Global Health & Tropical Medicine course #3: Global Mental Health GH & TM course Recap of lectures Marieke Oostvogels, AIGT MIH and GP in training, worked in a local hospital in Sierra Leone as a doctor when the Ebola outbreak started in 2014, and later in Liberia. Maartje Goudswaard, AIGT, works with refugees at iMMO and shared a local dimension of Global Health Pim Scholte - psychiatrist, AMC & Equator Foundation/Arq • Marieke discussed the epidemic and the national response initiated 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, vividly illustrated by her examples. • As a result of violence, disaster or oppression there are about 20 million refugees globally. In 2016, 1 million people applied for asylum in the EU and 30.000 in the Netherlands. • Medical assessment can play an important role in the asylum procedure as signs and symptoms can serve as evidence of torture, punishment or traumatic events, which can otherwise be www.globalhealth.eu [email protected] UMCUInternationalOffice Physical & mental health & poverty Mental disorders are closely related to other health conditions (incl. HIV/AIDS, maternal and child health and non- communicable diseases). There is a vicious circle between poverty and mental health. 13% of GDB Disability Adjusted Life Years (DALYs) is due to mental, neurological and substance use disorders (MNS). Depression, anxiety disorders, substance abuse, schizophrenia and bipolar disorder are most common. Global Burden of Disease (GDB) Public mental health approach A primary care and community oriented approach. Focusses on health promotion and disorder prevention. Health promotion and disorder prevention on three levels/platforms: population, community and health care. Mental Health gap There is a substantial global disparity between the number of people in need of mental health care and the availability of professionals and services. Urgent to address this because of the persisting increase in MNS disorders: e.g. with 18% global increase in depression between 2005-2015. Claudi Bockting - clinical psychologist and professor of Clinical Psychology UU & Arq Promising interventions for LMICs 1. Low-intensity psycho- logical interventions by non-specialists 2. Use of transdiagnostic treatment 3. New technology (internet, mobile phones) Internet-based interventions for mental health show promising results in high income countries: encouraging mental health outcomes and efﬁcient in the need for professionals. More RCTs are highly needed, especially in LMICs. More evidence needed Rembrant Aarts - psychiatrist and AIGT, Equator Foundation/Arq The capacity to restore health after shocking events among which natural disasters, man- made trauma and attachment trauma. Resilience greatly depends on social support, feeling of safety, self regulation and perspective for the future. Forced migration 65.3 million people are forcedly displaced globally of whom 21.3 million are refugees. Most refugees come from Syria, Somalia and Afghanistan. Resilience Children <5 are in need of the circle of security: a secure base and safe haven. Yet, young migrants deal with extreme complicated life situations, such as separation and loss, and fear and shame. Although children are resilient, there is a risk of PTSD or complex trauma later in life. Young migrants

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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 [email protected] 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