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Centre for Public Mental Health

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Presentation on theme: "Centre for Public Mental Health"— Presentation transcript:

1 Centre for Public Mental Health
Mental Health without Borders Martin Prince Centre for Public Mental Health Institute of Psychiatry, King’s 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 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
Mental Health Child health Infant mortality Nutrition/ Growth/ Development Reproductive health Fertility Pregnancy HIV/ AIDS Infectious disease Control and eradication of communicable diseases TB Malaria Mental Health Now this is not a mere ploy, a means of tricking the system and conning funders and policymakers into according a status to mental health that it does not merit This model is directly relevant to meeting the challenge of bridging the mental health gap CLICK 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% CMD n=168 19%
Now data collection is on-going but just to give you an idea of the data, among the first 1000 participants, 28% of people in the HIV+ve group had comorbid depression, anxiety or harmful alcohol use, and 13% of people had signs of cognitive impairment; as compared with 19% CMD and 6% CI among those without HIV. Future analyses will explore this relationship further. CMD n=168 19% CI n= % CMD n=37 28% CI n=16 13%

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

8 10/66 Dementia Research Group
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 … The title of the 1066 dementia research group comes from the observation that, while two-thirds or 66% of people with dementia live in developing countries, only10% of research has been carried out in these regions. The group, led by Prof Martin Prince has been working together for 10 years, and aims to provide a detailed evidence base to contribute with the improvement of the health and social welfare of older people in low and middle income countries 8

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, King’s College London

10 The Lancet Global Mental Health Series
No health without mental health Scarcity, inequity inefficiency Evidence base for mental health interventions Resources for mental health care Barriers to progress A Call for Action



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
Increasing the coverage of evidence-based community interventions in low and middle income countries 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!!!!

16 Implementation science – e. g
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 Additional inputs Roles None Tertiary referrals CPN Training 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 Existing mental health provision (in some regions)

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