Welcome to the newsletter #3 for the Gulbenkian Global Mental Health Platform
In this third issue we announce the International Forum on Innovation in Mental Health, the first technical meeting of the Gulbenkian Global Mental Health Platform.
International Forum on Innovation in Mental Health
The International Forum on Innovation in Mental Health will take place on the 3rd and 4th October, in Lisbon.
This meeting will focus on the documents produced by the Gulbenkian Platform about the links between mental disorders and noncommunicable diseases, about innovations in mental health care, and about the links between social determinants and mental ill health. 

During this first session, the speakers will present and discuss the technical document about health-system based strategies for organizing and delivering comprehensive and integrated care for mental disorders and other chronic health conditions.

The lecture Integrating mental health care in priority health programs: addressing a Grand Challenge in Global Mental health will end this first session.

The second session of the Forum will be on the publication that addresses innovative methodologies for shifting from hospital to community-based care, including operational approaches for establishing community mental health services and promoting social inclusion.

Session two will close with the lecture Beyond the Asylum - Innovations in community mental health.

The theme of the last session of the Forum is Social determinants of mental health.

During session three the document wich addresses population-based strategies that can be implemented through health and non-health sectors to promote mental health and prevent mental disorders will be presented and discussed.
Download the program pdf
Please make your registration here. Registration is free.
Lecturer - Vikram Patel
Vikram Patel is a Professor of International Mental Health and Wellcome Trust Senior Research Fellow in Clinical Science at the London School of Hygiene & Tropical Medicine (UK). He is the Joint Director of the School’s Centre for Global Mental Health and Honorary Director of the Public Health Foundation of India's Centre for Mental Health.

He is based in India where he leads a program of mental health research and capacity development. He is a co-founder of Sangath, a community based NGO in India. He serves on the WHO’s Expert Advisory Group for Mental Health and the Technical Steering Committee of the Department of Child & Adolescent Health, the World Economic Forum Global Agenda Council on Mental Health and Well-Being, and the Mental Health Policy Group of the Ministry of Health, Government of India. His book Where There Is No Psychiatrist (2003) has become a widely used manual for community mental health in developing countries.
Some questions on the lecture theme:
Why is it important to redesign health systems to integrate mental, neurological, and substance use disorders with other chronic diseases?
Vikram Patel - Because, quite simply, there is no health without mental health. Addressing chronic diseases without addressing mental health is to provide people with an incomplete and inadequate health care response to their needs. Furthermore, the tasks which are involved, for e.g. behavioural interventions, the organizational principles of the care delivery system, for e.g. the use of collaborative stepped care, and the central role of task-shifting, are similar.

In your opinion, what are the critical barriers to the integration of mental health care with general health care?
Vikram Patel - Primarily, the lack of a clear direction on how this can be done in the real-world, ideally based on the evidence derived from successful models of integration. In addition, other barriers include the concerns of health care providers to include mental health in their work, the fact that not all mental disorders can be successfully integrated in general health care, the lower importance and resource allocation for mental health, and the lack of non-specialist workers who are adequately skilled to provide the psychosocial interventions.

What should be the future areas of research on this topic?
Vikram Patel - Evaluations of various approaches for integration of mental health care along with other chronic diseases, examining the impact on both mental and physical health outcomes and their cost-effectiveness.
Lecturer - Sashi Sashidharan
Dr Sashidharan is a psychiatrist based in Glasgow UK. He currently works for Mental Health Rights, a third sector organisation that seeks to improve mental health care for people from disadvantaged and socially marginalised communities.

He has been involved in developing and implementing community mental health services over the last 25 years. He worked as Consultant Psychiatrist, Medical Director and Professor of Community Psychiatry in Birmingham, England. In 1992 he established one of the first crisis resolution & home treatment services in England.  He was also involved in the closure of three large mental hospitals in Birmingham and replacing these with an integrated model of functionalised community mental health care. He has also worked as a mental health consultant to the World Health Organization and the Asian Development Bank. He is involved in campaigns for race equality in mental health in the UK. 
Some questions on the lecture theme:
What are the key ingredients of successful approaches for delivering mental health care?
Sashi Sashidharan - A successful mental health system is one that provides individualised, accessible, integrated, and effective care and treatment. It must be based on sound values and principles. Prevention, early detection, evidence-based treatment, psychosocial rehabilitation are all essential components of a comprehensive mental health system.  For a service to be effective and successful it must be recovery-orientated and configured in the community. Ensuring the rights of individuals with mental health problems and protecting their autonomy are important.  Involvement of service users and families in planning and delivery of mental health care is essential for a successful mental health system. The sustainability of all health care systems is dependent on effective community engagement and inter-sectorial linkages.

In your opinion, what are the main difficulties in shifting from hospital to community-based care?
Sashi Sashidharan - The obstacles in shifting care and treatment from mental hospitals to the community vary from one setting to another. However, a common challenge is the power and resources invested in the mental hospital and the historical legacy of institutional care. Absence of mental health policy and professional inertia are also major barriers to shifting care and treatment from hospital into the community.  Without a commitment to reduce and downgrade hospital based resources and rethinking the current institutional model of psychiatry it is difficult to sustain community mental health services.  This will require clear policy commitments, strategic planning and re-allocation of resources.

Do methods of mental health care delivery and service organization face the same challenges around the world?
Sashi Sashidharan - The fundamental challenges in service organisation and care delivery are much the same the world over. These are the continuing institutional bias inherent in most mental health services, the coercive and controlling ideology that pervades mental health care, predominance of biomedical models of care, exclusion of service users’ views and preferences in service planning and care delivery and relatively low levels of investment in mental health. In many low and middle income countries addressing the ‘mh-gap’ is a major challenge. Similarly, there are significant concerns about the transferability of treatment models across different countries and cultures. However, the continuing investment in institutional models of psychiatric care remains the fundamental obstacle to mental health reform across the world.
Lecturer - Sir Michael Marmot
Professor Sir Michael G. Marmot is the Director of UCL Institute of Health Equity (Marmot Institute), Chair of the European Review on the Social Determinants of Health and the Health Divide, Director of the International Institute for Society and Health, and MRC Research Professor of Epidemiology and Public Health in University College London.

He has led a research group on health inequalities for 35 years. He was Chair of the Commission on Social Determinants of Health, which produced the report 
'Closing the Gap in a Generation’ (2008). He conducted a Strategic Review of Health Inequalities in England post 2010, which published its report 'Fair Society, Healthy Lives' (2010). He chaired the Breast Screening Review for the NHS National Cancer Action Team and is a member of The Lancet-University of Oslo Commission on Global Governance for Health. He is Principal Investigator of the Whitehall II Studies of British Civil Servants and the English Longitudinal Study of Ageing (ELSA) and is engaged in several international research efforts on the social determinants of health.
Some questions on the lecture theme:
Why is it important to identify and understand the social determinants of mental health?
Sir Michael Marmot - An individual's health relates to the circumstances in which they are born, grow, live, work and age - the so-called social determinants of health.  Common mental health disorders, including depression and anxiety, closely relate to the social determinants of health.  Therefore taking action to improve the social determinants of health is a critical part of improving mental health and reducing inequalities in mental health.

What are the main social determinants of mental health?
Sir Michael Marmot - The social determinants of mental health are experienced over the whole of life – in the quality of experience in the early years, and during education, in conditions of employment and family support, in environmental and community factors, incomes and assets, levels of social protection and public health and health service provision and quality of life for older people.

How do you think that the knowledge about the social determinants of mental health can be translated into policy changes?
Sir Michael Marmot - The WHO's Commission on the Social Determinants of Health ('Closing the Gap' 2008) and the Marmot Review of inequalities in England (Fair Society, Healthy Lives 2010) and the 2012/13 European Review of Social Determinants of Health and the Health Divide, described the evidence base and proposed a wide range of policies and actions that are required for an individual to flourish and thrive physically and mentally. They include:
  • Giving every child the best start in life (early years, 0-3 years)
  • Enabling all children, young people and adults to maximise their capabilities and have control over their lives through quality education
  • Creating fair employment and good work for all
  • Ensuring a healthy standard of living for all
  • Creating and developing sustainable places and community
  • Strengthening the role and impact of ill health prevention through equitable access to healthcare provision

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