mhGAP Newsletter Mental Health Gap Action Programme

June 2011

IN THIS ISSUE

•NewsfromWHO’sMentalHealthGapActionProgramme(mhGAP)•EuropeanCommissionfundingenablesscalingupofmentalhealthservicesinEthiopiaandNigeria

page 1

•EthiopianGovernmentcommitstomhGAPimplementation•PanamamhGAPprojectlaunched page 2

•Nigeriaintegratesmentalhealthintoprimaryhealthcare•JordanstartstrainingdoctorandnursesusingmhGAP page 3

•UpdatesfromPartners page 4

TheEuropeanCommission(EC)ispartneringwiththeWorldHealthOrganization,Univer-sidadAutónomadeMadrid,SpainandtheMinistriesofHealthofEthiopiaandNigeriatosupportmhGAPimplementationinthetwocountries.ECrecognizesthatveryfewinitiativeshavebeendirectedatmentalhealthconditionsindevelopingcountries.

Mr.XavierMarchal,Ambassadortothe EuropeanUniontoEthiopia,said:

“I am happy that the European Union Del-egation in Ethiopia has the possibility to support the WHO in rolling out mhGAP in two countries, one of which is Ethiopia…”

ThemhGAPproject,whichisco-funded bymultipledonors,willrunforthreeyearsstartingfrom2011to2013.

NewsfromWHO’sMentalHealthGapActionProgramme(mhGAP)

EuropeanCommissionfundingenablesscalingupof mentalhealthservicesinEthiopiaandNigeria

• ThemhGAPInterventionGuide(mhGAP-IG)isnowavailableinFrenchandSpanishwithArabic,ChineseandRussianversionstofol-low.TranslationsoftheGuideintoGreek,Indonesian,Japanese,PortugueseandThaiareunderway.

“The Intervention Guide needs to be available in the language that health care providers use in various regions. WHO is making all attempts to reach this objective.”

DrShekharSaxena,Director,DepartmentofMentalHealthandSubstanceAbuse

• AsacompaniontomhGAP-IG,WHOisdevelopingtrainingmaterials.Aimedatdoc-torsandnurses,thesetoolswillprovidethedetailsonhowtousethemhGAP-IGinassess-ingandmanagingpeoplewithmental,neu-rologicalandsubstanceusedisorders.Priortotheiruse,thesetrainingmaterialswillneedtobeadaptedtolocalsettings.

• TheupcomingmhGAPProgrammeGuidewillprovideguidanceforstrategicplanningatnationallevelaswellasservicedeliveryatlocallevel.Theaimistoassistmanagersatsub-nationallevelinplanningandman-agingthedeliveryofmentalhealthservices.

• mhGAPimplementationiscurrentlytakingplaceinEthiopia,Jordan,Nigeria,andPan-ama.ManyothercountriessuchasIndia,SierraLeone,andThailandhaveshowninterestintheprogramme.

DrAlaAlwan,AssistantDirector-Generalcommented:

“The response from countries on the mhGAP-IG has been very positive and this reinforces WHO commitment to implement the mhGAP as widely as possible.”

The mhGAP Intervention Guide in French and the mhGAP Intervention Guide in Spanish

mhGAP Ethiopia stakeholder consultation October 20 – 21 2010

www.who.int/mental_health/mhgap/en/ 1

mhGAP Newsletter Mental Health Gap Action Programme

TheMinistryofHealthinPanamahasembracedmhGAPwiththerecentlaunchofthepilotprojectintwodis-tricts;SanMiguelito(inPanamaprov-ince)andColon(inColonprovince).

Tobeginwith,primaryhealthcaredoctorsandnurseswillbetrainedintheareaofepilepsyanddepression.DrYaridaBoyd(Director,NationalInstituteofMentalHealth,Panama)said:

“We have chosen these (epilepsy and depres-sion) conditions since they are the common-est mental and neurological problems seen in primary care settings in the country … We also need to learn from the pilot activ-ities – what are the resources and time required to implement the project.”

TheMinistryofHealthappointedanationalcommitteeandorganizedthefirstmhGAPmeetinginOctober2010toprepareandplanforpilotprojects.RecentlyinMay,thesecondmeetingwasheldtoadaptthemhGAP-IGtolocalcontext,sothatthiscanbebuilt-inthetrainingprogrammesinPanama.

CittadinanzaONLUS,anItalianorganizationworkingintheareaofmentalhealth,issup-portingmhGAPimplementationinPanama.

“mhGAP will support the delivery of qua-lity mental health services to the people of Ethiopia, through integrating mental health into public health care, while focu-sing on priority disorders and vulnerable groups.”

DrKeseteBerhanAdmasu,theStateMinis-ter,FederalMinistryofHealth,GovernmentofEthiopia

Ethiopiaisacountrywith85millionpeo-pleand36psychiatrists.Recognizingtheneedtoscaleupmentalhealthservices,the

EthiopianGovernmenthasshownpoliticalcommitmenttothesuccessfulimplementa-tionofthemhGAPprogrammesupportedbyFondationd’HarcourtandtheEC.

WorkhasalreadybegunonadaptationofmhGAP-IGforthelocalsituationandondevelopingthetrainingmaterial.

ItisalsoproposedthatmhGAPwillbecomepartoftheundergraduatemedicaltrainingacrossuniversitiesinEthiopia.Keystakehol-dersrecentlyidentifiedthefollowinggoalsintheirconsensusstatement:

1) Advocate for mental health training in medical schools across Ethiopia.

2) Create a network to include representa-tives from all Ethiopian medical schools, to enable sharing of experience and resources.

3) Establish a working group to propose (i) a standardized, core curriculum for medical student training in mental health in Ethiopia, (ii) core competencies to be attained, and (iii) recommenda-tions for examinations in mental health.

EthiopianGovernmentcommitstomhGAPimplementation

PanamamhGAPprojectlaunched

Provinces implementing mhGAP pilot projects in Panama

mhGAP Adaptation Workshop in May 2011 in Panama

www.who.int/mental_health/mhgap/en/ 2

mhGAP Newsletter Mental Health Gap Action Programme

Nigeriaintegratesmentalhealthintoprimaryhealthcare

InFebruary,thefirsttrainingworkshoponmhGAP-IGwasheldinAmman,Jordan,organizedjointlybytheMinistryofHealthandtheWHOCountryOffice.TheworkshopobjectivesweremotivatinghealthworkerstobecomefamiliarwithmhGAP-IG,anddevelopingtheskillsneededforitsadoptionanduseinclinicalpractice.

Thefive-daytrainingconsistedof24train-ees(nursesanddoctors)fromfiveprimaryhealthcentresinAmman.Thehealthpro-fessionalsweretrainedonhowtorecognizeandtreatdevelopmentaldisorders,depres-sion,selfharm/suicideandothersignifi-cantemotionalormedicallyunexplainedcomplaintsaccordingtomhGAP-IG.Trainingmethodsincludedexplanatoryflowcharts,

quizgames,self-assessmenttestsandroleplays,which,accordingtothefeedbackoftrainees:“madethetrainingmorerealanduseful”.

Oneofthetrainers,DrRabihElChammay,remarked:“Trainees were very excited by the idea of learning new things about mental health. Thy were very interested as they saw that the knowledge about assessment and man-agement was clear and applicable.”

Oneofthetraineescommented:“I am really glad that I took this training! I now know how to deal with those who need us.”

mhGAPimplementationinJordaniswithinthelargercontextofmentalhealthreformledbytheMinistryofHealthandsupportedbytheWHO.AnewNationalMentalHealthPolicyandPlanwasrecentlylaunchedbytheMinistryofHealth,demonstratingtheircommitmenttostrengthenthedifferentlev-elsofthementalhealthsystem.

mhGAP training workshop in February 2011 in Jordan

A primary health care centre in Osun state, Nigeria

Nineoutof10personswithmentaldisordersinNigeriadonotreceiveanyservices.¹TheGovernmentofNigeriaisworkingwithWHOtoscaleupservicesformentalhealthcare.

We (Nigeria) are a typical case of a develop-ing nation with a population of 150 million that has few trained psychiatrists and other psychiatric medical personnel. … primary care (is) the most efficient and effective way towards achieving mental health …

TheChargéd’affaires,fromNigeria,ontheoccasionofmhGAPForum,October2010

ThemhGAPprojectfundedthroughtheEC,emphasizesintegrationofmentalhealthintoprimaryhealthcareinselecteddistrictsofNigeria.ThenationalstakeholderscommitteeappointedbytheFederalMinistryofHealth(FMOH)hasdecidedthatthefirstmhGAP

demonstrationprojectwilltakeplaceinOsunstate,locatedinsouthwestNigeria.Osunstatehastwotertiary,49secondaryand627primaryhealthcarefacilities.Therearenineconsultantpsychiatrists,12othermedi-caldoctors,twoclinicalpsychologists,52psychiatricnursesand10socialworkers.Itisplannedtotrainthenon-specializedhealthstaffinrecognizingandtreatingmental,neu-rologicalandsubstanceusedisordersunderthesupervisionandsupportofspecialists.

ProfessorOyeGureje,UniversityofIbadan,Nigeria,applaudingthecommitmentofFMOHsaid:

“Mental health conditions are on the list of prioritized disorders in the Nigerian pri-mary health care service but only a minority of persons in need receive treatment. The WHO mhGAP Intervention Guide, provides a

unique opportunity to address the huge bur-den of unmet need for mental health service in the country.”

¹ Gureje O, Lasebikan VO. Use of mental health services

in a developing country. Results from the Nigerian

survey of mental health and well-being. Soc Psychiatry

Psychiatr Epidemiol. 2006; 41: 44 – 9.

Jordanstartstrainingprimarycaredoctorsandnursesusing mhGAPInterventionGuide

www.who.int/mental_health/mhgap/en/ 3

mhGAP Newsletter Mental Health Gap Action Programme

UpdatesfromPartners

AnumberofNGOs,foundationsandinternationalassocia-tionsareworkingwithWHOtoimplementmhGAPincountries.ManyotherpartnersareusingmhGAPtechnicalmaterial.

• CBM,aninternationalNGO,committedtoimprovingthe qualityoflifeofpersonswithdisabilitiesinlow-incomeregionsoftheworld,issupportingprogrammesinBurkinaFaso,Ghana,Niger,Nigeria,SierraLeoneandTogo.DrJulianEaton,CBM’sMentalHealthAdvisorforWestAfricacommented:

“mhGAP is offering practical solutions to improve access to care even in challenging environments. These innovative programmes combine access to medical and psychosocial care with the pro-motion of human rights and social inclusion to improve the quality of life of people affected by mental health problems.”

• The Fondazione St. Camille de LellisisaSwissfoundation dedicatedtosupportingpeoplewithmentaldisordersinWestAfrica.InJanuary2010,thefoundationlaunchedaprojectStrengthening the Mental Health System in Beninwhichaimsatimprovingthecapacityoftheprimaryhealthcarestafftodiag-noseandtreatpeoplewithmentaldisorders.TheexpertsfromthefoundationfoundtherecentlytranslatedFrenchversionofmhGAPInterventionGuidetobeanimportanttoolinthisproject.

• BasicNeedsworkswithpeoplewithmentaldisabilityto buildaninnovativeapproachtotacklepoverty,aswellasillness.MsShobaRaja,Director,PolicyandPractice,BasicNeedssays:

“We are implementing mental health and development pro-grammes in several remote low-resource settings and train-ing local non-specialist health personnel – this has synergy with the scale up model advocated by WHO’s mhGAP”.

Anexampleoftheirmentalhealthanddevelopmentprogramme isbeingcarriedoutintheremotemountainousdistrictsofBaglungandMyagdiinNepalbythelocalpartnerLEADS.Sparselypopu-latedandpoorlyconnected,distancesherearestillmeasuredinthenumberofdaysittakestowalk.Inthisprogramme,mentalhealthclinicshavebeenintroducedathealthpostsinthetwodistricts,soforthefirsttimeruralhealthfacilitieshavebeguntoprovidementalhealthservicesintheseremotesettings.

• Cittadinanza ONLUSisorganizing,incollaborationwithWHO,aninternationalmeeting“mhGAPImplementation:Build-ingcapacityofprimaryhealthcareprovidersformentalhealth”inRimini,Italy,during12–14October2011.ThemeetingwillreviewmhGAPimplementationinseveralcountries,aswellasdiscussdraftsofmhGAP-IGtrainingmaterialsandtrain-ingexperiences.ThemeetingwillinvolvecountriesthatarebothimplementingmhGAPplussomeplanningtodoso.

Workshop organized in Benin on strengthening mental health systems in Benin by Ministry of Health and Fondazione St. Camille de Lellis

A primary health care clinic at Leherepipal health post, Nepal

Visit: www.who.int/mental_health/mhgap/en/Email: mhgap-info@who.intDepartment of Mental Health and Substance Abuse (MSD) World Health Organization © World Health Organization 2011 4