maling mental health in resource limited settings
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Global Mental Health: Implications for resource limited settings
Samuel MalingDepartment of Psychiatry
Mbarara University
Introduction
World Map: Land Area
World Map: population
Nurses Working
Physicians working
Poverty
About 14% of the Global burden of disease has been attributed to neuropsychiatric disorders
Developing countries tend to place much emphasis on communicable diseases
Mental illness are the most neglected of the neglected diseases
“Global health is “an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide.”
Global mental health is the application of these
principles to the domain of mental ill health.
Global inequity
Low- and middle-income countries are home to more than 80% of the global population but command less than 20% of the share of the mental health resources.
Resource Limited settings
Where materials, personnel, facilities, funds, and anything else that can be used for providing mental health care and services is scarce or not available
1. Policy2. Infrastructure within countries3. Mental health services4. Community resources 5. Human resources
Inequity within a limited resource setting
Health expenditure towards mental health
96%
4%
All other health expendituresMental health expenditure
Mental health expenditure towards mental hospital
55%45%
Expenditure for menatl health hospital
All other mental health expenditures
Human resources for mental health in each income group of countries per 100 000 population
Human resources for mental health in Uganda (Per 100,000 population)
Psych
iatrists
Other d
octors
Nurses
Psych
ologists
Social W
orkers OTPC O
0.080.04
0.78
0.01 0.01 0.01
0.2
THE REPUBLIC OF UGANDA MINISTRY OF HEALTH
NATIONAL MENTAL HEALTH POLICY 2008
JULY 2008
Global evidence for clinical treatments
Less than 1% of Clinical trials are from low-income countries and 10% of trials are from low-income and middle-income countries.
MDGs or ‘GMHDGs’?
Core indicators
Ensure that national and regional health plans pay sufficient attention to mental health
1: Presence of official policy, programmes, or plans for mental health, either including or accompanied by a policy on child and adolescent mental health
Invest more in mental health care
2: Specified budget for mental health as a proportion of total health budget
Increase trained staff to provide mental health care
3: Mental health and related professionals per 100 000 population
Make basic pharmacological treatments available in primary care
4: Proportion of PHC clinics in which a physician or an equivalent health worker is available, and at least one psychotropic medicine of each therapeutic category (antipsychotic, antidepressant, mood stabiliser, anxiolytic, and antiepileptic) is available in the facility or in a nearby pharmacy all year long
Increase the treatment coverage for people with schizophrenia
5: People treated each year for schizophrenia as a proportion of the total estimated annual prevalence of schizophrenia
Secondary indicators
Balance expenditure in hospital and community services
6: Proportion of total mental health expenditure spent on community-based services, including primary and general health-care services
Provide de adequate basic training in mental health
7: Proportion of the aggregate total training time in basic medical and nursing training degree courses devoted to mental health
Distribute staff equitably between urban and rural areas
8: Proportion of psychiatrists nationally who work in mental health facilities that are based in or near the largest cities
Ensure least restrictive practice
9: Involuntary admissions as a proportion of all annual admissions
Protect the human rights of people with mental disorder
10: Presence of a national body that monitors and protects the human rights of people with mental disorders, and issues reports at least every year
Reduce the suicide rate
11: Deaths by suicide and self-inflicted injury rate
1970’sMental health units in large Regional Referral
Hospitals (out-patient and in-patient services offered)