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Mental Health without Borders Martin Prince Centre for Public Mental Health Institute of Psychiatry, Kings College London

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Presentation on theme: "Mental Health without Borders Martin Prince Centre for Public Mental Health Institute of Psychiatry, Kings College London"— Presentation transcript:

1 Mental Health without Borders Martin Prince Centre for Public Mental Health Institute of Psychiatry, Kings College London

2 GMH Research in HSPRD (since 2000) §23 research grants §157 papers in international peer- reviewed journals §One MRC, three CAFOD and 18 Wellcome Trust studentships l sponsoring research in seven Latin American countries, China, India, Sri Lanka, Thailand, Moldova, Brazil, Ghana and Ethiopia §Joint study unit and short course in International Mental Health

3 Established priorities Child health l Infant mortality l Nutrition/ Growth/ Development Reproductive health l Fertility l Pregnancy l HIV/ AIDS Infectious disease l Control and eradication of communicable diseases l TB l Malaria Mental Health

4 MDG 6 – combat HIV, malaria and other diseases (HIV/ AIDS) Risk factor for infection? –Mental disorders increase susceptibility for infection –High seroprevalence among those with psychosis (3-7%) –10-20% infected through intravenous drug use Comorbidity –High prevalence of depression, anxiety and cognitive impairment Impact of comorbidity –Reduced adherence to ART –Faster disease progression and increased mortality Prince et al Lancet 2007

5 UMEED study – Goa, India: Mental health and engagement with HIV services Design –Cohort study of 2000 consecutive attendees at a voluntary testing and counselling centre Comorbidity? –Association between HIV status and mental health, cognitive impairment and alcohol and substance use prior to formal diagnosis Impact? –Are MI, CI and ASUD associated with Non-attendance for post-test counselling Delayed uptake of ART referral

6 Preliminary Analysis HIV-VE n=869 87% HIV+VE n=130 13% CMDn=168 19% CIn=51 6% CMDn=3728% CIn=1613%

7 Maternal and Child Health (Ethiopia and Ghana) l Two large cohort studies, both nested in demographic surveillance sites l Ethnographic research, and validation of MH assessments l Effects of maternal depression on infant health, growth and development, infant mortality maternal mortality and morbidity

8 10/66 aims to provide a detailed evidence–base to contribute to the improvement of the health and social welfare of older people in low and middle income countries … 10/66 Dementia Research Group

9 People on the Move – research into the consequences of displacement and migration in Asia Melanie Abas, Samanthika Ekanayake Tawanchai Jirapramukpitak Craig Morgan, Martin Prince Rob Stewart Jianmin Zhang Centre for Public Mental Health, IoP, Kings College London

10 The Lancet Global Mental Health Series 1.No health without mental health 2.Scarcity, inequity inefficiency 3.Evidence base for mental health interventions 4.Resources for mental health care 5.Barriers to progress 6.A Call for Action

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13 The new Centre for Global Mental Health (KHP AHSC and LSHTM) §51 academics §23 current PhD students §An established GMH research portfolio §Planned new MSc in Global Mental Health §Strategic focus on service evaluation §Promoting the new discipline of GMH

14 What research is needed? §to develop and evaluate interventions for people with mental disorders to be delivered by non-mental health professionals, §to evaluate how health systems can scale up feasible and effective interventions across all routine care settings §PACKAGES -> PROGRAMMES §HORIZONTAL INTEGRATION

15 The WHO Mental Health Global Action Plan §Seven priority areas – depression, psychosis, epilepsy, dementia, child and adolescent disorders, alcohol use, suicide §Development of evidence-based practice guidelines for non-specialists in LAMIC §Implementation §Evaluation!!!! §Increasing the coverage of evidence-based community interventions in low and middle income countries

16 Implementation science – e.g. constructing a district community mental health service District hospital (n = 250,000) Regional hospital (n = 1 million) Health Centre (n = 25,000) HP Existing mental health provision (in some regions) Additional inputs Roles NoneTertiary referrals CPNTraining and supervision of PHC staff Revolving drug budget Training for PHC staff Syndromal diagnosis and management Referral Follow-up Training for health extension workers Sensitisation CBR, Family psychoeducation


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