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Newsletter No. 5 November 2020
Overview of content:
- Psychological first aid tools for working in areas with little access to mental health care
- Providing psychological first aid
- Further reading and resources
- Download the MHHRI GBV manual
- Upcoming Events
Dear friends and colleagues
Psychological support tools for working in areas with little access to mental health care
Article 12 in the UN Committee on Economic Social and Cultural Rights recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
Nevertheless, in many countries people lack access to mental health care. Refugees and displaced populations are among those who often face barriers in accessing professional mental health services.
Mental health problems such as depression can be a strain for oneself and for the surrounding family and may in some cases even lead to suicide. Especially low-income countries struggle to keep up with the demand for psychological care due to lack of funding and facilities. Therefore, a lack of (and access to) professionals arises.
On a global basis, researchers believe that the loss of health due to mental illness is greater than with all other illnesses. Mental illness tops the list of causes of excess morbidity. It is therefore important to raise awareness about this issue and to advocate for better access to mental health care. Our team at MHHRI provides useful resources about mental health and human rights on our website.
A wide gap in mental health support in areas where humanitarian access is difficult, calls for innovative measures. WHO developed Self-Help Plus (SH+) to meet the challenges of delivering evidence-based mental health support to large numbers of people in conflict- or disaster-affected areas.
SH+ is a group-based self-help intervention guided by non-specialist facilitators with minimal training. It consists of a five-session pre-recorded audio course and an illustrated self-help book designed for low literacy populations.
Guided self-help is a promising intervention and has potential to improve reach and access to psychological support. So far research findings indicate that SH+ has great effect on reductions in psychological distress.
Here, we also want to mention some other initiatives aiming to make mental health care more available. One example is the manual “Where there is no psychiatrist – A Mental Health Care Manual”, which gives the reader a basic understanding of mental illness. It also provides training for general health workers to treat illnesses such as depression.
Another example is psychiatrist Dixon Chibanda, who had an innovative idea on how to provide mental health care in Zimbabwe, where there is a lack of psychiatrists. He started training grandmothers in evidence-based talk therapy, which equipped them with tools to treat depression among people in their community. This approach showed great results, reducing both depression and thoughts of suicide.
In these times of COVID-19 we should remember the words of WHO Director-General Dr Tedros Adhanom Ghebreyesus: “The right to health means that everyone should have access to the health services they need, when and where they need them, without suffering financial hardship. No one should get sick and die just because they are poor, or because they cannot access the health services they need”.
During the Coronavirus outbreak, it is especially important that we are reminded of this fundamental right. Key aspects of the right to health that are particularly important during the Coronavirus outbreak included. For more information related to COVID-19 and mental health, go back to our newsletter no 1 of March 2020.
Further reading and resources:
Where There Is No Psychiatrist – A Mental Health Care Manual.
Royal College of Psychiatrists, 2018
“This practical manual of mental health care is vital for community health workers, primary care nurses, social workers and primary care doctors, particularly in low-resource settings. This guide gives the reader a basic understanding of mental illness by describing more than thirty clinical problems associated with mental illness and uses a problem-solving approach to guide the reader through their assessment and management. Mental health issues as they arise in specific contexts are described – in refugee camps, in school health programmes, as well as in mental health promotion.”
Guided self-help intervention reduces refugees’ psychological distress and improves wellbeing in humanitarian crises
WHO 2020
“First randomised trial of its kind finds multimedia guided self-help intervention can be delivered rapidly to large numbers of people in low-resource humanitarian settings by non-specialists with minimal training. […] The study is the first randomised trial of a guided self-help group intervention in a low-resource humanitarian setting. Although longer follow-up is needed to determine the long-term effects of the intervention, the authors say that guided self-help could be a promising first-line strategy to address the vast gap in mental health support in areas where humanitarian access is difficult, such as South Sudan and Syria.”
Guided self-help intervention reduces refugees’ psychological distress and improves wellbeing in humanitarian crises.
TED Talk: Why I train grandmothers to treat depression
Dixon Chibanda, 2017
“Dixon Chibanda is one of 12 psychiatrists in Zimbabwe – for a population of more than 16 million. Realizing that his country would never be able to scale traditional methods of treating those with mental health issues, Chibanda helped to develop a beautiful solution powered by a limitless resource: grandmothers. In this extraordinary, inspirational talk, learn more about the friendship bench program, which trains grandmothers in evidence-based talk therapy and brings care, and hope, to those in need.”
Effect of a Primary Care–Based Psychological Intervention on Symptoms of Common Mental Disorders in Zimbabwe. A Randomized Clinical Trial.
Dixon Chibanda, Helen A. Weiss, Ruth Verhey et. al, 2016
“Zimbabwe has a large treatment gap for common mental disorders, with only 10 psychiatrists serving a population of 13 million. Prevalence of common mental disorders above 25% has been reported among adult primary care attendees,5-8 but there are no psychological services in primary health care. A potentially feasible approach to improve this situation would require task shifting, allowing properly trained and supervised lay health workers (LHWs) in primary care to contribute to the treatment of common mental disorders. […] Problem-solving therapy is an attractive option in a low-resource context because, unlike cognitive behavior therapy, it does not require extensive training or complex skills.”
Mental Health Among Displaced People and Refugees: Making the Case for Action at The World Bank Group
World Bank Group, 2017
“Forcibly displaced people’s mental health needs have often been neglected in response plans. Yet meeting these needs is critical to help displaced persons overcome trauma and rebuild their lives. Without appropriate mental health care, forcibly displaced people will often be unable to benefit fully from other forms of support that are provided to them. […] A shared commitment is needed from national and international actors to champion mental health parity in the provision of health and social services, including in humanitarian emergencies. High priority should go to identifying alternative sources of financing for mental health parity in health systems.”
Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature
Naslund, Aschbrenner, Bartels et.al, 2017
“Few individuals living with mental disorders around the globe have access to mental health care, yet most have access to a mobile phone. Digital technology holds promise for improving access to, and quality of, mental health care.
We reviewed evidence on the use of mobile, online, and other remote technologies for treatment and prevention of mental disorders in low-income and middle-income countries. Of the 49 studies identified, most were preliminary evaluations of feasibility and acceptability. The findings were promising, showing the potential effectiveness of online, text-messaging, and telephone support interventions.”
Health Gap Action Programme (mhGAP)
WHO launched the mental health gap action programme (mhGAP) in response to the wide gap between the resources available and the resources urgently needed to address the large burden of mental, neurological, and substance use disorders globally. Through mhGAP, WHO aims to provide health planners, policy-makers, and donors with a set of clear and coherent activities and programmes for scaling up care for mental, neurological and substance use disorders.
Digital Technology for Building Capacity of Non-specialist Health Workers for Task-Sharing and Scaling Up Mental Health Care Globally
Naslund, Shidhaye & Patel, 2019
“In this perspectives article, we consider the potential that digital technology holds for supporting non-specialist health workers in delivering evidence-based mental health care. Specifically, from our search of the academic literature, we identified seven promising examples from primary care settings in different low-income and middle-income countries (including India, Pakistan, Zimbabwe, Peru, China, and Nigeria) where digital platforms are being used to support delivery of mental health care from a variety of non-specialist providers by offering training, digital tools for diagnosis, guiding treatment, facilitating supervision, and integrating services.”
Achieving universal health coverage for mental disorders
Patel & Saxena, 2019
“A key element of the field of global mental health is the design and evaluation of innovative strategies for integrating cost effective pharmacological and psychosocial interventions in primary healthcare. The evidence from this work, from a range of contexts including high income countries, is showing the way to integration. A theme across this evidence is the placement of non-specialised providers (including peers, community health workers, and nurses) in primary healthcare and community settings.”
Download the manual Mental health and gender-based violence: Helping survivors of sexual violence in conflict for free. The manual is also available in Arabic, Russian, Spanish, Nepalese, Ukrainian and Portuguese. This training material has been written for those who provide assistance and support to women who survive gender-based violence and sexual trauma during disasters, wars and conflicts. Furthermore, we hope it may be helpful as well to those who work with gender-based violence survivors in other settings. Please share the manual and spread it among your colleagues, organizations or in your community.
Facebook
On our MHHRI Facebook page, we are continuously posting new and relevant articles that we add to our web site, as well as events and videos.
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Upcoming Events IRCT symposium in Georgia – postponed 17th biennial conference of the European Society for Traumatic Stress Studies |
The 11th International Society for Health and Human Rights (ISHHR) Conference
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| We appreciate feedback and comments The Mental Health and Human Rights Info Newsletter is a newsletter with the aim to provide insight on a certain subject across the scope of our work; human rights violations in war and conflict areas and mental health. Our intention is to deliver a newsletter as a short “lecture” where you can find relevant information regarding a specific subject with a mental health perspective.
We would appreciate your thoughts and suggestions on other issues you would like to see in this newsletter or if you are planning an event on related issues, please let us know so we can include your event in our newsletter. If you know anyone who would be interested in receiving this e-newsletter, please forward it, and encourage them to sign up. |