Session 2: Mike Davies

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MENTAL HEALTH IN LOW- AND MIDDLE-INCOME COUNTRIES

NEEDS, RESOURCES, ISSUES AND APPROACHES

MIKE DAVIES OBE

cbm

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CBM

• Formerly the Christian Blind Mission or Christoffel Blindenmission

• Founded 104 years ago• Today, providing technical and financial

support to 740 disability-related programmes in 89 countries

• Reaching > 23 million people in 2010• Mostly funded by individual donations

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NATURAL DISASTERS HAVE ACCELERATED CBM’S INVOLVEMENT IN COMMUNITYMENTAL HEALTH

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NEEDS

• 450 million people worldwide have psycho-social problems , including -

• 150 million with depression• 90 million with substance abuse disorders• 25 million with schizophrenia

(World Health Report 2001)

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RESOURCES

• Europe : One psychiatrist for 10,000 people• Africa : One psychiatrist for 200,000 people

IN LOW- AND MIDDLE INCOME COUNTRIESLESS THAN 1% OF THE HEALTH BUDGET IS

SPENT ON MENTAL HEALTH (WHO Mental Health Atlas 2005)

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MASS GRAVE- ACEH

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TREATMENT RATE

• cbm estimates that in developing countries, between 80 and 90% of persons with psychosocial problems do not get treatment of any kind

• For the vast majority, no accessible or affordable treatment option exists

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HOW TO BRIDGE THEGAP BETWEEN NEEDSAND RESOURCES?

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NCD SUMMIT (Sept 2011)

• Focused mainly on cancers, cardiovascular disease, chronic respiratory disease and diabetes.

By 2020, depression alone will be the second ranked disease burden, after cardiovascular disease

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CBM’S RESPONSE

• A paradigm shift towards community mental health work, with treatment emphasis at primary and secondary levels

• Multi-tiered intervention strategy focused on local capacity development, access to appropriate treatment, social integration, family counselling & support, livelihood development, advocacy to reduce stigma and prejudice, and empowerment of users and carers groups.

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UNCHAININGPEOPLE

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DUAL MODELS

1. Community mental health services, concentrating exclusively on people with psychosocial problems

2. Inclusion of persons with psychosocial problems in cross-disability, multi-intervention community-based rehabilitation (CBR) programmes

CBM UK 5th January 2012 18CBR guidelines April 13, 2023 18

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IN 2010 cbm…

• Helped 101,000 people with psychosocial problems in 31 countries

• Supported the work of 18 local mental health professionals

• Met the training costs of 44 mental health professionals

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The mayor’s solution?Put him on the bus to the next town…

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STRENGTHS

• Strong network of partners at all levels (local, national, international)

• Support for users groups and self-help groups

• The move towards inclusive approaches• Cost-effective interventions at community

level

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WEAKNESSES

• Not enough ‘care for the carers’• Preventive and promotional work remains

weak• Partner overload• Not enough time to do training• Insufficient evidence that inclusive

approaches work

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OPPORTUNITIES

• Emergency relief work• Involving community and religious leaders• Advocacy to influence policy/funding support• More central roles for user groups

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THREATS

• Biomedical orientation of government systems

• Lack of public/private partnerships• Professional resistance to community-based

MH approaches• Focus on 3ry care as first choice intervention• Many professionals don’t want to work where

they are most needed

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PEOPLE WITH PSYCHOSOCIAL PROBLEMS ARE INCREASINGLY INVOLVED IN PLANNINGCOMMUNITY MENTAL HEALTH PROGRAMMES

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THE WAY FORWARD

• Empowering user organisations & SHGs• Promotion of positive mental health• Capacity-building at all professional levels• Balance between medical, social and livelihood

interventions• Structured monitoring & evaluation leading to

systematic improvements of services• Stronger advocacy with governments• Staff care/burn-out prevention

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QUOTES FROM A ‘USER’

• “There are two critical issues in mental health today – a) the excessive medicalisation of human suffering and distress, and b) the widespread human rights abuses of people society labels as ‘mad’, ‘disturbed’ or ‘mentally ill’”

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QUOTES FROM A ‘USER’

• “The primary crisis in mental health is not the lack of economic resources or the need for better technologies… the crisis is a social, cultural and political one that requires changing how we think about madness, suffering and emotional pain”

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QUOTES FROM A ‘USER’

• “The UN Convention on the Rights of Persons with Disabilities is a clear and comprehensive blueprint … a human rights and social inclusion framework that represents a shift away from the medical model to a social model of disability. This is precisely what is needed in mental health”

In 2006, David Webb completed his PhD on suicide – the first thesis of its kind by someone who has attempted suicide. David has been a board member of the World Network of Users and Survivors of Psychiatry. His book ‘Thinking About Suicide’ was published in the UK in 2010, by PCCS Books

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BEFOREChained toa tree

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AFTERGrowing vanilla

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THANK YOU

cbm UKwww.cbmuk.org.uk

Tel – 1223 - 484700

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GLOBAL DISEASE BURDEN

• Of the 15 main types of disease affecting women in LOMICs, six are psychosocial –

depression (ranked 1), schizophrenia (4), bipolar disorder (7), self-inflicted injury (8), panic disorder and substance abuse

(WHO, Global Disease Burden, 2004)