Grand Challenges in Global Mental Health: Integration and Implementation in Research, Policy, and Practice
Office for Research on Disparities and Global Mental Health (ORDGMH)
National Institute of Mental Health (NIMH)
On April 2-3, 2012, ORDGMH, in the Office of the Director of NIMH, hosted a workshop in support of the Grand Challenges in Global Mental Health Initiative, focusing on an issue that previous survey work had identified as a global priority: to redesign health systems to integrate mental, neurological, and substance use disorders with other chronic diseases.
Building on the evidence base that demonstrates how addressing mental illness can improve outcomes in several priority areas of global health—i.e., maternal-child health, HIV-related disease, and non-communicable diseases—the workshop convened researchers with primary expertise in one of these three areas, along with mental health intervention researchers and global health program implementers to identify the best ways of (1) integrating mental health interventions into these global health platforms; and (2) producing research outcomes that will inform policy makers, advocates, researchers and service providers. The aim of the workshop, ultimately, is to leverage this knowledge to reduce the burden of disease and disability associated with mental disorders, while simultaneously helping to achieve the desired outcomes for these other programs.
Following opening remarks from NIMH Director Thomas Insel, M.D. and ORDGMH Director Pamela Collins, M.D., M.P.H., the workshop commenced with an introductory panel on the importance of care integration. Next, in a series of three evidence panels, investigators working in Afghanistan, Argentina, Bangladesh, Brazil, Nepal, Pakistan, Tanzania, Uganda, the United States, and Zimbabwe highlighted the importance of integrating mental health into care programs for each of the three global health priority areas that were the focus of the workshop. The first day concluded with a panel of representatives from funding agencies who discussed existing global platforms for integrated research.
The second day of the workshop built on the evidence presented on the first day to address existing programs designed to integrate mental health into global health care platforms. To set the stage, a panel of investigators gave presentations on community innovations for care, highlighting their applicability and relevance, beyond the North American context, to the field of global health. Next, a series of three case studies featured programs that are integrating mental health into each of the three priority areas. Discussants for each case study included invited experts from around the world with research and/or policy experience in the area of focus. The workshop concluded with a session highlighting the cross-cutting issues in care implementation for each of the three priority areas and future directions for mental health integration.
The following global, cross-cutting priorities emerged from the workshop presentations and discussions:
- Linking people to care
- Linking to quality care
- Providing care in the community
- Making the case to decision makers on the importance of addressing mental health needs
- Assessing costs of integrated care
Additionally, the participants addressed potential concerns by highlighting concrete selling points of care integration. Examples included:
- Concern: Care integration will dilute efforts to address “real” problems.
- Response: Oftentimes adding a task is very simple and requires little overhead.
- Concern: Embracing integration efforts will lead to anticipated high costs to the health care system.
- Response: Skills utilized for providing mental health interventions can strengthen other aspects of health care provision and thus lessen costs.
- Concern: Integrating mental health care may have negative ramifications for other systems of care.
- Response: The extensive evidence base shows that caring for mental disorders is essential for the success of maternal-child health, HIV-related disease, and non-communicable diseases programs.
For further information the Grand Challenges in Global Mental Health initiative please visit http://grandchallengesgmh.nimh.nih.gov/ or email grandchallengesGMH@mail.nih.gov. The workshop agenda and meeting materials are available at http://grandchallengesgmh.nimh.nih.gov/events.shtml .