to establish effective health systems for older adults with mental disorders23;24, and to identify barriers to
better care25;26.
In partnership with WHO and colleagues, including those in Ethiopia, India, South Africa and Uganda, we
now wish to launch a major new initiative to: (i) implement the WHO Treatment Guidelines for Dementia
and for Depression in these low income countries27, and (2) to assess the patient level outcomes and the
organizational level processes consequent upon these implementation programmes. This programme is
unique in terms of the strength of its evidence-based foundation and in terms of its ambition to provide
affordable and cost-effective care scaled up to the true needs of populations in low income countries.
2.1 Dementia in low and middle income countries
Already in 2010, most (58%) of the world’s estimated 35.6 million people with dementia live in low and
middle income countries (LAMIC)1. By 2050, numbers will have trebled to 115.4 million, 71% living in LMIC.
2
The 10/66 Dementia Research Group (10/66 DRG - www.alz.co.uk/1066) has been working, since 1998, to
inform policy and promote service development in those regions. Evidence collected by our researchers in
Latin America, India, China and Nigeria has shown that
• culture and education-fair assessment of dementia diagnosis2;3, cognitive function4, disability5 and
carer strain6 is feasible
• contrary to earlier suggestions, the age-specific prevalence of dementia is similar to that in high
income countries (HIC)7;8. Age adjusted, prevalence in most world regions is between 5% and 7% of
those aged 60 years and over1
• for older people in LMIC, dementia makes a much larger independent contribution than other
chronic diseases to disability9 and dependency10-12
• behavioural and psychological symptoms of dementia are as common as in HIC, poorly
understood, and independently associated with carer strain13
• carers are typically women, living with the care recipient in extended multigenerational
households. Carer strain is as prominent as in HIC, and many carers cutback on work to care or
employ paid carers14-16.
2.2 Depression
Depression is the leading cause of disease burden in most regions of the world [1]. Somatic presentations
are very common, especially tiredness, sleep problems, and aches and pains. Of these, only tiredness is
considered a ‘‘core’’ feature in current classifications. Anxiety symptoms often coexist with depressive
symptoms, particularly in community or primary care samples. The term ‘‘common mental disorders’’ is
used to describe the heterogeneous presentation of anxiety, depressive, and somatic symptoms in these
contexts [2]. The World Mental Health Surveys have described the prevalence and help-seeking
behaviours of people with depression in a large number of countries [3,4]. The major observations about
the epidemiology of depression from these and other studies on depression can be summarized as
follows: (1) the constellation of symptoms used to characterize depression can be identified in all cultures;
(2) the prevalence rates of depression vary considerably between populations, with rates ranging from
about 6% in China to over 20% in the US; (3) the age of onset is most commonly in young adulthood; (4)
the disorder often runs a relapsing or chronic course; (5) the disorder is two to three times more common
in women, although a few studies, particularly from Africa, have not shown this female excess; (6) social
factors, particularly related to economic or social disadvantages such as low education and violence, are
major determinants of the risk for depression, and in all countries at least 65% of all such cases receive no
effective treatment [5][6,7][8]. Depression has been associated with a range of poor health outcomes,
including poor infant growth (in th e case of maternal depression in some countries in South Asia, for
example) and worse physical health (for example, cardiovascular, TB or HIV outcomes through poor
adherence) [9,10].
3. Effective interventions at the population level
WHO has recently developed a series Treatment Guidelines within its mental health Gap Action
Programme (mhGAP), the central focus of the work plan of the Mental Disorders and Substance Abuse
Division at the WHO in Geneva 17. The Guidelines Development Group was jointly led by the WHO
Departmental Head, Dr Shekhar Saxena and by Professor Graham Thornicroft, and provides
recommendations to provide evidence-based care at first and second level facilities by the non-specialist
health care providers in low and middle income countries. These recommendations are based upon a
series of very thorough systematic reviews of all the relevant literature worldwide and the advice of over
70 experts, largely from low and middle income countries. The Treatment Guidelines provide for the first
time ever clear, affordable, evidence-based treatment advice specifically designed for primary care,
general health care, and mental health staff in low and middle income settings 18 17.
3
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(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)
(21)
(22)
(23)
(24)
(25)
(26)
(27)
Alzheimer's Disease International. World Alzheimer Report 2009. Prince M.J., Jackson J, editors. 2009. London,
Alzheimer's Disease International.
Ref Type: Report
Prince M, Acosta D, Chiu H, Scazufca M, Varghese M. Dementia diagnosis in developing countries: a cross-cultural
validation study. Lancet 2003; 361(9361):909-917.
Prince MJ, de Rodriguez JL, Noriega L, Lopez A, Acosta D, Albanese E et al. The 10/66 Dementia Research Group's
fully operationalised DSM-IV dementia computerized diagnostic algorithm, compared with the 10/66 dementia
algorithm and a clinician diagnosis: a population validation study. BMC Public Health 2008; 8:219.
Sosa AL, Albanese E, Prince M, Acosta D, Ferri CP, Guerra M et al. Population normative data for the 10/66 Dementia
Research Group cognitive test battery from Latin America, India and China: a cross-sectional survey. BMC Neurol
2009; 9(1):48.
Sousa RM, Dewey ME, Acosta D, Jotheeswaran AT, Castro-Costa E, Ferri CP et al. Measuring disability across cultures
Ð the psychometric properties of the WHODAS II in older people from seven low- and middle-income countries.
The 10/66 Dementia Research Group population-based survey. Int J Methods Psychiatr Res 2010.
Prince M. Care arrangements for people with dementia in developing countries. Int J Geriatr Psychiatry 2004;
19(2):170-177.
Llibre RJ, Valhuerdi A, Sanchez II, Reyna C, Guerra MA, Copeland JR et al. The Prevalence, Correlates and Impact of
Dementia in Cuba. A 10/66 Group Population-Based Survey. Neuroepidemiology 2008; 31(4):243-251.
Llibre Rodriguez JJ, Ferri CP, Acosta D, Guerra M, Huang Y, Jacob KS et al. Prevalence of dementia in Latin America,
India, and China: a population-based cross-sectional survey. Lancet 2008; 372(9637):464-474.
Sousa RM, Ferri CP, Acosta D, Albanese E, Guerra M, Huang Y et al. Contribution of chronic diseases to disability in
elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based
survey. Lancet 2009; 374(9704):1821-1830.
Acosta D, Rottbeck R, Rodriguez G, Ferri CP, Prince MJ. The epidemiology of dependency among urban-dwelling
older people in the Dominican Republic; a cross-sectional survey. BMC Public Health 2008; 8(1):285.
Uwakwe R, Ibeh CC, Modebe AI, Bo E, Ezeama N, Njelita I et al. The Epidemiology of Dependence in Older People in
Nigeria: Prevalence, Determinants, Informal Care, and Health Service Utilization. A 10/66 Dementia Research Group
Cross-Sectional Survey. J Am Geriatr Soc 2009.
Llibre RJ, Valhuerdi A, Sanchez II, Reyna C, Guerra MA, Copeland JR et al. The Prevalence, Correlates and Impact of
Dementia in Cuba. A 10/66 Group Population-Based Survey. Neuroepidemiology 2008; 31(4):243-251.
Ferri CP, Ames D, Prince M. Behavioral and psychological symptoms of dementia in developing countries. Int
Psychogeriatr 2004; 16(4):441-459.
Choo WY, Low WY, Karina R, Poip PJ, Ebenezer E, Prince MJ. Social support and burden among caregivers of patients
with dementia in Malaysia. Asia Pac J Public Health 2003; 15(1):23-29.
Dias A, Samuel R, Patel V, Prince M, Parameshwaran R, Krishnamoorthy ES. The impact associated with caring for a
person with dementia: a report from the 10/66 Dementia Research Group's Indian network. Int J Geriatr Psychiatry
2004; 19(2):182-184.
10/66 Dementia Research Group. Care arrangements for people with dementia in developing countries. Int J Geriatr
Psychiatry 2004; 19(2):170-177.
World Health Organization. Scaling up care for mental, neurological, and substance use disorders. http://www who
int/mental_health/mhgap_final_english pdf [ 2008 Available from:
URL:http://www.who.int/mental_health/mhgap_final_english.pdf
Patel V, Thornicroft G. Packages of care for mental, neurological, and substance use disorders in low- and middleincome countries: PLoS Medicine Series. PLoS Med 2009; 6(10):e1000160.
Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR et al. No health without mental health. Lancet 2007;
370(9590):859-877.
Prince M, Acosta D, Albanese E, Arizaga R, Ferri CP, Guerra M et al. Ageing and dementia in low and middle income
countries-Using research to engage with public and policy makers. Int Rev Psychiatry 2008; 20(4):332-343.
Gavrilova SI, Ferri CP, Mikhaylova N, Sokolova O, Banerjee S, Prince M. Helping carers to care--the 10/66 dementia
research group's randomized control trial of a caregiver intervention in Russia. Int J Geriatr Psychiatry 2009;
24(4):347-354.
Dias A, Dewey ME, D'Souza J, Dhume R, Motghare DD, Shaji KS et al. The effectiveness of a home care program for
supporting caregivers of persons with dementia in developing countries: a randomised controlled trial from Goa,
India. PLoS One 2008; 3(6):e2333.
Prince M, Livingston G, Katona C. Mental health care for the elderly in low-income countries: a health systems
approach. World Psychiatry 2007; 6(1):5-13.
Patel V, Boardman J, Prince M, Bhugra D. Returning the debt: how rich countries can invest in mental health capacity
in developing countries. World Psychiatry 2006; 5(2):67-70.
Flisher AJ, Lund C, Funk M, Banda M, Bhana A, Doku V et al. Mental health policy development and implementation
in four african countries. J Health Psychol 2007; 12(3):505-516.
Knapp M, Funk M, Curran C, Prince M, Grigg M, McDaid D. Economic barriers to better mental health practice and
policy. Health Policy Plan 2006; 21(3):157-170.
Tansella M, Thornicroft G. Implementation science: understanding the translation of evidence into practice. Br J
Psychiatry 2009; 195(4):283-285.
International Association for Human Values
P.O. Box 2091, CH-1211 Geneva 2; Tel. +41 – 22 – 738 28 88; eMail: Geneva@iahv.org
International Non-Governmental Organization (NGO) in special consultative status
with the Economic and Social Council (ECOSOC) of the United Nations
Member of the UN Global Compact
Second meeting of the mhGAP FORUM
7 October 2010 – WHO Geneva
The International Association for Human Values (IAHV)
IAHV is an international humanitarian and educational Non-Governmental Organization
committed to promote resurgence of Human Values in all aspects of life across the globe. The
Association partners with governments, educational institutions, other NGOs, corporations,
businesses and individual, to develop and promote programmes of personal development to
encourage the practice of Human Values in everyday life. IAHV along with its sister
organization, Art of Living Foundation, has one of the largest volunteer based networks in the
world. It has reached over 20 million people in over 140 countries from all walks of life with a
wide range of social, economic, cultural and educational activities. The organization works in
special consultative status with the Economic and Social Council (ECOSOC) of the United
Nations, participating in a variety of committees and activities, related to health and conflict
resolution. IAHV is known for its low overheads and strong organizational capacity. This is
because of the large inspired volunteer base.
IAHV Programmes
The key to IAHV`s success is the effective programmes of self development and stress
elimination that have been implemented world over regardless of race, culture or religion.
These programmes are directed at communities and taught in the primary care setting by certified
instructors. The practices are natural, do not carry any side-effects, are easily accepted and
integrated into one’s life and compliment any existent medical regimens. They are cost-effective
and can be taught to people from all walks of life, including children and vulnerable adults.
Scientific research on these practices have shown them to be very effective in relation to mental
health issues, both in apparently healthy as well in clinically ill people. These are briefly
reviewed below.
Contribution of IAHV to the mhGAP
1. Depression
Sudarshan Kriya and accompanying practices (SK&P), core programme implemented by IAHV,
have been studied in open and randomized trials, both in healthy populations and in populations
with psychopathology. This research, published in international peer-reviewed journals, suggest
that SK&P reduces depression, anxiety, and stress, and that increases well-being, optimism, and
mental focus. For example, SK&P was shown to have a success rate of 68-73%, in treating
clinical depression, regardless of severity. Substantial relief was experienced in three weeks, and
by one month, patients were considered to be in remission. At three months, the patients
remained asymptomatic and stable.
These effects may be mediated, at leas in part, by beneficial effects on the endocrine system, the
antioxidant system, and the nervous system, based on other research findings.
1
2. Mental health and trauma reliefTORY OF THE KONFLICT
It is common knowledge that post traumatic stress disorder (PTSD), is a major pathology linked
to wars or other man-made or natural disasters. By breaking down the delicate balance of the
nervous system, it can completely disable a person from normal functioning in society. IAHV
programmes have been offered in the war-torn and disaster areas of the world for many years,
including Kosovo, Iraq, Afghanistan, Kashmir, and Pakistan, natural disasters of Hurricane
Katrina, 2004 South Asian tsunami, earthquakes in Orissa, Gujarat, Bam, and the terrorist attacks
of 9/11, Madrid, and Mumbai. A recently published study on the South Asian tsunami
documented that IAHV programmes significantly help reduce PTSD symptoms.
3. Mental disorders in children and young adults
An age group in which mental disorders are most rapidly increasing is our children. This is
giving rise to unprecedented use of medication in children as early as few years of age. The result
of increased mental problems in youth is easy to see in the form of violence in schools. For this
reason, IAHV has a major focus with specially designed programmes for children an young
adults with very encouraging results from around the world where mental stability, physical wellbeing, sociability and Human Values are supported. Recent scientific research indicate that this
programme helps to eliminate depression, mental disorders, fear, anxiety, and other negative
emotions, as well as help curb substance abuse.
4. Suicide
One extreme end of mental disorder is suicide which is on the rise in EU countries. This has been
an issue directly addressed by IAHV. Among the farmers of the Indian states of Karnataka,
Andhra Pradesh and Maharashtra, more than 1,920 people have committed suicide between
January 2001 and August 2006.
IAHV spearheaded a special programme in villages of this region and as a result the suicide rate
was reduced dramatically.
Special programs were carried out for village youth to inspire them to become a part of the
solution. In the 308 villages where IAHV has worked so far, there has not been a single reported
instance of suicide after implementation of our programmes. Encouraged by the results, the
Government of Maharashtra has requested to take up the work in all affected districts. This work
can be applied to EU countries as well.
Possible collaboration of IAHV with mhGAP participants
The issue at hand is so large that collaborative efforts are required for any meaningful success to
curb the tremendous mental health problems today. IAHV is ready for such collaborative efforts
by making available by making available its programmes and the large volunteer base to
effectively prevent mental health problems in all communities. These programmes are costeffective, easy to implement, and sustainable, and as such can be easily combined with other
efforts in this regard.
Invitation to form partnerships
We therefore formally invite international organizations, national or local governments, NGOs,
academic institutions and other entities dedicated to achieving the goals of mhGAP to collaborate
with IAHV to
- develop pilot programmes to assess the efficacy of IAHV modalities for mbGAP goals,
- help educate and support people attending existing mental health services,
- facilitate further research on natural evidence based modalities and other interventions.
For further information please contact
Werner Peter Luedemann
Luedemann@iahv.org, Tel +49 -7804-973.911, Bad Antogast 1, D-77728 Oppenau, Germany
2
IASSID is an international and
interdisciplinary non-governmental
organization that seeks to promote the
development and exchange of
knowledge about intellectual disabilities.
Founded in 1964, IASSID is the first and
only world-wide group of scientists
focusing on intellectual disability.
The association organises a rolling
programme of World and Regional
Congresses, specialist meetings and
training events.
IASSID is in official relations with the
World Health Organization. We are
committed, as part of our work plan
with WHO, to supporting the
implementation of the mental health
Gap Action Programme (mhGAP). We
have undertaken reviews for WHO of
the evidence in support of interventions
for children with intellectual disability
and advised on the content of the
mhGAP Intervention Guide in relation to
intellectual disability.
To further support the implementation of
mhGAP, IASSID may be in a position to:
 Help build local research
capacity by supporting the
development or evaluation of
mhGAP activities (e.g., the
development of screening tools to
identify children with intellectual
disability, the evaluation of the
impact of community based
rehabilitation [CBR] and family
support interventions);
 co-ordinate and/or provide
training to health professionals
and other relevant groups to
support the implementation of
mhGAP interventions.
To discuss the possible involvement of
IASSID please contact Professor Eric
Emerson eric.emerson@lancaster.ac.uk
http://www.iassid.org
ILAE/IBE/WHO Global Campaign Against Epilepsy
“Epilepsy – Out of the Shadows”
Secretariat: Stichting Epilepsie Instellingen Nederlands
P.O. Box 540, 2130 AM Hoofddorp, The Netherlands
Tel.: + 31 23 558 8412, e-mail: hdboer@sein.nl
INTRODUCTION
The International League Against Epilepsy (ILAE)
The ILAE is the world's preeminent association of physicians and other health professionals working
towards a world where no persons' life is limited by Epilepsy.
ILAE's mission is to ensure that health professionals, patients and their care providers, governments,
and the public world-wide have the educational and research resources that are essential in
understanding, diagnosing and treating persons with epilepsy.
The International Bureau for Epilepsy (IBE)
IBE is an organisation of laypersons and professionals interested in the medical and non-medical
aspects of epilepsy.
IBE’s goal is to improve the quality of life of all persons with epilepsy and those who care for them.
The ILAE/IBE/WHO Global Campaign Against Epilepsy (GCAE)
In 1997 the WHO, ILAE and IBE joined forces to raise epilepsy to a level of awareness that had not
been achieved ever before. This partnership is the ILAE/IBE/WHO Global Campaign Against Epilepsy
with as its mission statement: To improve the acceptability, treatment, services and prevention of
epilepsy worldwide.
The objectives of the Campaign are:
 To increase public and professional awareness of epilepsy as a universal and treatable brain
disorder
 To raise epilepsy to a new plane of acceptability in the public domain.
 To promote public and professional education about epilepsy.
 To identify the needs of people with epilepsy at national and regional levels.

To encourage governments and departments of health, to address the needs of people with
epilepsy including awareness, education, diagnosis, treatment, care, services and prevention.
i
The ultimate goal of the Campaign is to close the treatment gap in epilepsy .
To date over 90 countries have developed activities under the Campaign!
mhGAP
Closing the GAP between what is urgently needed and what is currently available to
reduce the burden of mental, neurological, and substance use disorders worldwide
Activities under the Campaign are listed below showing to what expected mhGAP results they will
contribute to.
Meeting GCAE and WHO Leadership 2009:
From left to right: Tarun Dua (WHO), Mike Glynn (IBE President),
Ala Alwan (ADG WHO), Hanneke M. de Boer (GCAE), Emilio Perucca,
Benedetto Saraceno (WHO), Solomon Moshé (ILAE President)
International League against Epilepsy
International Bureau for Epilepsy
1
World Health Organization
ACTIVITIES
Regional Conferences and Declarations
Regional Conferences:
Aims: Raise awareness for epilepsy and the Campaign
Develop and adopt Regional Declarations on Epilepsy
Regional Declarations
Aims: - advocacy tool
- instrument for dialogue with governments, healthcare
providers, etc.
Results: Conferenes took place in all 6 WHO Regions
resulting in Regional Declarations in all WHO
Regions .
Discussions on Latin Ametican Declaration,
Santiago de Chile
mhGAP
Greater investment in care for mental, neurological, and substance use disorders
Regional Reports on Epilepsy
Reports on the implementation of the GCAE, including data, collected through questionnaires
Aims:
- advocacy tool
- instrument for dialogue with governments, healthcare providers, etc.
Contents:
- basic knowledge on epilepsy
- basic facts epidemiological burden
Results:
Regional reports have been published in all WHO Regions
mhGAP
Greater investment in care for mental, neurological, and substance use disorders
Assessment of Country Resources on Epilepsy
Project as part of WHO Atlas project.
Objectives
 Collect, compile and disseminate information on epilepsy resources
 Analyse globally + regionally epilepsy resources data
 Provide baseline for monitoring purposes over time
 Drive global and regional epilepsy programmes
 Make the world more aware of deficiency of epilepsy resources
 Provide impetus on international efforts to enhance resources
Aim:
Map needs and resources for epilepsy worldwide.
Goal: Develop Atlas on Country Resources
Result: Information collected from 160 countries covering 97,5% of the
world population
mhGAP
Greater investment in care for mental, neurological, and
substance use disorders
Demonstration Projects
General Objectives
• Reduce treatment gap and social and physical burden
• Educate health personnel
• Dispel stigma
• Prevention
Ultimate goal: Development of a variety of successful models of
epilepsy control that will be integrated into the health care systems
of the participating countries and regions and, finally, applied on a
global level.
Training of healthcare providers within Demonstration Project Brazil
2
Results:
Projects completed:
Projects ongoing:
Porject initiated:
Projects under investifgation:
Brazil,
China,
Senegal
Zimbabwe
Georgia
Honduras
Cameroon
Ghana, India
Awareness raising in China as part of the Demonstration Project
mhGAP
1. A comprehensive and result-oriented programme for mental health
implemented in targeted countries.
2. Increase in the proportion of primary health facilities that have trained health
professionals for diagnosis and treatment of mental, neurological, and
substance use disorders.
3. Greater coverage with essential interventions for people with mental,
neurological, and substance use disorders.
Project on stigma
Aims: Immediate:
 to explore nature of stigma in China and Vietnam
 to DEVELOP possible intervention studies
Aims longer term:
 to initiate stigma reduction interventions
 Results:
- Comprehensive literature reviews focussing on:
• Theory and concept of stigma
• Empirical studies of epilepsy stigma
• Empirical studies of epilepsy and QoL
Photo: CREST Principal Investigators
• Developed/developing countries
from: UK, Nehterlands, China
- Ethnographic studies in China and Vietnam to
Switzerland, USA, Vietnam
explore prevailing beliefs about and attitudes to
epilepsy
Mh GAP:
Enhanced implementation of human rights standards in care facilities for mental,
neurological, and substance use disorders.
Project on the burden of epilepsy
The Global Burden of Disease, Injuries, and Risk Factors Study (GBD) (1990) provides a complete
systematic assessment of the data on all diseases and injuries. Within a new GBD project,
comprehensive estimates of the burden of epilepsy, its disabling sequelae and its role as a risk factor
for other diseases and injuries will be developed.
Specific aims:
1. To generate comprehensive estimates of the burden of disease due to idiopathic epilepsy
2. To generate comprehensive estimates of the burden of disease due to epilepsy
3. To generate comprehensive estimates of the mortality and burden of disease due to epilepsy.
The Global Campaign Against Epilepsy is contributing to the above process.
mhGAP
Greater investment in care for mental, neurological, and substance usedisorders.
Development of guidelines on the treatment of epilepsy in children and adolescents
Guidelines for the treatment of epilepsy in childhood and adolescence are being drawn up in
collaboration with the WHO Department of Child and Adolescent Health and Development.
Result: An algorithm was developed for diagnosis and treatment of neonatal seizures especially in
resource limited settings, aiming at clinicians in developing countries.and published in Epilepsia.
mhGAP
1. Increase in the proportion of primary health facilities that have trained health
professionals for diagnosis and treatment of mental, neurological, and
substance use disorders.
3
2. Greater coverage with essential interventions for people with mental, neurological, and
substance use disorders.
Project on legislation
Collect information on existing legislation and regulations related to epilepsy in the areas of civil rights,
education, employment, residential and community services, and provision of appropriate health care,
from countries all over the world, in order to review the comprehensiveness and adequacy of these
legal measures in promoting and protecting the civil and human rights of people with epilepsy.
Result:
Mh GAP:
Enhanced implementation of human rights standards in care facilities for mental,
neurological, and substance use disorders.
Global Campaign Taskforce
Global Campaign Taskforce
The newly elected presidents of ILAE and IBE, Nico Moshé and Mike Glynn
respectively, decided that because the success of the Global Campaign is of
paramount importance to both IBE and ILAE, they will lead the effort
together, with Tarun Dua (representing WHO), thus forming the Campaign
Secretariat with Hanneke de Boer the Campaign Coordinator.
The Presidents set up a Global Campaign Taskforce to help and achieve this
goal. The Taskforce members are representatives of their respective regions,
and, most importantly, are people who are willing to “work”. Each member of
the Taskforce was asked to appoint a young person from their respective
countries to assist them with the work involved. Thus the Taskforce would
also create an in-built mechanism for capacity building.
Regional Involvement in GCAE activities
ILAE Stakeholders EURO
IBE Stakeholders EURO
ILAE/IBE Stakeholders EMRO
Regional Stakeholders meetings were organised in 3 regions this year (AMRO, EMRO and EURO with the
participation of the WHO Regional Advisors for Mental Health in order to discuss it seemed to me a good idea
to discuss future Campaign activities in the respective Regions.
mhGAP
Greater coverage with essential interventions for people with metal, neurological and
substance abuse disorders.
i
The difference between the number of people with active epilepsy and the number whose seizures are being appropriately
treated in a given population at a given point in time, expressed as a percentage.
4
INTERNATIONAL MEDICAL CORPS:
MENTAL HEALTH PROGRAMMING
Overview
The impact of mental illness on many of the world’s nations, coupled
with an alarming shortfall in accessible treatment options, led
International Medical Corps to make sustainable, accessible mental
health care a cornerstone of our relief and development programming.
We have developed our capacity to address both the immediate
psychosocial needs of communities struck by disaster and help those
with pre-existing mental health disorders. With this emphasis on
mental health care in emergency and transition settings, our teams
have broken new ground, conducting evidence-based research on
depression rates among women in Darfur and designing innovative
pilot studies in northern Uganda that combine emergency feeding with
enhancing mother-child interaction and improving maternal mood. We
have implemented mental health and psychosocial programs in Asia,
Africa, Latin America, and the Middle East, as well as in the United
States after Hurricane Katrina and in Haiti after the 2010 earthquake.
International Medical Corps relies on a two-fold strategy for the delivery of mental health care:
• Maximize the use of existing government health care infrastructure, while building positive relationships with
community leaders who can be valuable allies as well as important guides through the local culture;
• Strengthen local capacity through training and mentoring professional staff and by promoting the creation of
facilities that support care of the mentally ill, all with the ultimate goal of creating self-sustaining care.
Aside from being cost-effective, offering services through existing primary health care centers at the community level
is an accessible, non-stigmatizing way to offer local populations assistance for mental disorders without overtly
singling out those who require subsequent treatment. A key aspect of our strategy is to train local health
professionals to recognize and treat the signs of mental disorders as part of mainstream, community level primary
health care and to work at the grassroots level to change attitudes towards the mentally ill. This is done in
partnership with local governments in order to strengthen national capacity.
International Medical Corps and mhGAP
International Medical Corps has been involved in the development of the mhGAP program, particularly the essential
mental health package curriculum to improve service delivery. We are committed to supporting the use of the
curriculum and look forward to its final release. We believe that the curriculum fills a gap in international mental
health training; upon launch, we stand ready to begin applying it in our current programs, most specifically using the
tool when integrating primary health care and mental health in the Middle East, Haiti, and Chad.
As International Medical Corps has expertise in the area of mental health during and after emergencies, we anticipate
working with mhGAP to ensure the relevance of this program to humanitarian settings. In emergency and recovery
contexts, we work in partnership with governments and their health systems, to whom we will introduce the mhGAP
curriculum and provide support for its implementation to ensure the sustainability of this program after the
humanitarian crisis has stabilized.
International Medical Corps will integrate the objectives of the mhGAP program into our own advocacy efforts
surrounding mental health. We aim to draw more attention to the need to address mental health in low-resource
settings, particularly in areas experiencing or recovering from humanitarian crises. Focusing attention on our ability to
close the gap between the needs and what is currently available for mental health services will highlight to
stakeholders, including donors and operational agencies, that the international community has the tools available to
improve care for individuals with mental, neurological, and substance abuse disorders.
HEALTHY MIGRANTS FOR HEALTHY COMMUNITIES
The Migration Health Division (MHD) has the
institutional responsibility to oversee, support and
coordinate the Organization’s provision of migration
health services globally. These services aim to meet the
needs of Member States in managing health-related
aspects of migration, and to promote evidence-based
policies and holistic integrated preventive and curative
health programs which are beneficial, accessible, and
equitable for vulnerable migrants and mobile
populations. Recognizing that health serves as a
catalyst for fostering positive migration outcomes, and
in response to the 61st World Health Assembly
Resolution on the Health of Migrants, MHD seeks to
advance understanding and responses that contribute
to migrants’ improved status of physical, mental and
social well being, and enable them to contribute to the
social and economic development of their home
communities and host societies.
The Mental Health, Psychosocial Response and InterCultural Communication Section (PRC), acting within
MHD is responsible for addressing mental health and
psychosocial issues of migrants. Its programmatic role
is to support other IOM Departments, programs and
field missions to better serve migrant, host, displaced,
mobile and crisis-affected populations, including former
combatants through (a) identifying, analyzing and
responding to psychosocial and cultural integration
needs of target populations in a variety of educational,
sanitary, and community settings, (b) promoting
availability and accessibility of psychosocial and mental
health services for target populations, (c) promoting
access to culturally competent mental health care for
target populations, (d) providing ad-hoc designed and
integrated mental health, psychosocial, and cultural
integrative responses to crisis affected populations and
migrants in particularly vulnerable situations, including
unaccompanied minors, trafficked persons, stranded
migrants, demobilized soldiers and within IOM's
Assisted Voluntary Return (AVR) programs, and (e)
mainstreaming psychosocial approaches within IOM’s
core programs and activities.
IOM. 2010. Nairobi (Kenya). Psychosocial Programme.
IOM has been active in mental health and psychosocial programs, starting in 1999, in Albania, Cambodia, Colombia,
Congo, Georgia, Haiti, Iraq, Italy, Kenya, Kosovo, Jordan,
Lebanon, Liberia, Macedonia, Moldova, Montenegro, Palestine, Poland, Romania, Serbia, Syria, Turkey, United Kingdom,
Ukraine. IOM additionally provides medical assessments, including mental health to up to 300,000 migrants and refugees
to be resettled per year.
IOM intends to utilize the Mhgap tools and protocols within the
capacity building components at the primary health care level of
IOM emergency activities, and within the training of IOM medical and psychosocial staff of both emergency operations and
migrant medical assessments.
IOM- An intergovernmental organization with 460 field locations,
IOM is from 1951 committed to the principle that humane and
orderly migration benefits migrants and society.
It counts 127 Members and 94 observers including 17 States
and 77 global and regional IGOs and NGOs.
For further information, please contact:Guglielmo Schininà, gschinina@iom.int
INTERNATIONAL UNION
OF PSYCHOLOGICAL
SCIENCE
UNION INTERNATIONALE
DE PSYCHOLOGIE
SCIENTIFIQUE
FOUNDED / FONDÉE EN
1951
EXECUTIVE COMMITTEE
COMITÉ EXÉCUTIF
President/Président
Rainer K. Silbereisen
University of Jena
Past President/
Président sortant
Bruce Overmier
University of Minnesota
Vice President/VicePrésident
Kan Zhang
Chinese Academy of Sciences
Secretary-General/
Secrétaire général
Pierre L.-J. Ritchie
Université d’Ottawa
Treasurer/Trésorier
Michel Sabourin
Université de Montréal
Deputy Secretary-General/
Secrétaire Générale
adjointe
Ann Watts
Entabeni Hospital
MEMBERS
Helio Carpintero
Un. Complutense de Madrid
Peter Frensch
Humboldt University
Laura Hernandez-Guzman
Uni. Nacional Autónoma de
México
James Georgas
University of Athens
Maria Larsson
Stockholm University
Pamela Maras
University of Greenwich
Janak Pandey
University of Allahabad
Gonca Soygut
Hacettepe University
Barbara Tversky
Columbia University
Executive Officer
Nick Hammond
IUPsyS Secretariat
Mission
The mission of the Union is the development, representation and
advancement of psychology as a basic and applied science
nationally, regionally, and internationally.
Basic Facts about the International Union of Psychological
Science
• IUPsyS serves as the global organization for psychology and
psychological organizations. It is a member of two major
science organizations, the International Council for Science
and the International Social Science Council.
• Within the United Nations family, IUPsyS has official
relations with the World Health Organization (WHO) and
special consultative status with the Economic and Social
Council (ECOSOC). Through its other affiliations, it also
realtes to UNESCO and UNICEF.
• IUPsyS is an organization of organizations – its members
are national psychology associations or national psychology
federations: 73 National Members, representing over
500,000 psychologists, on all continents.
• IUPsyS is governed by its Assembly (100+ Delegates from
National Members); by its Executive Committee (16
members presently from 13 countries); and its Officers (6
from 5 countries).
• IUPsyS was founded officially in 1951, but did exist before
that year as the International Psychology Committee ; as
such, it sponsored the very first International Congress of
Psychology in Paris,in 1889.
• IUPsyS today addresses the full breadth of psychology as a
profession and a science
• The Union’s priorities are set by its Strategic Plan which is
established every four years. In addition, to Strategic
Planning, there are only two Standing Committees refelcting
their central importance to the sustained priorities of IUPsyS:
Capacity-building and Communications & Publications.
• The 2008-12 SP identifies two areas for dedicated strategic
planning activities. The first occurred in 2009 to address the
Union’s publications and communications programme. The
second will take place in 2011 to address capacity-building.
Capacity-building
In the current SP, several activities operate under the scope of
Capacity-building. A prime example is the Advanced Research
Training Seminars (ARTS),a historic flagship activity of the Union
and the longest continuously running capacity-building activity.
__________________________________________________________________________
Member of the International Social Science Council and of the International Council for Science
In consultative status with the Economic and Social Council (ECOSOC) of the United Nations
In formal associate relations with UNESCO
In official relations with the World Health Organization (WHO)
INTERNATIONAL UNION
OF PSYCHOLOGICAL
SCIENCE
UNION INTERNATIONALE
DE PSYCHOLOGIE
SCIENTIFIQUE
FOUNDED / FONDÉE EN
1951
EXECUTIVE COMMITTEE
COMITÉ EXÉCUTIF
President/Président
Rainer K. Silbereisen
University of Jena
Past President/
Président sortant
Bruce Overmier
University of Minnesota
Vice President/VicePrésident
Kan Zhang
Chinese Academy of Sciences
Secretary-General/
Secrétaire général
Pierre L.-J. Ritchie
Université d’Ottawa
Treasurer/Trésorier
Michel Sabourin
Université de Montréal
Deputy Secretary-General/
Secrétaire Générale
adjointe
Ann Watts
Entabeni Hospital
MEMBERS
Helio Carpintero
Un. Complutense de Madrid
Peter Frensch
Humboldt University
Laura Hernandez-Guzman
Uni. Nacional Autónoma de
México
James Georgas
University of Athens
Maria Larsson
Stockholm University
Pamela Maras
University of Greenwich
Janak Pandey
University of Allahabad
Gonca Soygut
Hacettepe University
Barbara Tversky
Columbia University
Executive Officer
Nick Hammond
IUPsyS Secretariat
www.iupsys.net
The Global Mental Health Gap Action Programme (mhGap)
and
The International Union of Psychological Science (IUPsyS)
WHO approved Official Relations with IUPsyS in 2002 and
periodically renewed based on a series of Work Plans. In its work
with WHO and other international organizations, IUPsyS has
determined that it is better to focus on a small number of
collaborative activities that are mutual priorities of both. The Union
concluded that this approach offers greater possibility of making a
value-added contribution compared to peripheral contributions to a
larger number of activities.
The Global Mental Health Gap Action Programme (mhGap) is
emerging as a flagship activity for WHO in the domain of mental
health. IUPsyS supports the WHO objective to pursue a significant
scaling-up of activities related to this programme. Preliminary
discussions have been held on the contribution IUPsyS can make to
this endeavour. There is an agreement in principle that this will be a
prominent component of the current Work Plan.
The specific focus for IUPsyS work on mhGap will be determined
partly by the outcome of the Union’s trategic planning for capacitybuilding. One focus under consideration is the development of
evidence-based intervention packages for priority conditions. In
particular, IUPsyS would collaborate with WHO on the relevant
psychological and psychosocial evidence base pertinent to the
capacity-building priority in the three targeted mhGap priorities
(Health Systems, Human Rights, Health Delivery). Initially, the area
of Health Delivery will likely be the IUPsyS primary focus.
The initial task will be one or more scoping documents that will
identify pertinent knowledge and knowledge transfer potential in
primary care as well as adaptations from tertiary and secondary
care to primary care. Careful attention will be given to culturally
mediated attenuations and adaptations that may be required to
enable the effectiveness of primary care. At a later stage, it is
anticipated that guidelines will be developed according to the criteria
established by WHO for the adoption of guidelines.
The Union recognizes the magnitude of the challenge involved in
meeting the goals of mhGap. This will require a significant
concentration of diverse resources. IUPsyS will strive to use its
internal resources to leverage other resources in order to meet the
challenge in those areas where its contribution can bring a clear
value-added dimension to the mhGap programme.
__________________________________________________________________________
Member of the International Social Science Council and of the International Council for Science
In consultative status with the Economic and Social Council (ECOSOC) of the United Nations
In formal associate relations with UNESCO
In official relations with the World Health Organization (WHO)
Association of Aichi Psychiatric Hospitals
Japanese Association of Psychiatric Hospitals
Dr Toshihiko Funahashi, M.D., Ph.D.
-President, Association of Aichi Psychiatric Hospitals
-Chair of Training Program Committee, Japanese Association of
Psychiatric Hospitals
-Chief Occupational Psychiatrist for TOYOTA
http://www.jindai.or.jp/
http://www.lucent-stress.com/
http://www.lucent-mental.com/
Dr Susumu Matsuzaki, M.D.
-Former President, Association of Aichi Psychiatric Hospitals
-Former Board Member, Japanese Association of Psychiatric
Hospitals
http://www.matsuzaki.or.jp/index.php
http://www.ginza.jp/g-med/
http://www.ginza-ms.com/
Association of Aichi Psychiatric Hospitals (ASK)
Association of Aichi Psychiatric Hospitals(ASK) was founded in 1950 (The year
2010 marks the 60th year);
-to promote the mental health of people in Aichi Prefecture,
-to provide appropriate medical and welfare services to people with mental
disorders,
-to protect human rights,
-to help social reintegration.
As of September 1st, 2010, the total number of ASK member hospitals is 41,
with 11892 psychiatric beds, accounting for 82.0% of all psychiatric hospitals,
and 94.1% of the total psychiatric beds in Aichi Prefecture.
http://aiseikyo.or.jp/message/index.html (Japanese)
ASK holds "Mental Health Event" for advocacy in the week of World Suicide
Prevention Day (September 10th) annually.
Japanese Association of Psychiatric Hospitals (JAPH)
Japanese Association of Psychiatric Hospitals (JAPH) was founded in 1949;
-to promote the mental health in Japan,
-to provide appropriate medical and welfare services to people with mental
disorder,
-to protect human rights,
-to help social reintegration.
As of April 1st, 2009, the total number of JAPH member hospitals is 1,213, with
294,972 psychiatric beds, accounting for 72.8% of all psychiatric hospitals and
84.1% of the total psychiatric beds in Japan. (These figures indicate that mental
health care is primarily provided by private hospitals in Japan.)
http://www.nisseikyo.or.jp/ (Japanese)
Our Contribution to WHO in 2010
-20,000 USD (Association of Aichi Psychiatric Hospitals)
for implementation of mhGAP focusing on Suicide Prevention
-100,000USD (Japanese Association of Psychiatric Hospitals.)
for implementation of mhGAP in countries
The reason why we support WHO and Our Expectation
Psychiatric care in Japan has been carried out with adequate consideration for
the human rights of individual patients, utilizing the limited healthcare resources
efficiently. But we intend to further advance psychiatric care in collaboration with
WHO and WHO experts. And Mental Disorder is now one of the diseases with
the highest disease burden. In this regard, implementing mhGAP is very
important. That is the reason why we decided to support WHO.
Though implementing in developing countries is very challenging, it is essential
that WHO steadily implement mhGAP, tailored to the specific circumstances in
individual countries.
And we hope WHO would utilize Japanese expertise and successful experience
in implementing mhGAP.
ASK published this booklet in order to explain major mental
disorders with a strong wish to promote early detection and early
th
treatment, commemorating the 60 Anniversary.
During these years, mental health legislation in Japan has been
being revised for better protection of people with mental disorder.
And there have been significant improvements in the treatment
of mental disorders; effective medicines with less side effects,
and new therapy and counselling, together with new theories for
treatment. But, prejudice still exists and many people are
hesitating to go to mental clinic.
We hope English version would be helpful in mhGAP activity in
countries.
JOHNS HOPKINS
U
N
I
V
E
R
S
I
T
Y
Bloomberg School of Public Health
Department of International Health
615 N. Wolfe Street, Room E8132
Baltimore MD 21205-2179
410-502-5364 / FAX 410-614-1419
Health Systems Program
The Applied Mental Health Research (AMHR) Group is comprised of faculty
members at the Johns Hopkins Bloomberg School of Public Health from the Center
for Refugee and Disaster Response and the Departments of International Health and
Mental Health. AMHR focuses on cross cultural mental health assessments,
intervention design, adaptation, and implementation, and program monitoring and
impact evaluations. Our primary role is to provide technical assistance to MH service
providers including governments and nongovernmental organizations (NGOs)
assisting populations in low- and middle-income countries. AMHR has a particular
interest in provision of services in disaster affected and otherwise unstable or fragile
environments.
Since 1999 AMHR has operated by building local interest and capacity in the
conduct of science-based mental health needs assessments, using this information
to inform program Design, adapting interventions for local Implementation,
Monitoring the quality of interventions and Evaluating their impact , using a single
structured process (collectively referred to as DIME). Capacity building is done
through an apprenticeship model including collaboration and direct training on
activities that constitute the DIME process. The process itself consists of a
combination of qualitative and quantitative research methods and planning and
design tools specifically adapted for field use using minimal resources by nonresearchers.
Our intent is to integrate this process into service programs, both to inform those
programs while also advancing the field of global mental health. We believe that this
is necessary given that most mental health and psychosocial interventions still have
little or no data supporting their use in non-Western contexts. Local data on the
impact/effectiveness of interventions is particularly lacking for the most
disadvantaged populations.
The primary faculty of AMHR come from diverse backgrounds including
humanitarian response, medicine, public health, psychiatric epidemiology and clinical
psychology. Together these give AMHR a unique and well-rounded approach to
international mental health. Primary faculty and their contacts are:
lamurray@jhsph.edu
• Laura Murray, Ph.D.
• Paul Bolton, MBBS
pbolton@jhsph.edu
jbass@jhsph.edu
• Judith Bass, Ph.D.
• William Weiss, DrPH.
bweiss@jhsph.edu
• Courtland Robinson, Ph.D.
crobinso@jhsph.edu
• Stephanie Skavenski, MSW, MPH
sskavenski@yahoo.com
•
•
•
•
•
•
•
•
•
•
•
•
AMHR website: http://www.jhsph.edu/refugee/response_service/AMHR/
AMHR’s experience and expertise can contribute now and in the future to
mhGAP in multiple ways including:
Processes to implement, monitor, and evaluate the success of mhGAP.
Ability to feed real-time empirical data into mhGAP efforts. These may include
needs and prevalence studies, feasibility studies, controlled trials,
implementation and integration of services, training and supervision
processes, and validation of MH assessment tools
Understanding and ongoing study of the implementation of MH interventions
by local organizations and local staff with little to no MH backgrounds.
Experience with building sustainable personnel structures with both
counselors and local supervisors.
Deep knowledge of the evidence-based treatments for the range of MH
problems.
Comprehension of human resources needed for training, and ongoing fidelity
to intervention models.
Appreciation of additional supports needed to keep newly trained counselors
healthy themselves and protected from vicarious trauma.
Specialty in children and adolescents, which among MH populations is the
least addressed and has the fewest services.
Access to ongoing studies of implementation and integration of MH programs.
Productive partnerships with funders and stakeholders interested in MH
issues.
Long-term relationships and partnerships with organizations and low-resource
country governments interested in integrating MH.
Selected relevant publications:
•
•
•
•
•
•
•
Bolton P, Bass J, Murray LK, Lee K, Weiss W, & McDonnell SM. Expanding the Scope of
Humanitarian program evaluation. Prehospital & Disaster Medicine. 2007: 22 (5): 390-395.
Bolton P, Bass J, Betancourt T, Speelman L, Onyango G, Clougherty KF, Neugebauer R,
Murray LK, & Verdeli H. Interventions for Depression Symptoms among Adolescent survivors
of war and displacement in Northern Uganda: A randomized controlled trial. JAMA. 2007: 298
(5): 519 – 527.
Murray LK, Cohen JA, Mannarino A. Cognitive Behavioral Therapy in Refugee Youth for
Symptoms of Trauma. Child and Adolescent Psychiatric Clinics of North America. 2008:
17(3): 585-604.
Murray, LK, Haworth A, Semrau K, Aldrovandi GM, Singh M, Sinkala M, Thea DM, & Bolton
P. Violence and abuse among HIV-Infected Women and their children in Zambia: A
Qualitative Study. Journal of Nervous and Mental Disease, August, 2006, 194 (8)
Bolton P, Bass J, Neugebauer R, Clougherty K, Verdeli H, Ndogoni L, Wickramaratne P,
Weissman M. ‘Results of a Clinical Trial of a Group Intervention for Depression in Rural
Uganda.’ JAMA. 2003;289:3117-3124.
Bolton P, Tang A. ‘An alternative approach to cross-cultural function assessment.’ Soc
Psychiatry Psychiatr Epidemiol. 2002;37(11):537-543.
Bolton P. ‘Cross-cultural validity and reliability testing of a standard psychiatric assessment
instrument without a gold standard.’ J Nerv Ment Dis. 2001;189(4):238-42.
Centre for Disability and Development,
London School of Hygiene & Tropical Medicine
Co-ordinator: Dr Hannah Kuper
The Centre for Disability and Development at the London School of Hygiene &
Tropical Medicine (LSHTM) was launched in June, 2010. The aim of the Centre is to
establish LSHTM as an international centre with expertise and competence in
disability research and teaching in the context of public health and development.
The Centre includes a range of researchers, with broad skills and knowledge in the
field of disability.
The remit of the Centre is to address major gaps in our knowledge about disability,
including data on prevalence of conditions and impact and effectiveness of
interventions. In this way, the Centre can make a contribution towards the
achievement of the aims of mhGAP. The Centre for Disability and Development is
collaborating with colleagues from the Centre for Global Mental Health at LSHTM
and with programme stakeholders, in particular CBM.
Web address: www.lshtm.ac.uk
DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
National Institutes of Health
National Institute of Mental Health
6001 Executive Boulevard
Bethesda, Maryland 20892
September 27, 2010
The National Institute of Mental Health (USA) is one of the 27 institutes and centers that constitute the
National Institutes of Health, the nation’s medical research agency and the largest source of funding for
medical research in the world. Each Institute has a specific research agenda, and the NIMH is the lead
Federal agency for research on mental and behavioral disorders.
NIMH envisions a world in which mental illnesses are prevented and cured. The mission of NIMH is to
transform the understanding and treatment of mental illnesses through basic and clinical research,
paving the way for prevention, recovery, and cure. To fulfill its mission, the Institute:
•
Conducts research on mental disorders and the underlying basic science of brain and behavior,
•
Supports research on these topics at research settings throughout the United States and the world,
•
Collects, analyzes, and disseminates information on the causes, occurrence, and treatment of
mental illnesses.
•
Supports the training of more than 1,000 scientists each year to carry out basic and clinical
mental health research.
•
Communicates with scientists, patients, the news media, and primary care and mental health
professionals about mental illnesses, the brain, behavior, and opportunities and research advances in these areas.
The Institute’s overarching Strategic Objectives are to 1) promote discovery in the brain and behavioral
sciences to fuel research on the causes of mental disorders; 2) chart mental illness trajectories to
determine when, where, and how to intervene; 3) develop new and better interventions that incorporate
the diverse needs and circumstances of people with mental illness; and 4) strengthen the public health
impact of NIMH-supported research.
The work of the Institute is carried out by the 7 offices that form the Office of the NIMH Director and
the 7 research Divisions that oversee extramural and intramural research activities. The NIMH Office
for Research on Disparities and Global Mental Health (ORDGMH) coordinates the Institute’s efforts to
reduce mental health disparities both within and outside of the United States. The office’s combined
focus on local and global mental health disparities reflects an understanding of how the rapid
movements of populations, global economic relationships, and communication technologies have
created more permeable borders and new forms of interconnectedness among nations and people. These
trends both require and enable researchers to address the variations in incidence, prevalence, and course
of mental disorders and access to care across diverse populations using a global perspective. ORDGMH
oversees research on global mental health, health disparities, and women’s mental health. The office
works in close collaboration with NIMH’s Office of Rural Mental Health Research to address the mental
health needs of people living in rural areas.
The activities of the WHO Mental Health Gap Action Programme (mhGAP) activities align with the
mission of NIMH and the activities of ORDGMH. NIMH will support the establishment and
maintenance of an mhGAP electronic reference library that will facilitate access to 1) the best clinical
and non-clinical information on evidence-based interventions for MNS disorders, 2) best practices
relevant to mental health and social care for treatment decision-makers in varied care settings, and 3) a
reference library on scaling up successful intervention in low- and middle-income countries. NIMH will
also support the development of normative tools to assist implementation of mhGAP in countries. These
tools will include an adaptation guide, training materials for different cadres of health planners and nonspecialist care providers, and monitoring and evaluation tools for planning and implementation of the
program.
Selected Recent Publications of the NIMH and the National Advisory Council for Mental Health:
National Institute of Mental Health Strategic Plan
http://www.nimh.nih.gov/about/strategic-planning-reports/index.shtml
From Discovery to Cure: Accelerating the Development of New and Personalized Interventions for
Mental Illnesses
http://www.nimh.nih.gov/about/advisory-boards-and groups/namhc/reports/fromdiscoverytocure.pdf
s
Visit the NIMH Web site at http://www.nimh.nih.gov.
Working together to make health for all a reality
Promoting Equity, Justice and Rights in Health Care
The NGO Forum for Health grew out of the annual meeting of NGOs which had attended the
International Conference on Primary Health Care, Alma Ata, in 1978.
The Mission of the Geneva-based Forum is to contribute to making health for all a reality by advocating for protection and realization of the right to health;
by promoting equity and justice in access to health for all persons at all stages of their life;
and by promoting and encouraging healthy life choices. The Forum gives special priority to the right to
health of the poor and socially excluded.
Objectives
• To help to ensure that health be given higher priority, by governments, the UN and NGOs, through
raising awareness, encouraging research, and building alliances,
• To promote a holistic and integrated approach to public health recognizing the economic, social
and spiritual dimensions of mental and physical health,
• To promote gender equity in all health policies and programmes, for the benefit of health users and
health providers.
Activities are based on needs identified by member organizations and include:
Advocacy and independent public information through the organization of symposia and panels, for
example ‘Achieving the Millennium Development Goals through Primary Health Care: what does it
mean in practice?’; ‘How to make inputs into the meetings of the WHO’;
• Information-sharing and exchange of experience and good practices;
• Mutual support of member organizations in their campaigning and lobbying;
• Network-building;
• Issue-based working groups, most recently the Mental Health and Psychosocial Working Group
(MHPSWG)
•
Areas of particular concern and focus are health rights; primary health care; child health and survival;
mental health; sexual and reproductive health; HIV/AIDS; needs and conditions of health workers;
gender issues in health; achieving the MDGs; and relations with the WHO.
The Forum has 25 member organisations. President: Alan Leather, Honorary Chair: Ann Lindsay
Contact the Forum Coordinator, Gabriella Sozanski, for further information
Email: info@ngo-forum-health.ch
Check out our website: www.ngo-forum-health.ch
________________________________________________________________
NGO Forum for Health
c/o International Aids Society
Ch. de l’Avanchet 33
CH - 1216 Cointrin
Tel: +41 76 338 22 29
info@ngo-forum-health.ch
www.ngo-forum-health.ch
Working together to make health for all a reality
Promoting Equity, Justice and Rights in Health Care
Mental health in most countries is at best neglected and at worst the subject of outright
stigmatization and discrimination. In an effort to promote the rights of those affected and their access
to quality services, the NGO Forum for Health established a Mental Health and Psychosocial Working
Group. Chairperson of the Working Group is Ann Lindsay.
The primary mission of the Group is the promotion of mental health and psychosocial well-being
through:
• a higher priority for mental health and significantly improved care services;
• greater public consciousness of mental health issues;
• reduced stigmatization of mental disorders;
• promoting the right of all individuals to receive support for optimal functioning, both physically and
mentally.
Aims and objectives
• To increase understanding and raise awareness of MH and PS support as a priority issue;
• To promote the integration of MH and PS support in primary health care;
• To ensure linkages between mental health issues and related concerns, including vulnerable
populations, human rights, gender equality, poverty, violence, the environment, and peacebuilding.
Activities contributing to the implementation of the mental health GAP action plan
At the Geneva Health Forum 2010: Towards Global Access to Health, a special session was
organized by the Working Group on Regional Challenges for Achieving Global MH
•
The MHPSWG is currently conducting a study on the activities of international NGOs involved in the
MH and PS field in order to facilitate greater cooperation among organizations and to identify gaps
in care as well as good practices. The first results of the study, a web-based survey on 44 INGOs
form a good basis for further research. The next stage will be the establishment of a network of
partners to promote knowledge-sharing and influence change.
•
The NGO Forum for Health will commemorate World Mental Health Day 2010 by arranging a
Symposium at the Geneva international Conference Centre, 8 October (9:00-13:00) addressing the
theme ‘Mental Health: the missing dimension to the MDGs – special implications for women and
children’. See attached flyer.
•
Areas for further collaboration
Promoting respect for human rights and basic standards in MH and PS care;
Encouraging and participating in productive partnerships among NGOs and with international
organisations, with a view to reducing the burden of MH;
Strengthening the NGO network involved in MH and PS support;
Using the network effectively to ensure that information reaches segments of population with
MH disorders, in low- and middle-income countries;
Building broader, more global cooperation among NGOs and with international organisations.
Contact Working Group coordinator Stefan Germann at Stefan_Germann@wvi.org
________________________________________________________________
NGO Forum for Health
c/o International Aids Society
Ch. de l’Avanchet 33
CH - 1216 Cointrin
Tel: +41 76 338 22 29
info@ngo-forum-health.ch
www.ngo-forum-health.ch
DEPARTMENT OF PSYCHOLOGY
STELLENBOSCH UNIVERSITY, STELLENBOSCH, SOUTH AFRICA
Selected staff members: Prof Mark Tomlinson, Prof Leslie Swartz, Prof Ashraf
Kagee, Prof Tony Naidoo, Prof Lou-Marie Kruger
The Department of Psychology has a broad portfolio of research interests but with a
particular interest in maternal and child mental health. There are a number of
randomized controlled trials investigating the improvement of the early mother-infant
relationship, community based trials aimed at preventing mother to child transmission
of HIV and reducing neonatal deaths; and others aimed at reducing alcohol use,
improving maternal mental health, in the antenatal and postnatal period. The
department also has an interest in focussing on the health system challenges of
scaling up mental health services for women and children. Research has also
focussed on foundational conceptual issues in mental health, with particular
emphasis on cultural issues, linguistic diversity, and political factors as they affect
mental health in Africa. There has been an interest in the application of mental
health knowledge and skills in non-traditional populations and settings, with
explorations of the role of community-based approaches in service provision and
development projects. Mental health questions have been conceptualised more
broadly within studies interrogating the role of socioeconomic factors and social
exclusion on mental health, taking into account gender, race and other divisions of
power. A particularly salient issue in the African context is the impact of trauma and
violence on mental health, and this has been extensively explored both conceptually
and empirically. Comorbidity with physical illness (notably, HIV/AIDS) has also been
explored, and mental health issues have been placed in the broader rubric of health
psychology. We have studied issues of social exclusion and human rights as they
affect disabled people in general, and mental health issues are intimately involved
with disability issues. In Africa in particular, many conditions, including epilepsy and
some sensory impairments are considered under the mental health rubric, and as
part of the province of mental health work.
Selected recent publications
Kagee, A., & Martin, L. (2010). Symptoms of depression and anxiety among a
sample of South African patients living with HIV. AIDS Care, 22, 159-165.
Lund, C., Breen, A., Flisher, A. J., Kakuma, R., Corrigall, J., Joska, J. A.,
Swartz, L., & Patel, V. (2010). Poverty and common mental disorders in low and
middle income countries: A systematic review. Social Science & Medicine, 71, 517528.
Chisholm, D., Flisher, A., Lund, C., Patel, V., Saxena, S., Thornicroft, G., &
Tomlinson, M. (2007). Scale up services for mental disorders: A call for action.
Lancet, 370, 1241-1252.
Cooper, P. J., Tomlinson, M., Swartz, L., Landman, M., Molteno, C., Stein, A.,
McPherson, K., & Murray, L. (2009). Improving the quality of the mother-infant
relationship and infant attachment in a socio-economically deprived community in a
South African context: a randomised controlled trial. BMJ, 338:b974.
doi:10.1136/bmj.b974.
Swartz, L. (2008). Globalisation and mental health: Changing views of culture
andsociety. Global Social Policy, 8, 304-308.
Tomlinson, M., Rudan, I., Saxena, S., Swartz, L., Tsai, A. C., & Patel, V.
(2009). Setting priorities for global mental health research. Bulletin of the World
Health Organization, 87(6), 438-446.
Tomlinson, M., Solomon, W., Singh, Y., Doherty, T., Chopra, M., Ijumba, P.,
Tsai, A.C., & Jackson, D. (2009). The use of mobile phones as a data collection tool
in South Africa: A report from a household survey. BMC Medical Informatics and
Decision Making, 9:51. doi:10.1186/1472-6947-9-51
Tomlinson, M., Stein, D.J., Williams, D., Grimsrud, A., & Myer, L. (2009). The
Epidemiology of Major Depression in South Africa: Results from the SASH Study.
South African Medical Journal, 99, 368-373.
Stichting Epilepsie Instellingen Nederland (SEIN) – Epilepsy Institute in the Netherlands
INTRODUCTION
SEIN - The Epilepsy Institute in the Netherlands strives to improve the quality of life of people with
epilepsy globally. It provides multi-disciplinary care to people with complex forms of epilepsy.
SEIN provides its services in two clinical facilities in Heemstede and Zwolle (total 160 beds), ten
outpatient clinics providing care to about 11,000 patients a year, and also provides long stay
sheltered residential accommodation (Heemstede, Cruquius and Zwolle) for over 400 people with
epilepsy and complex needs. SEIN’s main catchment area is the northern, eastern and western
part of the Netherlands although patients may come from any part of the country.
Core functions

Diagnostics and treatment (out-patient and in-patient)

Long-stay ( central and de-centralised)

Research (clinical and basic)

Public and professional education

Special education
SEIN was designated a WHO Collaborating Centre for Research, Training and Treatment in Epilepsy
in 2004
ACTIVITIES WITHIN THE FRAMEWORK AS A WHO COLLABORATING CENTRE
1. Providing comprehensive epilepsy care.
The Netherlands have a population of 16.000.000 of
whom an estimated 120.000 have epilepsy. SEIN has:
•
510 beds at three sites
–
100 short/medium stay
–
410 long stay
•
1.300 employees
•
1.300 admissions (per annum)
•
50 patients for neurosurgery (per annum)
Number of people with epilepsy in The
Netherlands
17%
17%
66%
Seizure-free with
medication
Refractory epilepsy
Good QoL
Refractory epilepsy
In Need of Care
SEIN was founded in 1882 by a wealthy lady, Lady Teding van Berkhout
Lady Teding
Van Berkhout
Founder
Purchase
Estate Meer en Bosch
1884
Opening Hospital
Queen Emma
1934
Location Heemstaete
Zwolle
1999
New buildings
Cruquishoeve
2010
mhGAP Greater coverage with essential interventions for people with mental and neurological
disorders
2. Develop special education and fellowship programmes for young researchers from developing
countries.
SEIN organises annual 2-week pilot courses in clinical epileptology for young doctors with a
general interest in neurology and more specifically in epilepsy from resource-poor countries in
order to pass on much needed knowledge and expertise in comprehensive epilepsy care.
Furthermore SEIN offers fellowships to young researchers from resource-poor countries
mhGAP Increase in the proportion of primary health facilities that have trained health professionals
for diagnosis and treatment of mental and neurological disorders
3. Collaborate with other institutions in the area of health care.
SEIN has entered into a Memorandum of Understanding (MoU) for research on two projects in
1
collaboration with the CAAE (China Association Against Epilepsy) involving two more WHO
Collaborating Centres (WHO-CC) in China (Beijing Neurosurgical Institute and Fudan University
Hospital in Shanghai). These two projects are funded by the Ministry of
Health of China and SEIN. Project partners in other countries include the
Division of Public Health, University of Liverpool, United Kingdom
(WHO-CC); Division of Neurosciences of UCL, (WHO-CC); and the School
Of Public Health, University of Texas, United States of America.
Signing MoU: left to right: Jean
Willem Barzilay, Shichuo Li
mhGAP A comprehensive and result-oriented programme for mental health and neurological
disorders implemented in targeted countries
4. In collaboration with the WHO/HQ & the WHO Regional Office for Europe will develop
finalise and publish a regional report on epilepsy.
The World Health Organization (WHO) and the two international
epilepsy organisations, the International Bureau for Epilepsy (IBE) and
the International League Against Epilepsy (ILAE), announced the
publication of a report into epilepsy in Europe, which concludes that
many aspects of epilepsy care are seriously under-resourced.
The Fostering epilepsy care in Europe report has been developed as
part of the IBE/ILAE/WHO Global Campaign Against Epilepsy (GCAE).
The report addresses the current challenges faced in epilepsy care and
offers recommendations to tackle them, as well as providing a
panoramic view of the present epilepsy situation across the continent.
The report was written by many European experts in the field and was
edited and published in close collaboration with WHO HQ, the WHO
Regional Office for Europe and SEIN.
mhGAP Greater investment in care for mental and neurological disorders
5. Assist in carrying out the project on Epilepsy and Legislation
A questionnaire was developed for collection of data on existing legislation
and regulations related to epilepsy in the areas of civil rights, education,
employment, residential and community services, and provision of
appropriate health care from countries all over the world, in order to
review the comprehensiveness and adequacy of these legal measures in
promoting and protecting the civil and human rights of people with
epilepsy.
Participants Legislation workshop Marseille
A document “Basic principles for Epilepsy Legislation and
Guidance Instrument for developing, adopting and
implementing epilepsy legislation” was developed for publication.
mhGAP Enhanced implementation of human rights standards (in care facilities) for mental and
neurological disorders
6. Organise a regional conference on epilepsy as a public health issue.
Such a conference is under preparation involving all principal investigators of the demonstration
projects, ILAE/IBE and WHO leadership, SEIN representatives and other collaborators in the
GCAE
mhGAP Greater investment in care for mental and neurological disorders
7. Assist in the carrying out a demonstration project in epilepsy in the Eastern European
Region.
The Demonstration Project, aiming at reducing the treatment gap will be completed by the end of
2010. At the request of WHO SEIN has taken the lead in this project.
The continuation of the collaboration with the present partners in Georgia is a logical next step in
order to ascertain sustainability of improving epilepsy care in Georgia.
mhGAP Increase in the proportion of primary health facilities that have trained professionals for
diagnosis and treatment of mental and neurological disorders
2
Department of Psychiatry
The Universidad Autónoma de Madrid (UAM) is a public university offering
graduate and postgraduate degrees in a wide variety of programmes at its 63
departments and eight research institutes. Although founded barely four decades ago, it
has already achieved an outstanding international reputation for its high-quality teaching
and investigation. It recognized as one of the best Spanish universities in both national
and international rankings. The UAM has a well-established tradition in the area of
cooperation with other universities from the rest of Spain and abroad, being one of the
Spanish universities with the highest rates of student mobility in international
programmes, including 170 bilateral agreements with universities outside of Europe.
International teaching and research activities at the Department of Psychiatry
Faculty members of the UAM Department of Psychiatry are currently participating in
mental health training programmes for health care providers in several developing
countries. For the last 10 years the Department has had an international PhD
Programme the University of Carabobo in Venezuela. The Department also has an
established collaboration for postgraduate training in mental health with the University
of Health Sciences in Phnom Penh, and for a children’s crisis support programme in
Battambang, Cambodia. Moreover, through the Banco Santander Endowed Chair, the
Department has an ongoing collaboration with UNAM University in Mexico City for
research and training in mental health
The UAM Department of Psychiatry is also involved in international projects
funded by the European Commission, including:
- Psycho-social Aspects Relevant to Brain Disorders in Europe: PARADISE
(http://paradiseproject.eu);
- Collaborative Research on Ageing in Europe: COURAGE in Europe
(www.courageineurope.eu);
- Multidisciplinary Research Network on Health and Disability in Europe:
MURINET (www.murinet.eu).
The Department plays a leading role in the International Mental Health Research
Network, and launched the Madrid Declaration, aimed at promoting a coordinated
European-wide effort in mental health research
(http://www.cibersam.es/MadridDeclaration.), which was subscribed by representatives
from seven nationally-funded mental health research networks, as well as leaders of
ongoing EU-funded mental health projects.
Collaboration with the World Health Organization
The UAM Department of Psychiatry has a long history of cooperation with the WHO’s
Department of Mental Health and Substance Abuse, and has been involved in a number
of WHO initiatives, including the Choosing Interventions that are Cost-Effective
(WHO-CHOICE) programme. This project has generated cost-effectiveness data in 14
epidemiological sub-regions of the world for key health interventions able to reduce
leading contributors to disease burden. In addition, the Head of the Department, Prof.
J.L. Ayuso-Mateos is currently a member of the Essential package for mental,
neurological and substance use disorders Guideline Development Group and of the
International Advisory Group for the revision of the ICD 10.
The UAM Department of Psychiatry is one of the four institutions participating in the
project Scaling up services for mental, neurological and substance use (MNS)
disorders within WHO mental health Gap Action Programme (mhGAP), funded
recently by the EuropeAid program of the European Comission. In this project, led by
the WHO’s Department of Mental Health and Substance Abuse, the UAM collaborates
with the Health Ministries of Ethiopia and Nigeria. The main objectives of this project
are to expand service coverage for mental and neurological disorders in pilot areas of
these two countries under the WHO mhGAP programme. It also includes capacitybuilding for health planners/programme managers and health care providers to develop
and implement care and services for people with MNS disorders.
Relevant Publications:
• Arana A, Wentworth C, Ayuso-Mateos JL, Arellano F.Suicide-Related Events in
Patients Treated with Antiepileptic Drugs. New England Journal of Medicine
2010; 363:542-551
• Nuevo R, Chatterji S, Verdes E, Naidoo N, Arango C, Ayuso-Mateos JL. The
Continuum of Psychotic Symptoms in the General Population: A Cross-national
Study. Schizophr Bull. 2010 Sep 13. [Epub ahead of print]
• Ayuso-Mateos JL, Nuevo R, Verdes E, Naidoo N, Chatterji S. From depressive
symptoms to depressive disorders: the relevance of thresholds. British Journal
of Psychiatry 2010 May;196(5):365-71.
• Chisholm D, Gureje O, Saldivia S, Villalon CM, Wickremasinghe R, Mendis N,
Ayuso-Mateos JL, Saxena S . Schizophrenia treatment in the developing world:
an interregional and multinational cost-effectiveness analysis. Bulletin of the
World Health Organization 2008; 86, 542-551
Address:
Departamento de Psiquiatría
Facultad de Medicina
Universidad Autónoma de Madrid
C/ Arzobispo Morcillo 4
28029 Madrid, Spain
www.uam.es
www.trastornosafectivos.com
www.pmhp.za.org
Introduction
Maternal mental illnesses, particularly depression and anxiety, are endemic in low-income
1
and informal settings globally . The prevalence of antenatal depression is nearly three times
higher than in developed countries2, with levels as high as 41% in rural areas3. During the
perinatal period, mental illness renders women particularly vulnerable: decreasing access to
4
5
antenatal care , placing women at increased risk of HIV infection , associated with infant
mortality, and a significant risk factor for loss of developmental potential in children6.
Globally, there is a call for mental health care to be integrated into routine primary care7.
However, such services are almost non-existent in the maternal care environment in
developing countries. Although there is an enormous treatment gap for primary-level mental
illness, high antenatal care uptake in South Africa (92%)8, provides a unique opportunity for
the development of integrated services.
The Perinatal Mental Health Project (PMHP) operates an integrated mental health service in
the public sector: at a maternity hospital as well as at community-based, midwife-run obstetric
units in low resource settings. The PMHP is located within the Department of Psychiatry and
Mental Health at the University of Cape Town. As a partner to the Mental Health and Poverty
a
b
Project (MHaPP), and subsequently to the Centre for Public Mental Health (CPMH), the
PMHP collaborates with international partners in global mental health.
Activities
The PMHP operates in four main areas, in line with the mhGAP programme core strategies9:
a) The integrated PMHP service delivery model provides free screening, counselling and
psychiatric services at the same site at which women receive maternal care.
b) The PMHP provides interactive training on maternal mental health (MMH) to a range of
health workers and service providers through novel, accessible, evidence- based methods
and materials. This approach recognises the
challenges of an overburdened health care
cadre in low-resource settings, offering an
adaptable programme that enhances skills and
empowers health care workers at all levels.
The PMHP training enables a task-shifting
approach, which facilitates the integration of
mental health services using existing staff and
resources.
c) Collaborating with UCT, WHO and
international research consortia, the PMHP is positioned in the academic field, contributing
iterative, practical, evidence-based knowledge. The PMHP is in the final preparation phase of
developing and validating a screening tool for maternal mental disorders in low-resource
settings. The SA DoH has suggested that this screening tool may be used nationally as the
initial step towards scaling-up MMH services.
d) The PMHP has advocated for increased awareness of maternal mental disorders, bringing
MMH forward on the public health agenda. The Project has achieved this through targeted
campaigns involving the media, use of the Project’s own short film, website and engagement
with government. The Project contributed components on MMH, gender and HIV to the draft
of the new National Mental Health Policy for South Africa.
a http://workhorse.pry.uct.ac.za:8080/MHAPP
b The CPMH is a joint initiative by the Department of Psychiatry and Mental Health UCT and the Department of Psychology at Stellenbosch. It is
an independent, inter-disciplinary academic research and teaching centre for public mental health promotion and service development in Africa.
Contact Dr Simone Honikman Tel +27 (0)21 689 8390 Email simonehonikman@networld.co.za Address: Department
of Psychiatry and Mental Health, University of Cape Town; Building B, 46 Sawkins Road; Rondebosch, Cape Town,
South Africa, 7700
Contribution that PMHP is making or can make to mhGAP:
The PMHP has made specific contributions to the WHO and World Federation for Mental
Health, Mental Health Promotion Case Studies publication in 200410. The PMHP participated
in a WHO meeting on MMH and Child Health and Development in Low and Middle Income
Countries, in 2008, and contributed to the subsequent report11.
Focusing on the needs of vulnerable women by developing an integrated service, the PMHP
model makes use of existing resources to develop a sustainable, evidence-based intervention
in resource-constrained settings. For example, the PMHP has facilitated the development and
integration of MMH into health services provided by village health workers at a low-resource,
rural NGO in South Africa. The PMHP collaborated with the NGO to train its cadre of health
workers in MMH and basic counselling skills. The PMHP facilitated a strategic planning
session to develop a pragmatic, sustainable intervention suitable for the setting; and to help
the NGO establish partnerships and links to utilise existing resources in the community. The
PMHP continues to provide technical support in an advisory capacity.
Collaboration with PMHP on the implementation of mhGAP:
This experience makes the PMHP a strategically placed partner for implementation of
mhGAP. The PMHP would envision assisting in the following (through collaboration with other
experts in the field):
1. Technical advice
4. Systems development for monitoring
and evaluation
2. Program design (for services and
training)
5. Training (development of training
materials and conducting training for
trainers and for health workers)
3. Service protocol development
6. Document development (training
manuals, service development
manuals, best-practice guidelines)
References
1 Saxena, S., Thornicroft, G., Knapp, M., & Whiteford, H. (2007). Resources for mental health: scarcity, inequity, and inefficiency. The Lancet,
370, 878-889.
2 Tomlinson, M., Grimsrud, A. T., Stein, D. J., Williams, D. R. & Myer, L. (2009). The epidemiology of major depression in South Africa: Results
from the South African Stress and Health study. South African Medical Journal, 99, 368-373
3 Rochat, T., Richter, L.M., Doll, H.A., Buthelezi, N.P., Tomkins, A., & Stein, A. (2006). Depression Among Pregnant Rural South African
Women Undergoing HIV Testing. Journal of the American Medical Association, 295(12), 1376-1378.
4 World Health Organisation (2009). Mental health aspects of women’s reproductive health: A global review of the literature. WHO Press.
5 Cook, J.A., Grey, D., Burke, J., Cohen, M. H., Gurtman, A. C., Richardson, J. L., et al. (2004). Depressive symptoms and AIDS-related
mortality among a multisite cohort of HIV positive women. American Journal of Public Health, 94, 1133–1140.
6 Engle, W., Tomashek, K., William, C.,(2007). “Late-Preterm” Infants: A Population at Risk. Pediatrics, 120(6), 1390-1401.
7 The Lancet Global Mental Health Group. (2007). Scale up services for mental disorders: a call for action. The Lancet, 1 – 12.
8 UNAIDS (2009). AIDS Epidemic Update, November 2009: UNAIDS & WHO.
9 mhGAP: Mental Health Gap Action Programme : scaling up care for mental, neurological and substance use disorders (2008). WHO Press
10Saxena, S. & Garrison, P. (eds) (2004). Mental Health Promotion: Case studies from countries. WHO Press.
11 Maternal mental health and child health and development in low and middle income countries Report of the meeting held in Geneva,
Switzerland 30 January – 1 February 2008; WHO
Contact Dr Simone Honikman Tel +27 (0)21 689 8390 Email simonehonikman@networld.co.za Address: Department
of Psychiatry and Mental Health, University of Cape Town; Building B, 46 Sawkins Road; Rondebosch, Cape Town,
South Africa, 7700
UNHCR and Mental health programmes
The Office of the United Nations High Commissioner for Refugees (UNHCR) was established
in 1950 by the United Nations General Assembly. The agency is mandated to lead and coordinate international action to protect refugees and resolve refugee problems worldwide. Its
primary purpose is to safeguard the rights and well-being of refugees. It strives to ensure that
everyone can exercise the right to seek asylum and find safe refuge in another State, with the
option to return home voluntarily, integrate locally or to resettle in a third country. It also has a
mandate to help stateless people and supports internally displaced persons.
Many protection risks have their roots in trauma, accumulated stress due to unattended
psychosocial and mental health problems, family seperaton, threats and persuction, as well
as inadequate access to shelter, food, basic health services.
UNHCR is working in emergency and long
term conflict affected displacement
situations to address mental health in their
ongoing public health programmes. In the
immediate emergency UNHCR advocates
to it’s partners and governments, to
ensure a coordinated response in line with
the Interagency Standing Committee
Guidelines on Mental health and
Psychosocial support.
Once the situation stabilizes UNHCR strives to establish strong mental health and
psychosocial support programmes embedded into the public health programmes.
Mental Health and Psychosocial support programmes in refugee settings
Mental health services are offered in all refugee operations, but vary in quality and extend of
the services provided. Programmes are provided in line with the national programmes,
protocols and services. However, mental health and psychosocial support programmes
address the needs of conflict-affected populations.
In an effort to improve the quality of programmes and the interlinkages between the health
and social/community sector, UNHCR and Healtnet TPO are implementing a programme on
improved psychosocial and mental wellbeing of refugees residing in Tanzania, Rwanda and
Burundi through developing, installing and evaluating a model of comprehensive services for
MHPSS within existing UNHCR-supported care structures for refugees. Experiences are used
to improve programming in other refugee operations.
Monitoring Mental Illness in refugee camps
Within the monthly Health Information
System (HIS) (data collected at health
facility level), UNHCR has included 7
categories of mental illness, that are
dissagregated by the following age groups
(0-4; 5-17, 18-60; 60+). The 7 categories
have all been difined in case definitions
groups.
Other interventions
A rapid assessment tool for alcohol
and other substance use has been
developed and used to identify
patterns of substance use and related
harms in conflict affected populations.
Based on assessments in 9 countries,
interventions that could be
implemented to minimize harms
related to substance use in conflict
affected populations have been
established.
UNICEF Statement for mhGAP Forum
The goal of UNICEF’s work with and for children and adolescents is to mobilize political
will and resources to protect, respect and fufill the rights of all children – with special
attention to the most marginalised and vulnerable. Guided by the Convention on the Rights of
the Child and related human rights instruments, UNICEF invests in the well-being of children
and adolescents within the context of the five focus areas of the organization’s Medium Term
Strategic Plan (MTSP): Child Survival, Basic Education and Gender Equality, HIV/AIDS,
Child Protection and Policy Advocacy for Children’s Rights. Within this context, special
emphasis is afforded to working strategically with and for adolescents to ensure that they
have the abilities, skills, values and experience to negotiate multiple life domains, become
economically independent, protect themselves from exploitation and abuse, avoid risky
behaviour and participate positively in their communities and families.
Although mental health has not been formally integrated into its work for children and
adolescents, UNICEF is interested in collaborating with partners in government, civil society
and across the UN to explore how increased attention to mental health, substance abuse,
violence, trafficking, physical and sexual abuse, living in conflict zones and related areas can
strengthen adolescent well being and rights. For this reason, participation in the Mental
Health GAP process is of special interest to UNICEF.
UNICEF has carried out and is planning several initiatives that could contribute to good
practice and lessons learned in the area of mental health, substance abuse and related areas.
These include:
• UNICEF Regional Office for CEE/CIS has implemented HIV prevention
programming for most-at-risk and especially vulnerable adolescents throughout the
CEE/CIS region. This work has included establishment of an evidence base around
substance abuse among adolescents and young people and implementation of
interventions designed to reduce risk and harm associated with drug use.
• UNICEF has agreed with WHO to partner in carrying out a Desk Study of policies,
programmes and interventions in adolescent mental health and well being across
various UN agencies, development partners and international NGOs
• The upcoming edition of UNICEF’s “State of the World’s Children,” (SOWC) on the
topic of Adolescents, to be launched in January 2011, will include a special panel
addressing mental health issues among adolescents
• During the launch of SOWC, UNICEF and WHO will collaborate to hold an Expert
Roundtable discussion on mental health for adolescents and young people. The
roundtable will be jointly hosted by UNICEF and WHO and will include experts
from Johns Hopkins University, George Washington University and other eminent
institutions and organizations concerned with adolescent mental health
UNICEF believes that adolescent mental health is integral to all programming aimed at
improving the well-being of adolescents and is pleased to be a part of the mhGAP.
The UNODC-WHO Joint Programme on Drug Dependence Treatment and Care is a
milestone in the development of a comprehensive, integrated health-based approach to drug
policy that can reduce demand for illicit substances, relieve suffering and decrease drug-related
harm to individuals, families, communities and societies. The initiative sends a strong message
to policymakers regarding the need to development services that address drug use disorders in
a pragmatic, science-based and humanitarian way, replacing stigma and discrimination with
knowledge, care, recovery opportunities and re-integration.
The UNODC-WHO joint programme on drug dependence treatment and care was
launched in February 2009, at the 52th CND (Commission on Narcotic Drugs) in Vienna as a
result of UNODC’s emphasis on starting a large-scale urgent process to develop effective
interventions to treat substance use disorders, particularly addiction, and reducing the health
and social consequences of these conditions by means of supporting evidence-based drug
dependence treatment and care worldwide with particular interest in middle and low income
countries. The aim of the initiative is to advocate for effective and humane treatment for all
people with drug use disorder, while implementing concrete coordinated, public health-oriented
approaches from the health and law enforcement sector to address the problem.
The Joint Programme is the first global joint
effort building on the expertise, experience and
activities of the two participating UN Organizations
with regard to evidence-based services for drug
dependence treatment and care. It offers Ministries
of Health, Interiors, Justice and other relevant
ministries in low- and middle-income countries specific
recommendations to establish and strengthen policies
and plans to scale up drug dependence treatment and
care services. The Joint Programme is a valuable tool
for policy/decision-makers and civil society.
The Joint Programme aims to stimulate action
at all levels by strengthening commitment to support
development and implementation of evidence-based
services for drug dependence treatment and care
globally; and providing technical support to catalyse change in low- and middle-income countries
for improving the coverage and quality of drug dependence treatment and care services,
including by developing and disseminating the required norms, standards, guidelines and other
technical tools.
The Joint Programme is currently active in two countries in the Balkans, Albania and
Serbia, and in Haiti.
More
information
about
the
Joint
Programme
can
http://www.unodc.org/unodc/en/drug-prevention-and-treatment/index.html
Vienna International Centre │ PO Box 500 │ 1400 Vienna │ Austria
Tel.: (+43-1) 26060-0 │ Fax: (+43-1) 26060-5866
be
found
at:
WHO Collaborating Center for Psychosocial Rehabilitation and Community Mental Health
of Yongin Mental Hospital is the leading, global mental health organization in psychosocial
rehabilitation care, community mental health services, and psychiatric rehabilitation research.
Our vision is to increase capabilities of mentally ill people as community members by
providing services and recovery-oriented approaches to them. Since the Yongin WHO CC
was designated in 2003, all staffs have moved toward this goal by developing psychosocial
programs from the institution to the community.
Mission
The mission of the Yongin WHO CC is to provide extensive psychosocial rehabilitation
programs through the advancement of research; to develop national mental health policy
through affiliated community mental health centers; to provide the high quality of education
to mental health professionals, mentally ill people, and their families; to conduct and
disseminate evidence- based best practice and information; and increase awareness of mental
health and fundamental human right issues.
Program and Projects of the WHO CC
PEPS (Patient Empowerment Program for Schizophrenia)
Family Link Korea Project
SEBoD (Socio-Economic Burden of Depression) Korea
Alliance Program for psychoeducation of mentally ill
Yongin WHO Mental Health Fellowship in Asia
International Mental Health Symposium and Workshops
Program for Development of Professional Academic Skills
of Young Psychiatrists
10th International Mental Health
2009 Fellows from India and Japan
Conference, Sept. 3-4, 2010
Yongin WHO CC can support in the implementation of mhGAP in the following ways
By reinforcing existing partnership with WHO, Yongin WHO CC would involve in
the implementation of mhGAP actively.
By strengthening basic education and training for mental health professionals from
middle and low income countries in Asia, Yongin WHO CC will help them to
upgrade their skills and knowledge, and contribute to the implementation of mhGAP
in their own countries.
By developing and promoting programs for mental health care, Yongin WHO CC
will try its best to promote of mental health by prevention of depression and others.
By joining the WHO’s advocacy efforts of mental health, Yongin WHO CC will
continue to increase awareness of mental health issues among policy makers and
general population.
For more information about Yongin WHO CC, please visit the following websites:
http://www.yonginwhocc.or.kr/
or
http://www.yonginwhocc.or.kr/english.php
4 Sangha-Dong, Giheung-Gu, Yongin-City, Kyeonggi-Province, Korea (449-769)
Tel: +82-31-288-0233
Fax: +82-31-288-0363
Email: yiwhocc@naver.com
WORLD ASSOCIATION FOR PSYCHOSOCIAL REHABILITATION
ASSOCIATION MONDIALE POUR LA RÉADAPTATION PSYCHOSOCIALE
ASOCIACIÓN MUNDIAL PARA LA REHABILITACIÓN PSICOSOCIAL
Liaison Office with World Health Organization
Mario Negri Institute
Via La Masa 19
20156 Milano
Italy
Tel ++39-02-39014431
Fax ++39-02-39014300
E-mail angelo.barbato@marionegri.it
Milan, 27 September 2010
The World Association for Psychosocial Rehabilitation (WAPR) since its
foundation in 1986 pursued the collaboration with World Health Organization as
a key aspect of its activities, as witnessed by the 1996 a joint WAPR/WHO
consensus statement, which defined psychosocial rehabilitation as a strategy
that facilitates the opportunity for individuals impaired or disabled by a mental
disorder to reach their optimal level of functioning in the community, through the
improvement of individuals’ competencies and the introduction of environmental
changes.
The steady growth of WAPR over the last years mirrors the ever increasing
importance of the prevention and reduction of social disability as a framework
for the community care of people with severe mental disorders.
Membership of the WAPR is open not only to mental health professionals,
but also to researchers of various disciplines, administrators, policymakers,
consumers and their relatives, advocacy groups. Therefore, the WAPR is a
scientific society, a multi-disciplinary professional organization and an advocacy
group, all rolled into one. This is because its primary aim is to provide all
stakeholders with a forum for the ongoing discussion of the relevant issues
concerning long-term mental health care, by sharing experiences in the areas of
research, practices and policies.
Psychosocial rehabilitation now is coming of age and the ambition of WAPR
is to bring together the rigor of the scientific inquiry, the humanistic view, the
attention to social and political context, the everyday experience of care, the
empowerment of persons struggling for health.
WAPR is represented in many countries of all continents, therefore it speaks
to a worldwide audience, aiming to overcome the limitations of current scientific
exchanges, too often restricted to professionals from a small group of highincome western countries.
Over the last years the collaboration of WAPR with WHO programs has
been especially relevant in the following areas:
1. Support to consumers organization and involvement of consumers
in community mental health programs and services;
2. Definition of specific aspects related to mental health within the
framework of community based rehabilitation;
3. Promotion of community mental health principles, priorities and
practices in low/middle income countries, to shift service delivery
from long term institutions to effective community care.
4. Training of health professionals in principles and practices of
psychosocial rehabilitation of severe mental disorders.
WAPR is proud to continue its collaboration with WHO and fully support the
goals of mhGAP program. WAPR officers and organizational network will be
available for all initiatives in the areas mentioned above.
MEMBER ASSOCIATIONS
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahrain
Bangladesh
Belgium
Bolivia
Brazil
Bulgaria
Burkina Faso
Cameroon
Canada
Chile
China
Colombia
Congo, Dem. Rep. of
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Estonia
Ethiopia
Finland
France
Georgia
Germany
Greece
Guatemala
Guinea
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Japan
Jordan
Kazakhstan
Kenya
Kuwait
Kyrgyzstan
Latvia
Lebanon
Libya
Lithuania
Luxembourg
Macedonia
Malaysia
Mexico
Mongolia
Morocco
Myanmar
Netherlands
New Zealand
Nicaragua
Nigeria
Norway
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Saudi Arabia
Senegal
Serbia & Montenegro
Singapore
Slovakia
Slovenia
South Africa
South Korea
Spain
Sri Lanka
Sudan
Sweden
Switzerland
Syria
Taiwan
Thailand
Tunisia
Turkey
Uganda
United Arab Emirates
United Kingdom
United States of America
Uruguay
Venezuela
Vietnam
Zambia
WORLD FEDERATION OF NEUROLOGY
A non-governmental organisation in association with the World Health Organization
President
Dr Vladimir Hachinski
First Vice President
Dr Werner Hacke
Secretary-Treasurer General
Dr Raad Shakir
Executive Board
Dr Ryuji Kaji
Dr Gustavo Roman
Dr Wolfgang Grisold
Registered Office
Hill House
Heron Square
Richmond-upon-Thames
TW9 1EP
UK
Executive Director
Mr Keith Newton
Tel: +44 (0) 208 439 9556/9557
Fax: +44 (0) 208 439 9499
e-mail: info@wfneurology.org
Website: www.wfneurology.org
World Federation of Neurology (WFN) is a non-governmental organization in
relation with WHO. It is a world-wide federation of national neurological societies
comprising 110 member societies representing the majority of the world’s neurologists
(approximately 30,000). Since 2007, the Chinese Society of Neurology, the Hong
Kong Society of Neurology, and the Taiwan Society of Neurology are WFN members.
The mission of the World Federation of Neurology is to improve human health
worldwide by promoting prevention and the care of persons with disorders of the
entire nervous system by: fostering the best standards of neurological practice;
educating, in collaboration with neuroscience and other international public and
private organizations; and facilitating research through its Research Groups and other
means. Dementia, epilepsy and stroke are central areas in the field of activity of the
WFN.
WFN and the Mental health Gap Action Programme (mhGAP)
World Federation of Neurology is especially involved in mhGAP matters through its
Africa Initiative. The WFN Africa Initiative started because WHO had pointed out the
lack of specialists in sub-Saharan Africa, which is dramatically worse than in any other
continent. We need to train more neurologists, and concluded in London 2006 that the
training should be on the African continent to ensure that the candidates return to their
home countries. The following training programs are established:
In established centres in Africa (*French-speaking, +English-speaking trainees):
Western Africa: Dakar*, Abidjan* and Nigeria+, Northern Africa: Rabat*, Cairo+,
Southern Africa: South Africa+ (Cape Town, Johannesburg, Durban).
Horn of Africa: Ethiopia (Addis Ababa).
For the above established centres, the likely return per unit effort or resources is
expected to be high especially in the West African centres. Several sub-Saharan
African neurologists have already been trained in these countries and have returned to
their native countries to practice.
WFN is partnering with the International Brain Research Organization (IBRO) and the
European Federation of Neurological Societies (EFNS) in developing neurology in
Africa. IBRO has organized 20 Neuroscience Schools in Africa, which have provided
opportunities for young African neuroscientists (basic and clinical) to receive high
quality training. EFNS, IBRO and WFN are providing neurology training through
Regional Teaching Courses (RTC), which have been held in Dakar (2008), Addis
Ababa (2009) and Abidjan (2010). The next RTC is planned for July 2011in Yaounde
(Cameroon) where the Government and the University are planning to start a
Neurology Residency programme very soon.
World Federation of Neurology is registered in England as a company limited by guarantee, No. 3502244
Registered Charity No. 1068673
WFN is engaged in initiating Teaching Courses for neurological nurses. The potential
of Khartoum is interesting as the Faculty there has started a series of short training
courses for nurses and other health workers. One such course was performed by
Osheik Seidi in Sudan in 2009, and another is planned for 2011.
The goal is to improve the neurologist/population ratio throughout the continent by
25% in 4 years (general neurology training). WFN works to facilitate inter-university
exchange programs for general and specialized neurology training, facilitate inservice training of the African neurologists, develop leadership among African
neurology trainers and trainees, harmonize neurology training programs and to assist
African countries/sub-regions in the creation of new neurology training centres.
How further collaboration between WHO and WFN can assist in the
implementation of mhGAP
The mhGAP (Mental Health Gap Action Programme) focuses on chronic disorders
within mental health, like schizophrenia, depression, epilepsy and dementia. WHO
hopes for community-based models. Much of the work has to be performed by
nurses. The WHO programme says that “it is effective and feasible to treat people
with epilepsy using inexpensive antiepileptic medicines at primary care level”. We
agree fully, provided that the training in epilepsy is adequate and updated.
Epilepsy affects around 50 million people worldwide, and 80 % of patients with
epilepsy in Africa receive no treatment. One prerequisite for this part of the mhGAP
is the training of health personnel. Each African University Hospital must therefore
have at least one neurologist, who should be responsible for educating nurses and
primary health care workers in neurology (epilepsy, stroke). WFN looks forward to an
improvement and expansion in updated training of health personnel in epilepsy.
References:
1. WHO/WFN. Atlas. Country Resources for Neurological Disorders 2004.
WHO, Geneva 2004.
2. WHO/WFN: Neurological Disorders. Public Health Challenges. WHO,
Geneva 2006.
3. Aarli JA: Addressing Unmet Neurology Needs Worldwide. Neurology Today;
2008, July 17.
4. Aarli JA, Diop AG, Lochmüller H. Neurology in sub-Saharan Africa: A
challenge for World Federation of Neurology. Neurology 2007:69:1715-1718.
5. Njamnshi AK. Nonphysician management of epilepsy in resource-limited
contexts: roles and responsibilities. Epilepsia. 2009 Sep;50 (9):2167-8.
Bergen/London 16 September 2010
Johan A. Aarli
Past President WFN, WFN Representative to WHO
The contribution of the World Psychiatric Association to the mhGAP
The World Psychiatric Association (WPA) is the largest international association in the mental
health field. It includes 135 national psychiatric societies, representing more than 200,000
psychiatrists. Several organizations of users and carers are among its affiliated members.
As part of the mhGAP, the WPA organized with the WHO, in October 2009, a Policy
Roundtable in Abuja, Nigeria, aiming to develop road maps for the nine African countries identified
by the mhGAP as needing intensified support to scale up mental health services: Burundi, Cote
d’Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Liberia, Malawi and Nigeria.
The Roundtable was attended by high-level representatives of those countries, including two
ministers of health. The road maps produced have been shared with the relevant governments, and a
follow-up meeting will take place in December 2010 in Sudan.
The WPA Scientific Sections on Schizophrenia, Addiction Psychiatry, Child and Adolescent
Psychiatry, Suicidology and Old Age Psychiatry and several WPA experts in the area of mood
disorders provided their input in the production of the mhGAP intervention guide.
The WPA is supporting the mhGAP by a donation.
Further WPA activities relevant to the mhGAP include: a) the train-the-trainers workshops
targeting clinical officers and nurses working in the community and aiming to promote the
integration of mental health into primary care, carried out in collaboration with the national
governments and followed by a phase of supervision and follow-up (we had one in Ibadan, Nigeria
in January 2009 and five at different sites in Sri Lanka between June and July 2010); b) the trainthe-trainers workshops on the management of the mental health consequences of disasters and
conflicts (a first one was co-organized with the WHO in Geneva in July 2009; several others have
been held or are going to take place in various regions); c) the programme of one-year fellowships
for young psychiatrists from low and lower middle income countries at centres of excellence in
psychiatry (five fellowships have been already assigned and the selected young psychiatrists are
now working at the University of Pittsburgh, the Institute of Psychiatry in London, the University of
Maryland School of Medicine, the Case Western Reserve University in Cleveland and the
University of Melbourne); d) the recently produced WPA guidance on steps, obstacles and mistakes
to avoid in the implementation of community mental health care, which will be translated in several
languages; e) the production of a set of recommendations about best practices in working with
service users and carers; f) the international research project on physical health in people with
severe mental disorders, including several centers in low and lower middle income countries; g) the
WPA programme on depression in persons with physical diseases, with materials available now in
14 different languages; h) the dissemination of World Psychiatry, the official WPA journal, which
is produced in several languages, reaches in its printed versions more than 33,000 psychiatrists in
121 countries and is freely available on the PubMed system.
World Vision International
Mental Health Gap Action Programme (mhGAP)
About World Vision International (WVI)
“Our vision for every child, life in all its fullness; Our prayer for every heart, the will to make it so”
World Vision is a Christian relief, development and advocacy organisation dedicated to working
with children, families and communities to overcome poverty and injustice. Inspired by our
Christian values, we are dedicated to working with the world’s most vulnerable people. We serve
all people regardless of religion, race, ethnicity or gender. World Vision is a federal partnership
working in almost 100 countries worldwide, serving more than 100 million people.
WVIs work in Mental Health and Psychosocial Support (MHPSS)
Historically, alongside majority of humanitarian relief and development agencies, WVI has focused
on concrete activities that address the visible impacts of poverty. WVI now acknowledges that
both the tangible and intangible aspects of peoples’ lives contribute to poverty and
disempowerment of children, families and their communities. In the past decade, WVI has
increased its attention to the mental health and psychosocial support (MHPSS) needs of people in
emergency and developing contexts.
WVI has already contributed significantly to the practice of MHPSS programs through a range of
community based psychosocial activities. To improve the organisation’s coordination and
information-sharing in MHPSS programs, a WVI MHPSS Working Group has been established
through WVIs Global Centre. The goal of this group is “To build the World Vision partnership’s
interest and expertise in MHPSS programming to support children, families and communities to reach their
full potential and experience ‘life in all its fullness’.”
Specific objectives of WVIs MHPSS working group include:
• Establishing an information and knowledge base about MHPSS that will be accessible for
WVI staff;
• Developing and expanding evidence-based MHPSS programs for WVI to implement as part
of humanitarian and development programs;
• Collaborating with internal and external partners to promote MHPSS in WVI and in the
broader mental health and humanitarian sectors.
WVIs work in the MHPSS sector has begun work in earnest towards reducing the mental health gap
in low and middle income countries. Some of the significant work over recent years has included:
• Development and validation of an Interpersonal Psychotherapy for Groups (IPT-G) program
for people living with depression, anxiety and/or significant symptoms of trauma;
• Collaboration with War Trauma Foundation and World Health Organisation to develop a
Psychological First Aid Guide for low and middle income countries;
• Piloting Trauma-Focused Cognitive Behaviour Therapy (TF-CBT) approaches for supporting
children affected by child-trafficking
• Implementation of a rehabilitation program for former child soldiers in northern Uganda;
• Co-Chairing of the IASC MHPSS Reference Group (with UNICEF);
• Supporting the integration and scale-up of the IASC Guidelines on Mental Health and
Psychosocial Support in Emergency Settings (IASC, 2007) throughout WVI and through
inter-agency initiatives;
• Supporting the integration and scale-up of community-based psychosocial support activities
across the standard WVI programming models;
•
•
•
•
Working towards the integration of MHPSS activities as a cross-cutting concern for all
other sectors, such as nutrition, early childhood development, education, livelihoods, health,
water and sanitation and child protection;
Increasing international staff capacity to design and implement MHPSS activities and/or
programs in emergency and development contexts;
Developing organisation-wide communications guidelines to promote and advocate for
MHPSS needs and issues;
Exploring ways for WVI to establish monitoring and evaluation indicators to increase the
organisations capacity to measure impacts of MHPSS activities and programs.
WVI collaborations sought to assist in the implementation of mhGAP.
WVI is interested in continued collaboration with other organisations to develop our MHPSS
programs and responses, which is ultimately intended to assist in achieving the mhGAP objectives.
With organisational interest growing in MHPSS a range of partnership opportunities exist. WVI has
identified the following areas as priorities for future collaboration:
•
•
•
•
•
•
•
Exploring partnerships with agencies to support the roll-out of the Psychological First Aid
Guide for low and middle income countries;
Developing training and partnership arrangements that have potential to provide WVI with
surge capacity for MHPSS responses in
emergencies;
Developing validated materials that can
support the combined needs of spiritual
nurture and MHPSS in emergencies as
well as developing contexts;
Establishing a network of human
resources that can be utilised to support
the design and evaluation of MHPSS
programs;
Developing WVI guidelines for
implementing MHPSS programs,
including supervision and other ethical
requirements and responsibilities;
Exploring partnerships with academic
institutions for research opportunities,
particularly around alternative
interventions for community-based
mental health activities.
Use our influence as a large global
development organisation to make the
case for governments and other
development actors to pay greater
attention to mental health and identifies
specific actions that can be taken.
"Unflinching in its candor, Unlisted, reminds me of the incredible power that
one compelling story can have in shaping the way we think about major societal
issues." HELENE GAYLE, PRESIDENT OF CARE
This Award Winning documentary is the focus of a major Mental Illness
Awareness Campaign in the US involving national TV, nationwide screenings,
and press. The goal is to inspire individuals and families to come out about
their own experiences with mental illness so to:
• Expose the crisis of families fractured by untreated mental illness
• Help individuals and families get support and services
• Dispel myths and reduce stigma
Physician and filmmaker Delaney Ruston spent years hiding from her dad,
unlisted in the phone book, because his untreated schizophrenia was so out of
control. Now that her dad is finally receiving treatment and services, Delaney
decides to reconnect…..and to film her journey. As a doctor Ruston has seen
how untreated mental illness tears families apart…but is rarely discussed.
Her story aims to change that.
The film is now available to aid your work in encouraging people to learn more and
share their stories. For a FREE DVD contact: westermeyerr@who.int or
Delaneyruston@gmail.com
www.unlistedfilm.com has free downloadable Screening Tool Kit
*** Where in the World is Mental Health? is Ruston’s documentary inproduction exploring global mental health. Thus far filming has occurred in
France, China, India, and the US. Ruston welcomes your insights on this topic
and film project (email above) To learn more visit www.unlistedfilm.com and
see the trailer under “more films”.