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Welcome to the newsletter #4 for the Gulbenkian Global Mental Health Platform
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In this fourth issue we dive deeper into the programme of the International Forum on Innovation in Mental Health, the first technical meeting of the Gulbenkian Global Mental Health Platform, and present mental health news from around the world.
The International Forum on Innovation in Mental Health will take place on the 3rd and 4th of 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. 

You are cordially invited to attend this Forum. Admission is free, but please register here.
 

Document two â€“ Innovation in mental health care delivery and service organization


The second session of the Forum will present and debate the document 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.


Presenter - Julian Eaton

Julian Eaton, a psychiatrist by training, is a mental health advisor for CBM in West Africa and Co-ordinator of their technical global Advisory Working Group on Community Mental Health. His work involves engaging with Governments and other service providers to strengthen mental health systems as well as promoting CBM’s broader focus of working for an inclusive society where service users are empowered to participate in processes of policy and legislation development, as well as practical aspects of their implementation. In this capacity, he must ensure meaningful application of evidence-based practice, and has published on issues relating to scaling up mental health services in low income countries.
 
Julian lived for 8 years in Nigeria after completing psychiatry specialist training and a Masters in Mental Health Services Research in the UK. He now lives with his family in Lomé, Togo, where CBM’s West Africa Regional Office is located.
Some questions on the lecture theme:
What can be the role of an NGO in mental health care delivery and service organization?

Julian Eaton â€“ Non-Governmental Organisations can participate in co-ordinating activities of people affected by mental health issues in working together to address their needs; for example to provide peer support, employment opportunities, or campaign for a change in negative and stigmatising attitudes in communities in which they live. Such organisations with an interest in mental health have historically been run by professionals, either local or international, with a mandate in development, disability, or health. The shift to more participation by the people more personally affected is to be welcomed. 

What are the main difficulties of changing services?


Julian Eaton â€“ In general, Governments have a constitutional responsibility to provide formal health care services, and sometimes wider social services. In poorer countries of the world, this responsibility remains largely neglected. This may be because of lack of resources or capacity, but at the core of this neglect is the low priority given to people with mental health problems. NGOs are in a good position to both fill the gap in services, but more importantly, to advocate for an increase in prioritisation by Government services for mental health care, and to provide support that is needed as such service reform starts to take place. This advocacy and provision of support has to be done over the long-term, as systems change very slowly. One of the greatest challenges is that reform is difficult to make sustainable as Governments are often reluctant to take on responsibility for scaling up and fully funding even successful improvements. 

From your experience, do methods of mental health care delivery and service organization face similar challenges around the world?

Julian Eaton â€“ There are surprising similarities in the challenges faced in reform around the world, mainly based on the common experience of exclusion and neglect of people with psychosocial disabilities. There is no doubt though that some countries have progressed further in positive reform than others. Some countries have enshrined rights in law, some have increased investment in accessible services, some have closed abusive institutions, and some have ensured that service users have a greater voice in their care and the services that they use. 
 
The challenge now is to learn the lessons of how such positive change was achieved, and to marshal resources to implement such innovative ideas in a practical way for improvement in countries where people do not yet benefit from such reform. NGOs are in a good position to play a key role in this. 

Discussant - Palmira Santos

Palmira Santos is a senior clinical psychologist at Mozambique´s Ministry of Health (MISAU), with a Masters in Mental Health Policies and Services.

She has played a key role in the development of Mozambique’s MISAU mental health strategy, which relies on task-shifting and focuses on primary care for mental health services provision. She has coordinated a program with new, specialized mental health services for children and adolescents, which has been implemented in three major regions of Mozambique and will ultimately be available in all 10 provinces. She is the coordinator of training programs for mental health professionals of the National Health Service from all over the country.

Her research seeks evidence for the main causes of lack of response to rehabilitation programs and she has coordinated the first national evaluation of mental health services. 
Some questions on the lecture theme:
What are the main problems and challenges facing mental health in your country?

Palmira Santos â€“ As a low-middle income country, some of the main challenges for mental health development in Mozambique are related to human resources, financing and the absence of a mental health law. Thus, the shift to community-based services is one of the main goals that we expect to achieve until 2015.

What are the main strengths and weaknesses of the healthcare system?

Palmira Santos â€“ Regarding the strengths of our mental health system and in spite of not having a mental health law, we consider that our young country has made important steps on this way by approving a mental health strategy for 5 years and by including the mental health topics in our National Health Policy.
Also, the universal access to services and the availability of psychotropic drugs in public services co-financed by the government are some of the important achievements of our health care system.
On the other hand, our main weaknesses are related to human resources that can work to improve the quality of services. The budget is low for the burden of health problems in general and worse for mental health. Thus, institutionalization is still a major concern if we are not able to create community-based services for rehabilitation, care, housing and employment for those mentally ill.

In your country, what are the priorities of service organization to improve mental health care delivery?

Palmira Santos â€“ If we want to improve our mental health service delivery we will need to invest in primary care services. For that, our first priority is training human resources: we want to train new specialists and also to implement a task-shifting philosophy. We need to create a sustainable and easy to use information system. Finally, we must make sure that a mental health law is approved.

Mental health worldwide

Launch of the European Joint Action on Mental Health and Well-being.
This 3-years initiative aims at establishing a process for structured collaborative work in Mental Health policy at the European level and builds on previous work developed under the European Pact for Mental Health and Well-being. The Joint Action involves 45 partners representing 27 EU Member States and is coordinated by Faculdade de Ciências Médicas, Nova University of Lisboa (Portugal).
The OECD Mental Health and Work Project.
OECD governments increasingly recognise that policy has a major role to play in keeping people with mental ill-health in employment or bringing those outside the labour market back into it, and in preventing mental illness.
Commission Calls for Guatemala to Protect Patients.
The Inter-American Commission on Human Rights has told Guatemala that it must take steps to protect children and adults from abuses in psychiatric facility and Disability Rights International continues to pressure Guatemalan government to end human rights abuses at notorious psychiatric facility.
Commission Calls for Guatemala to Protect Patients
Call for action: The collapse of mental health services in Greece
Call for action: The collapse of mental health services in Greece.
"In Greece, a social and humanitarian crisis is taking place that calls for European collaboration and support".
Text from ARGO – NGO Network for Psychosocial Rehabilitation and Mental Health.
Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez.
The United Nations Special Rapporteur examines a number of abusive practices commonly reported in health-care settings and describes how the torture and ill-treatment framework applies in this context.
Suriname launched its mental health policy and plan.
This document sets three priority strategic areas of action: decentralization of psychiatric care, integration of mental health in primary care, and strengthening the mental health information system.
 
Ghana passes mental health law. 
The new legislation aims to protect the human rights of people with mental illness, to make sure that mental health care is nationally available and integrated into general health care, and to shift from institutional care to community care.
China passes mental health law.
China's legislature has passed a mental health law that  improves and protects the rights, treatment and care of those suffering from mental health problems.

China passes mental health law
Mexico promises community mental health
Mexico promises community mental health.
The Mexican government has amended its health law in a way that – for the first time â€“ promises to transform the country’s mental health services to a community-based mental health system.
Mental health in Armenia: new perspectives.
Within the framework of a memo signed between Ministry of Health of Republic of Armenia and Open Society Foundations a working group has been created to develop a mental health strategy for the Republic of Armenia.
2014 Geneva Prize for Human Rights in Psychiatry.
Nominations are sought for the 2014 Geneva Prize for Human Rights in Psychiatry, an award made every three years for exceptional achievement in defending human rights in psychiatry.
Visit the Platform's website:
http://www.gulbenkianmhplatform.com
Copyright © 2013 Lisbon Institute of Global Mental Health, All rights reserved.
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