Archive for Mental Health

Health in the Eastern Mediterranean Region

The vast complexities of the Middle East and surrounding regions cannot be understood without bringing health into the battleground of analysis. In this context, the Global Health PhD Network organised the event “Health in the Eastern Mediterranean Region” on 28th of October, 2016 with the funding of the University of Edinburgh’s Global Health Academy. The event was framed as a series of four short conferences on diverse topics related to Health in the region, and two networking recesses at the venue’s foyer at 7 Bristo Square, where delicious kenafa was served by the University’s Middle Eastern Society.

The first speaker was Dr Runa MacKay. She studied medicine at the University of Edinburgh at a time where it was not usual for women to go this further in their studies. In 1955 after qualifying in medicine, Dr Mackay arrived at the Edinburgh Medical Missionary Society Hospital in Nazareth, now in Israel, which has served the Arab population there for more than 150 years. Dr Runa Mackay spent around fifty years working across Lebanon, Palestine, and Israel for the betterment of health conditions among the Palestinian population who live within Israel, either in health policy or as a practitioner in war torn Beirut and West Bank. Today, back in Edinburgh, she has written the book “Exile in Israel”, where she tells her personal experience throughout those years which have taken her to state, as she did in the event, that she feels more Palestinian than British.

As the second speaker, Khuloud Alsaba, researcher from the Syrian Center for Policy Research and a final-year PhD candidate in International Public Health Policy talked about part of her research project: “War in Syria: Political Determinants of Health”. In a very critical and insightful way she explained how within the discourse of “The War on Terror” health facilities and health care workers have become a legitimate target. However, turning access to health into a weapon of war has brought unexpected hardships for the population. Khuloud argued that polio, once an eradicated disease, has reappeared in Syria as a consequence of a thrashed and weakened public health system. She concluded by stating that these war tactics are not only militarily and economically inefficient, but also (and most importantly) a violation of the human rights of Syrians.

After a short networking recess, the event carried on with the third talk. Via videoconferencing, Ben Clavey, a young medical student and the co-coordinator at Medact Arms and Militarisation Group, gave a concise explanation about this NGO and its work in the Middle East. Medact is an organisation where health professionals can go beyond the clinic and actively engage with the search for solutions to the most pressing global health issues. Through analysis, lobbying, and education, it aims at having an impact in policy on four main areas: peace and security, climate and ecology, economic justice, and health and human rights. Regarding the Middle East, he added that Medact’s activity in the region has been extensive. It has worked in Iraq and Palestine performing in ground analysis and campaigning for the respect of human rights and adequate health policy for the victims of armed conflict in both countries. Recently, it has worked on warning and lobbying against airstrikes by the British military in Syria and also against UK arms sales to Saudi Arabia, who has been involved in the destruction of Yemen’s health system and the targeting of its hospitals and other healthcare facilities. Finally, Ben invited us to become part of Medact’s effort in taking health as a human right into policy either by donating or joining the organisation. A stand with further information for those interested in participating was set on the venue’s lobby as well.

The fourth and last speaker was Parisa Mansoori, a PhD candidate at the Centre for Global Health Research at The University of Edinburgh, who presented her research project on Iranian health sciences and academic literature production. According to recent data, Iran has had a dramatic increase in the amount of health related academic publications in the past few years. This stands out as a unique situation among the emergent economies, due to the quality of the articles produced in Iran, which have found their way into high impact international journals. Moreover, Parisa pointed out that practically a large proportion of this new literature has been produced by a small group of academics in Tehran University of Medical Sciences and few other Tehran-based institutions. By providing a thorough characterisation of this phenomenon, she expects to lay ground for further progress and development of Iran’s health sciences and their contribution to the global scientific arena.

In conclusion, the event managed to assemble in a couple of hours a wide range of experiences related to health in the Eastern Mediterranean region. Just as this region has been traditionally associated with armed conflict and violent political struggle, health has also been a very pressing issue both then and now, as Dr MacKay and Khuloud Alsaba exemplified. However, as Ben Clavey from Medact and Dr MacKay let us see, there are still spaces for hope and resistance, as well as moments for empathy and sharing. Furthermore, in spite of these difficulties, the region hasn’t stopped creating new knowledge. As Parisa Mansoori portrayed, the region is home for highly qualified and capable academics who contribute to the development of science and knowledge around the world. Lastly, thanks to the networking sessions and kenafa tasting we were reminded that, as in any other place, there are people living everyday lives in this region, where the creation and recreation of very rich cultures has made of it a quite unique and special place.

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Bernardo Moreno-Peniche, MSc Medical Anthropology, University of Edinburgh

 

Images taken by: Clàudia Serra Vinardell

Rewarding research: Social Science and Health Research in Zambia

Rewarding research: Using my ‘self’, psychotherapeutic perspectives and reflection in social science and health research in Zambia

Following a long career in the NHS in Scotland as an Art Psychotherapist and leading several projects training mental health staff in Ghana and Zambia, I embarked on an MSc in Africa and International development at the University of Edinburgh.

My MSc incorporated a work-based placement at ZAMBART[1] in Zambia where I conducted a secondary analysis of case studies of households caring for patients with TB /HIV – from a mental health perspective. This gave me the opportunity to include my ‘self’ and my professional knowledge and stance as elements which worked in dialogue with each other as to inform and shape my dissertation. .

This was no mean task and required both reflection and personal challenge – an acceptance of painful self-realisations – in order to expose the normalised assumptions endemic in my attitudes. I judged men as ‘bad men’ – when their risk taking behaviours impacted on their families. Recognising this and then understanding these behaviours from a non-judgmental psychotherapeutic stance enabled the complex systemic relationships around men’s mental health in rural Zambia to no longer be hidden in a blind spot – beginning their exposure to greater understanding and analysis.

Such fruitful discoveries from such a self-reflective approach and a psychotherapeutic stance point add to the enhanced value of practitioners engaging in research and the blending of psychotherapeutic stances with research objectives.

More detail on this aspect of my work-based placement is given in  Who Cares about Mr Mubanga

 


Lesley Hill, MSc Africa and International Development (2014)

 

References

[1] ZAMBART – a non-for profit research organisation based within the University of Zambia that is also a research collaborating centre for the London School of Hygiene and Tropical Medicine

 

Global mental health – its time to pull together

The recent report from the UK’s All-Party Parliamentary Group on Global Health and Mental Health (MH) is very welcome. Not only does it describe the parlous state of MH services in many parts of the world, it presents an evidence-base for global action. It is important to acknowledge, for example, that patients can be caged, chained or subjected to abusive traditional approaches and that Western mental health services are not all bad. The report summarises the growing body of research showing that there are cost-effective solutions to mental health problems that even the poorest countries could implement and benefit from. These include improving social and economic environments, integrating mental health into general health care, using trained and non-specialist health workers to provide culturally appropriate community care, increasing access to self-help and empowering people with mental health problems to support and advocate for themselves and each other.

Further, and more specifically, the WHO (1) have previously shown that interventions such as psychosocial and antidepressant treatment are ‘very cost-effective’ interventions for panic disorder and depression throughout the world, and that psychosocial treatments plus older antipsychotic and mood stabilising drugs are ‘cost-effective’ for schizophrenia and bipolar disorder.

Another report released in November, from the Overseas Development Institute (2), gives a complimentary perspective – mental (ill) health does not receive due policy attention due to stigma and a lack of coherence across the mental health community. The time has come for the mental health community to work together to achieve shared goals such as reducing stigma and increased funding for MH services across the globe.

 

 


Professor Stephen Lawrie, Head of Psychiatry, University of Edinburgh


 

1.Chisholm D, on behalf of WHO-CHOICE. Choosing cost-effective interventions in psychiatry: results from the CHOICE programme of the World Health Organisation. World Psychiatry 2005; 4: 37-44.
2. Mackenzie J. Global mental health from a policy perspective: a context analysis. Overseas Development Institute 2014.

October 10th 2013 – World Mental Health Day: Time for Action

Today celebrates World Mental Health Day, an initiative to raise awareness about mental health disorders worldwide, which was instigated by the World Federation for Mental Health and the World Health Organisation over two decades ago.  The theme this year is ‘Mental Health and Older Adults’.

Worldwide, the ageing population is increasing, with the current population aged 60 years and over expected to expand to 2 billion by 2050, as lifetime expectancy continues to rise.  As a recent report, published by the World Health Organisation “Mental Health of Older Adults: Addressing a Growing Concern” identified, mental health problems are often under-recognised in this age group.  Depression is common, accounting for 9.17 million Disability Adjusted Life Years (DALYS).  Dementia is recognized as a public health priority and by, 2050 it is estimated that 115 million people will be affected, of which over 50% will be in low and middle-income countries (Yasamy et al, 2013)

People living with mental disorders (PLWMD) face many challenges in accessing appropriate care worldwide, and this is exacerbated in low and middle income countries (LMIC), where it is estimated 90% of those individuals suffering from a mental disorder do not receive treatment (Patel et al ,2010).

Stigma, the negative attitudes and labelling that occur based on prejudices and misinformation about mental illness, has serious consequences.  Older adults, whilst respected in some communities, in others face significant stigma.  This is the case in some parts of Malawi, for example, where older adults may be perceived as witches, and subsequently ostracized and even victimized within their local communities.  This is an area that some Governments are starting to recognize requires action (http://www.nyasatimes.com/2013/08/24/elderly-not-witches-says-malawi-pres-banda).

Elder maltreatment has been defined by the World Health Organisation as “a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust that causes harm or distress to an older person”.  It is estimated to affect 4-6% of older adults in High Income Countries (World Health Organisation, 2011).  In low and middle-income countries, the situation is less clear.

Dementia, is not just a problem that affects the older adult population, and particularly in sub-saharan Africa, the spectrum of HIV-associated neurocognitive disorders may affect up to 50% of people living with HIV/AIDS.

Perspectives from the mental healthcare field in a low income country:

How does the epidemic of mental disorders translate to experience in everyday psychiatric practice in a low-income context?  In my work in a psychiatric institution in one of the poorest countries in the world, Malawi, we are faced with challenges in offering basic levels of care to individuals who have often gone for many years without treatment.  The result is that they often arrive in a life-threatening condition, in some cases exacerbated by their neglect within general healthcare services, in part due to the stigma they face even within the healthcare profession.  Whilst we are fortunate to have a reasonable supply of medication within our hospital, provision of other important aspects of care, such as intensive nursing, occupational and rehabilitation and social therapy are limited.   On discharge from hospital the level of community care provision is sparse, often represented by a single monthly clinic that has no supplies or resources for providing psychological or social therapies.  In this context, there is a need to improve training and education of primary healthcare professionals in basic interventions for mental disorders.  Even within a specialist hospital, we have few nursing staff who have undergone specialist mental health training, and many have not chosen to be deployed to work in this area.

World Mental Health Day has an important role to play worldwide, by raising public and professional awareness of these issues, in the hope that we will move towards a brighter future in which individuals experiencing mental distress and mental illness, are able to access appropriate care and treatment in a non-judgemental and supportive way, that is tailored to their needs and respects their basic rights.  We still have a long way to go, but I am hopeful that World Mental Health Day will continue to be one of the many small steps required to raise awareness of the needs of people living with mental illness, one of the most vulnerable groups in society, whether in low-, middle- or high- income countries.

 

Dr Selena Gleadow Ware is a Consultant Psychiatrist and Lecturer in Mental Health at the College of Medicine, University of Malawi and Visiting Honorary Lecturer at Edinburgh University where she facilitates the module on Global Mental Health.

selena gleadow ware TH

 

 

 

 

 

 

References

Patel V, Maj M, Flisher AJ, De Silva MJ, Koschorke M, Prince M; WPA Zonal and Member Society Representatives. Reducing the treatment gap for mental disorders: a WPA survey. World Psychiatry. 2010 Oct; 9(3):169-76.

World Health Organisation (2011) Elder Maltreatment. Factsheet No. 357 http://www.who.int/mediacentre/factsheets/fs357/en/

World Health Organization. Dementia, A Public Health Priority, 2012, World Health Organisation.  http://whqlibdoc.who.int/publications/2012/9789241564458_eng.pdf

Yasamy, WT., Dua, T., Harper, M., Saxena, S. Mental Health of Older Adults: Addressing A Growing Concern.  2013. World Health Organisation.  http://www.who.int/mental_health/world-mental-health-day/WHO_paper_wmhd_2013.pdf

World Mental Health Day: Mental Health Foundation

http://www.mentalhealth.org.uk/our-work/world-mental-health-day/world-mental-health-day-2013/?view=Standard