What is the Mental Health Gap Action Programme (mhGAP)?

Introduction

The World Health Organisation (WHO) Mental Health Gap Action Programme (mhGAP) aims at scaling up services for mental, neurological and substance use disorders for countries especially with low- and middle-income.

Background

Mental, neurological, and substance use disorders are common in all regions of the world, affecting every community and age group across all income countries. While 14% of the global burden of disease is attributed to these disorders, most of the people affected – 75% in many low-income countries – do not have access to the treatment they need.

As such, the programme asserts that with proper care, psychosocial assistance and medication, tens of millions could be treated for depression, schizophrenia, and epilepsy, prevented from suicide and begin to lead normal lives – even where resources are scarce.

The following overview is from the WHO ‘mhGAP Mental Health Gap Programme: Scaling Up Care for Mental, Neurological, and Substance Use Disorders’ published on 01 January 2008:

Mental, neurological and substance use disorders are highly prevalent and burdensome globally. The gap between what is urgently needed and what is available to reduce the burden is still very wide.

WHO recognizes the need for action to reduce the burden, and to enhance the capacity of Member States to respond to this growing challenge. mhGAP is WHO’s action plan to scale up services for mental, neurological and substance use disorders for countries especially with low and lower middle incomes. The priority conditions addressed by mhGAP are: depression, schizophrenia and other psychotic disorders, suicide, epilepsy, dementia, disorders due to use of alcohol, disorders due to use of illicit drugs, and mental disorders in children. The mhGAP package consists of interventions for prevention and management for each of these priority conditions.

Successful scaling up is the joint responsibility of governments, health professionals, civil society, communities, and families, with support from the international community. The essence of mhGAP is building partnerships for collective action. A commitment is needed from all partners to respond to this urgent public health need and the time to act is now!

References/Further Reading

WHO mhGAP Mental Health Gap Action Programme: Scaling Up Care for Mental, Neurological, and Substance Use Disorders (WHO site; published 01 January 2008).

Outline of the Mental Health Gap Action Programme (mhGAP) (WHO site).

Clinical Review: WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: A Systematic Review of Evidence from Low and Middle-Income Countries (BMJ Journals: Evidence-Based Mental Health).

What was the National Mental Health Development Unit (UK)?

Introduction

The National Mental Health Development Unit (NMHDU) was a governmental organisation in England charged with supporting the implementation of mental health policy.

The unit worked to achieve this by advising on best practice for improving mental health and mental health services. NMHDU closed on 31 March 2011.

The NMHDU was funded by the Department of Health and the National Health Service, and aimed to work in partnership with the NHS’s strategic health authorities and all stakeholders. The unit was launched in 2009, following the abolition of the National Institute for Mental Health in England (NIMHE). The director of the NIMHE, Ian MacPherson, became the director of the NMHDU.

The Unit had several specific programmes of activity, including to support the Improving Access to Psychological Therapies (IAPT) scheme. The Unit also supported the government’s strategy for mental health, New Horizons, which was published in December 2009 following the end of the National Service Framework plans.

What Does the Czech Republic Spend on Mental Health Care, and Where?

Research Paper Title

Expenditures on Mental Health Care in the Czech Republic in 2015.

Background

Expenditures on mental health care in the Czech Republic are not being published regularly, yet they are indispensable for evaluation of the ongoing reform of Czech mental health care.

The main objective of this study is to estimate the size of these expenditures in 2015 and make a comparison with the last available figures from the year 2006.

Methods

The estimation is based on an OECD methodology of health accounts, which structures health care expenditures according to health care functions, provider industries, and payers.

The expenditures are further decomposed according to diagnoses, and inputs used in service production.

Results

The amount spent on mental health care in 2015 reached more than 13.7 billion Czech korunas (EUR 501.6 million), which represented 4.08% of the total health care expenditures.

This ratio is almost identical with the 2006 share (4.14%).

There are no significant changes in the relative expenditures on mental health care and in the structure of service provision.

Conclusions

The Czech mental health care system remains largely hospital based with most of all mental health care expenditures being spent on inpatient care.

Future developments in the expenditures will indicate the success of the current effort to deinstitutionalise mental health care.

Reference

Broulikova, H.M., Dlouhy, M. & Winkler, P. (2020) Expenditures on Mental Health Care in the Czech Republic in 2015. The Psychiatric Quarterly. 91(1), pp.113-125. doi: 10.1007/s11126-019-09688-3.

Beyond Paranoia & Panic: Mental Health Strategies to Combat the Psychological Impact of COVID-19

Research Paper Title

Mental Health Strategies to Combat the Psychological Impact of COVID-19 Beyond Paranoia and Panic.

Background

On 30 January 2020, the World Health Organisation (WHO) declared the outbreak of coronavirus disease 2019 (COVID-19) an international public health emergency after the number of cases soared across 34 regions in Mainland China and surpassed that of severe acute respiratory syndrome (SARS) in 2003.

The virus was believed to have originated from a wholesale seafood market in the city of Wuhan in the province of Hubei towards the end of December 2019.

Shortly after, the number of cases increased exponentially in Wuhan and nearby cities and provinces before spreading throughout the world.

Located approximately 3,432 km from the epicentre of Wuhan, Singapore is a densely populated city-state of 5.7 million who saw 1,592,612 international visitors in 2019; of these, 380,933 were visitors from Mainland China.

After a tourist from Wuhan was identified as the first case of COVID-19 infection on 23 January 2020 in Singapore, the country responded decisively by initiating a series of public health measures to contain the outbreak that included travel advisories, restriction of entry into the country by individuals who had travelled to Mainland China in the preceding 2 weeks, mandatory quarantine for contact cases and rigorous contact tracing of individuals linked to confirmed COVID-19 cases.

You can access the full article here.

Reference

Ho, C.S., Chee, C.Y. & Ho, R.C. (2020) Mental Health Strategies to Combat the Psychological Impact of COVID-19 Beyond Paranoia and Panic. Annals of the Academy of Medicine, Singapore. 49(3), pp.155-160.

Do we need Evidence-based Rehabilitation Programmes to Facilitate Community Integration & Functional Recovery?

Research Paper Title

Addressing Severe Mental Illness Rehabilitation in Colombia, Costa Rica, and Peru.

Background

Many Latin American countries face the challenge of caring for a growing number of people with severe mental illnesses while promoting deinstitutionalisation and community-based care.

This article presents an overview of current policies that aim to reform the mental health care system and advance the employment of people with disabilities in Colombia, Costa Rica, and Peru.

Methods

The authors conducted a thematic analysis by using public records and semi-structured interviews with stakeholders.

The authors found evidence of supported employment programmes for vulnerable populations, including people with disabilities, but found that the programmes did not include people with severe mental illnesses.

Results

Five relevant themes were found to hamper progress in psychiatric vocational rehabilitation services:

  1. Rigid labour markets;
  2. Insufficient advocacy;
  3. Public subsidies that create conflicting incentives;
  4. Lack of deinstitutionalised models; and
  5. Lack of reimbursement for evidence-based psychiatric rehabilitation interventions.

Conclusions

Policy reforms in these countries have promoted the use of medical interventions to treat people with severe mental illnesses but not the use of evidence-based rehabilitation programmes to facilitate community integration and functional recovery.

Because these countries have other supported employment programmes for people with non-psychiatric disabilities, they are well positioned to pilot individual placement and support to accelerate full community integration among individuals with severe mental illnesses.

Reference

Cubillos, L., Muñoz, J., Caballero, J., Mendoza, M., Pulido, A., Carpio, K., Udutha, A.K., Botero, C., Borrero, E., Rodríguez, D., Cutipe, Y., Emeny, R., Schifferdecker, K. & Torrey, W.C. (2020) Addressing Severe Mental Illness Rehabilitation in Colombia, Costa Rica, and Peru. Psychiatric Services (Washington, D.C.). 71(4):378-384. doi: 10.1176/appi.ps.201900306. Epub 2020 Jan 3.

The Taluk Mental Health Programme Initiative

Research Paper Title

Taluk Mental Health Program: The new kid on the block?

Background

This article highlights the platform and framework for the new public mental health initiative, the Taluk Mental Health Programme (TMHP), rolled out by the Government of India, as part of the expansion of the District Mental Health Programme.

In this initial phase, TMHP has been approved for ten taluks of Karnataka state.

In the authors’ collective opinion, few of the initiatives in the country could be considered as foundations for conceptualising the TMHP:

  • Research programmes and projects in the community;
  • Community intervention programmes running in two taluks of Karnataka since the past one and a half decade (Thirthahalli and Turuvekere taluks of Karnataka); and
  • The Primary Care Psychiatry Programme of National Institute of Mental Health and Neurosciences.

The article briefly describes the above initiatives and ends with further suggestions to scale up TMHP.

Reference

Manjunatha, N., Kumar, C.N., Chander, K.R., Sadh, K., Gowda, G.S., Vinay, B., Shashidhara, H.N., Parthasarathy, R., Rao, G.N., Math, S.B. & Thirthalli, J. (2019) Taluk Mental Health Program: The new kid on the block? Indian Journal of Psychiatry. 61(6), pp.635-639. doi: 10.4103/psychiatry.IndianJPsychiatry_343_19.

A Review of Effective/Cost Effective Interventions of Child Mental Health Problems in Low- and Middle-Income Countries (LAMIC)

Research Paper Title

Effective/cost effective interventions of child mental health problems in low- and middle-income countries (LAMIC): Systematic review.

Background

This systematic review protocol aims to examine the evidence of effectiveness and cost-effectiveness of interventions for children and adolescents with, or at risk of developing mental disorders in low- and middle-income countries (LAMICs).

Methods

The researchers will search Medline Ovid, EMBASE Ovid, PsycINFO Ovid, CINAHL, LILACS, BDENF and IBECS. We will include randomised and non-randomised controlled trials, economic modelling studies and economic evaluations.

Participants are 6 to 18 year-old children and adolescents who live in a LAMIC and who present with, or are at high risk of developing, one or more of the conditions: depression, anxiety, behavioural disorders, eating disorders, psychosis, substance abuse, autism and intellectual disabilities as defined by the DSM-V.

Interventions which address suicide, self-harm will also be included, if identified during the extraction process.

The researchers will include in person or e-health interventions which have some evidence of effectiveness (in relation to clinical and/or functional outcomes) and which have been delivered to young people in LAMICs.

They will consider a wide range of delivery channels (e.g., in person, web-based or virtual, phone), different practitioners (healthcare practitioners, teachers, lay health care providers) and sectors (i.e., primary, secondary and tertiary health care, education, guardianship councils).

In the pilot of screening procedures, 5% of all references will be screened by two reviewers.

Divergences will be resolved by one expert in mental health research.

Reviewers will be retrained afterwards to ensure reliability. The remaining 95% will be screened by one reviewer.

Covidence web-based tool will be used to perform screening of references and full text paper, and data extraction.

Results

The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences.

The results will be presented descriptively and, if possible, meta-analysis will be conducted. Ethical approval is not needed for anonymised secondary data.

Conclusions

The systematic review could help health specialists and other professionals to identify evidence-based strategies to deal with child and adolescents with mental health conditions.

Reference

Grande, A.J., Ribeiro, W.S., Faustino, C., de Miranda, C.T., Mcdaid, D., Fry, A., de Moraes, S.H.M., de Oliveira, S.M.D.V.L., de Farias, J.M., de Tarso Coelho Jardim, P., King, D., Silva, V., Ziebold, C. & Evans-Lacko, S. (2020) Effective/cost effective interventions of child mental health problems in low- and middle-income countries (LAMIC): Systematic review. Medicine (Baltimore). 99(1):e18611. doi: 10.1097/MD.0000000000018611.

Suicide in Older Adults: Intervention Required

Research Paper Title

Suicide in Older Adults.

Abstract

Suicide in older adults is a critical problem that nurses and other health professionals need to address.

Evidence-based interventions for prevention of late-life suicide are urgently needed, as well as increased availability of health care professionals with knowledge and skills to recognise suicide risks and intervene to provide effective care for this vulnerable population.

Reference

Sorrell, J.M. (2020) Suicide in Older Adults. Journal of Psychosocial Nursing and Mental Health Services. 58(1), pp.17-20. doi: 10.3928/02793695-20191218-04.

Health Policies: Consider the Direct & Indirect Cross-effects between Mental Health & Physical Health

Research Paper Title

The relationship between physical and mental health: A mediation analysis.

Background

There is a strong link between mental health and physical health, but little is known about the pathways from one to the other.

The researchers analyse the direct and indirect effects of past mental health on present physical health and past physical health on present mental health using lifestyle choices and social capital in a mediation framework.

Methods

They use data on 10,693 individuals aged 50 years and over from six waves (2002-2012) of the English Longitudinal Study of Ageing.

Mental health is measured by the Centre for Epidemiological Studies Depression Scale (CES) and physical health by the Activities of Daily Living (ADL).

Results

The researchers find significant direct and indirect effects for both forms of health, with indirect effects explaining 10% of the effect of past mental health on physical health and 8% of the effect of past physical health on mental health.

Physical activity is the largest contributor to the indirect effects.

There are stronger indirect effects for males in mental health (9.9%) and for older age groups in mental health (13.6%) and in physical health (12.6%).

Conclusions

Health policies aiming at changing physical and mental health need to consider not only the direct cross-effects but also the indirect cross-effects between mental health and physical health.

Reference

Ohrnberger, J., Fichera, E. & Sutton, M. (2017) The relationship between physical and mental health: A mediation analysis. Social Science & Medicine (1982). 195, pp.42-49. doi: 10.1016/j.socscimed.2017.11.008. Epub 2017 Nov 8.