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Challenges and priorities for global mental health in the Sustainable Development Goals (SDG) era

ACADEMY OF MEDICAL SCIENCES
June 2018

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Published in 2011, the Grand Challenges in Global Mental Health initiative provided a framework to guide the research needed to improve treatment and prevention of mental health disorders and expand access to mental health services. At the Academy’s workshop on global mental health participants reflected on progress since 2011, focusing on specific life-course stages, and identified priorities for research in treatment and prevention, as well as enduring challenges and emerging opportunities

Community mental health: Theory, practices and perspectives

WYNGAERDEN, Francois
May 2018

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Mental health problems are commonplace and affect more than one in four people worldwide. They are responsible for a quarter of all disabilities. This document aims to provide a basis for exploring these concepts as part of more in-depth work, including an update of the 2011 mental health framework document.

 

A seminar was held in Kigali, Rwanda on 7 - 9 December 2017. It brought together 45 participants from 12 countries to think about and discuss community mental health concepts and practices. The objectives of this document are twofold:

• Set out analysis by an external expert, with a focus on community mental health at HI, in light of the literature and concepts and practices within the sector

• Undertake preliminary work to identify new concepts for implementation, based on the aspects covered in the seminar, as part of ongoing in-depth work in this area, including the updating of the 2011 mental health framework document.

 

Case histories from Rwanda, Lebanon and Madascagar are given. There is an extensive bibliography in the Annex

 

This document is intended for HI and partner staff members who work in the mental health and psychosocial support sector. It is also intended for HI staff working on mental health strategy. It can also be used to feed into the work of field staff developing, implementing and assessing mental health and psychsocial support programmes

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies

PETERSEN, Inge
et al
February 2017

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The aim of this study was to identify key governance issues that need to be addressed to facilitate the integration of mental health services into general health care in the six participating "Emerald" countries (Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda).  The study adopted a descriptive qualitative approach, using framework analysis. Purposive sampling was used to recruit a range of key informants, to ensure views were elicited on all the governance issues within the expanded framework. Key informants across the six countries included policy makers at the national level in the Department/Ministry of Health; provincial coordinators and planners in primary health care and mental health; and district-level managers of primary and mental health care services. A total of 141 key informants were interviewed across the six countries. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesised at a cross-country level.

Mental health and trauma in asylum seekers landing in Sicily in 2015: a descriptive study of neglected invisible wounds

CREPET, Anna
RITA, Francesco
REID, Anthony
et al
January 2017

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While the medical conditions of newly migrated asylum seekers to Sicily were being addressed, the mental health of those who may have experienced trauma before, during, or after their migration was not addressed. "Médecins sans Frontières (MSF), in agreement with the Italian Ministry of Health, provided mental health (MH) assessment and care for recently-landed asylum seekers in Sicily. This study documents mental health conditions, potentially traumatic events and post-migratory living difficulties experienced by asylum seekers in the MSF programme in 2014–15." 

Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal

ACHARYA, Bibhav
MARU, Duncan
SCHWARZ, Ryan
et al
January 2017

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"Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation."

Mad studies: Intersections with disability studies, social work, and mental health

INTERSECTIONALITIES, A GLOBAL JOURNAL OF SOCIAL WORK, ANALYSIS,RESEARCH, POLITY AND PRACTICE
December 2016

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A special issue of the online journal "Intersectionalities - A Global Journal of Social Work Analysis, Research, Polity, and Practice", Vol 5, No.3 (2016) providing 10 articles on the theme of Mad studies. Titles of papers included are: 

Doing Mad Studies: Making (Non)sense Together; 

An Introduction to Anti-Black Sanism; 

Why Mad Studies Needs Survivor Research and Survivor Research Needs Mad Studies; 

Recovery-as-Policy as a Form of Neoliberal State Making; 

“About Nothing Without Us”: A Comparative Analysis of Autonomous Organizing Among People Who Use Drugs and Psychiatrized Groups in Canada; 

Too Young to Be Mad: Disabling Encounters with 'Normal' from the Perspectives of Psychiatrized Youth; 

Relocating Mad_Trans Re_presentations Within an Intersectional Framework; 

A Desire to be ‘Normal’? A Discursive and Intersectional Analysis of ‘Penetration Disorder’; 

Racialized Communities, Producing Madness and Dangerousness; 

Psy-Times: The Psycho-Politics of Resilience in University Student Life

Not forgetting severe mental disorders in humanitarian emergencies: a descriptive study from the Philippines

WEINTRAUB, Ana Cecilia Andrade de Moraes
et al
November 2016

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"In response to the Typhoon Haiyan in the Philippines, Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB) decided to concentrate its efforts in the severely affected area of Guiuan and its four surrounding municipalities. The MSF-OCB intervention included a comprehensive approach to mental health, including care for people with pre-existing and post-disaster severe mental disorders. Based on this experience of providing MH care in the first five months after Typhoon Haiyan, we report on the monthly volume of MH activities and beneficiaries; sociodemographic and care seeking characteristics of beneficiaries receiving MH counselling/care, stratified by the severity of their condition; profile and outcomes of patients with severe mental disorders; prescribing practice of psychotropic medication; and main factors facilitating the identification and management of individuals with severe mental disorders"

International Health, Vol.8, No.5, pp. 336-344

Doi: 10.1093/inthealth/ihw032

Problem Management Plus (PM+) Individual psychological help for adults impaired by distress in communities exposed to adversity

WORLD HEALTH ORGANIZATION
2016

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With this manual, the World Health Organization (WHO) is responding to requests from colleagues around the world who seek guidance on psychological interventions for people exposed to adversity.

The manual describes a scalable psychological intervention called Problem Management Plus (PM+) for adults impaired by distress in communities who are exposed to adversity. Aspects of Cognitive Behavioural Therapy (CBT) have been changed to make them feasible in communities that do not have many specialists. To ensure maximum use, the intervention is developed in such a way that it can help people with depression, anxiety and stress, whether or not exposure to adversity has caused these problems. It can be applied to improve aspects of mental health and psychosocial well-being no matter how severe people’s problems are.

Improving Ghana’s mental healthcare through task-shifting-psychiatrists and health policy directors perceptions about government’s commitment and the role of community mental health workers

AGYAPONG, Vincent
et al
October 2016

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The aim of this study was to examine the perceptions of psychiatrists and health policy directors about the policy to expand mental health care delivery in Ghana through a system of task-shifting from psychiatrists to community mental health workers (CMHWs). A self-administered semi-structured questionnaire was developed and administered to 11 psychiatrists and 29 health policy directors. Key informant interviews were also held with five psychiatrists and four health policy directors. .

Globalization and Health (2016) 12:57

DOI 10.1186/s12992-016-0199-z

The promise and the reality: a mental health workforce perspective on technology-enhanced youth mental health service delivery

ORLOWSKI, Simone
LAWN, Sharon
MATTHEWS, Ben
et al
October 2016

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Digital technologies show promise for reversing poor engagement of youth (16–24 years) with mental health services. In particular, mobile and internet based applications with communication capabilities can augment face-to-face mental health service provision. Results of in-depth qualitative data drawn from various stakeholders involved in provision of youth mental health services in one Australian rural region are described. Data were obtained using focus groups and semi-structured interviews with regional youth mental health clinicians, youth workers and support/management staff and analysed via inductive thematic analysis. Six main themes were identified: young people in a digital age, personal connection, power and vulnerability, professional identity, individual factors and organisational legitimacy. 

 

DOI: 10.1186/s12913-016-1790-y

Being a refugee in Turkey and western Europe: how it affects mental health and psychosocial wellbeing

JOURNAL OF MENTAL AND PSYCHOSOCIAL SUPPORT IN CONFLICT AFFECTED AREAS
September 2016

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"In this personal reflection, the author is a Syrian refugee who describes his experiences as a psychosocial worker in Syria and with refugees in Turkey and Greece. He highlights how women and children lack safety in the camps. The second section discusses how he became a refugee himself. Due to his experiences in Syria, he now finds himself in a difficult situation in the Netherlands, the county where he applied for asylum and has received a permit, but his ‘cry for help’ remains unheard and unrecognised by the (health) workers in the asylum centre."

Mental health and psychosocial support for South Sudanese refugees in northern Uganda: a needs and resource assessment

ADAKU, Alex
et al
September 2016

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Since December 2013, an armed conflict in South Sudan has resulted in the displacement of over 2.2 million people, more than 270,000 of whom were, at the time of the research, in refugee settlements located throughout Uganda. A mental health and psychosocial support (MHPSS)​MHPSS needs and resource assessment was carried out in Rhino Camp refugee settlement in northern Uganda, between June and August 2014 following World Health Organization (WHO) and United Nations High Commissioner for Refugees (UNHCR) guidelines for MHPSS needs assessments in humanitarian settings. The assessment used a range of methodologies including: 1) a desk (literature) review to understand the context for mental health service provision; 2) an analysis of data from existing health information systems (HIS); 3) an assessment of the current infrastructure for service provision using a shortened version of a Who does What Where until When (4Ws); and 4) semi-structured individual and group interviews (total n = 86) with key informants (n = 13) and general community members (individual interviews n = 28, four focus groups with n = 45).

Mental health problems in Juba, South Sudan: local perceptions, attitudes and patient care - A socio-anthropological study

LOHINIVA Anna-Leena
May 2016

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Mental health programming is important in post-conflict settings such as South Sudan. Handicap International is currently implementing a project entitled “Touching Mind, Raising Dignity; to stop the stigma toward people with mental health problems” which aims to improve the social and community involvement of people living with mental health problems. This qualitative research study was conducted to understand local concepts linked to mental health problems and health-seeking in order to develop effective mental health interventions in the context of Juba, South Sudan. The study was conducted in four locations in Juba among community members, people with mental health problems, their caregivers and service providers. Focus group discussions & in-depth interviews were conducted with a total of 130 study participants. The interviews were conducted in English or by translating from Juba Arabic. The data was analysed using thematic analysis. Respondents used two wide categories when discussing people with mental health problems: mad (majnun) and sad and tired (mariid= sick). Substance abuse related madness and maratsarra (epilepsy) were genuine community concerns. Mild signs and symptoms were not recognized as mental health problems, the causes of mental health problems were viewed as numerous and complex, and mental health problems were believed to be common in South Sudan. 

Mental health funding and the SDGs What now and who pays?

MACKENZIE, Jessica
KESNER, Christie
May 2016

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"This report provides an overview of who is currently funding mental health and who isn’t, but could be. It is a synthesis of research previously conducted in this field and analyses both existing and new funders. It highlights how little information there is on what donors are spending on mental health globally, what types of activities are funded and why funding mental health delivers a variety of benefits, and it suggests how to frame the issue to encourage more investment".

Living in hell : how people with mental health conditions in Indonesia are treated

HUMAN RIGHTS WATCH (HRW)
March 2016

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This report examines the abuses—including pasung—that persons with psychosocial disabilities face in the community, mental hospitals, and various other institutions in Indonesia, including stigma, arbitrary and prolonged detention, involuntary treatment, and physical and sexual violence. It also examines the government’s shortcomings in addressing these problems.

Based on research across the Indonesian islands of Java and Sumatra, Human Rights Watch documented 175 cases of persons with psychosocial disabilities in pasung or who were recently rescued from pasung. 

 

Living in hell : abuses against people with psychosocial disabilities in Indonesia

HUMAN RIGHTS WATCH (HRW)
March 2016

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This article with a video is related to a report examining the abuses—including pasung—that persons with psychosocial disabilities face in the community, mental hospitals, and various other institutions in Indonesia, including stigma, arbitrary and prolonged detention, involuntary treatment, and physical and sexual violence. It also examines the government’s shortcomings in addressing these problems.

Based on research across the Indonesian islands of Java and Sumatra, Human Rights Watch documented 175 cases of persons with psychosocial disabilities in pasung or who were recently rescued from pasung. 

 

Emergence and structuring of support groups for people living with mental health problems in Togo, Madagascar, Lebanon and South Sudan

CALVOT Thomas,
PEGON Guillaume
February 2016

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"Based on an ethnographic type baseline study conducted on four support groups for people living with mental health problems, evolving in various contexts (prisons, hospitals, refugee camps and mental health centres) in Madagascar, Lebanon, South Sudan and Togo, this study identifies four dynamics contributing to the emergence and the structuring of these groups: survive, get medical care, get organised, advocate." 

Interventions for children affected by armed conflict: a systematic review of mental health and psychosocial support in low- and middle-income countries

JORDANS, Mark. J. D.
PIGOTT, Hugo
TOL, Wietse A
January 2016

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Over one billion children under the age of 18 live in countries affected by armed conflict. This systematic review replicates an earlier study, aiming to provide a comprehensive update of the most current developments in interventions for children affected by armed conflict. For the period 2009– 2015, a total of 1538 records were collected. Twenty-four studies met the inclusion criteria, and the included interventions involve data from 4858 children. Two types of analysis were conducted. First, for an account of intervention descriptions, thematic analysis was used to summarise themes, with a specific focus on cultural adaptations. Second, all evaluation studies reporting quantitative data were categorised into level of evidence (1 = randomized controlled trials, all types; 2 = quasi-experimental design and controlled studies; 3 = non-controlled design; 4 = case studies) 

Current Psychiatry Reports, vol 18 (9), doi:10.1007/s11920-015-0648-z

Globalising mental health or pathologising the global south? : mapping the ethics, theory and practice of global mental health

MILLS, China
FERNANDO, Suman
Eds
2014

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In response to moves from the World Health Organisation (WHO) and the Movement for Global Mental Health (MGMH) to redress the unequal access to mental health care in low and middle-income countries (LMIC) compared to high-income countries (HICs), the papers in this special issue of Disability and the Global South seek to highlight the issues of simply exporting a system developed in the global North irrespective of social and cultural context and lay the ground for (re)imagining and practising healing and support differently in LMICs and in HICs. The issue is a collection of 14 articles, including voices from the field

Disability and the Global South, Vol. 1, No.2

Field based training for mental health workers, community workers, psychosocial workers and counselors : a participant-oriented approach

VAN DER VEER, Guus
FRANCIS, Felician Thayalara
July 2011

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"This article discusses the training of mental health workers whose basic job is with clients that have been seriously affected by armed conflict and/or natural disasters by using ‘helping through talking’, and who have had little education that is relevant to this work. It sums up the characteristics required of the workers, their learning needs, the messages that the training needs to convey, and the characteristics and potential contents of a tailor made, participants-oriented programme"
Intervention, Vol 9, Issue 2

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