GHF2010 – PS15 – Global Mental Health: Challenges and Opportunities in a Changing World

Session Outline

Parallel session PS15, Monday, April 19 2010, 14:00-15:30, Room 2
Chair(s): Ann Lindsay, Honorary Chair of the NGO Forum for Health, Mental Health & Psychosocial Support Working Group, Switzerland, Pandelis Giannakopoulos, Professor, Head of the Department of Psychiatry, Geneva University Hospitals, Switzerland
Summary: The impact of globalization presents challenges to mental health, as to health systems generally. The session takes a region-by-region view of the challenges to the achievement of mental health within the current global crisis. A panel will join Professor Patel, made up of leading global voices on mental health as well as regional voices rooted in local practical programme experience. Together they will propose solutions to overcome some of these challenges and achieve better mental health outcomes for all.
Global Mental Health: Challenges and Opportunities in a Changing World
Vikram Patel, Professor for international mental health, London School of Hygiene and Tropical Medicine, UCL, United Kingdom
Experiences from Russia/CIS: Setting Up a Russian Counselling Association
Jennie McNamara, President, European Association for Counselling, United Kingdom
Mental and Physical Health of Kosovar Albanians in Their Place of Origin: A Post-War Six-Year Follow-Up Study 
Ariel Eytan, Associate Professor, Department of Psychiatry, Geneva University Hospitals, Switzerland
Capacity Building for Mental Health and Psychosocial Support in Humanitarian Emergencies: Current Experiences from the Gaza Strip
Claire Colliard, Founder and Executive Director, Centre for Humanitarian Psychology, Switzerland
Challenges in Responding to Community Depression in Africa
Lincoln Ndogoni, Africa Regional Psychosocial Advisor, World Vision International, Kenya

Session Documents

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Session Video

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Session Report

Photo by John Brownlee, ICVolunteers.org

Submitted by: Tikwiza Nkowane (ICVolunteers); Contributors: Ulla Darre (ICVolunteers) Participants from different parts of the globe joined together to present the challenges, opportunities and aims they are hope to achieve in the area of Mental Health. The session was chaired by Chaired by Alan Leather and Pandelis Giannakopoulos. Surveys, interactions, methodologies and mapping of Mental Health were presented as a way of improving global Mental Health.

Stefan Germann spoke on behalf of Lincoln Ndogoni, Africa Regional Psychosocial Advisor for World Vision International Kenya, on the subject of Challenges in Responding to Community Depression in Africa.

An introductory video stated that 10-20% of individuals in Africa suffer from depression while less than 1% receives treatment. This is due both to geography, the distance between healthcare providers and their patients, and cost. The video showed a methodology developed by Lincoln Ndogoni and his colleagues, known as Interpersonal Therapy Groups (IPTG). The aim of IPTG is to improve the mental health of depressed patients and to move them to a level out of depression. Several profiles of group therapy counsellors were shown and each counsellor expressed the importance of continual assessment and training in helping them in their work, in particular their ability to facilitate group discussions. Patients suffering from depression who had participated in IPTG expressed their gratitude and spoke about the improvement in their quality of life which had resulted from going through the programme.

Stefan Germann explained that the methodology used by IPTG had been evaluated by US universities and been published in the US.  He said it shows that with investments in communities, this can help to improve the situation for people who have been affected by depression.

Mark Van Ommeron spoke on the subject of Mental Health and Psychosocial Support in Humanitarian Settings, Psychological First Aid on behalf of Jennie McNamara, President of the European Association for Counselling, UK.

Mr van Ommeron, from the Mental Health and Substance Abuse department at WHO, focused his presentation on Psychological First Aid. This is a patient-centred approach which seeks to determine and fulfill needs by discussion with the patient. The speaker described it as a very brief, non-clinical intervention. He expressed the opinion that group debriefing has no positive effect and does not work. On the contrary, it is potentially harmful. There has been no direct evidence of whether Psychological First Aid works, but there is a strong anecdotal consensus that it has been shown to work, for example following a social traumatic event. A diagram of an intervention pyramid shows that clinical care is at the top of the pyramid. This demonstrates that only a small number of people benefit from this service; in the middle of an emergency it may not be available to all. Psychological First Aid is at the base of the pyramid, less costly and more widely available. It advocates basic services that are safe, socially appropriate and protect the dignity of the individual. Mr van Ommeron stressed that Psychological First Aid is not the answer to all problems because there are other issues that have to be considered, for instance pre-existing social problems, emergency-induced social problems and pre-existing psychological/psychiatric problems. A model Psychological First Aid Guide created by WHO together with other international organisations is currently under peer review.

Ariel Eytan, Associate Professor, Department of Psychiatry, Geneva University Hospitals (HUG), gave a presentation on the Mental and Physical Health of Kosovar Albanians in Their Place of Origin: A Post-War Six-Year Follow-Up Study. After the return of some 34,000 refugees to Kosovo in 2001, many of whom had been in Switzerland, the IOM undertook a study which was followed up by a survey in 2007.

During the months of September and October 2001 Kosovo was just starting to be reconstructed and there was lack of growth within the country. The aims of the study were to assess the health status of those returning to Kosovo, to assess their needs, to identify risk factors leading to worsening mental health and to monitor the evolution of the health situation over time. Approximately 1,000 people were interviewed for the survey which posed questions ranging from perceptions of mental and physical health to actual use of Health Service facilities. The survey also attempted to assess the prevalence of Post-Traumatic Stress Disorder (PTSD). The International Organisation for Migration (IOM) provided logistical support including vehicles, data entry and surveyors. The results were published and feedback was given to professionals in Kosovo and IOM Prishtina.

The results of the survey showed that PTSD rates in 2001 were at 23.2% while by 2007 they had lowered to 14.5%. Mr Eytan stated that this incidence rate for PTSD was in accordance with figures from similar environments. Although the rate had gone down in 2007, this was not a simple linear decrease. His closing statement was that in their interviews, people described their symptoms as “ill health without access to care”.

Claire Colliard, Founder and Executive Director for the Centre for Humanitarian Psychology, Switzerland, spoke on the subject of Capacity Building for Mental Health and Psychosocial Support in Humanitarian Emergencies, illustrating her presentation with the example of the Gaza Strip.

Ms Colliard gave a brief background of the current situation in Gaza and the effect it is having on the health care system. The recent war of 2009 destroyed infrastructure causing widespread health problems, disruption to water and electricity supplies, increasing unemployment and undermining the education system. Her talk focused on rebuilding the health care system through the Inter Agency Standing Committee  Mental Health and Psychosocial model with its Guidelines and Public Health model. The Ministry of Health is building three new departments: training, evaluation and research, and rehabilitation. As of today, 40,000 patients are registered, of whom 6,000 are followed up regularly.

In the discussion which followed the presentations, an audience member stated that dialogue between care providers and patients should be improved. The panel agreed and said that this was even more important where there are cross-cultural differences. The idea of Telemedicine or E-therapy, to bring mental health therapy to distant regions was seen as a very promising development for the future. Although Vikram Patel was unable to present his topic, the presentations heard provided the audience with ideas to develop and implement.

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