course Tropical Medicine Global Health - Julius Centrum mental... · Global Health & Tropical...

Global Health & Tropical Medicine

course#3: Global Mental Health

GH & TM course

Recap of lectures

Marieke Oostvogels, AIGT MIH and GP in training, workedin a local hospital in Sierra Leone as a doctor when theEbola outbreak started in 2014, and later in Liberia.

Maartje Goudswaard, AIGT, works with refugees at iMMOand shared a local dimension of Global Health

Pim Scholte - psychiatrist, AMC & Equator Foundation/Arq

• Marieke discussed the epidemic and the national responseinitiated to curb it which rests on three pillars: early detection,isolation and treatment. • The Ebola outbreak had grave consequences for daily (social)life, economic implications and the health care systems, vividlyillustrated by her examples.

• As a result of violence, disaster or oppression there are about20 million refugees globally. In 2016, 1 million people applied forasylum in the EU and 30.000 in the Netherlands. • Medical assessment can play an important role in the asylumprocedure as signs and symptoms can serve as evidence oftorture, punishment or traumatic events, which can otherwise be

www.globalhealth.eu globalhealth@umcutrecht.nl UMCUInternationalOffice

Physical & mentalhealth & poverty

Mental disorders areclosely related to otherhealth conditions (incl.HIV/AIDS, maternal andchild health and non-communicable diseases). There is a vicious circlebetween poverty andmental health.

13% of GDB DisabilityAdjusted Life Years(DALYs) is due tomental, neurologicaland substance usedisorders (MNS).Depression, anxietydisorders, substanceabuse, schizophreniaand bipolar disorder aremost common.

Global Burden ofDisease (GDB)

Public mental healthapproach

A primary care andcommunity orientedapproach. Focusses onhealth promotion anddisorder prevention.   Health promotion anddisorder prevention onthree levels/platforms:population, communityand health care.

Mental Health gap

There is a substantial globaldisparity between thenumber of people in need ofmental health care and theavailability of professionalsand services. Urgent to address thisbecause of the persistingincrease in MNS disorders:e.g. with 18% globalincrease in depressionbetween 2005-2015.

Claudi Bockting - clinical psychologist and professor ofClinical Psychology UU & Arq

Promising interven-tions for LMICs

1. Low-intensity psycho-logical interventions bynon-specialists 2. Use of transdiagnostictreatment 3. New technology(internet, mobilephones)

Internet-basedinterventions for mentalhealth show promisingresults in high incomecountries: encouragingmental health outcomesand efficient in the needfor professionals. More RCTs are highlyneeded, especially inLMICs.

More evidenceneeded

Rembrant Aarts - psychiatrist and AIGT, EquatorFoundation/Arq

The capacity to restorehealth after shockingevents among whichnatural disasters, man-made trauma andattachment trauma.Resilience greatly dependson social support, feelingof safety, self regulationand perspective for thefuture.

Forced migration

65.3 million peopleare forcedly displacedglobally of whom 21.3million are refugees. Most refugees comefrom Syria, Somaliaand Afghanistan.

Resilience

Children <5 are in need ofthe circle of security: asecure base and safe haven.Yet, young migrants dealwith extreme complicatedlife situations, such asseparation and loss, andfear and shame. Althoughchildren are resilient,  thereis a risk of PTSD or complextrauma later in life.

Young migrants