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Mental health Intervention guide to make care more accessible

18 October 2010 -- WHO estimates that over 75% of people living in developing countries do not receive any mental health treatment or care. A new, easy-to-use guide to identify and provide care for mental health disorders will help expand care at a cost that is affordable, even for low- and middle-income countries.

Transcript of the podcast

Veronica Riemer: You're listening to the WHO Podcast and my name is Veronica Riemer. In this episode we look at how WHO is integrating mental health into primary health care systems across the world.

Veronica Riemer: An estimated one in four people globally will experience a mental health condition in their life. People with mental, neurological and substance use disorders are frequently stigmatized, neglected and abused. The World Health Organization estimates that over 75% of people living in developing countries do not receive any mental health treatment or care.

To mark World Mental Health Day this year, WHO has produced a simple, easy-to-use guide to identify and provide care for mental health disorders for use in communities. Dr Margaret Chan, Director-General of the World Health Organization, calls it a simple, authoritative publication, for the non-specialist.

Dr Margaret Chan: Mental health problems are real disorders. They cause death and disability. They cause suffering. They have symptoms. And they can be managed, in any resource setting. This is the message we can now communicate with confidence. No matter how weak the health system or how constrained the resources, something can always be done.

Veronica Riemer: An epilepsy project in rural China integrated a simple model of epilepsy control into local health systems and achieved excellent results. Dr Shichou Li, President of the China Association Against Epilepsy explains.

Dr Li: We trained mainly the doctors working in the county and township level. So we have to educate them first and also we have the public education for the people to let them know what epilepsy is.

Veronica Riemer: Zhaoming is a person who has been living with epilepsy for years. He tells us how treatment has dramatically improved his life.

Zhaoming: When I first got the illness, everyone thought I was a wicked person or possessed by evil spirits. I could not get work because people didn’t know what to do if I had a seizure. In 2001 I started to take this medicine and have felt much better. I started my own business and now sell woollen carpets. Life now is good.

Veronica Riemer: The trial project that started in six provinces has now been extended to 15 and tens of thousands of epilepsy sufferers have been treated.

The intervention guide is part of the WHO Mental Health Gap Action Programme, also know as mhGAP, which focuses on ways to extend and improve services to benefit more people in developing countries on a lasting and sustainable basis. Doctor Shekhar Saxena, WHO's Director of the Mental Health and Substance Abuse Department, explains.

Dr Shakar Saxena: We have too many mental hospitals which provide specialist services in terrible environments and we have very few services in the community. WHO's task is to put it right, so that services relatively inexpensively can be provided to a large number of people and specialist services can be made available when necessary. This is the primary objective of mhGAP programme. We are expanding care, putting more people in care at a cost that is affordable, even by low and middle income countries.

Veronica Riemer: The Intervention guide takes the contribution of hundreds of experts, their knowledge and experience, and puts it into less than 100 pages of clinical wisdom and practical advice. As well as providing information about effective medicines, the guide covers many simple psychosocial interventions: like educating the patient and family, giving advice on sleep, and linking to community resources for social support. Dr Saxena tells us how this guide is presented.

Dr Shakar Saxena: The guide is extremely simply made, just four or five symptoms to identify these disorders like, depression, psychosis, epilepsy, then some more symptoms and signs to diagnose them and provide treatment.

The guide is gender sensitive, and age sensitive, so we have special sections for what should be done if the person is a woman, child or an old person. Then there are clinical decision-making trees where assessment leads to action - what management should be done. All management is so simple that it can be done by busy doctors, busy nurses and medical assistants or whoever is manning the first and second level care in these countries.

Veronica Riemer: Dr Julian Eaton is a British psychiatrist and mental health advisor for the Christoffel-Blindenmission in Nigeria. His task is to support projects that include community mental health in their work. His vision is that this guide will be used by health workers to prescribe both medical and non-medical treatments that patients can afford and that will have a significant impact on their lives. He also sees the guide as an important training resource.

Dr Julian Eaton: If we are going to achieve major scaling up of services as is the aim, if we are going to close the gap, then we need to shift tasks to people who are available, who can be trained in a practical way but who can do an important and scientifically based job. That will require training; training on quite on a large scale. Although not yet a training guide, the next stage is to develop training materials from that, and it is an excellent basis upon which to do that.

This giant leap which we have to take from this guide, which is fantastic, I haven't emphasized how much I think it is great, but I think it is. It is no good unless people believe in it and really feel inspired and motivated to do something about it. To make sure that systems react to it through policy and legislation.

Veronica Riemer: The Intervention guide is currently available in English, and will soon be available in Chinese, French and Spanish. Other language versions, such as Arabic and Russian are also planned. If you would like more information about the Intervention guide and the mhGAP please see the links published on the transcript page of this podcast.

That's all for this episode of the WHO podcast. Thanks for listening. For the World Health Organization, this is Veronica Riemer in Geneva.

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