Showing papers by "Benedetto Saraceno published in 2022"

Social Vulnerability and Mental Health Inequalities in the “Syndemic”: Call for Action

Abstract: Covid-19 is referred to as a “syndemic,” i.e., the consequences of the disease are exacerbated by social and economic disparity. Poor housing, unstable work conditions, caste, class, race and gender based inequities and low incomes have a profound effect on mental health and wellbeing. Such disparities are increasing between, among and within countries and are exacerbated by human rights violations, in institution and in society, stigma and discrimination. Social capital can mediate health outcomes, through trust and reciprocity, political participation, and by mental health service systems, which can be coercive or more open to demand of emancipation and freedom. Societal inequalities affect especially vulnerable groups, and Covid itself had a wider impact on the most socially vulnerable and marginalized populations, suffering for structural discrimination and violence. There are complex relations among these social processes and domains, and mental health inequalities and disparity. Participation and engagement of citizens and community organizations is now required in order to achieve a radical transformation in mental health. A Local and Global Action Plan has been launched recently, by a coalition of organizations representing people with lived experience of mental health care; who use services; family members, mental health professionals, policy makers and researchers, such as the International Mental Health Collaborating Network, the World Federation for Mental Health, the World Association for Psychosocial Rehabilitation, the Global Alliance of Mental Illness Advocacy Networks (GAMIAN), The Mental Health Resource Hub in Chennai, India, The Movement for Global Mental Health (MGMH) and others. The Action Plan addresses the need for fundamental change by focusing on social determinants and achieving equity in mental health care. Equally the need for the politics of wellbeing has to be embedded in a system that places mental health within development and social justice paradigm, enhancing core human capabilities and contrasting discriminatory practices. These targets are for people and organizations to adopt locally within their communities and services, and also to indicate possible innovative solutions to Politics. This global endeavor may represent an alternative to the global mental discourse inspired by the traditional biomedical model.

An outstanding message of hope: the WHO World Mental Health Report 2022

Abstract: Abstract The new WHO World Health Report on Mental Health includes a comprehensive and updated assessment of the current mental health situation at the global level, a critical and well-documented reflexion on the progresses achieved and the failures registered in global mental health, and an indication of the paths and strategies that should be prioritised to ensure the transformations that are urgently needed. The report offers significant enrichments on different areas like social determinants, premature mortality of persons suffering from mental disability, the negative aspects of the persistence of inpatient institutions, the role of people with lived experience as important agents of change, the importance of child and adolescent mental health. The present Editorial stresses the importance of Deinstitutionalisation as a cross-cutting element of all health policy, plans, budgeting and service organisation and draws attention to the fact that the ubiquitous persistence of large psychiatric institutions is a clear indicator that reality is far from declarations despite the UN Convention on the Rights of Persons with Disability.

Improving mental health care in rural Kenya: A qualitative study conducted in two primary care facilities

Abstract: Abstract Mental health research is needed in African countries in order to improve quality of care at local levels. This paper presents the results of a study conducted in 2018 among one hundred care givers in two peripheral primary health care facilities in rural Kenya. Opened interviews were performed, with the aim of eliciting relevant issues. The body of knowledge generated by the Global Mental Health (GMH) movement was used as the theoretical frame of reference. Five broad topics emerged as particularly significant in the specific context of this study: a. a globally negative perception of mental illness; b. a lack of trained professionals associated with limited opportunities for task-sharing or task-shifting; c. an intense stigmatization of affected individuals; d. the importance of strengthening the collaboration between the formal health sector and traditional healers, and, e. the necessary efforts to be made in order to reach patients living in remote areas. Our study highlights the importance of actively detecting mental disorders, promoting initiatives to reduce stigma and adapting western designed tools for specific settings in low and middle income countries (LMICs).

S2045796022000373jed 1..4

Abstract: The new WHO World Health Report on Mental Health includes a comprehensive and updated assessment of the current mental health situation at the global level, a critical and well-documented reflexion on the progresses achieved and the failures registered in global mental health, and an indication of the paths and strategies that should be prioritised to ensure the transformations that are urgently needed. The report offers significant enrichments on different areas like social determinants, premature mortality of persons suffering from mental disability, the negative aspects of the persistence of inpatient institutions, the role of people with lived experience as important agents of change, the importance of child and adolescent mental health. The present Editorial stresses the importance of Deinstitutionalisation as a cross-cutting element of all health policy, plans, budgeting and service organisation and draws attention to the fact that the ubiquitous persistence of large psychiatric institutions is a clear indicator that reality is far from declarations despite the UN Convention on the Rights of Persons with Disability. Why a new WHO report on mental health? Twenty years after the World Health Report 2001, Mental Health: New understanding, new hope (WHO, 2001), the first authoritative global framework for action in mental health, marking the beginning of a new phase in global mental health, WHO considered the time was come to launch a new World Report dedicated to mental health (WHO, 2022). The WHO must be heartily congratulated on this excellent and unique contribution to global mental health: a fundamental document that will be a reference for the coming decades. This is what had to be done in this very moment. Not because the vision and the recommendations of the 2001 Report have lost their validity. But because, in the last 20 years, many aspects of our societies have changed; changes occurred in science and technology, in the recognition of the importance of mental health and in the available responses to mental health care needs. Indeed, it is especially important to policy makers and all other mental health stakeholders to have access to a report from an organisation, with the moral and technical authority as WHO. This document includes a comprehensive and updated assessment of the current mental health situation at the global level, a critical and well-documented reflexion on the progresses achieved and the failures registered in global mental health, and an indication of the paths and strategies that should be prioritised to ensure the transformations that are urgently needed. The title of the report – Transforming mental health for all – expresses very well what is the main purpose of the report: to provide a support to the global transformation that we need in the present phase of our history. Most importantly, to attain this objective, drawing on the latest evidence available, showcasing examples of good practice from around the world, and giving voice to people with lived experience, the report highlights why and where change is needed and how it can be achieved on the ground. (WHO, 2022). The WHR 2022 presents significant innovations with respect to the WHR 2001. These differences represent an extraordinary improvement both of vision and comprehensiveness of mental health issues. While the Lancet Commission published in 2018 (Patel et al., 2018) represented a seminal piece of science providing the state of the art of global mental health, the 2022 WHR represents a seminal, normative and authoritative ‘compass’ for policy makers and professionals. Significant enrichments The report offers eight significant enrichments. (i) in previous report, social determinants were considered as essential elements of the aetiological model of mental ill health, while in the present report they are seen as fundamental components of practical intervention to restore mental health of people. In addition, new social determinants are considered, namely, climate change and pandemic. (ii) the report provides a much more detailed and deep analysis of mental health interventions which go beyond traditional clinical treatment. The report clearly states that interventions to promote and protect mental health should be delivered across multiple sectors because the factors determining mental health are multisectoral in nature. (iii) the report introduces an especially essential element that was not considered previously, namely the data about premature mortality of persons suffering from mental disability. Policy makers and professionals should consider carefully this dramatic and unrecognised difference between people suffering from mental health disorders and the rest of the population. Such health inequality is not the consequence of any unmodifiable biogenetic characteristic but the results of stigma, discrimination, reduced access to care and severe side effects of uncontrolled psychotropic drugs prescription. (iv) the report provides more emphasis on the negative aspects of the persistence of inpatient hospitals and institutions which consume significant fraction of mental health budget and human resources. (v) at the time of the WHR 2001, the UN Convention of the Rights of Persons with Disability (UN, 2006) was not yet in existence and, quite rightly, the present WHR 2022 stresses the importance of that Convention which for the first time provides a legal frame to the rights of persons with disability. Also, because of the intense public debate which has accompanied the conception, formulation and interpretation of the CRPD, the WHR 2022 stresses the importance, implications and contribution to traditional mental health care provision of the wishes and opinions of people with lived experience: people with lived experience are important agents of change and can increase awareness and acceptance of mental health conditions among the public (WHO, 2022). Human rights violations continue to pervade institutions and communities around the world, including health services. (WHO, 2022). Stressing the fact that too often people with mental health conditions are subject to some of the world’s worst human rights abuses by the services responsible for their care, the report presents a comprehensive overview of the measures that may contribute to reduce the use of coercion in mental health services, emphasising the importance of using a mix of strategies designed to modify attitudes, return rights and reshape care environments. Very often new laws and policies are needed to scale up rights; promoting community-based services; strengthening active participation of people with lived experience of mental health conditions; and providing appropriate training for mental health professionals. Strongly supporting this view, the report stresses the special importance of a strong investment in the promotion of research contributing to advance the understanding of policies and interventions that are effective in the reduction of coercion, within an implementation science paradigm. It is true that there is evidence of the effectiveness of many interventions: among others, staff training, integrated care, shared decision-making interventions (advance care directives, joint care plans and crisis cards), and programmes such as ‘Safewards,’ ‘Six Core Strategies’ and ‘open door policies’ (Barbui et al., 2020; Gooding et al., 2020). However, much research is still needed to better understand the level of effectiveness each intervention/strategy has in relation to each type of coercion, and what should be done to incorporate these interventions in clinical practice in places with various levels of resources. As mentioned in the report the use of involuntary admission and coercive care remains the subject of concern and debate among and between service users and professionals. These conflicting views about involuntary admission remain an important obstacle to the creation of the large consensus that is needed to incorporate a more updated human rights approach in mental health legislations and services across the world. Research alone cannot solve this problem, but in combination with other strategies (particularly service reforms and promotion of debates involving users, professionals and families), certainly it may have a key role in advancing supported decisionmaking and reducing all forms of coercion. (vi) Child and adolescent mental health should be considered as a fundamental component both of policy and service provision. Nevertheless, despite the dramatic evidence provided by the age pyramid in most countries of world, still the mental health of children and adolescents do not enough concern the western world (including academic and political international organisations). The WHR 2022 significantly corrects this distortion. (vii) As mentioned in the report, a profound reorganisation of mental health services is one of the major priorities in mental health and should have two main objectives: shifting the locus of care for persons with severe mental conditions away from psychiatric hospitals towards the community, and scaling up care for anxiety, depression, and other common mental health conditions by community-based services (WHO, 2022) This model of reorganisation is not new. It has been repeatedly proposed by WHO in the last decades and is now supported by very robust evidence. What is noteworthy in the report is the emphasis given to all questions related to this topic and the clarity with which they are presented. Discussions on services reform are often confused by a lack of common language. WHO uses the term ‘communitybased mental health care’ for any mental health care that is provided outside of a psychiatric hospital. This includes services available through primary health care, specific health programmes (for example HIV clinics), district or regional general hospitals as well as relevant social services. It also includes a ran