providers. The barriers to these
reforms have been reiterated endlessly. This campaign emphasised the need for
governments and policy makers to address this issue as a priority outlining the
reasons for the integration not only to improve health outcomes for the
individual, but also for cost-effectiveness as primary care is less expensive.
The WFMH emphasised the critical role of the mental health advocate and patient/service
user in shaping this major health reform.
In 2010, the World Mental Health Day’s theme was
entitled:”Mental Health and Long term Physical Illnesses”. This extended the
concept of the ‘integration of care’ by focusing on the co – occurrence of
physical and mental health disorders. The WHO has focused on 4 main chronic
illnesses: cardiovascular disease, diabetes, cancer and respiratory illnesses
which are responsible for 60% of the world’s deaths [5]. Over the last two
decades, evidence has demonstrated that people with chronic illnesses are more
likely to suffer from depression and anxiety compared to the general
population. Major depression with chronic physical health problems in turn
increases the burden of the chronic illness, causes an increase in functional
impairment and increases medical costs due to an increase in complications.
The presence of a mental health problem with chronic physical illness also impairs
self care and long term adherence with medication and treatment regimes.
The cost of co-morbidity is great in terms of social,
personal and functional impairment. Mental illness contributes to worse
outcomes in cardiovascular disease, diabetes, stroke, HIV and many other
chronic physical illnesses. Many indicators suggest that people with mental
illness and chronic physical illness struggle to obtain access to appropriate
mental health care. There are a number of factors including lack of education
and training in health care professionals, leading to non-identification of
symptoms at an early stage and hence a lack of appropriate and timely
intervention. If systems of care are integrated, there is an increased
likelihood that mental health problems would be identified at an early stage
and treated effectively. This would reduce the personal burden as well as
minimize the social burden of illness and its long term medical costs.
Person-centered Medicine Projects
Body and Mind
In 2004 the WFMH highlighted the
need for meaningful collaboration between health care professionals and people
with mental health problems and their care givers/families in a call to action
campaign toolkit for Metabolic Syndrome and Mental Health. It was based on
emerging evidence and recommendations published in the Journal of Clinical
Psychiatry (2005) highlighting the need for guidelines on monitoring and
management of metabolic syndrome in diverse geographical and cultural
settings.
At the time it had already been identified that the
connection between severe mental illness and metabolic syndrome was emerging as
an important public health concern and physical health problems such as
obesity, hypertension and type 2 diabetes were increasingly recognized as
occurring alongside mental illness. People with mental illness were recognized
as having a reduced life expectancy compared to the general population and
metabolic syndrome was a significant factor which needed to be addressed by
health care professionals.
The WFMH considered that it was important to inform and
educate all relevant stakeholders about metabolic disorders and promote best
practice in managing metabolic syndrome. The materials provided in the tool
kit were provided to promote optimal physical health monitoring for people with
mental illnesses, raise awareness of the need to balance physical
risks/benefits of antipsychotic medication and encourage people with mental
illness to take responsibility for their physical health.
Keeping Care Complete Survey
This was a unique global survey
conducted by the WFMH in 8 countries gathering information from carers /relatives/families
of those with severe mental illnesses (n=982) to assess their perspectives on
health care provision, relapse prevention, recovery, stigma and what
constitutes effective treatment.
The Keeping Care Complete Survey was targeted at helping to
capture this unmet need for information in this important area. The survey
aimed at improving the understanding of the daily challenges faced by carers
/families of those with mental illnesses which at times is unrecognized by
health care systems and the public. The results of the survey were revealing
regarding the true concerns of carers and what they considered as complete
care. The following summarise the conclusions to the survey questions:
·
Medication cannot succeed
in a vacuum – a holistic approach is required
·
Family support and
individual psychological support is crucial
·
Exercise, a healthy diet
and a stable lifestyle are key factors to overall wellbeing – not just control
of symptoms
·
Mental Health teams need
to offer advice on diet, exercise and a healthy lifestyle options as well as
input on alcohol/drugs and ensure regular physical health checks
·
It is essential for
caregivers to work along side mental health care professionals to ensure
optimum outcomes
Diabetes and Depression Dialogue
The Dialogue on Diabetes and
Depression (DDD) is an international collaborative effort to examine the
co-morbidity of diabetes and depression (www.diabetesand-depression.org). It
was set up with the aim of reviewing the evidence to date in the field,
defining gaps in knowledge and formulating strategies for prioritizing research
and action in this important area. The grouping consists of global experts in
the fields of mental and physical health from different health care systems.
The WFMH was invited to join this initiative in order to provide the
perspective from users/carers and provide valuable insights to strategies for
the future delivery of services for these co-morbid conditions.
The Group’s international membership ensures that culture
and country are considered along with the various factors affecting the
development of these comorbid conditions. Individual working groups have
already produced publications to inform the field in terms of epidemiology,
effective interventions and addressed gaps in the knowledge on service
provision at improving health care delivery in these co-morbid conditions. The
overall outcome is aimed at improving the person’s experience of the treatment
they receive and therefore the overall outcomes in terms of depression and
diabetes.
As part of the WFMH’S contribution, an international
awareness pack has been produced and is available on the WFMH website (www.wfmh.org).
This pack provides solid evidence based information that can be used by organisations
around the world to inform the general public on this important public health
issue. The pack contains fact sheets which can be detached and reproduced
separately. These include the following:
·
Diabetes and Depression:
an overview of International Efforts
·
The Epidemiology of
Diabetes and Depression
·
The Diagnosis and
Treatment of Depression and Diabetes
·
The Role of Self Care in
managing Depression and Diabetes
·
The Role of Family Members
in Helping to manage Diabetes and Depression
·
Summary: What we know
about Diabetes and Depression
The pack emphasizes the importance of self care in managing
diabetes and depression. A critical component of the treatment which is often
overlooked is self-empowerment and education, which improves the ability to
care for oneself in the journey to recovery.
The WFMH is committed to working with international partners
to disseminate this important information about diabetes and depression. From
a public perspective, it is important to distribute this growing evidence base
on the adverse consequences of these co-morbid conditions and available
effective treatments. With appropriate awareness, information and resources,
depression and diabetes can be more frequently recognized and effectively
treated.
The Great Push: Strategic Alliance with the Movement for Global Mental
Health
In 2008 the Lancet called on
government and donors for ‘Action on Mental Health’ drawing attention to the
impact of mental illness on the economies of countries and the wellbeing of the
millions who go untreated [6,7]. As a majority of governments had been
unresponsive, the WFMH formed a world campaign in strategic alliance with the
Movement for Global Mental Health in 2010 in order to promote mental health on
the international agenda with the following aims:
·
To increase visibility of
mental health problems to the general public and governments
·
To address the stigma and
the abuse of human rights associated with mental illness
·
To improve the
opportunities for treatment and recovery
·
To pressurize governments
to take appropriate action
The campaign is now encapsulated in the theme for 2011: “The
Great Push: Investing in Mental Health.” The essential elements of the
campaign are focussed on: (i) Unity; (ii) Visibility; (iii) Rights and (iv) Recovery.
Perceptions of disunity in the mental health world need to
be dispelled. In the initial WFMH Great Global Consensus, there appeared to be
substantial agreement on fundamental issues. Mental Health visibility remains
poor and stigma high. WFMH support for mental health issues must be made more
public – hence the theme for the next World Mental Health Day will be to
highlight the importance of good mental health and the need for more investment
in this area by governments. Appalling conditions exist in many mental health
hospitals including abuse of human rights and lack of mental health legislation
to safeguard them. Governments must not be allowed to remain silent on these matters.
The WFMH has proposed the setting up of a Centre for Mental Health and Human
Rights to tackle such issues with governments.
Thousands of individuals receive no mental health care
because of the absence of mental health care professionals to assess and
diagnose their illnesses. This is the first rate limiting step to recovery. Recently,
methods for mental health screening and diagnosis have been developed using
computer technology to empower nurses and health assistants, aimed at improving
the detection, diagnosis and treatment of mental illness. Pilot studies are
ongoing in India, Europe and Australia which are proving to be promising with a
view to bringing treatment and relief to those who would otherwise go
undiagnosed.
Conclusion
The WFMH has shown a clear
commitment to the Person-centered Medicine Movement since its launch [8]. At
the recent Third Geneva Conference on Person-centered Medicine, the WFMH,
joined in the clear united collaborative effort across disciplines and
specialties. There was a strong commitment to the promotion of health as a
state of physical, mental social and spiritual wellbeing as well as the relief
of suffering related to physical and mental ill health. Support was shown for the
universal adoption of the slogan ‘ No Health without Mental Health’.
The WFMH has demonstrated its ongoing dedication to this
endeavour by a formal agreement to commit to the development of a task force
composed of affiliated associations and organizations. The WFMH believes that
it is well positioned to inform the INPCM movement of users/families
perspectives in collaboration with the European Federation of Associations of
Families with Mental Illness (EUFAMI). The WFMH has also shown its commitment
to the movement by forming an alliance with INPCM to promote a person-centered
approach to care founded on evidence and humanism to improve understanding of
illness and positive health on an individual basis as well as on a community and
also global level. The WFMH is committed to further efforts to this perspective
on health in order to promote the benefits of adopting a more holistic approach
to care to improve health and social outcomes and quality of life for people
with mental illness and their carers through such global efforts.
References
[1] Copeland, JR.
(2010) World Federation for Mental Health perspectives on person-centered
medicine. International Journal of Integrated Care, 10, Suppl. 009.
[2] Brody, EB.
(2004) The World Federation for Mental Health: its origins and contemporary
relevance to WHO and WPA policies. World Psychiatry, 3 (1), 54-55.
[3] WHO (2005)
Mental health: facing the challenges, building solutions. Report from the WHO
European Ministerial Conference. Copenhagen, Denmark.
[4] Prince, M.,
Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, MR & Rahman, A.
(2007) No health without mental health. Lancet, 370 (9590), 859-877.
[5]
Preventing Chronic Diseases; A
Vital Investment. WHO Global Report 2005.
[6]
Patel, V., Araya, R., Chatterjee,
S., Chisholm, D., Cohen, A., De Silva, M., Hosman, C., McGuire, H., Rojas, G. & van Ommeren, M. (2007)
Treatment and prevention of mental disorders in
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[7] Patel, V.,
Garrison, P., de Jesus, Mari J., Minas, H., Prince, M. & Saxena, S. (2008)
Advisory group of the Movement
for Global Mental Health. The Lancet's series on global mental health: 1 year
on. Lancet, 372 (9646), 1354-1357.
[8] Mezzich, JE (2011) The Geneva Conferences and the emergence of the
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