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)