Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010.

A person's mental health and many common mental disorders are shaped by various social, economic, and physical environments operating at different stages of life. Risk factors for many common mental disorders are heavily associated with social inequalities, whereby the greater the inequality the higher the inequality in risk. The poor and disadvantaged suffer disproportionately, but those in the middle of the social gradient are also affected. It is of major importance that action is taken to improve the conditions of everyday life, beginning before birth and progressing into early childhood, older childhood and adolescence, during family building and working ages, and through to older age. Action throughout these life stages would provide opportunities for both improving population mental health, and for reducing risk of those mental disorders that are associated with social inequalities. As mental disorders are fundamentally linked to a number of other physical health conditions, these actions would also reduce inequalities in physical health and improve health overall. Action needs to be universal: across the whole of society and proportionate to need. Policy-making at all levels of governance and across sectors can make a positive difference.

Social determinants of mental health

Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)62191-6.pdf

Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11

Background: In developing countries, most people with mental, neurological and substance-abuse (MNS) disorders do not receive adequate care mainly because of a lack of mental health professionals. Non-specialist health workers, but also other professionals with health roles, such as teachers, may therefore have an important role to play in delivering MNS health care. Researchers in The Cochrane Collaboration carried out a review of the effects of using non-specialist health workers or other professionals with health roles to help people with MNS disorders in developing countries. After searching for all relevant studies in scientific databases, they found 38 studies published before October 2012. Their findings are summarised below. What is a non-specialist health worker? Any type of health worker (like a doctor, nurse or lay health worker) who is not a specialist in mental health or neurology but who may have had some training in these fields. We also looked at teachers, as they can be particularly important in the care of children and youths. What the research says: The studies in this review were from 22 developing countries. In most studies, lay health workers delivered the mental health care, and addressed depression or anxiety (or both), or post-traumatic stress disorder. The review shows that the use of non-specialist health workers, compared with usual healthcare services: Â· may increase the number of adults who recover from depression or anxiety (or both) two to six months after treatment; Â· may slightly reduce symptoms formothers with depression; Â· may slightly reduce the symptoms of adults with post-traumatic stress disorder (non-specialists and teachers were used in one study); Â· probably slightly improves the symptoms of people with dementia; Â· probably improves/slightly improves the mental well-being, burden and distress of carers of people with dementia; Â· may decrease the quantity of alcohol consumed by problem drinkers. It is uncertain whether lay health workers or teachers reducepost-traumatic stress disorder symptoms among children. There were too few studies to draw any conclusions about the cost-effectiveness of using non-specialist health workers or teachers, or about their impact on people with other MNS conditions such as epilepsy, schizophrenia, and alcohol and drug abuse problems. In addition, very few studies measured unintended consequences of non-specialist health worker-led care - such effects could impact on the appropriateness and quality of care. Quality of the evidence: Overall, non-specialist health workers and teachers have some promising benefits in improving people's outcomes for general and perinatal depression, post-traumatic stress disorder and alcohol-use disorders, and patient and carer outcomes for dementia. However, this evidence is of low or very low quality in some areas, and for some issues no evidence is available. Therefore, we cannot make conclusions about which specific interventions using non-specialist health workers to help people with MNS disorders are more effective.

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Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)61094-5.pdf

Mental health and psychosocial support in humanitarian settings: Linking practice and research

Background: Neonatal deaths account for over 40% of all deaths in children younger than five years of age and neonatal mortality rates are highest in areas affected by humanitarian emergencies. Of the ten countries with the highest neonatal mortality rates globally, six are currently or recently affected by a humanitarian emergency. Yet, little is known about newborn care in crisis settings. Understanding current policies and practices for the care of newborns used by humanitarian aid organizations will inform efforts to improve care in these challenging settings. Methods: Between August 18 and September 25, 2009, 56 respondents that work in humanitarian emergencies completed a web-based survey either in English or French. A snow ball sampling technique was used to identify organizations that provide health services during humanitarian emergencies to gather information on current practices for maternal and newborn care in these settings. Information was collected about continuum-of-care services for maternal, newborn and child health, referral services, training and capacity development, health information systems, policies and guidelines, and organizational priorities. Data were entered into MS Excel and frequencies and percentages were calculated. Results: The majority of responding organizations reported implementing components of neonatal and maternal health interventions. However, multiple barriers exist in providing comprehensive care, including: funding shortages (63.3%), gaps in training (51.0%) and staff shortages and turnover (44.9%). Conclusions: Neonatal care is provided by most of the responding humanitarian organizations; however, the quality, breadth and consistency of this care are limited.

/pdf/neonatal-survival-interventions-in-humanitarian-emergencies-yv5pb5ogg5.pdf

Neonatal survival interventions in humanitarian emergencies: a survey of current practices and programs

(1) Background: Every year, 2.5 million neonates die, mostly in low- and middle-income countries (LMIC), in total disregard of their fundamental human rights. Many of these deaths are preventable. For decades, the leading causes of neonatal mortality (prematurity, perinatal hypoxia, and infection) have been known, so why does neonatal mortality fail to diminish effectively? A bottom-up understanding of neonatal morbi-mortality and neonatal rights is essential to achieve adequate progress, and so is increased visibility. (2) Methods: We performed an overview on the leading causes of neonatal morbi-mortality and analyzed the key interventions to reduce it with a bottom-up approach: from the clinician in the field to the policy maker. (3) Results and Conclusions: Overall, more than half of neonatal deaths in LMIC are avoidable through established and well-known cost-effective interventions, good quality antenatal and intrapartum care, neonatal resuscitation, thermal care, nasal CPAP, infection control and prevention, and antibiotic stewardship. Implementing these requires education and training, particularly at the bottom of the healthcare pyramid, and advocacy at the highest levels of government for health policies supporting better newborn care. Moreover, to plan and follow interventions, better-quality data are paramount. For healthcare developments and improvement, neonates must be acknowledged as humans entitled to rights and freedoms, as stipulated by international law. Most importantly, they deserve more respectful care.

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2.5 Million Annual Deaths—Are Neonates in Low- and Middle-Income Countries Too Small to Be Seen? A Bottom-Up Overview on Neonatal Morbi-Mortality

This review links practice, funding, and evidence for interventions for mental health and psychosocial wellbeing in humanitarian settings. We studied practice by reviewing reports of mental health and psychosocial support activities (2007–10); funding by analysis of the fi nancial tracking service and the creditor reporting system (2007–09); and interventions by systematic review and meta-analysis. In 160 reports, the fi ve most commonly reported activities were basic counselling for individuals (39%); facilitation of community support of vulnerable individuals (23%); provision of child-friendly spaces (21%); support of community-initiated social support (21%); and basic counselling for groups and families (20%). Most interventions took place and were funded outside national mental health and protection systems. 32 controlled studies of interventions were identifi ed, 13 of which were randomised controlled trials (RCTs) that met the criteria for meta-analysis. Two studies showed promising eff ects for strengthening community and family supports. Psychosocial wellbeing was not included as an outcome in the meta-analysis, because its defi nition varied across studies. In adults with symptoms of post-traumatic stress disorder (PTSD), meta-analysis of seven RCTs showed benefi cial eff ects for several interventions (psychotherapy and psychosocial supports) compared with usual care or waiting list (standardised mean diff erence [SMD] –0·38, 95% CI –0·55 to –0·20). In children, meta-analysis of four RCTs failed to show an eff ect for symptoms of PTSD (–0·36, –0·83 to 0·10), but showed a benefi cial eff ect of interventions (group psychotherapy, school-based support, and other psychosocial support) for internalising symptoms (six RCTs; SMD –0·24, –0·40 to –0·09). Overall, research and evidence focuses on interventions that are infrequently implemented, whereas the most commonly used interventions have had little rigorous scrutiny.

Anne Golaz

Papers

Mental health and psychosocial support in humanitarian settings: Linking practice and research

Neonatal survival interventions in humanitarian emergencies: a survey of current practices and programs

2.5 Million Annual Deaths—Are Neonates in Low- and Middle-Income Countries Too Small to Be Seen? A Bottom-Up Overview on Neonatal Morbi-Mortality

Global Mental Health 3 Mental health and psychosocial support in humanitarian settings: linking practice and research