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Welcome to the newsletter #5 for the Gulbenkian Global Mental Health Platform
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The Gulbenkian Global Mental Health Platform, in collaboration with the World Health Organization, has synthesized in the form of three technical documents the knowledge 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 the Forum the three draft documents will be presented and discussed.

You are cordially invited to attend this Forum. Admission is free, but please register here.
 
Document one â€“ Integrating the response of health systems to mental disorders and other chronic diseases


The first session of the Forum will present and debate the document about health-system based strategies for organizing and delivering comprehensive and integrated care for mental disorders and other chronic health conditions.
Presenter – Jürgen Unützer
Dr. Unützer is an internationally recognized psychiatrist and health services researcher. His work focuses on innovative models of care that integrate mental health and general medical services and on translating research on evidence-based mental health care into effective clinical and public health practice. He has over 200 scientific publications and is the recipient of numerous federal and foundation grants and awards for his research to improve the health and mental health of populations through patient-centered integrated mental health services.
 
Dr. Unützer trained in Medicine (MD, Vanderbilt University), Public Policy (MA, University of Chicago), and Public Health / Health Services (MPH, University of Washington). He completed fellowships in Geriatric Psychiatry at UCLA and in Primary Care Psychiatry at the University of Washington. Dr. Unützer is Professor and Vice-Chair in the Department of Psychiatry and Behavioral Sciences at the University of Washington where he directs the Division of Integrated Care and Public Health. He also holds adjunct appointments as Professor in the Departments of Health Services and Global Health in the UW School of Public Health and as Affiliate Investigator at the Group Health Research Institute in Seattle, WA.
 
Dr. Unützer directs the AIMS Center (http://uwaims.org) dedicated to "Advancing Integrated Mental Health Solutions" and the IMPACT Program (http://impact-uw.org) which has supported the development, testing and implementation of an evidence based program for depression treatment in more than 600 primary care practices in the United States and abroad.

Some questions on the lecture theme:
What is the importance of integrating mental health care and general medical services?

Jürgen Unützer â€“ Individuals with mental illness almost always also have one more other health problems (either a need for preventive health care or care for one or more chronic medical problems). Integrated care allows a more patient-centered approach in which all of the patient’s health needs can be addressed in a coordinated and often more effective way.
There will never be enough mental health specialists to meet the mental health care needs of populations, even in developed countries. For example, in the United States, only about 2/10 adults with a diagnosable mental health disorders see a mental health specialist in any given year. In contrast, about 5/10 receive some care for a mental health problem from a primary care provider. Leveraging primary care services can be a very effective way to improve access to mental health services if mental health professionals collaborate effectively with mental health providers.
 
What are the main barriers faced by integrated models of care?

Jürgen Unützer â€“ Several factors are barriers to integrated care:
  • Systems of care and payment for mental health and primary care services are often separate and not coordinated.
  • Primary care systems are often busy and overwhelmed with the care for acute and chronic medical needs and concerned about taking on responsibility for caring for individuals with mental disorders.
  • Mental health professionals may not have the skills and interests to work closely with primary care providers.
What are the best strategies to improve care at the interface of general medicine and mental health?

Jürgen Unützer â€“ Evidence-based Collaborative Care programs in which mental health professionals work closely with primary care providers to support care provided in primary care settings. These programs follow principles of good chronic illness care such as measurement based practice, treatment to target, population-based tracking of patients, and systematic specialty consultation if patients in primary care are not improving as expected. There is now substantial evidence from over 70 studies for the effectiveness of this approach. A recent metaanalysis by the Cochrane Collaborative is a good introduction to this literature.

Discussant â€“ Gabriel Ivbijaro
Dr Gabriel Ivbijaro MBE qualified in Benin City, Nigeria where he specialized in psychiatry and neurology. He subsequently specialized in General Practice in the United Kingdom and completed a Masters degree in Psychiatry and Neurology at the University of Leeds, UK and a Masters degree in Leadership at Middlesex University, UK. He is Chair of the North East London Faculty Royal College of General Practitioners.

As a member of World Organization of Family Doctors (Wonca) Dr Gabriel Ivbijaro has championed the cause of mental health globally among family doctors by setting up the Wonca Special Interest Group (SIG) in Psychiatry & Neurology in 2001. This international group of Family Doctors worked together to highlight the mental health needs of patients presenting to general practice and, in recognition of the SIG’s work under the leadership of Dr Gabriel Ivbijaro, Wonca awarded it Working Party status and it became the Wonca Working Party on Mental Health in 2006. Since then Dr Ivbijaro has supported primary care globally and worked in collaboration with the World Health Organization (WHO) to produce the influential jointly edited Wonca/WHO document "Integrating Mental Health into Primary Care: A Global Perspective". He brought together over 100 internationals contributors and edited the Companion to Primary Care Mental Health in 2012 which received a five star Doody’s review in 2013. 

Dr Gabriel Ivbijaro was a member of the WFMH International Experts Forum on Reducing Disparities in Mental Health Services for Ethnic Minorities in December 2008 and has provided technical expertise and support for the World Federation for Mental Health (WFMH) promotional material for World Mental Health Day 2009, 2010 and 2012. He was elected European Vice President of WFMH in October 2011. 

Some questions on the lecture theme:
What are the benefits of integration of mental health into primary care?

Gabriel Ivbijaro â€“ In general, many people who experience mental health problems continue to be disadvantaged in terms of general health outcomes, poor life expectancy, social isolation, stigma and poor satisfaction with health provision, despite the aspiration that people with mental health problems should have parity of access to health.
There are many effective treatments available for mental health problems and yet, up to 50% of people with a diagnosis of schizophrenia, do not receive any treatment at all even in developed nations. People who experience mental health problems are also more likely to have a co-occurring physical health problem.
These problems are on the increase and yet we know that effective primary care can address many of these mental and physical health co-morbidities. Life expectancy is also increasing with improvements in the general health of the population which means that co-morbid mental, physical and social problems will no longer be the exception but the norm for many people as they grow older.
People who experience mental health problems are often happy to use primary care health services because there is a reduction in stigma which improves access to health care, co-morbid conditions are better tackled, health promotion and early diagnosis is improved which in the long run leads to better health outcomes. This is also very cost-effective. Integrating mental, physical and social health into primary care will reap benefits.
 
What are the essential steps to integrate mental health into primary care?

Gabriel Ivbijaro â€“ The first step to integrate mental health into primary care is for service users, patients, providers and other stakeholders to believe in the plan. This can be achieved through service co-design. The process should be supported by policies which enable incentives to be aligned to the delivery of integrated mental health in primary care. A clear patient pathway should be developed so staff, service users, patients and carers can understand how to navigate the system. This may sometimes need to be achieved through the use of patient navigators who will also act as patient advocates to ensure patients, service users and their carers receive what they are entitled to.      
Good record keeping and data sharing are important and services need to be delivered by the appropriate skill mix of primary care staff. Core staff skills should include health promotion, mental health assessment and treatment. The service should first map out the skills available in the existing staff team and develop a training plan to address any gaps identified.     
This can be summarised as follows:
  1. Integration to be embedded in government policy in order to promote buy-in
  2. Alignment of incentives and payments to support integration
  3. Input from patients, cares and secondary care providers in pathway design
  4. Availability of the full range of biopsychosocial interventions
  5. Developing clear processes and protocols
  6. Adequate training of the primary care workforce and CPD (Continuous Professional Development)
  7. Regular audits and patient/service user feedback to encourage continuous improvement
  8. Celebration of good practice
From your experience, what are the main obstacles to this integration?

Gabriel Ivbijaro â€“ Some of the obstacles to integration include the tendency for some professionals to work in silos resulting in a lack of sharing of expertise and resources. Integrated practice can also be discouraged through the use of perverse incentives and payment systems, poor investment in staff, poor supervision and lack of Continuing Professional Development (CPD).   
The health and social economy needs to work together to ensure that patient, service user and carer interests are at the centre of the process and we have to make it easier for patient, service users and their carers to access and use the resources available. This may require joint training initiatives for primary, secondary and social care providers.   

Mental health worldwide
Mental Health Action Plan 2013-2020.
The Sixty-sixth session of the General Assembly of the World Health Organization, which took place in Geneva from 20 to 28 May, adopted the Mental Health Action Plan 2013-2020. The adoption of the action plan represents a formal recognition of the importance of mental health for WHO’s member states.
The core principles of this action plan are the universal access and equity in mental health, the promotion of human rights, the empowerment of persons with mental disorders and psychosocial disabilities, and the application of an evidenced-based practice.
Mental Health: A legislative framework to empower, protect and care; A Review of Mental Health Legislation in Commonwealth Member States.
During the 66th World Health Assembly, Health Ministers of Commonwealth member states adopted a legislative framework to empower, protect and care for persons with mental disorders.
Reports about the Republic of Moldova.
We published in our website a series of reports about mental health in the Republic of Moldova. The series comprises reports on the organization of mental health services and on the ongoing reform in the country, which aims to integrate mental health into primary healthcare and to shift care towards community mental health centers.
New Mental Health Legislation in China.
China is fundamentally transforming the provision of mental health services to its citizens under a new law that took effect on May 1. The new law eliminates most forms of involuntary treatment, puts strict limits on use of seclusion and restraints, and bans use of treatment as a form of punishment.
India battles misconceptions on mental illness.
Many Indian villagers blame evil spirits, and stigma still runs deep. As suicides soar, officials focus on training community-based mental health workers.
"Chains free" mental health campaign in Indonesia may end "pasung".
A new national programme in Indonesia is now trying to eliminate "pasung" – practices such as locking up or shackling to the floor people with mental disorders.
The Worldwide Campaign to End the Institutionalization of Children.
After years of fighting abuses against children on a country-by-country basis, Disability Rights International has gathered much evidence that the institutionalization of children with disabilities is a worldwide problem.
India launches programme for child-health screening.
The Ministry of Health and Family Welfare launched the Child Health Screening and Early Intervention Services initiative, a national programme for universal screening of children to detect birth defects and development delays.
The MINDS Foundation.
The MINDS Foundation is a nonprofit organization that provides grassroots mental health education programs, medical treatment, and reintegration services in rural India.
Eric Rosenthal receives 2013 Charles Bronfman Prize.
Eric Rosenthal, founder and director of Disability Rights International, has been awarded the 2013 Charles Bronfman Prize for his global leadership in the field of human rights, advocating for those most vulnerable to abuse. 
The Summary of the International Association for Women's Mental Health Congress in Lima is now online.
The 5th World Congress on Women's Mental Health in Lima was attended by 458 delegates from 57 countries and highlighted the current hot issues in this field. 
3rd Global Mental Health Summit.
The 3rd Movement for Global Mental Health Summit, organized by the Movement for Global Mental Health, will be held on 21-22 August 2013 in Bangkok, Thailand.
The State of the World’s Children 2013 – Children with Disabilities.
UNICEF’s The State of the World’s Children 2013, released on May 30, is dedicated to the situation of children with disabilities.
UNHCR’s mental health and psychosocial support for persons of concern.
This review reports on how well the United Nations High Commission for Refugees considers and provides for the well-being and mental health of persons of concern to the agency.
Jean Delay Prize.
Nominations are sought for the Jean Delay Prize, the most important award of the World Psychiatric Association. 
The Lancet Global Health.
Launched in June 2013, The Lancet Global Health will publish original research, commentary, correspondence, and blogs on any aspect of global health, and offer readers unrestricted access to all content.
Training programmes
The International Diploma in Mental Health Law and Human Rights is a collaboration between WHO and the ILS Law College in Pune, India. It builds the capacity of students to advocate for human rights and to influence national legislative and policy and service reform in line with key international human rights standards.
The International Master in Mental Health Policy and Services, an international course promoted by the NOVA University of Lisbon in collaboration with WHO, is addressed to health professionals willing to develop public health skills in the area of mental health.
The Latino Mental Health Research Training Program is an 11-week summer research training programme designed to prepare undergraduate and graduate level researchers to address disparities in mental health care of U.S. Latinos with serious mental illness.
Latest papers on global mental health
Check the Latest papers section in our website: PLoS Medicine published five Policy Forum articles focused on integrating mental health care into other health care platforms (e.g. maternal and child health, HIV, NCDs). These articles emerged from the 2012 NIMH workshop, “Grand Challenges in Global Mental Health: Integration and Implementation in Research, Policy, and Practice.” 
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http://www.gulbenkianmhplatform.com
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