Mental Health: Think Globally, Act Locally
By Thomas Insel on July 06, 2011
Accessing mental health care can be a struggle for many people around the world, in high- as well as middle- and low- income countries, and may be intertwined with a host of other, seemingly unrelated difficulties. For example, a recent story on Public Radio International reported that, for men and women with mental illness in Uganda, access to care is one part of the treatment, but securing a livelihood is an equally important next step; yet, few organizations offer assistance, and discrimination against people with mental disorders can reduce opportunities. As the ranks of unemployed and underemployed Americans continue to grow, this story is becoming more common in the U.S. as well.
These global commonalities represent an opportunity for us to learn from the experiences in other countries or among other cultures to help improve mental health care in the U.S. Using the wisdom of global shared experience, along with varied perspectives, might help psychiatry as a field to find reasonable and rational solutions to reduce the burden of mental illness. At the same time, a coordinated, global response to the major problems facing people with mental illness could speed progress toward solutions.
Today, Nature published the Grand Challenges in Global Mental Health, a synthesis of the views of more than 400 researchers, advocates, and clinicians working in more than 60 countries on mental health issues. Research specifically focused on solving these challenges could significantly transform the field and the lives of people with mental disorders. This initiative provides many reasons for excitement, but three in particular are foremost in my mind.
First, borrowing the World Health Organization's approach, the group focused on mental, neurological, and substance use (MNS) disorders. From a research and a clinical perspective, grouping these types of disorders makes sense. A better understanding of the developing brain as it processes the daily social and environmental exposures that create human experience will help us to avert these disorders. From the perspective of service delivery, this unified approach makes even more sense. Many of these conditions are co-morbid, and effective health systems capitalize on the benefits of multi-disease management 1. In countries that lack neurologists and psychiatrists, nurses and general practitioners must be equipped to identify and treat people with MNS disorders in addition to the other medical conditions that often accompany them.
Second, the Grand Challenges are timely. In the last year in particular, there has been a growing recognition of the importance of mental disorders in the global public health community. The World Health Organization released its Mental Health Gap Action Plan Implementation Guide (mhGAP-IG), and in October, the World Mental Health Summit will mark the 4th anniversary of the Lancet Mental Health Group's Call for Action for scaling up services for mental disorders. This year also marks the 20th anniversary of the "Principles for the protection of persons with mental illness and the improvement of mental health care," adopted by the UN General Assembly in 1991. Funders have also responded to the growing momentum to study the provision of mental health care services globally. For example, the Department for International Development in the United Kingdom announced funding of up to 7.5 million pounds toward research on improving mental health services in low-and middle-income countries.
Likewise, NIMH has increased its investment in mental health research in low- and middle-income countries through its Collaborative Hubs for International Research on Mental Health. The message of the Grand Challenges initiative is, however, that rich and poor countries alike need to focus their attention on research that will improve the lives of people with MNS disorders. The stage is being set for truly collaborative efforts across countries that will enable the U.S. to learn from innovations in Uganda and vice versa.
Third, the Grand Challenges list priorities that will require investment in basic science as well as health services research. Equally important is research that informs policies. Translation of research to policy will be critical to avert social exclusion and marginalization—this enables people to live full lives when they do develop these disorders—and to provide the protections to staff and patients necessary for safe, humane, high quality care. This initiative provides an opportunity for research funders to take up one of the challenges or one or more of the research goals. But, the message is not to research funders alone. It's a global initiative in another sense: it requires participation and cooperation across sectors to get the job done.
Lifting the considerable burden of these disorders doesn't only benefit individuals with MNS disorders. For example, improving access to appropriate care may also translate to increased productivity through greater ability to attain and maintain work. These effects, in turn, may ease stress and financial burdens borne by an individual's family and other support systems. As such, the Grand Challenges in Global Mental Health offer an unprecedented opportunity to make significant, meaningful advances, not only in global mental health, but perhaps in the quality of life for us all.
1 Katon WJ, Lin EH, Von Korff M, Ciechanowski P, Ludman EJ, Young B, Peterson D, Rutter CM, McGregor M, McCulloch D. Collaborative care for patients with depression and chronic illnesses. N Engl J Med. 2010 Dec 30;363(27):2611-20. PubMed PMID: 21190455.
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