"Two recent studies (Petersen et al. 2013; Burgess and Campbell 2014) articulate that HIVaffected women's mental health problems are often anchored to the complex social realities listed above, which will carry important implications for the organization of appropriate services. The Movement for Global Mental Health (MGMH) takes interest in scaling-up access to services for such women (Lee et al. 2010; Patel 2012), and identifies the expansion of primary mental health care (PMHC) services in low-and middle-income countries (LMIC) (WHO 2010; Thornicroft and Tansella 2013) as crucial to this process. It is well known that primary mental health services in many LMIC operate under severe resource scarcity (Saxena et al. 2007). "
[Show abstract][Hide abstract] ABSTRACT: How do practitioners respond to the mental distress of HIV-affected women and communities? And do their understandings of patients' distress matter? The World Health Organization (WHO) along with advocates from the Movement for Global Mental Health (MGMH) champion a primary mental health care model to address burgeoning mental health needs in resource-poor HIV-affected settings. Whilst a minority of studies have begun to explore interventions to target this group of women, there is a dearth of studies that explore the broader contexts that will likely shape service outcomes, such as health sector dynamics and competing definitions of mental ill-health. This study reports on an in-depth case study of primary mental health services in a rural HIV-affected community in Northern KwaZulu-Natal. Health professionals identified as the frontline staff working within the primary mental health care model (n ¼ 14) were interviewed. Grounded thematic analysis of interview data highlighted that practitioners employed a critical and socially anchored framework for understanding their patients' needs. Poverty, gender and family relationships were identified as intersecting factors driving HIV-affected patients' mental distress. In a diver-gence from existing evidence, practitioner efforts to act on their understandings of patient needs prioritized social responses over biomedical ones. To achieve this whilst working within a primary mental health care model, practitioners employed a series of modifications to services to increase their ability to target the sociostructural realities facing HIV-affected women with mental health issues. This article suggests that beyond attention to the crucial issues of funding and human resources that face primary mental health care, attention must also be paid to promoting the development of policies that provide practitioners with increased and more consistent opportunities to address the complex social realities that frame the mental distress of HIV-affected women. Practitioners working in a primary mental health care model account for distress using a social discourse rather than a biomedical one. To respond to the social needs of patients practitioners developed new strategies to work around the current structure of services. Practitioner strategies signal the need to expand attention to the social needs of HIV-affected women in resource-poor settings within primary mental health care services.
Health Policy and Planning 08/2014; 30(7). DOI:10.1093/heapol/czu092 · 3.47 Impact Factor
"In countries whose health policies remain in the grips of international donors, the ability to prioritize mental health is hindered by the blinkered views of Northern donors, who generally harbor misguided views that mental health is not a priority for poor people or less-resourced countries. Activists from the Movement for Global Mental Health recently called for a special session of the UN General Assembly or for a summit on mental health38—which may prove to be a fruitful way of galvanizing the global community, from donors to governments, to act on the evidence that we already possess. "
[Show abstract][Hide abstract] ABSTRACT: This article charts the historical development of the discipline of global mental health, whose goal is to improve access to mental health care and reduce inequalities in mental health outcomes between and within nations. The article begins with an overview of the contribution of four scientific foundations toward the discipline's core agenda: to scale up services for people with mental disorders and to promote their human rights. Next, the article highlights four recent, key events that are indicative of the actions shaping the discipline: the Mental Health Gap Action Programme to synthesize evidence on what treatments are effective for a range of mental disorders; the evidence on task shifting to nonspecialist health workers to deliver these treatments; the Movement for Global Mental Health's efforts to build a common platform for professionals and civil society to advocate for their shared goal; and the Grand Challenges in Global Mental Health, which has identified the research priorities that, within the next decade, can lead to substantial improvements in the lives of people living with mental disorders. The article ends by examining the major challenges for the field, and the opportunities for addressing them in the future.
[Show abstract][Hide abstract] ABSTRACT: Non-communicable diseases (NCDs), principally heart disease, stroke, cancer, diabetes, and chronic respiratory diseases, are a global crisis and require a global response. Despite the threat to human development, and the availability of affordable, cost-effective, and feasible interventions, most countries, development agencies, and foundations neglect the crisis. The UN High-Level Meeting (UN HLM) on NCDs in September, 2011, is an opportunity to stimulate a coordinated global response to NCDs that is commensurate with their health and economic burdens. To achieve the promise of the UN HLM, several questions must be addressed. In this report, we present the realities of the situation by answering four questions: is there really a global crisis of NCDs; how is NCD a development issue; are affordable and cost-effective interventions available; and do we really need high-level leadership and accountability? Action against NCDs will support other global health and development priorities. A successful outcome of the UN HLM depends on the heads of states and governments attending the meeting, and endorsing and implementing the commitments to action. Long-term success requires inspired and committed national and international leadership.
The Lancet 06/2011; 378(9789):449-55. DOI:10.1016/S0140-6736(11)60879-9 · 45.22 Impact Factor
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