Friday, 20 June 2014

Have your say on the treatment gap in global mental health

Posted: 19 Jun 2014 04:50 AM PDT
by Victoria de Menil and Valentina Iemmi
Lord Crisp chairing the APPG on global mental health (c) Victoria De Menil
Lord Crisp chairing the APPG on global mental health
(c) Victoria de Menil

An historic first took place in Portcullis House on 10 June. The UK All Party Parliamentary Groups (APPGs) on global health and mental health convened a joint hearing to discuss global mental health. The event, chaired by Lord Nigel Crisp together with James Morris MP, was the first of two oral evidence sessions to address the question of whether the UK government should be “doing more or doing differently” to address the treatment gap in global mental health. Three additional Parliamentarians, Meg Hillier MP, Vicount Eccles and Peter Bottomley MP, were also in attendance.

The session opened with evidence from three speakers: Professor Vikram Patel of the London School of Hygiene and Tropical Medicine, Professor Graham Thornicroft of the Institute of Psychiatry, and Dr Gary Belkin, director of New York University’s Global Mental Health Programme. Their task was to answer two questions: how significant a problem is mental illness in low- and middle-income countries; and what evidence is there for cost-effective ways to address mental health needs in low- and middle-income countries?

Startling statistics
Vikram Patel highlighted a few startling statistics. Suicide kills more young women globally than maternal causes. Furthermore, the life expectancy of people with schizophrenia is 15-20 years shorter than the general population. Finally, mental disorders are the cause of one-quarter of years lived with disability globally, which places it above cardiac disease and cancer in terms of disability. Equally noteworthy, however, was a positive scenario: if maternal depression were eliminated, then 25% of childhood stunting and malnourishment would disappear in South Asia.

Professor Patel also emphasised the timeliness of this hearing and cited four changes that make today an opportune time to invest in mental health:
1.       The WHO has issued a new Comprehensive Mental Health Action Plan that establishes an international consensus on priorities and solutions in addressing the gap;
2.       Middle-income countries such as Brazil, India and China have increased public investments in mental health care and need technical support to make best use of those funds;
3.       In spring 2015, the World Bank will devote a session to mental health within its annual finance meeting;
4.       Evidence has emerged that appropriately trained and supervised non-specialist health workers can deliver mental health treatments successfully, which Vikram Patel deemed one of the most exciting innovations for mental health care in years.
Fear of contagion
Graham Thornicroft’s specialty is stigma, and he recounted how an Ethiopian nurse did not want to touch the case notes of a patient with mental illness for fear of contamination. Many individuals say that stigma and social exclusion are more painful than the primary symptoms of their condition. Reporting findings from the INDIGO study, Professor Thornicroft explained that some individuals internalize stigma and stop trying to make friends or find jobs. However, the evidence suggests the best antidote to stigma is personal contact.

What gap?
Professor Patel corrected a common myth that there is no mental health treatment in low- and middle-income countries: “We shouldn’t assume that people aren’t getting treatment. They are getting treatment, but they are getting the wrong treatment.” Most people with a common mental disorder in India are prescribed sleeping medicines (benzodiazepines) and vitamins. Professor Thornicroft is also likely to have shocked more than one person in the public with an image of the shackled feet of a mentally ill person who had been “treated” with hyenas by a traditional healer in Somalia. The gap for mental health care is not for any treatment, but for evidence-based treatment.

Professor Thornicroft quantified the gap, pointing out that low- and middle-income countries are not the only ones with this problem. Whereas in the UK treatment is available for one-third of people with mental disorders (varying by illness type), only 10% of people access evidence-based treatmentsin low- and middle-income countries.
Diagram for root-cause analysis presented by Dr Belkin (c) Victoria de Menil
Diagram for root-cause analysis presented by Dr Belkin
(c) Victoria de Menil

Gary Belkin spoke in absolute terms about the gap, estimating it to be “one billion minds and lives” – the name of a project he is working on with the Institute for Healthcare Improvement. He believes that to tackle a problem of that scale requires standardized quality improvement tools. The Billion Minds and Lives project is expected to test a set of quality improvement tools in large-scale projects in Ghana, Kenya, Ethiopia, Zambia and Rwanda. In a show-and-tell moment, Dr Belkin projected a large image of what is cryptically known as a “fishbone diagram for root-cause analysis,” a group problem-solving technique that maps proximate and underlying causes of a problem. The outcome – a meaningful mess of squares and arrows (see photo) – was observed by several audience members to capture the true complexity of factors at play in addressing mental health problems.

Dr Belkin closed with a rousing invocation to the British government to take action: “The only people that can make this change happen are governments.” He advised a two-way approach to scaling up mental healthcare: “Take mental health with you when you go out; and bring others in.” In other words, mental health policy makers need to branch out to non-mental health arenas, such as the G8, and also to bring non-specialist actors, such as schools and primary care providers, into the discussion about mental health.

Voices of dissent
The hearing was not without controversy. When it opened up for questions, a service user said he had heard that outcomes for schizophrenia were better in low- and middle-income countries and asked whether that was related to their taking less antipsychotics or to being less isolated. Professor Patel responded that the claim that outcomes are better in developing countries is based on a single study conducted by the WHO 25 years ago. All studies conducted locally since then have demonstrated the contrary. He stated firmly, “The life expectancy of someone with schizophrenia in India is half that in England – I see that as a bad outcome.”

Derek Summerfield, a psychiatrist of South African origin affiliated with the Institute of Psychiatry, challenged the speakers, particularly Professor Thornicroft, declaring that it was “slick and facile” to say that stigma is the reason people in low-income countries don’t seek services. He argued that they don’t seek services because they live in absolute poverty and are struggling to survive. They don’t have depression, they have poverty. He called the desire to spread mental healthcare globally a “new imperialism.”

In response to Dr Summerfield, Professor Patel stated,“What Dr. Summerfield is pointing out is failures in our Western medical system, and I wish him and his colleagues the best of luck in sorting that out. What we are concerned with is the mental health systems in the rest of the world.” Professor Thornicroft agreed with Dr Summerfield that poverty is central to mental health problems in low-income countries and that the two problems should ideally be addressed in tandem. He cited the work of BasicNeeds as exemplary of this two-pronged approach to tackling health and poverty. Lord Crisp closed the debate by inviting Dr Summerfield to “tell us what you think we should do as parliamentarians – and not just to avoid mental health.”

The second parliamentary hearing will be held on 7 July 2014. Lord Crisp is asking for all relevant evidence addressing the question of what parliamentarians should do to address the mental health treatment gap ahead of the second session. So now is your chance to have your say in the UK government’s response to global mental health.

To contribute evidence or register to attend the second session, email Jonty Roland.
For more on the proceedings of global mental health hearings on Twitter, follow @APPGGlobHealth, @ThornicroftG, @abillionminds

About the authors
Victoria de Menil is a PhD Student within the Personal Social Services Research Unit at the London School of Economics and Political Science.
Valentina Iemmi is Research Officer within the Personal Social Services Research Unit at the London School of Economics and Political Science.

Thursday, 19 June 2014

Oxford University Bioethics Job Opportunity

University of Oxford

Senior Researcher (Associate Professor) in Medical Ethics

University of Oxford - NDPH

Old Road Campus, Headington, Oxford
The Ethox Centre is seeking to appoint a Senior Researcher (Associate Professor) in Medical Ethics to lead the development of a major new programme of research in one of its four priority research areas: clinical ethics, research ethics, population health ethics, or global health ethics and to take a leading role in the organisation and provision of teaching and assessment of students in medical ethics across the clinical ethics curriculum.
The Ethox Centre is an internationally recognised multidisciplinary bioethics research centre and is a vibrant and intellectually exciting place to work. It is expected that you will play a senior management and strategic leadership role, including the mentoring of early career researchers, generating significant research funding and developing partnerships to enhance the centre’s growing international reputation.
You will hold a relevant PhD/DPhil, have significant post-qualification experience and have an outstanding international reputation for research in one or more of the Ethox Centre's priority research themes. You will have an excellent publication record, ambitious research plans and a strong track record in attracting externally funded research. Excellent leadership, people management skills and interpersonal skills are essential. You will have the ability to teach ethics to medical students and have demonstrable expertise in supervising research students. A willingness to travel in the UK and internationally is also essential for this role.
It is anticipated that suitably qualified candidates will be offered an Associate Professor title at the University of Oxford.
The post is offered full-time for a fixed-term of 5 years and is based at the Old Road Campus, Headington, Oxford.
The closing date for applications is 12.00 noon on 28 July 2014.

Tuesday, 17 June 2014

USA has most expensive and worst performing healthcare system among rich countries

And the UK  has the best.

Common Wealth Fund   original at link here

Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally

Executive Summary

The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity. In this edition of Mirror, Mirror, the United Kingdom ranks first, followed closely by Switzerland (Exhibit ES-1).
Expanding from the seven countries included in 2010, the 2014 edition includes data from 11 countries. It incorporates patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care. It includes information from the most recent three Commonwealth Fund international surveys of patients and primary care physicians about medical practices and views of their countries’ health systems (2011–2013). It also includes information on health care outcomes featured in The Commonwealth Fund’s most recent (2011) national health system scorecard, and from the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD).
Overall health care ranking


Post-doc: political philosophy and bioethics: Kiel, Germany

Campus Kiel
Position in political philosophy/theory and bioethics
Institute of Experimental Medicine,
Emmy Noether-Research Group „Political philosophy and bioethics“, University of Kiel
Duration and Starting Date: two years, starting immediately. Salary depending on qualifications (TV-L 13 50% or 100%).
A full-time post-doc position is available in the Emmy Noether-Research Group „Political philosophy and bioethics“, which is funded by the German Research Council (Deutsche Forschungsgemeinschaft, DFG) and is situated at the University of Kiel, Institute of Experimental Medicine (Prof. Dr. Alena Buyx).  Political philosophy has informed bioethical debates for several decades, for example in the discussions about the just allocation of health care resources. The Emmy Noether Research Groups looks across a number of issues and discussions in bioethics and examines how concepts and theories of political philosophy have been used to build arguments for particular policy applications in bioethics, and whether this has happened in a consistent way. Exemplary fields of inquiry are theories of justice and priority setting in medicine and health care; normative justifications of public health interventions; health, healthcare and global justice; and solidarity in contemporary bioethics.
Post-doctoral candidates should have completed, or be close to the completion of, a doctorate in political theory/political philosophy, bioethics or a related discipline and should have proven potential to conduct and publish research at an international level. Post-doctoral candidates’ research should fall within the group’s main areas of work. However, other projects will be considered, provided they are compatible with the group’s general focus, namely an analysis of theories of political philosophy in the context of bioethics and their application to practical bioethical questions.
All candidates must have strong analytical skills as well as a demonstrated interest in interdisciplinary and teamwork. Fluency in English is essential; (passive) knowledge of German would be an asset.
Applications of women are specially invited; in the case of similar qualifications, competence and specific achievements, women will be considered on preferential terms, within the framework of the legal possibilities. Candidates with disabilities with equivalent qualifications will be given preference. Weekly working time is currently 38 hours and 50 minutes. Positions are temporary and project-based, with longest possible duration of three years.
Please send your application (cover letter, a 2/3 page research project proposal, CV, two writing samples (not more than 5,000 words, can be excerpts), and contact details for two references IN ONE FILE) to with Ref.-No. 688.209.CK. Closing date is 2014-07-11.

Universitätsklinikum Schleswig-Holstein
Dezernat Personal | Recruiting Center

Friday, 13 June 2014

Free access to 2012-13 Social Sciences journals of Taylor & Francis

Social Sciences Free Mobile Access

Enjoy Free Access to over 500 Social Sciences Journals with Taylor & Francis Online Mobile!
To celebrate the launch of the latest update to Taylor & Francis Online Mobile, we are offering you free online access to the 2012 and 2013 volumes of our Social Sciences titles during June. 
Subjects included in this free article access offer are Social Sciences, (Anthropology, Criminology, Gender, Sociology), Development Studies, Economics, Finance, Business and Industry, and Law
Free access is exclusive to mobile devices and is available on iPhone, Android, BlackBerry, and tablets, including iPad. 
Start exploring our Social Sciences Journals now by following these easy steps:
  1. First, grab your mobile device and visit
  2. Then 'Tap' to start navigation.
  3. Browse to the journals tab, select your subject area (use the subject list above for reference) and then chose your journal of interest
  4. Navigate to 'Decades' 2010s
  5. Enjoy all content in years 2012 and 2013 for free!
Plus… Want to access your institution's subscriptions off campus?
Your research doesn't need to be restricted to your institution or workplace. It's easy to access your library's subscriptions whilst travelling, at conferences, and at home, giving you greater flexibility and saving you valuable time.
Simply pair your mobile device to your library to get started, follow our easy written instructions to find out how. 

Tuesday, 10 June 2014

King's College London: Post-doc on capabilities approach and health ethics

More information at:  7 July 2014 Deadline. 

Vacancy Details

Job titleDivisionJob refClosing date
Research AssociateSocial Science, Health & MedicineWDAF164414JT07/07/2014
SummaryApplications are invited for a full-time 12 month Research Associate post to work on a project extending the capabilities approach to population level health ethics. The post holder will have a strong background in the capabilities approach and health with an interest in measurement and application. The project further extends Sridhar Venkatapuram’s argument for a moral right to the capability to be healthy laid out in Health Justice to population level issues. The post holder will carry out philosophical research in one or more of the project’s four research areas including social responsibility for health capabilities and health equity, personal responsibility for health, health capability measurement versus alternatives, and aggregation issues related to promoting health capabilities.
DetailThe post holder will be based at the Department of Social Science, Health & Medicine at King’s College London (Strand Campus) and supervised by the PI on the project, Dr. Sridhar Venkatapuram. She/He will be responsible for examining issues at the frontier of capabilities theory leading to single or co-authored publications and dissemination of outputs. She/He will also have opportunities to teach on the pioneering MSc in Global Health and Social Justice offered in the department. The post holder will be encouraged to become part of the thriving community of philosophers at King’s and in London involved in pushing forward global justice and health ethics debates. The successful applicant will have demonstrable expertise in the capabilities approach with evidence of ability to undertake substantive applied philosophical research that will contribute to the aims of the project. Experience with health measurement, social statistics, economic cost-benefit analysis or related quantitative disciplines would be advantageous. Equality of opportunity is College policy.

The appointment will be made, dependent on relevant qualifications, within the Grade 6 scale, currently £31,644 to £37,756, per annum plus £2,323 per annum London Allowance. This is a fixed term contract for 35 hours/week for 12 months.

For an informal discussion of the post please contact Dr. Sridhar Venkatapuram at +44 (0)20 7848 1862 or via email at
Salary£33,967 - £40,079
Post duration12 months

Tuesday, 3 June 2014

4 yr PhD funding in international health law/ human right to health & health equity Groningen

PhD position International Health Law (1.0 fte) (214180)


Groningen University Faculty of Law
The Faculty of Law is a modern, internationally oriented institution with a four-hundred-year-long tradition. The Faculty of Law has over 3,600 students and almost 400 staff members and is thus one of the largest faculties of the University of Groningen. Its effective quality-control system ensures continuous improvement in the quality of teaching and research.
Department of International and Constitutional Law
The PhD candidate will be based at the Department of International and Constitutional Law of the Faculty of Law.

Job description

International health law is quickly developing into a branch of international law. There is a need for creating coherency among the existing standards so as to improve the implementation by all the stakeholders in the health field and to more effectively address the growing health inequalities within and between nations. The department's international health law programme focuses on the following topics:
  • international health law as an emerging field of public international law
  • health security threats, including emerging infectious diseases; armed conflicts and other man-made disasters; as well as environmental health problems, including the medical impact of climate change
  • the widening global and national health inequalities, and in relation to this the lack of universal access to basic health services, including family planning services; and the global increase in non-communicable diseases.
The researcher is also expected to make a contribution to our research into how international standards in the field of health, in particular human rights and equity standards, can best be applied at a domestic level (Right to Health Initiative - University of Groningen).
The language of this research project is English.


The ideal candidate:
  • has an advanced degree in law (preferably a master degree) with a specialization in public international law and human rights law
  • has an excellent command of the English language
  • is interested in conducting academic research in an international environment
  • has excellent writing skills
  • has good analytical and communication skills.

Conditions of employment

The University of Groningen is offering a salary of at least € 2,083 gross per month in the first year up to a maximum of € 2,664 (salary scale Dutch Universities) gross per month in the last year for a full-time position. The position is a temporary one for a period of 4 years and should be rounded off with an individual thesis. The appointment is conditional for a period of 12 months. If suitability is established on the basis of an assessment, the appointment will be confirmed for the remaining period. An average of 10% of the appointment time will be spent on the organisation of research activities of the Groningen Centre for Law and Governance and the editing of academic publications in the English language.
The PhD student will participate in the Faculty training programme for PhD students and will draw up a personal training and supervision plan.
The Faculty offers the opportunity to attend international conferences and to participate in workshops and seminars.
The Department of International Law, where the PhD student will be based, is a Member of the Netherlands School of Human Rights Research.
Starting date: academic year of 2014/2015.
You may apply for this position before 01.08.2014 Dutch local time by means of the application form (click on "Apply" below on the advertisement on the university website).
Interested applicants should submit:
  • a curriculum vitae and a list of marks or results from your first degree
  • a research proposal (with a maximum of 5 pages) in connection with (a sub-topic in the field of) international health law (see above).
Shortlisted candidates will be invited to an interview. The interviews will be held in September 2014.
Unsolicited marketing is not appreciated.


For information you can contact:
Dr. Brigit Toebes, +31 50 3635676,