Public mental health capacity development in Africa:

Proposal for a Centre for Public Mental Health

Dr Crick LundDept of Psychiatry and Mental Health

University of Cape Town

Authors

• Lund C,1 Muller L,2 Flisher AJ,1 Swartz L,2Kagee A,2 Naidoo A,2 Kleintjes S.1

1. Department of Psychiatry and Mental Health, University of Cape Town, South Africa

2. Department of Psychology, University of Stellenbosch, South Africa

Background

• Mental disorders make a significant contribution to the burden of disease in Africa (10%)

• Mental disorders will contribute 15% of GBD by 2020

• Mental health intersects with many other public health priorities eg HIV/AIDS, MCH

• Poverty and mental ill-health interact in a vicious cycle

• Many African countries have histories of civil conflict, forced migration, trauma

Cycle of poverty and mental ill-health

Poverty

• Economic deprivation

• Low education

• Unemployment

• Lack of basic amenities/housing

Mental Ill Health

• Higher prevalence

• Poor/lack of care

• More severe course

Social exclusionHigh stressorsReduced access to social capital /safety netMalnutritionObstetric risksIncreased risk of violence & trauma

Increased health expenditureLoss of employmentReduced ProductivitySocial drift

But…

• Mental health is given low priority

• Lack of capacity to develop policy, plan services, conduct research

• Stigma and ignorance continue to inform public and policy makers’ opinions

• Low resources for mental health

Existence of MH policy

Yes (50%)

No

Dates of existing MH policies

Since 199182-9172-8162-71

Capacity building needs

• Public health approaches to mental health

• Evidence-based decision-making• Mental health policy, service planning

and budgeting• Mental health leadership and

management• Legislation and human rights for

mental health• Monitoring and evaluation• Quality improvement• Advocacy

Current clinical and

public health training

programmes on the

continent seldom offer

these aspects

Proposal: Centre for Public Mental Health

Objectives:1. Capacity development:

• Honours/Post-grad Diploma• MPhil in Public Mental Health• Modules in MH Professional

training• Targeted training

Distance learning

Occupation oriented

Core competencies: Honours/Diploma and MPhil

• Mental health in context: Needs, resources, constructs and problems in African countries.

• Intervening for mental health: Effective evidence-based interventions.

• Research for mental health: Mental health and health systems research.

• Management & policy for mental health: Public administration, policy, legislation and leadership

Objectives (cont)

2. Research– Mental health policy, services,

legislation– Epidemiology– Culture and Social determinants of

mental health– Community psychology– Multiple methods: descriptive and

intervention studies3. Consultancy4. Advocacy

Scientific Advisory Panel

Director + Management

Board

UCT Office�Research

Officers�Admin staff

Stellenbosch Office�Research Officers�Admin staff

Core functions:1. Capacity building• Honours/Diploma• MPhil• Professional Training• Short courses2. Research3. Consultancy4. Advocacy

Next steps

• UCT and Stellenbosch approval• Networks:

– Internal: Public Health, Psychology, Psychiatry, OT, Nursing, Social Work, Public Administration

– External: • Africa: Ethiopia, Ghana, Kenya, Tanzania, Uganda,

Zambia• …and beyond: WHO, NYU, Lisbon, Melbourne, Pune

• Fundraising