Wellbeing for All Global Mental Health Developments and Directions CCF

Wellbeing for All Global Mental Health Developments and Directions CCF 7 February 2020 Kelly O’Donnell, PsyD [email protected] http://membercareassociates.org 2020 Kelly and Mich èle O’Donnell—see the notes under the slides too

Purpose What brings you here? What brings all of us--the world community—here? To orient colleagues across sectors, disciplines, cultures, and countries to GMH. To review recent developments and directions (GMH markers) To consider ways to connect and contribute to GMH on behalf of human wellbeing, locally through globally.

. Wellbeing for All GMH Overview To say “Your side of the global boat is sinking”. is crazy. We are all on the same precarious, perilous, and precious global boat.

Message for World Mental Health Day-10 October 2018 UN Secretary-General António Guterres “Health encompasses both physical and mental well-being. Yet, for too long, mental health has been mostly an afterthought, despite its overwhelming impacts on communities and young people, everywhere .Healthy societies require greater integration of mental health into broader health‑ and social‑care systems, under the umbrella of universal health coverage. The United Nations is committed to creating a world where, by 2030, everyone, everywhere has someone to turn to in support of their mental health, in a world free of stigma and discrimination. If we change our attitude to mental health—we change the world. It is time to act on mental health.”

“It’s time for the world to listen. It’s time for leaders to act. It’s time for mental health for all.” Amina Mohammed, UN Deputy Secretary-General 18 May 2019 (two minute video message)

GMH Overview Three Resources Global Mental Health: Collaborating Across Sectors for Sustain able Development and Wellbeing Medicus Mundi Switzerland, Bulletin (June 2017) Global Mental Health: What’s Up? Recent Developments and Directions Global Insights, Office of International Affairs, American Psychological Association (June 2019) Click HERE for the full version.

. “Mental health affects and is affected by many crucial issues pertinent to global development and quality of life, including poverty, food security, trauma, conflict, interpersonal violence, terrorism, gender equality, education, human security, natural disasters, and climate change. mental ill health [contributes] significantly to the total global burden of disease. Anxiety and depression for example, respectively affect an estimated 264 million and 322 million people and contribute to an estimated 3.4% and 7.5% of all years lived with disability. Depression is the single largest contributor to global disability. (WHO, 2017a)” [note: estimates vary] O’Donnell and Eaton, 2017

. “Despite the fact that there are hundreds of millions of people experiencing a mental, neurological, or substance use condition, the attention paid to these conditions has been scant historically. Even in high income countries only 35-50% of the people with severe mental disorders receive treatment, and in low income countries the vast majority, typically 76-85%, receive little or no effective care (WHO, 2013, p. 8). In sub-Saharan Africa, governments spend only around 1% of their health budgets on mental health, a number that is very similar to the proportion of international development assistance for health dedicated to mental health (Gilbert, Patel, Farmer, and Lu, 2015) O’Donnell and Eaton, 2017

. Further, the extreme neglect, human rights abuse, and social exclusion of people with mental illness means that they could be seen as the epitome of people who are “left behind.” In addition, “people with these disorders are often subjected to social isolation, poor quality of life and increased mortality. These disorders are the cause of staggering economic and social costs.” (WHO Department of Mental Health, The Bare Facts).” O’Donnell and Eaton, 2017

Like a Death Sentence Human Rights Watch (2012) See update 2017 .

Global Mental Health Defined “Global Mental Health (GMH) is an emerging domain of research and practice that promotes equitable mental health and well-being for all. GMH is international, interdisciplinary, culturally relevant and multi-sectoral. GMH emphasizes the right to equity in health and encourages healthy behaviors and lifestyles. GMH is committed to preventing and treating mental, neurological, and substance use conditions (MNS) especially for vulnerable populations such as poverty, conflict, and trauma and in low- and middle-income countries. GMH seeks to improve policies and programs, professional practices and research, advocacy and awareness, and social and environmental factors that affect mental health and well-being.” (O’Donnell and Lewis O’Donnell, 2016 and O’Donnell and Eaton, 2017).

Lancet Commission on GMH and Sustainable Development (October 2018) 1. 2. 3. 4. 5. 6. 7. Summary of Key Recommendations Address mental health across all the Sustainable Development Goals Include mental health in the essential package of services for Universal Health Coverage Take a public health approach to prevention and promotion Ensure inclusion of people with mental health conditions Increase investment in mental health Harness learning from research to help drive change Measure progress against existing commitments Source: MHIN Policy Brief October 2018

. Wellbeing for All GMH Developments and Directions

GMH-DD 1 There is a mental health pandemic A bitter truth is better than a sweet lie. There is a pandemic of mental ill health—estimates vary, but hundreds of millions--people 25% lifetime prevalence. 15-25% shorter life spans than general population Depression and dementia are major/growing contributors to the global burden of disease. Massive social and economic costs of not investing in prevention and care.

GMH-DD 2 There is a Trauma Pandemic “You can’t just Pontius Pilate 800,000 people.” Romeo Dallaire .

Image courtesy GIST-T

A global lens for trauma: Four Violences Quantified 1.Direct violence: 1.5 billion people live in countries afflicted by political or criminal violence and war, 300 million people live amidst violent insecurity. One-third of all women in the world experience sexual, physical or other abuse in their lifetime women are more than twice as likely as men to have PTSD. “Silent emergencies” - stress at work, bullying, divorce, abandonment, neglect, emotional abuse, etc. 2.Natural violence: 268 million people are affected annually by natural disasters Loss of a loved one – in 2012, 56 million people died

A global lens for trauma: The Four Violences Quantified 3. Structural violence: 1.22 billion people lived in extreme poverty in 2010 (WB) US 1.50 a day; in all, 2.4 billion lived on US 2 a day that year Hunger and malnutrition (925 million); 218 million are child laborers 4. Cultural violence: Discrimination, oppression, apartheid, colonialism, exploitation and racism all exert a chronic stress that may lead to trauma.

GMH-DD 3 Mental health affects us all Who is hurting—hiding--helping? Who doesn’t know someone with a mental health condition? Film trailer: https://www.youtube.com/watch?v Y8Tbiciyzq0 Film website: http://hiddenpicturesthemovie.com/

GMH-DD 4 There is no health without mental health WHO Mental Health Action Plan 2013-2020 Vision: “A world in which mental health is valued, promoted, and protected, mental disorders are prevented and persons affected by these disorders are able to exercise the full range of human rights and to access high-quality, culturally appropriate health and social care in a timely way to promote recovery, all in order to attain the highest possible level of health and participate fully in society and at work free from stigmatization and discrimination.”

Four Objectives Mental Health Action Plan Strengthen effective leadership and governance for mental health. Provide comprehensive, integrated and responsive mental health and social care services in community-based settings. Implement strategies for promotion and prevention in mental health. Strengthen information systems, evidence and research for mental health.

Overview: Mental Health Action Plan 2013-2020 Vision A world in which mental health is valued, promoted, and protected, mental disorders are prevented and persons affected by these disorders are able to exercise the full range of human rights and to access high-quality, culturally appropriate health and social care in a timely way to promote recovery, all in order to attain the highest possible level of health and participate fully in society and at work free from stigmatization and discrimination. Cross-cutting Principles Universal health coverage Human rights Evidence-based practice Life course approach Multisectoral approach Regardless of age, sex, socioeconomic status, race, ethnicity or sexual orientation, and following the principle of equity, persons with mental disorders should be able to access, without the risk of impoverishing themselves, essential health and social services that enable them to achieve recovery and the highest attainable standard of health. Mental health strategies, actions and interventions for treatment, prevention and promotion must be compliant with the Convention on the Rights of Persons with Disabilities and other international and regional human rights instruments. Mental health strategies and interventions for treatment, prevention and promotion need to be based on scientific evidence and/or best practice, taking cultural considerations into account. Policies, plans, and services for mental health need to take account of health and social needs at all stages of the life course, including infancy, childhood, adolescence, adulthood and older age. A comprehensive and coordinated response for mental health requires partnership with multiple public sectors such as health, education, employment, judicial, housing, social and other relevant sectors as well as the private sector, as appropriate to the country situation. Empowerment of persons with mental disorders and psychosocial disabilities Persons with mental disorders and psychosocial disabilities should be empowered and involved in mental health advocacy, policy, planning, legislation, service provision, monitoring, research and evaluation. Goal To promote mental well-being, prevent mental disorders, provide care, enhance recovery, promote human rights and reduce the mortality, morbidity and disability for persons with mental disorders Objectives and Targets 1. To strengthen effective leadership and governance for mental health Global target 1.1: 80% of countries will have developed or updated their policy/plan for mental health in line with international and regional human rights instruments (by the year 2020). Global target 1.2: 50% of countries will have developed or updated their law for mental health in line with international and regional human rights instruments (by the year 2020). 2. To provide comprehensive, integrated and responsive mental health and social care services in community-based settings Global target 2: Service coverage for severe mental disorders will have increased by 20% (by the year 2020). 3. To implement strategies for promotion and prevention in mental health Global target 3.1: 80% of countries will have at least two functioning national, multisectoral mental health promotion and prevention programmes (by the year 2020). Global target 3.2: The rate of suicide in countries will be reduced by 10% (by the year 2020). 4. To strengthen information systems, evidence and research for mental health Global target 4: 80% of countries will be routinely collecting and reporting at least a core set of mental health indicators every two years through their national health and social information systems (by the year 2020).

Two MH Resources—WHO Psychological First Aid (2011) mhGAP Humanitarian Intervention Guide (2015)

GMH-DD 5 There is no sustainable development without mental health Transforming Our World: The 2030 Agenda for Sustainable Development (Sept. 2015) . "Today we are also taking a decision of great historic significance. We resolve to build a better future for all people, including the millions who have been denied the chance to lead decent, dignified and rewarding lives and to achieve their full human potential. We can be the first generation to succeed in ending poverty; just as we may be the last to have a chance of saving the planet ” (paragraph 50) The five overlapping themes in the SDGs: People-Peace-Prosperity-Planet-Partnership

SDGs—and SDG 3 Goal 1 End poverty in all its forms everywhere Goal 2 End hunger, achieve food security and improved nutrition and promote sustainable agriculture Goal 3 Ensure healthy lives and promote well-being for all at all ages. Goal 3.4 By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being Goal 4 Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all Goal 5 Achieve gender equality and empower all women and girls Goal 6 Ensure availability and sustainable management of water and sanitation for all Goal 7 Ensure access to affordable, reliable, sustainable and modern energy for all Goal 8 Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all Goal 9 Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation Goal 10 Reduce inequality within and among countries Goal 11 Make cities and human settlements inclusive, safe, resilient and sustainable Goal 12 Ensure sustainable consumption and production patterns Goal 13 Take urgent action to combat climate change and its impacts Goal 14 Conserve and sustainably use the oceans, seas and marine resources for sustainable development Goal 15 Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss Goal 16 Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels Goal 17 Strengthen the means of implementation and revitalize the global partnership for sustainable development

GMH-DD 6 “Nothing about us without us” Empowerment and Human Rights “Listen to and engage people with lived experience. Facilitate meaningful participation at all stages of development and implementation of services. Strengthen the advocacy voice of people affected to hold governments accountable.” --One of the seven key recommendations, Lancet Commission on GMH and SD, October 2018

Cape Town Declaration (2011) Pan African Network of People with Psychosocial Disabilities “We recognise that people with psychosocial disabilities have been viewed in bad ways, with derogatory words being used to describe us such as mentally disturbed, having unsound minds, idiots, lunatics, imbeciles and many other hurtful labels We are people first! We have potentials, abilities, talents and each of us can make a great contribution to the world. We in the past, presently and in the future, have, do and will continue to make great contributions if barriers are removed . For as long as others decide for us, we do not have rights. No one can speak for us. We want to speak for ourselves. We want to be embraced with respect and love . We wish for a better world in which all people are treated equally, a world where human rights belong to everyone. We invite you to walk beside us. We know where we want to go”.

GMH-DD 7 Do task shifting and task sharing (and stop protecting your professional turf) SUNDAR (beautiful) Vikram Patel Simplify message UNpack treatments (core components) Deliver where people are Affordable and available human resources Reallocation of specialists See: -- Mental Health for All and Involving All, TedTalk (September 2012) Vikram Patel

The Friendship Bench “The Friendship Bench project is an evidence-based intervention developed in Zimbabwe to bridge the mental health treatment gap. Their mission is to enhance mental well-being and improve quality of life through the use of problem solving therapy delivered by trained lay health workers. The Friendship Bench focuses on people who are suffering from common mental disorders, such as anxiety and depression. Produced by: Nicky Wimble, United For Global Mental Health” Video: https://www.youtube.com/ watch?v Th77mCuL5GY

GMH-DD 8 Scale up GMH all government--all society—all settings primary health care—universal health coverage ‘from global-political declarations to community action-impact’

. “Evidence-based psychological interventions commonly used in high-resource settings can be effective in low-resource contexts, including when they are delivered by trained and supervised non-specialists. These interventions have proved helpful in the treatment of common mental health problems, such as depression, anxiety and traumatic and chronic stress, as well as other difficulties, such as harmful alcohol use. Cultural and contextual adaptations can increase the effectiveness of psychological interventions, and make them more accessible to people affected by crises. Treatments are best delivered in local languages, using recognisable terminology and case examples, and implemented in ways that do not exacerbate stigma or exclusion. Humanitarian settings demand psychological interventions that are as brief and as low-cost as possible, and which optimise limited human resources.” Scalable psychological interventions for people affected by adversity, Schaefer et al (July 2018) Mental Health and Psychological Support in Humanitarian Crises, Humanitarian Exchange/HPN, ODI

GMH-DD 9 Society-culture impact mental health

Social Determinants of Health “Because mental disorders are so strongly socially determined, the global burden of these disorders is unlikely to be relieved by improved access to mental health treatments alone. In the words of the final report of the WHO Commission on the social determinants of health in 2008: “Why treat people only to send them back to the conditions that made them sick in the first place?” Social determinants of mental disorders and sustainable development goals: A syste matic review of reviews . Lund at al (1 April 2018) Lancet Idioms of Distress-- the socio-cultural understanding of mental ill health Diagnostic shifts—continuum of severity (distress, disability, duration) vs being a “disorder or a disease”, and the socio-cultural context for mental ill health

Social Determinants: war, conflict poverty, injustice, TRAUMA etc. Video: Living Peace: The Story of Abby and Kyalu Trauma and treatment in Democratic Republic of Congo, Promundo (watch the overview here)

GMH-DD 10 Be Global Citizens Embracing our common identity, belonging, and responsibilities as humans (not global homogeneity, cultural conformity, national non-sovereignty ) Gyeongju Action Plan (2016) “Education for Global Citizenship: Achieving the SDGs Together” “In addition to literacy and numeracy, education must advance the cause of global citizenship which: promotes integrated development of the whole person emotionally, ethically, intellectually, physically, socially, and spiritually; imbued with an understanding of our roles, rights and responsibilities for the common good in service to humanity and the advancement of a culture of peace, non-violence, freedom, justice, and equality “empowers learners to assume active roles to face and resolve global challenges and to become proactive contributors to a more peaceful, tolerant, inclusive, and secure world” [UNESCO 2014]; nurtures a sense of solidarity and empathy in order to end poverty, protect the planet, ensure human rights, and foster prosperous and fulfilling lives for all .We commit to An education that teaches conflict resolution, a deep appreciation for diversity, ethical reasoning, gender equality, human rights and responsibilities, interdependence, multilingual and multicultural competence, social justice, sustainable development, and values.” (pages 1,2) [bold font added for emphasis]

Sign at the bus stop Lake Avenue and California Ave, Pasadena California, 11 April 2019

GMH-DD--Summary GMH on the Global Stage In the towers and the trenches and everything in-between

Global Mental Health: What’s Up? Recent Developments and Directions "The GMH markers [10 DDs] represent many advances on behalf of “mental health and wellbeing for all.” They point to what we sense is a tangible shift into a new phase for GMH: a collective game changer with serious positive implications for on the ground, community-based improvements in mental health. Some of the many areas impacted—the advances and shifts—include greater awareness, acceptance, advocacy, collaboration, and action for: health budgets, policies, and laws; scaling up, task shifting, and the central roles of people with lived experience; parity, primary health care, and universal health coverage; humanitarian action, trauma-informed care, and peacebuilding; health, mental health, and social work training programs in academic, organizational, and community settings; implementation science, indigenous psychologies, and culturally-appropriate and faith-sensitive services; and social and commercial determinants of health, stigma, and human rights. We are seeing a convergence of many efforts, the fruit of the labor of thousands of civil society, lived-experience, local and faith-based, business, academic, and government colleagues around the world. This next GMH phase--Generation 2.0--is increasingly “human.” It is about investing in our common humanity, our human family. It is people committed to people in order to resolutely make healthy lives—including mental health--and wellbeing for all a reality. It is everyone’s responsibility.”

Final Exam Do yuo udnesrtanid GHM? I cdnuolt blveiee taht I cluod aulaclty uesdnatnrd waht I was haernig adn laernnig abuot GHM. The phaonmneal pweor of the hmuan mnid. Aoccdrnig to rscheearch by cloleauges in Tahilnad, it deosn't mttaer in waht oredr the ltteers in a wrod are, the olny iprmoatnt tihng is taht the frsit and lsat ltteer be msolty in the rghit pclae. The rset can be a taotl mses and you can still raed it wouthit a porbelm. This is bcuseae the huamn mnid deos not raed ervey lteter by istlef, but the wrod as a wlohe. Amzanig huh? So it is jsut lkie udnresatndnig GHM, rghit? It is nto so hrad—wiht soem parctcie!

. Wellbeing for All GMH Directions and Developments Kelly and Michele O’Donnell, Member Care Associates, Inc. [email protected] www.membercareassociates.org