mental health without borders martin prince centre for public mental health institute of psychiatry,...
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Mental Health without Borders
Martin Prince
Centre for Public Mental HealthInstitute of Psychiatry, King’s College London
GMH Research in HSPRD (since 2000)
23 research grants157 papers in international peer-
reviewed journalsOne MRC, three CAFOD and 18
Wellcome Trust studentships sponsoring research in seven Latin
American countries, China, India, Sri Lanka, Thailand, Moldova, Brazil, Ghana and Ethiopia
Joint study unit and short course in ‘International Mental Health’
Established priorities
Child health Infant mortality Nutrition/ Growth/ Development
Reproductive health Fertility Pregnancy HIV/ AIDS
Infectious disease Control and eradication of communicable
diseases TB Malaria
Mental Health
Mental Health
Mental Health
MDG 6 – combat HIV, malaria and other diseases (HIV/ AIDS)
Risk factor for infection?– Mental disorders increase
susceptibility for infection– High seroprevalence among those
with psychosis (3-7%)– 10-20% infected through
intravenous drug use
Comorbidity– High prevalence of depression,
anxiety and cognitive impairment
Impact of comorbidity– Reduced adherence to ART– Faster disease progression and
increased mortality
Prince et al Lancet 2007
UMEED study – Goa, India: Mental health and engagement with HIV services
Design– Cohort study of 2000 consecutive
attendees at a voluntary testing and counselling centre
Comorbidity?– Association between HIV status
and mental health, cognitive impairment and alcohol and substance use prior to formal diagnosis
Impact?– Are MI, CI and ASUD associated
with• Non-attendance for post-test
counselling• Delayed uptake of ART referral
Preliminary Analysis
HIV-VEn=86987%
HIV+VE
n=13013%
CMD n=168 19%CI n=51 6%
CMD n=37 28%CI n=16 13%
Maternal and Child Health (Ethiopia and Ghana)
Two large cohort studies, both nested in demographic surveillance sites
Ethnographic research, and validation of MH assessments
Effects of maternal depression on
• infant health, growth and development,
• infant mortality • maternal mortality and morbidity
10/66 aims to provide a detailed evidence–base to contribute to the improvement of the health and social welfare of older people in low and middle income countries …
10/66 Dementia Research Group
www.alz.co.uk/1066
People on the Move – research into the consequences of displacement and migration in Asia
Melanie Abas, Samanthika Ekanayake
Tawanchai JirapramukpitakCraig Morgan, Martin Prince Rob Stewart
Jianmin Zhang
Centre for Public Mental Health, IoP, King’s College London
The Lancet Global Mental Health Series
1. No health without mental health
2. Scarcity, inequity inefficiency
3. Evidence base for mental health interventions
4. Resources for mental health care
5. Barriers to progress
6. A Call for Action
The new Centre for Global Mental Health (KHP AHSC and LSHTM)
51 academics23 current PhD studentsAn established GMH
research portfolioPlanned new MSc in
Global Mental HealthStrategic focus on
service evaluationPromoting the new
discipline of GMH
What research is needed?
to develop and evaluate interventions for people with mental disorders to be delivered by non-mental health professionals,
to evaluate how health systems can scale up feasible and effective interventions across all routine care settings
PACKAGES -> PROGRAMMES
HORIZONTAL INTEGRATION
The WHO Mental Health Global Action Plan
Seven priority areas – depression, psychosis, epilepsy, dementia, child and adolescent disorders, alcohol use, suicide
Development of evidence-based practice guidelines for non-specialists in LAMIC
Implementation Evaluation!!!!
Increasing the coverage of evidence-based community interventions in low and middle income countries
Implementation science – e.g. constructing a district community mental health service
District hospital (n = 250,000)
Regional hospital(n = 1 million)
Health Centre(n = 25,000)
HPHPHP
HPHP
Existing mental health provision (in some regions)
Additional inputs
Roles
None Tertiary referrals
CPN Training and supervision of PHC staff
Revolving drug budget
Training for PHC staff
Syndromal diagnosis and management
Referral
Follow-up
Training for health extension workers
Sensitisation
CBR, Family psychoeducation