Week 14

WHO on Mental Health

• Mental health is defined by the WHO as a state of well-being where individuals can cope with life's stresses, realize their abilities, learn, work, and contribute to their community.
• It's seen as integral to overall health and well-being, influencing decision-making, relationships, and how we shape the world.
• The WHO considers mental health a basic human right, crucial for personal, community, and socio-economic development.

WHO on Mental Health Promotion and Prevention

• Promotion and prevention involve identifying individual, social, and structural factors influencing mental health.
• Interventions aim to reduce risks, build resilience, and create supportive environments.
• These interventions can target individuals, specific groups, or entire populations.
• Reshaping the determinants of mental health often requires action beyond just the health sector.

WHO on Mental Health Care & Treatment

• Suicide prevention is a global priority involving strategies like:
  • Means restriction (e.g., banning highly hazardous pesticides).
  • Responsible media reporting.
  • Social and emotional learning for adolescents.
  • Early intervention.
• Promoting child and adolescent mental health is another priority, with strategies including:
  • Policies and laws that promote and protect mental health.
  • Supporting caregivers in providing nurturing care.
  • Implementing school-based programs.
  • Improving the quality of community and online environments.
• School-based social and emotional learning programs are highly effective across all income levels.
• Promoting and protecting mental health at work is a growing area of interest, using strategies like:
  • Support through legislation and regulation.
  • Organizational strategies.
  • Manager training.
  • Interventions for workers.

Employer Actions for Mental Health

• Employers can model and support taking time off.
• Include workers in decision-making processes.
• Value worker safety and health.
• Ensure adequate staffing levels.
• Assign a senior leader to promote staff well-being.
• Train supervisors to provide support to employees.
• Health workers reported increased harassment, burnout, and poor mental health days in 2022 compared to 2018, according to a CDC report in MMWR October 2023.

Community-Based Treatment

• The WHO strongly advocates for community-based treatment due to its:
  • Accessibility and acceptability compared to institutionalization.
  • Prevention of human rights abuses.
  • Delivery of better recovery outcomes.
• Community-based treatment can be delivered through:
  • Integration with primary care, including general practitioners.
  • Community health services like mental health centers, peer support, and supported living.
  • Services in social service and non-health settings, such as schools and prisons.
• Innovative approaches are needed to scale up care, such as non-specialist psychological counseling or digital self-help, to address the care gap for common conditions like depression and anxiety.

World Mental Health Today

• Mental disorders are the leading cause of years lived with disability (YLDs), accounting for one in six YLDs globally.
• People with schizophrenia (incidence 1 in 200 persons) die, on average, 10 to 20 years earlier than the general population, often from preventable physical diseases.
• The economic consequences of mental health conditions are enormous, with productivity losses and other indirect costs often exceeding healthcare costs.
• Globally, mental health care is severely underfunded, especially community-based approaches.
• Countries dedicate less than 2% of their healthcare budgets to mental health on average.
• Over 70% of mental health expenditure in middle-income countries goes to psychiatric hospitals.
• Around half the world’s population lives in countries with just one psychiatrist for every 200,000+ people (WHO World Mental Health Report 2022).

Mental Health & The Treatment Gap

• A significant challenge in global mental health is providing services where there is a shortage of professionals.
• 1 in 4 people globally suffer from a mental health condition.
• 450 million people currently need mental health care (WHO).

Approaches to Delivering Mental Health Services

• Complex psychiatric terminologies or techniques are not always necessary for delivering urgent mental health services.
• Drawing on local understandings of illness may be the most culturally appropriate way to deliver primary mental health care.
• Task shifting - Equipping Community Health Workers (CHWs) with training in cognitive behavioral therapy to be frontline providers of community-based mental health care is proving successful for depression, anxiety, and PTSD.

Moral Case for Prioritizing Global Mental Health

• Two foundational assumptions:
  • Mental health is a global public good, as important as physical health.
  • Community-based approaches are the most effective and efficient way to deliver evidence-based psychosocial interventions to everyone.

Addressing the Moral Case

• Mental health task-shifting is sustainable but not yet accomplished at scale.
• Millions of CHWs are needed globally, including in high-income countries.

Structural Violence

• Much of the semester's discussions can be interpreted through the lens of structural violence.
• Structural violence describes social arrangements that put individuals and populations in harm’s way, embedded in the political and economic organization of the social world (Farmer et al, p. 325-326).
• These arrangements cause injury, typically not to those responsible for perpetuating the inequalities.
• Poverty and inequality powerfully shape risks for disease, leading to poor health through access to food, water, environmental inequalities, and stress.
• Laws and customs promoting sexism, racism, classism, and ethnic discrimination cause physical and mental health problems.
• Cultural explanations for health disparities can obscure structural violence, requiring careful examination.
• Social and environmental forces limit the effectiveness of clinical treatments.

Lessons from Baltimore, Haiti, & Rwanda

• It is possible to decrease the extent to which social inequalities are embodied as health disparities.
• There's a call for social and economic rights, including national health insurance, primary education, food security, and clean water.
• Proximal interventions can lessen premature morbidity and mortality, such as interventions increasing the agency of the poor to reduce their risk of HIV.

Structural Interventions Impact

• Structural interventions can have a significant impact on outcomes by making upstream investments to improve downstream impacts.
• Strategies include improving community conditions through laws, policies, and regulations that support health for all, addressing individuals' social needs by including patient screening questions about social factors, and providing clinical care, with social workers, community health workers, and community organizations providing direct support to meet patients’ social needs.

Global Health Ethics, Projects, and Human Rights

• Philosophically, the claim that health is a human right makes sense, but there is a gap between ideals and practical realities, especially when rationing clinical healthcare due to limited resources.
• Two major questions are raised:
  • Where and how can available resources be increased?
  • How can those resources be ethically and equitably allocated?

What is "global" about global health?

• Conditions within the United States are very much a part of global health!
• Equity lens & attention to structural factors
• Holistic view that transcends national boundaries

A Closing Thought

• Becoming a world citizen does not require subscribing to a particular political point of view but involves recognizing the rights and dignity of all humans. Problems of disease and health inequities are rooted in legacies of colonialism and structural violence.