A NEW MOVEMENT FOR GLOBAL MENTAL HEALTH AND ITS

1 LOCATION AND MOVEMENT CONTROL (SPECTRUM PROCEDURE LOCATION AND
10 GENERAL APPROACH TO HYPERKINETIC MOVEMENT DISORDERS PROFESSOR
112 INDIVIDUALS IN MOVEMENTS A SOCIAL PSYCHOLOGY OF CONTENTION

13 THE ORGANIZED BLIND MOVEMENT IN IOWA PROGRESS PERIL
4 WHAT ARE SOCIAL MOVEMENTS AND WHAT IS GENDERED
9 BASIC MOVEMENTS OF CROSSFIT FOUNDATIONS 1 AIR SQUAT

A new Movement for Global Mental Health and its possible impact in Nigeria

A new Movement for Global Mental Health and its possible impact in Nigeria

Author:

Dr Julian Eaton, MRCPsych

CBM Mental Health Advisor, West Africa

P.O Box 8451, Wuse, Abuja, Nigeria

[email protected]

Key Words:

Community mental health services; Human Rights; Africa; Nigeria

Word count:

Summary – 94 words

Main Article – 796

Summary:

Despite international guidelines and a strong evidence base, most low- and middle- income countries have failed to make the transition to community-based services to meet the needs of people with mental illness. Nigeria, despite its strong academic history in psychiatry, has also failed to make this shift.

The launch of a new Movement for Global Mental Health, by making resources available on-line, and building a strong advocacy network, should re-energise efforts to modernise services. Professionals in Nigeria should seize this opportunity to join what will be a significant area of research in the future.

Introduction

The 2001 World Health Report; New Understanding, New Hope (WHO, 2001) was a landmark document in the field of international mental health service development. It highlighted the emerging evidence relating to the burden of mental health problems (Murray and Lopez, 1996; IOM, 2001), and the lack of an effective response to it. Importantly, it also outlined the principle of using evidence-based approaches to bridge this treatment gap. Since then, there have been a series of important documents analysing the situation (WHO, 2005), and issuing guidelines to practice (WHO, 2004, 2008). All have reinforced the message that the quality of life of people with mental health problems can be improved with access to community-based mental health services, and appropriate legislation to address the social exclusion and human rights abuse they suffer.

Developing services in an evidence-based manner

In many higher income countries, there has been a profound revolution in the shape of services along these lines, with good evidence of its efficacy (Leff, 1997). The lack of progress in achieving such a change in low- and middle-income countries (LMIC) is well recognised, despite some notable efforts (Cohen, 2001). In 2007, The Lancet commissioned a series of papers to review the current situation (Jacob et al, 2007; Saxena et al), to assess the body of evidence related to treatment in LMICs (Patel et al, 2007), and to identify barriers to change (Saraceno et al, 2007).

Many of the findings are familiar in the Nigerian context. Services are generally centred around a small number of specialist hospitals, there are few professionals, and resources allocated to mental health are inadequate and inequitably distributed (Gureje, 2003). In Nigeria only 2.2% of Gross domestic Product (GDP) is spent on health, and of this less than 1% is allocated to mental health (WHO, 2005). The result is that the majority of cases do not receive the care they need (Gureje, 2002). As is the case in much of Africa (where less than 50% of countries have a mental health policy), the legislative process has stalled due to lack of political will and ineffective advocacy (WHO, 2005). Policy that has been adopted (FMOH, 1991) has not been implemented.

Despite these barriers, there are signs that Nigeria is joining the drive to bring about meaningful change. A new process of updating policy has received WHO support, and various practical programmes have shown good results (Eaton and Agomoh, 2007). Nigeria’s academic history is strong, and remains so. The evidence base for effective service models is increasing (Thornicroft and Tansella, 2004; Patel et al, 2007). The challenge now is to draw on the momentum of international initiatives to scale up community-based services and initiatives to combat human rights abuses (Aina et al, 2007), in ways that works in practical ways in Nigeria (Gureje, 2007). This presents an opportunity for academics and practitioners in Nigeria to reinforce their credentials as leaders in African psychiatric research.

The Movement for Global Mental Health

The final Lancet paper ends with a call to greater urgency in efforts to distil evidence-based knowledge and experience in addressing these problems (Chisholm et al, 2007). The emphasis is on action, and one of the vehicles for this action is the Movement for Global Mental Health, which was launched on World Mental Health day in 2008 (Horton, 2008). It aims to provide information and practical guidance for those who sign up to its main aims;

1. The immediate scaling up of the coverage of services for mental disorders especially in low and middle income countries, based on an evidence-based package of affordable and accessible community-based services for core mental disorders

2. A new commitment to the protection of the human rights of persons with mental disorders and their families.

3. New funding for mental health both as health assistance to low and middle-income countries from international donors and lending agencies, and in budget allocations from governments (a minimum increase in investment within 10 years of US$2 per head in low-income countries and US$3–4 in middle-income countries)

This will be done through creation of an interactive website (www.globalmentalhealth.org) where information resources can be shared. It already contains a wide range of information; some from academic sources, but also experiences and lessons learnt from practitioners in the field (Patel et al, 2008).

The Movement is not just about sharing information, it aims to bring about change by mobilising resources through effective advocacy. It is a mass movement, which will be more effective if it has a large membership experienced in the realities of working in low and middle income countries, therefore, those who share the principles above are encouraged to go to the website, and join.

References

Aina OF, Ladapo HTO, Lawal RA, Owoeye OA. Community-orientated services in a psychiatric hospital. Efforts to reduce stigmatization. Nigerian J Psychiatry 2007; 5 (1):19-25

Chisholm D, Flisher AJ, Lund C, Patel V, Saxena S, Thornicroft G, Tomlinson M –The Lancet Global Mental Health Group. Scale up services for mental disorders: a call for action. Lancet 2007; 370:1241-52

Cohen A. The effectiveness of mental health services in primary care: the view from the developing world. Geneva: WHO, 2001

Eaton J and Agomoh AO. Developing mental health services in Nigeria: The impact of a community-based mental health awareness programme. Soc Psychiatry Psychiatr Epidemiol 2008; 43(7):552-558

Federal Ministry of Health. The National Mental Health Policy in Nigeria. Lagos: Federal Ministry of Health, 1991

Gureje O. Psychological disorders and symptoms in primary care: association with disability and service use after 12 months. Soc Psychiatry Psychiatr Epidemiol 2002; 37:220-4

Gureje O. Country Profile: Psychiatry in Nigeria. Int Psych 2003; 2:10-12

Gureje O, Chisholm D, Kola L, Lasebikan V, Saxena S. Cost-effectiveness of an essential mental health intervention package in Nigeria. World Psychiatry 2007; 6:42-48

Horton R. Editorial: A Movement for Global Mental Health is launched. Lancet 2008; 372:1274

Institute of Medicine. Neurological, Psychiatric and Developmental Disorders. Meeting the Challenge in the Developing World. Washington DC: National Academy Press, 2001

Jacob KS, Sharan P, Mirza I, Garrido-Cumbrera, Seedat S, Mari JJ, Sreenivas V, Saxena S. Mental heath systems in countries: where are we now? Lancet 2007; 370:1061-1077

Murray CJL and Lopez AD. The global burden of disease Vol 1. A comprehensive assessment of the mortality and disability from diseases, injuries and risk factors in 1990, and projected to 2020. Cambridge MA: Harvard University Press, 1996

Leff J. Care in the Community. Illusion or reality? London: Wiley, 1997

Patel V, Araya R, Chatterjee S, Chisolm D, Cohen A, De Silva M, Hosman C, McGuire H, Rojas G, van Ommeren M. Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet 2007; 370:991-1005

Patel V, Garrison P, Mari J de J, Minas H, Prince M, Saxena S. The Lancet’s Series on Global Mental Health: 1 year on. Lancet 2008; 372:1354-1357

Saraceno B, van Ommeren M, Batniji R, Cohen A, Gureje O, Mahoney J, Sridhar D, Underhill C. Barriers to improvement of mental health services in low-income and middle-income countries. Lancet 2007; 370:1164-74

Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet 2007; 370:878-89

Thornicroft G and Tansella M. Components of a modern mental health service: a pragmatic balance of community and hospital care: overview of systematic evidence. Br J Psychiatry 2004; 185:283-90

World Health Organisation. World Health Report. Mental Health: new understanding, new hope. Geneva, Switzerland: WHO, 2001

World Health Organisation. Mental Health Policy, Plans, and Programmes. Geneva, Switzerland: WHO, 2004

World Health Organisation. Atlas: Mental Health Resources in the World. Geneva, Switzerland: WHO, 2005

World Health Organisation. mhGAP Mental Health Gap Action Programme; Scaling up care for mental, neurological, and substance use disorders. Geneva: WHO, 2008

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