Posted: 19 Jun 2014 04:50 AM PDT
by Victoria de Menil and Valentina Iemmi
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?
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.
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.
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.
Friday, 20 June 2014
Thursday, 19 June 2014
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
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
Position in political philosophy/theory and bioethics
Institute of Experimental Medicine,
Emmy Noether-Research Group „Political philosophy and bioethics“, University of Kiel
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 firstname.lastname@example.org Ref.-No. 688.209.CKClosing date is 2014-07-11.
Dezernat Personal | Recruiting Center
Dezernat Personal | Recruiting Center