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Mental health case study

Provides examples of mental health services
JULIAN EATON: The field of global mental health has really been delayed compared to many other areas of global public health for a number of reasons. First of all, I think for a long time, the burden of these conditions on populations wasn’t really recognised. And it wasn’t until the 90s when measures of burden, which really looked at disability, as opposed to just mortality, were done properly using the disability adjusted life year, it was recognised how important these conditions were and how impactful they were on people’s functioning. After that, it was still challenging based on the stigma associated with mental ill health.
Many people chose not to go into careers associated with mental health, and politicians and decision makers really don’t prioritise the area. Subsequent to that though, it’s really an area that’s growing very fast, both in terms of research and in terms of implementation. There’s a much clearer coherence around what the field means, and there are a number of places around the world now where one can study global mental health. It’s really always had, at the core of it, a human rights approach and a recognition of, particularly, an area that causes so much disability, the importance of thinking about social factors and social determinants of mental ill health have always been an important area of the work.
So as far as that public health perspective, we’ve also been getting much stronger evidence related to efficacy of interventions, including in very low income and low resource settings. And there are a number of ways that we’ve tried to look at the way that we can adapt models that have often been developed in high income countries to be impactful in low income settings. One of the important things to recognise about mental health compared to other areas is that there are large numbers of people who are disabled, specifically, because of having a mental health type impairment. But also it’s something that affects many other people with other disabilities.
So, for example, particularly in the area of hearing impairment, there are much higher levels of depression and anxiety associated with hearing impairment, but also with many other types of disabilities. So the typical situation in a low income setting is of a gross neglect of the mental health services within the health system. Typically, in sub-Saharan Africa, less than 1% of the health budget is spent on mental health, and very few staff are dedicated to working in mental health. The small amount of money that is spent is typically spent very inefficiently and often in large institutions, which are often quite abusive and not a place where you’d particularly want to seek care.
So some of the broad principles associated with this new growth in global mental health is partly to increase access to mental health services. And that means really taking them away from these large institutions and to a much more decentralised space where people can access them, particularly in primary care for example, to make them much more patient-centred to be meeting the needs of people, often going beyond just health services and thinking about livelihoods and other social interventions that promote inclusion as well, and thinking about the significant lack of human resources by task shifting.
So looking not at replicating the tendency for people to go to specialists to seek care, but really seeing mental health as something that– Mental health care is something that people can access in primary care, and from people who are not specialists in mental health, but are able to give appropriate evidence-based interventions at their level where that’s supported by good supervision and the opportunity to step up to more appropriate care when needed.

In this case study, Dr. Julian Eaton, from the Centre for Global Mental Health at LSHTM, and CBM International, discusses mental health. He provides an overview of the field of mental health and examples of lives of people with mental health difficulties in various settings.

Dr. Eaton describes the field of mental health and discusses the stigma that is often associated with mental health. He highlights the human rights and social approach and the importance of adapting models to low income settings.

He then discusses people with disabilities and mental health, and some of the access barriers in different mental health settings. He concludes by discussing the importance of increasing access to global mental health services and task shifting.

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Global Health and Disability

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