1. Global Mental Health: A way forward
Pamela Y. Collins, MD, MPH
Office for Research on Disparities & Global Mental Health
NIMH
Associate Clinical Professor of Epidemiology & Psychiatry
Columbia University

2. National Institutes of Health
NIH is a part of the US Department of Health and Human Services and is the nations medical research agency
Largest source of funding for medical research in the world
NIH is made up of 27 institutes and centers, of which the National Institute of Mental Health is one
Fogarty International Center is dedicated to facilitating global health research conducted by US and international investigators
3. NIMH Offices and Divisions
Office of the Director
NIMH Divisions
Office on AIDS
Office of Autism Research Coordination
Office of Constituency Relations and Public Liaison
Office for Research on Disparities and Global Mental Health
Office of Rural Mental Health
Office of Science Policy, Planning, and Communications
Division of Intramural Research Programs
Division of Neuroscience and Basic Behavioral Science
Division of Adult Translational Research and Treatment Development
Division of Developmental Translational Research
Division of AIDS Research
Division of Extramural Activities
4. Resources for mental health are scarce and inequitably distributed between countries, between regions, and within local communities. (Saxena et al., 2007)
5. 6. The biological basis of mental disorders
from the brain, and from the brain only, arise our pleasures, joy, laughter and jests, as well as our sorrows, pains, griefs, and tears.
all the most acute, most powerful, and most deadly diseases, and those which are most difficult to be understood by the inexperienced, fall upon the brain.
Hippocrates
Adams, 1939, p.360 in Costello, 2010
7. Understanding Etiology of Mental Disorders
WHO, 2000, Womens Mental Health
8. Worldwide Distribution of DALYs Lost Among Young Women, By Age Group, 2002
Ages 5-14
Ages 15-29
Notes: Numbers are rounded.
Source: Disease Control Priorities in Developing Countries, second edition, 2006, Table 59.1
9. Worldwide Distribution of DALYs Lost Among Young Men, By Age Group, 2002
Ages 5-14
Ages 15-29
Notes: Numbers are rounded.
Source: Disease Control Priorities in Developing Countries, second edition, 2006, Table 59.1
10. Source: Global Burden of Disease, WHO 2004
11. Identifying Global Mental Health Research Priorities
http://grandchallengesgmh.nimh.nih.gov
12. Global Engagement in Mental Health Research Directions: Grand Challenges
Responses:
Grand Challenges Canada
commits up to $20 million
to combat stigma and
to address Goal C:
Improve treatment &
Expand access to care
13. A Practical Goal for Services: Integrate mental health into primary care
Long-standing goal globally
Needs favorable political conditions
Benefits from decentralized government
Adequate training/supervision of primary care providers
Grand Challenges
Integrate screening and core packages of
services into routine primary health care
Strengthen the mental-health component in the training of all health-care personnel
14. Psychiatry NOS:What are we talking about??
Diagnostic systems need improvement
Think dimensionally
Need valid, simplified diagnoses for use in primary care
What are the real disorders?
What language can we use?
Grand Challenge
Develop valid and reliable definitions, models and
measurement tools for quantitative assessment at
the individual and population levels for use across
cultures and settings
15. No Health without Mental Health
A human is a single organism, health should not be segmented into mental and physical.
Mental disorders can increase risk, morbidity, and mortality associated with infectious and non-communicable disease
Grand Challenge
Redesign health systems to integrate MNS
disorders with other chronic-disease care
16. The social context of mental health in
Context of poverty/economic deprivation
Internal displacement due to conflict
Power of devastating traumatic experiences
Exposure to chronic, daily stressors
Grand Challenge
Understand the impact of poverty,
violence, war, migration and disaster
17. What care do we provide?Where does that care occur?
Engage traditional sources of support in the community (religious leaders, teachers, traditional healers) in mental health
Our treatment settings contribute to stigma
Grand Challenge
Provide effective and affordable community-based care and rehabilitation
Develop culturally informed methods to eliminate the stigma, discrimination and social exclusion of patients and families across cultural settings
18. Using policy & implementing plans for mental health services
Importance of integrating mental health into all levels of health system
Translate research to policy
Clinical experience informing policymakers
Grand Challenge
Establish and implement minimum health
care standards for MNS disorders around
the world
19. Task shifting for mental health
Usingproviders with more abbreviated training to perform the tasks of specialists
Good examples in many low- and middle-income countries
India MANAS trial (Patel et al., 2010)
Pakistan Lady Health Workers ( Rahman et al, 2008)
Uganda Group IPT for depression (Bolton et al, 2003)
Chile Treating depression in primary care (Araya et al, 2003)
20. Challenges for research
In 1990 5% of the worlds research investment addressed 93% of the worlds population (Commission on Health Research for Development)
By 2003 global health research expenditures quadrupled (Global Forum for Research, www.globalhealthforum.org)
Critical questions cannot be answered with data from a limited portion of the worlds population
Brain drain!
Burden of clinical and administrative responsibilities
Lack of demand for publication
Few opportunities for research capacity-building
Poorly accessible research findings
21. Opportunity #4: Encouraging a greater focus on global health
22. Focus on Equity:Reduce the treatment gap in LMICs
On the Pulse of Global Mental Health Action:
Identifying Strategic Research Opportunities
2-3 March, 2010
Hyatt Regency, Bethesda, MD
23. Scientific Opportunity: Human Heredity & Health in Africa (H3 Africa)
24. Build on global health programs
25. Anticipate global public health needs
26. Build Research Capacity
27. Opportune Time for Global Mental Health Activities
Global Funding Opportunities
Global Policy Opportunities
UK-East Kilbride: HRPC10
Improving Mental Health
Services in Low Income
Countries
DFID is seeking Expressions of
Interest (EOIs) from suppliers
to lead a consortium of
organisations with multi-
disciplinary skills in the theme
"Improving Mental Health Services
in Low Income Countries".
28. New Developments in Global Mental Health
Meet criteria for vulnerability
Merit targeting by development strategies and plans
Different development stakeholders have roles to play in designing &implementing policies and programs for reaching people with mental disorders
Development programs should protect the human rights of people with mental disorders and build capacity to participate in public affairs
WHO, 2010