MENTAL HEALTH GAP ACTION PROGRAMME (Mhgap)

MENTAL HEALTH GAP ACTION PROGRAMME (mhGAP)

3rd meeting of the mhGAP Forum

ANNEX E

Submissions from the participating organizations

64 Great Suffolk Street London SE1 0BL United Kingdom Tel: +44 (0)20 7981 0880 ADI Submission for mhGAP Forum Fax: +44 (0)20 7928 2357 Geneva, 10 October 2011 Email: [email protected] Web: www.alz.co.uk

Alzheimer’s Disease International (ADI) is the worldwide federation of 76 Alzheimer associations. ADI’s mission is to strengthen and support Alzheimer associations and raise awareness about dementia worldwide, to improve the knowledge of and information on risk factors, and to make dementia a global health priority. Our vision is an improved quality of life for people with dementia and their families throughout the world.

ADI has commissioned three reports on global dementia, the World Alzheimer Report 2009, with the latest prevalence data and information about the impact of the disease. The World Alzheimer Report 2010 contains the global economic impact of Alzheimer’s disease and related dementias. The World Alzheimer Report 2011 on the Benefits of Early Diagnosis and Intervention shows that (early) diagnosis and intervention do matter, but many people do not receive any diagnosis, so there is a treatment gap for both medical and non-medical interventions.

We welcome the priority that is given to dementia in the Mental Health GAP programme and promote the programme where we can. There are still governments in the world who – wrongly – think that dementia does not occur in their country. This programme gives a unique opportunity to improve the quality of life of people with dementia and their families. It brings together the most effective interventions that can be used from today on. The World Alzheimer Report 2011 explicitly recommends the mhGAP intervention guide especially for primary care services.

The national Alzheimer associations are well positioned to assist in the implementation of this plan. A list of countries where we have a member association can be found on the ADI website. ADI has publish about mhGAP in our newsletter Global Perspective and will put it on our website in as many languages as are possible. We took part in a special meeting in the EMRO region. When we know that a country is going to work with mhGAP, we can support our member association to take part in the programme and implementation.

We hope to hear more about the programme during the Forum meeting.

Marc Wortmann Executive Director Alzheimer’s Disease International

Alzheimer’s Disease International, The International Federation of Alzheimer’s Disease and Related Disorders Societies, Inc. In official relations with the World Health Organization

Dear Colleagues and Participants in the mhGap Forum October 10, 2011

I am grateful to have become aware of the publication of the mhGap Intervention Guide very early in its availability. Utilization Within the actions of Psy-pour-Haïti, this manual was presented to Dr. Jocelyne PIERRE-LOUIS, Head of National Mental Health Services, Ministry of Health, Haïti, first in English (Jan. 2010) and subsequently in French (August 2010) when the French version became available.

There are now plans to use it widely in the development of innovative projects fostering prevention of alcohol/drug dependency and suicide.

These projects include targeting specialized populations of women, youth, the unemployed, the homeless, and occupants of the IDP camps.

The mhGap Intervention Guide has been incorporated into the teaching curriculum of Psy-pour-Haïti in the programs provided to train Haïtian community mental health workers,

Modules implementing information provided in the MhGap Intervention Guide concerning Depression and Alcohol/Drug Dependency were taught in January 2010 In courses held on site at the Haïtian Adventist Hospital in Port-au-Prince (Diquini).

Suggestions for Further Collaboration Students from 10 different geographic zones will continue to receive training from PPH.

Assistance in funding of organization of the training programs, provision of copies of the mhGap Intervention Guide to each student and allowance for supervision of beginning utilization in each community would enhance the implementation of the tools provided by the mhGap Guide.

Respectfully,

Denise Bouvier, Psychologist FSP Nyon, Switzerland ______

C.P. 1308 1260 Nyon 1 Tél. : +41(0)78 707 35 72 e-mail : [email protected] Site : psy-pour-haiti.org

PSY-POUR-HAITI.ORG

Association Psy Pour Haiti

MISSION STATEMENT Psy pour Haiti has been created to address the urgent need for mental health services in Haiti. Working in close collaboration with the Haitian people, Psy pour Haiti aims to promote resilience and enhance mental health by providing sustainable services, support and training to people and organizations where mental health services are insufficient.

ABOUT US: Psy pour Haiti is a non-profit organization founded to provide rapid responses to critical ongoing mental health needs in Haiti which have been highlighted by the earthquake of January 2010. It is our goal to empower and enable the Haitian people to meet these needs as quickly as possible with resources developed within the country.

OUR WORK: Psy pour Haiti is providing training to Haitians for primary-level intervention in order to prevent chronicity of sequelae and avoid the need for specialized care whenever possible. In conjunction with existing hospitals, Psy pour Haiti is establishing psychological services where consulting a specialist is now possible on a regular basis. Aware of the heavy burden carried by many with high responsibilities, Psy pour Haiti offers special support, resources and coaching to those in leadership capacities.

SERVICES: Current services include: 1) Regular, ongoing training programs in French for Haitians, equipping them in basic listening and counseling skills for use in their communities. 2) Once-a-quarter drop-in psychological consultations on a first-come-first-serve basis in conjunction with 2 hospitals, one in Port-au-Prince and another in Cap Haitien. 3) Regular networking meetings for leaders for peer-debriefing, supervision and support. Specialized individual help is available on request.

DONATIONS: Denise Bouvier RAIFFEISEN, NYON IBAN: CH26 80442 0000 5203 1179

C.P. 1308,1260 Nyon 1, Suisse Téléphone: +41(0)78 7073572 Email: [email protected] Site: psy-pour-haiti.org

PSY-POUR-HAITI.ORG

Association Psy Pour Haiti

NOTRE MISSION: Psy pour Haïti a été créée pour répondre aux besoins urgents en matière de santé mentale en Haïti. Dans une collaboration étroite avec le peuple Haïtien, Psy pour Haïti a pour but de promouvoir la résilience et renforcer la santé mentale en offrant des services durables dans la formation, soutien et aide aux individuels et aux organisations où les services actuellement disponibles sont insuffisants.

QUI SOMMES NOUS: Psy pour Haïti est une association à but non-lucratif établie pour fournir des réponses rapides aux besoins critiques et chroniques dans le domaine de la santé mentale en Haïti. Ces besoins ont été mis davantage en évidence depuis l’immense tremblement de terre du 12 janvier 2010. Notre objectif est de faciliter un processus qui permet au peuple Haïtien de répondre le plus rapidement possible à ces besoins avec des ressources développées au sein du pays.

NOTRE TRAVAIL: Psy pour Haïti offre des formations aux Haïtiens pour une intervention au premier niveau, dans le but de prévenir une chronicité de séquelles et d’éviter le plus possible un recours aux spécialistes. En collaboration avec des hôpitaux existants, Psy pour Haïti est en train d’établir des services psychologiques où il est déjà possible de consulter un spécialiste régulièrement.

SERVICES: Actuellement, nos services comprennent : 1) Des formations offertes régulièrement en français aux Haïtiens afin de leur permettre de développer leur pratique d’écoute et de relation d’aide pour assister leurs communautés. 2) Des services psychologiques offerts par des personnes qualifiées qui sont disponibles une fois par trimestre en conjonction avec 2 hôpitaux, un à Port-au-Prince, l’autre au Cap Haïtien. 3) Des réunions régulières de « réseautage » destinées aux leaders pour une intervision, debriefing et soutien spécialisé. Des services individualisés sont disponibles sur demande.

DONS: Denise Bouvier RAIFFEISEN, NYON IBAN: CH26 80442 0000 5203 1179

C.P. 1308,1260 Nyon 1, Suisse Téléphone: +41(0)78 7073572 Email: [email protected] Site: psy-pour-haiti.org PSY-POUR-HAITI.ORG

Association Psy Pour Haiti

DONATIONS: Denise Bouvier RAIFFEISEN, NYON IBAN: CH26 80442 0000 5203 1179

C.P. 1308,1260 Nyon 1, Suisse Téléphone: +41(0)78 7073572 Email: [email protected] Site: psy-pour-haiti.org

PSY-POUR-HAITI.ORG

Association Psy Pour Haiti

DONS: Denise Bouvier RAIFFEISEN, NYON IBAN: CH26 80442 0000 5203 1179

C.P. 1308,1260 Nyon 1, Suisse Téléphone: +41(0)78 7073572 Email: [email protected] Site: psy-pour-haiti.org

Autism Speaks Global Autism Public Health Initiative

Autism Speaks is the world’s largest autism science and advocacy organization. Its mission is to fund research into the causes, prevention, treatments and a cure for autism; increase awareness of autism spectrum disorders; and advocate for the needs of individuals with autism and their families. Officially designated a non-governmental organization associated with the United Nations Department of Public Information, the first and only such organization devoted to autism, Autism Speaks is able to reach a global audience in its efforts to promote the dignity, equal rights, social progress and better standards of life for individuals with autism. In 2008, Autism Speaks launched the Global Autism Public Health Initiative (GAPH), an ambitious international advocacy effort designed to help countries around the world: (1) enhance public and professional awareness of autism; (2) facilitate scientific research, including research that informs public health policy; and (3) build capacity for autism services, especially in early detection and intervention. Through GAPH, Autism Speaks has already established or is exploring partnerships with local governments, professionals, and parent advocates in over 20 countries across Central and South America, the Middle East, Eastern and Western Europe, South Asia, Africa, and the Pacific Rim.

A major barrier to improving the health and wellbeing of children and families touched by autism around the world is the paucity of expertise and subsequent lack of capacity for autism services and research. Capacity-building is a core component of GAPH development and closing the treatment gap requires development of community-based intervention that is feasible, cost- effective, and can be delivered with fidelity by professionals and non-professionals alike. GAPH implements strategies developed in the field of global mental health where experts acknowledge the need for innovative solutions to scaling up services, especially in countries struggling with many public health priorities outside of autism and developmental disabilities.

Furthermore, collaboration and partnership are essential for the success of GAPH programs. Autism Speaks aims to serve as a catalyst for meaningful change, but we recognize that committed local and international leadership and support is essential for achieving our goals. Successful partnerships allow us to leverage shared investments, speed development, enhance impact, and facilitate dissemination of program activities and outcomes to communities in need. As the priorities and approaches of GAPH are well aligned with those of the World Health Organization’s (WHO) Mental Health GAP Action Program in reducing the global burden of mental health issues, in April of 2010 Autism Speaks and WHO announced an official partnership. The Autism Speaks-WHO partnership aims to build upon the synergy between the GAPH and mhGAP to have the greatest impact and broadest reach in rapidly delivering meaningful, impactful, and sustainable solutions to families struggling with autism and other mental health disorders around the world.

No Health without Mental Health October 2011

The Shirley Foundation and Autistica welcome the opportunity to contribute to the Mental Health Forum in partnership with the WHO and its other partners.

The Shirley Foundation is the leading funder of autism projects in the UK having donated over £66million to research and service development in the field of autism and developmental disorders. It continues to fund strategically significant projects such as:

the mhGAP initiative, a WHO Europe project, supporting the work of Autistica research into the cost of autism to the UK economy

Autistica is the UKs leading charity funding autism research, in the UK. It seeks to use biomedical research to bring benefits to individuals and families affected by autism. It is dedicated to raising and investing funds to support high quality peer reviewed research, focussing on determining the causes and biological basis of autistic spectrum disorders and advancing and evaluating new treatments and evidence based interventions.

Autism is one of the most significant but least researched developmental disorders. Autistica has set its self the task of achieving major breakthroughs within 10 years.

Its main focus in support of the mhGAP initiative is, and will be, to support capacity building in areas of low to middle income or areas where diagnosis is at a low level.

Currently Autistica is in the process of facilitating a programme of 6 Mentored Fellowships in partnership with a major Indian corporate, assisted by a leading Indian Minister. This programme will enable Indian researchers to study in the UK before returning to increase capacity in India. This is part of an initiative to ensure involvement at an international level, by countries where there is no established autism research network.

Continuing support

By supporting capacity building, Autistica will enhance knowledge, support evidence based interventions, practice and research, with the expressed aim of ensuring an improvement in the quality of life for individuals and families.

One of Autisticas aims is to influence the direction of research together with the dissemination of information on autism and research findings... A key new initiative is the direct involvement of individuals with autism, their families and carers in these processes.

It will continue to promote evidence based intervention as described in the mhGAP reports.

Personnel involved in The Shirley Foundation and Autistica will continue to contribute to mhGAP and its aims and objectives

Eileen Hopkins Autism Consultant -The Shirley Foundation Director of International Development - Autistica

CBM – Building an inclusive society

CBM is an international Christian development organisation, committed to improving the quality of life of persons with disabilities in the poorest countries of the world. Based on over 100 years of professional expertise, CBM addresses poverty as a cause and a consequence of disability, and works in partnership to create a society for all. CBM’s vision is: “an inclusive world in which all persons with disabilities enjoy their human rights and can achieve their full potential”.

CBM’s goals are: to support Partners in health care for existing conditions which can lead to disability, through local capacity development. CBM also emphasises prevention and early intervention to improve outcomes. to improve the quality of life of persons with disabilities through accessible health care, education, livelihood and rehabilitation services. At present many of these services are designed for persons with disabilities. The aim is to ensure that mainstream services can also meet their needs in the future. to advocate for inclusion, and promotion of rights of persons with disabilities, in all aspects of development activities and social life (mainstreaming).

In order to achieve this, CBM follows a twin track approach, consisting of Enabling and empowering persons with disabilities, their families and representing organisations through increasing their access to support services and through their political empowerment. Identifying and overcoming the barriers in society that people with disability face e.g. physical accessibility, communication, attitudes, legislation.

Mental health care in Sri Lanka, after the Tsunami Picture: CBM/Lohnes

CBM promotes service developments which are accessible to all people, particularly the poorest. Therefore CBM works proactively with its Partners to break down barriers which prevent people accessing services. These barriers include poverty, lack of education, gender, religion, age, social stigma and geographic isolation. CBM prioritises services that improve the lives of children and women, and takes into account environmental issues.

Together we can do more… Together with its Partner organisations, CBM reaches over 20 million persons annually. CBM Member Associations support a joint programme of development work with over 60 million Euros annually. Currently, CBM supports more than 900 projects in over 90 countries in Africa, Asia, Latin America and Eastern Europe through 12 Re- gional Offices. Local and expatriate professionals (nurses, special educators, doctors, physiotherapists, rehabilitation experts and project managers, field staff) offer their skills through more than 750 Partner organisations. CBM emphasises sustainable, community-based approaches which encourage self-reliance and contribute to poverty alleviation and community development. Building local capacity is a priority and CBM invests significantly in personnel development.

International Cooperation, Advocacy and networking CBM works with like-minded local and international organisations to build alliances to improve the quality of life of persons with disabilities. CBM works in cooperation with United Nations (UN) agencies, including the World Health Organization (WHO), NGOs and Disabled Peoples’ Organisations (DPOs) to develop networks and programmes. CBM strives to always include persons with disabilities at every level. CBM has been involved from the outset with "VISION 2020: The Right to Sight", a global initiative to eliminate avoidable blindness by the year 2020, and other global initiatives on hearing and education for all. CBM is a pioneer in Community Based Rehabilitation (CBR), and was involved in the development of the new WHO-ILO-UNESCO CBR guidelines (launched in October 2010).

CBM and Community Mental Health CBM has been involved in Community Mental Health (CMH) work through its partners for many years. For the last 5 years, mental health has been a formal mandate area. Activities in MH started in West Africa and Asia (particularly following the Tsunami). CBM supports a number of standalone CMH programmes and many of the 210 CBM supported CBR programmes worldwide have a CMH component.

Awareness raising exercise by community volunteers in Nigeria Picture: CBM

Each year, at least 100,000 people access CMH services supported by CBM. Since 2007, CBM has had an Advisory Working Group in Community Mental Health, composed of five MH experts who advise and build capacity of the CBM regional offices for the implementation of CMH. They also participate in global forums and networks to scale up CMH services worldwide.

CBM and mhGAP CBM is proud to be an active participant in mhGAP. CBM was a member of the group developing mhGAP materials, and is already actively involved in its implementation, for example in Nigeria, Niger and Sierra Leone. The WHO’s goal of closing the gap between need and services in the area of mental health is shared by CBM. In line with the core value of professionalism, it is important to CBM that the Programme is built on a strong evidence-base. CBM will continue to support its partners in collaborating with mhGAP as part of the process of scaling up quality services and ensuring that rights of people with psychosocial disabilities are promoted. Joint NGO/Government/local partner programmes are using mhGAP as a platform to build services, and training curriculums are increasingly using mhGAP materials as resources.

CBM is strongly committed to working with the WHO to ensure that mental health care is available to those who need it, so that together we can build an inclusive society.

CBM Nibelungenstr. 124, 64625 Bensheim, Germany • www.cbm.org • [email protected]

The Centers for Disease Control and Prevention (CDC) is a US Government agency that promotes public health. CDC’s Internet web site is located at www.cdc.gov .

CDC’s Vision for the 21st Century: “Health Protection…Health Equity”

CDC’s Mission: Collaborating to create the expertise, information, and tools that people and communities need to protect their health – through health promotion, prevention of disease, injury and disability, and preparedness for new health threats.

CDC seeks to accomplish its mission by working with partners throughout the nation and the world to

• monitor health,

• detect and investigate health problems,

• conduct research to enhance prevention,

• develop and advocate sound public health policies,

• implement prevention strategies,

• promote healthy behaviors,

• foster safe and healthful environments,

• provide leadership and training.

Historically, CDC did not consider mental health as part of its mission, but this has changed over the past decade, and now CDC is engaged in a variety of activities related to mental health. 1

Reference: 1. Safran MA. Achieving recognition that mental health is part of the mission of CDC. Psychiatric Services . 2009; 60(11): 1532-1534.

Department of Health and Human Development

THE GULBENKIAN GLOBAL MENTAL HEALTH PLATFORM

The Calouste Gulbenkian Foundation

The Calouste Gulbenkian Foundation is a Portuguese private institution of public utility whose statutory aims are in the fields of arts, charity, education and science. The head-office, located in Lisbon, comprises the Calouste Gulbenkian museum, a congress area with auditoriums, a space for temporary exhibitions, the Art Library and the Modern Art Centre. The Calouste Gulbenkian Foundation also has a research biomedical science institute, (the Instituto Gulbenkian de Ciência) in the outskirts of Lisbon, and delegations in London and Paris.

Global Health Initiatives

The Foundation actively pursues its statutory aims in Portugal and abroad through a wide range of direct activities and grants supporting projects and programmes. In regard to that, we have been for some years, through our Department of Health and Human Development, focusing on Global Health issues, namely:

• As member of the European Foundation Centre, we participated, with other key organizations, in the European Partnership for Global Health where we have funded the publication of “European Perspectives on Global Health – A Policy Glossary” , published in 2006.

• We funded The Global Health Europe (a platform for European engagement in global health) portal website ( www.globalhealtheurope.org ) aimed to be a central tool for dissemination and exchange of information and for establishing a network of key actors.

• With four European Foundations (Fondazione Cariplo, Fondation Mérieux, Nuffield Foundation, and Volkswagen Stiftung), we are involved in a Postdoctoral Fellowship Programme “Neglected Communicable Tropical Diseases and Related Public Health Research”.

Global Mental Health Platform Project

There are at least two compelling arguments to put mental health in the global and development agendas: a public health argument based on the huge burden attributable to mental disorders and a moral argument based on the unacceptable gap in access and treatment of mental disorders and in systematic violation of the human rights of people with mental disabilities.

As a continuation and evolution of some recent and successful grant-giving activities, ([1] the support for the National Epidemiological Study on Psychiatric Morbility; [2] the 2010 Forum on Mental Health “Mind Faces”; [3] the International Master´s Degree in Mental Health Policy and Services, organized in partnership with the Faculty of Medical Sciences, University of Lisbon and with the technical contribution of the World Health Organization, we propose to position ourselves in the broader and complex picture of Global Mental Health.

The project will be jointly conducted with the Department of Mental Health of the Faculty of Medical Sciences of the Nova University of Lisbon and will establish partnerships with Brazilian and Indian institutions and with the World Health Organization and will create a Global Platform for networking knowledge and experiences from low and middle income countries.

The Calouste Gulbenkian Foundation could play a prominent role in:

• Conceptualizing and better defining the links, commonalities and differences between NCDs and Mental Disorders;

Department of Health and Human Development

• Mapping the existing knowledge (epidemiology of Mental Disorders, assessment of cost- effective interventions, strategies leading to change, implication for health systems reforms, economic impact assessment);

• Bridging the Human Rights community to the Mental Health Community promoting common language and synergies in national and international projects;

• Networking actors (public health experts, research centres, Intergovernmental Agencies, Foundations, NGOs, development Agencies) with special emphasis on some of those countries characterized by a fast economic growth where NCDs are increasingly becoming a public health priority (e.g. Brazil and India).

In order to establish a Global Mental Health Platform, several activities will be undertaken, namely:

• High-level technical meetings of world expert aiming at conceptualize, mapping the knowledge and inspiring the preparation of high-level technical documents (on: human rights of people with mental disabilities; effective interventions, including preventive; health systems implications and strategies to promote change);

• A global event involving a variety of international stakeholders combining Health, Human Rights and Culture;

• The establishment of a Global Web Forum as the permanent site of Global Platform for Mental Health.

Meanwhile, a Steering Committee was appointed and is composed of the following persons:

• Benedetto Saraceno, Head and Scientific Coordinator • José Miguel Caldas de Almeida, Faculty of Medical Sciences of the Nova University of Lisbon • Sérgio Gulbenkian, Calouste Gulbenkian Foundation • Jorge Soares, Calouste Gulbenkian Foundation

CALOUSTE GULBENKIAN FOUNDATION Department of Health and Human Development

Av. de Berna, 45 A 1067-001 Lisboa, PORTUGAL

Email: saú[email protected] Website: www.gulbenkian.pt

10 October 2011

Progress of epilepsy control work in China in recent years

Shichuo Li, M.D.; China Association Against Epilepsy

In China, it was estimated that there are about 9 million people with epilepsy, two thirds of them are “active” cases and every year 400,000 new cases occur. Epilepsy was described 2200 years ago in the “Medical Classic of the Yellow Emperor” (Huang Di Nei Jing) and has been treated by “Traditional Chinese Medicine” in a long history but most effective control of epilepsy should be attributed to modern medicine including surgical treatment since the 20 century. In recent years, the epilepsy control has got a great progress in China, those include: 1, Epidemiological survey in urban and rural communities in 1980’s and beginning of the 21 century; 2, A demonstration project of “Global Campaign Against Epilepsy” (GCAE) co-sponsored by IBE, ILAE and WHO was conducted in 2002-04 in rural area of 6 provinces. After 24 months, 71% of the persons with epilepsy (PWE) treated with PHB whose seizures decreased more than 50% (26% seizure free). The treatment gap in the project area decreased 12.8% (from 2000, 62.6% to 2004, 49.8%). A follow-up study of the demonstration project was implemented in 2008; 3, An extended national project on “management of epilepsy control in rural China” has been then implemented since 2005. Recently, 19 of 32 provinces are involved in the project and around 50,000 PWE are under treatment by PHB and Valproic acid. The Ministry of Finance and Ministry of Health provide funds of 13 million CHY (2 million USD) to support this project every year; 4, China Association Against Epilepsy (CAAE) was established in 2005 and since then, a series of significant programs were carried out in China, as “CAAE International Epilepsy Forum”, “International Epilepsy Caring Day”, establishment of “patients self-help organizations”, public education in 30+ cities, publication of clinical guidelines and a green book, etc.; 5, The technique of clinical treatment and basic research got a remarkable progress as well; 6, Since the mhGAP launched in WHO, this project has been introduced into China. The CAAE has draft signed a Memorandum of Understanding with the “BasicNeeds” and started a feasibility study of training program for control of epilepsy and mental disease in rural area of the Shunping County of Hebei Province. Attached are some pictures taken from the project on “management of epilepsy control in rural China” .

PWE involved in the Project

2005 ～～～09 2010 Total

Screened out 77,930 13,578 91,508

Diagnosed 61,080 11,806 72,886

PHB treated 40,088 6,327 46,415

Vlp treated ------3,664 3,664

PWE treated by phenobarbital

Work target 2009 2010 Total

Under 40,088 6,327 46,415 management

Follow ---up 34,821 6,198 41,019 recently

Lost 4,834 1,235 6,069 deaths 433 239 672

Before treatment （治疗前）

After treatment （治疗后）

A PWE in Gansu Province: His house before treatment （甘肃某患者治疗前住房）

His house after treatment (the family economy improved) （治疗后住房，家庭经济改善）

Fondation d’Harcourt was established in 1964 upon the initiative of the d’Harcourt family as an independent non-profit foundation. Our headquarters are in Geneva, Switzerland.

Our Approach to Giving

The Foundation works to support vulnerable people by ensuring that their basic needs are fulfilled. We have learned that visible challenges are accompanied by psychological and social needs. Meeting non-tangible needs that are not immediately linked to physical survival is also primary and essential to the well-being and dignity of each person, regardless of socio-economic status.

Our Mission

We are committed to providing disadvantaged people with opportunities to become aware of their own personal resources. We support vulnerable groups so that they may gain confidence in their potential and trust in the contributions they can make to their communities .

Our Program Our program does not have a geographic focus, but we target a few topics that are severely neglected world-wide.

We invest in projects that enhance the human and social capital of underprivileged populations.

We specifically sustain pilot interventions which integrate a psychosocial approach in addressing critical sectors of human development, such as: − social reintegration and design of income-generating activities − access to health services and strengthening of public health systems − quality education and vocational training

Our Strategy

- We develop partnerships with non-profit organizations - Non Governmental Organizations, intergovernmental agencies, public institutions and private foundations – that are working directly with beneficiaries in the field

- We only fund programs that we can monitor in partnership with the implementing organization.

- We value initiatives that stimulate capacity-building at the local level and lead to a progressive sharing of responsibilities with in-country stakeholders

- We give priority to culturally sensitive activities developed in collaboration with local authorities and government institutions

Our Commitment to WHO mental health Gap Action Program

We have allocated financial resources to implement mhGAP pilot phase in Ethiopia for the years 2010-2012 and we are committed to call the attention of other Swiss-based private foundations on these efforts, so that they may also engage in this partnership.

Contacts Maddalena Occhetta - Program Manager Fondation d’Harcourt [email protected]

Global Initiative on Psychiatry 30 years of global action for mental health

Global Initiative on Psychiatry (GIP) is an international non-profit foundation that supports the development of mental health care services in developing countries.

GIP started as a human rights organization with the goal of ending the incarceration of dissidents in psychiatric hospitals, focusing primarily on the USSR. When the Berlin Wall came down at the end of the 1980s and all political prisoners were released, we changed our focus on developing humane and ethical mental health care services. Initially we focused our work exclusively on Central & Eastern Europe and the former Soviet Union. We started with small projects, setting up psychiatric associations, associations of psychiatric nurses, family oråganizations and eventually also consumer organizations. We trained mental health professionals, established day care programs and gradually a new approach to mental health care provision was developed; an approach that focused on trying to keep people in the community as much as possible. Gradually the projects became bigger and, together with our partners in the target countries, we received support from local and national authorities. As a result of ten or fifteen years of hard work, the landscape of mental health in many of the countries fundamentally changed.

Starting in 2005, GIP also focused on countries outside of this region; in particular, in Africa and South East Asia. In many of these countries, the work is the same as we did and continue to do in Central & Eastern Europe and the former Soviet Union. We use all the experience and knowledge acquired in the past, in new countries and regions, to consolidate the successes of the past and integrate the results in general health care services. In all geographical areas, we continue to work on the basis of the same principle: to stimulate and support local partners and to help them realize their plans and ideals. We believe that is what it is all about: to make sure that people in each country and community take their own responsibility and they themselves bring about the necessary changes.

Community mental health care

GIP works with local partners to develop care and support for these persons in the community, Caregivers are trained to provide this type of care and educate family and patients to make sure that they adequately know how to deal with the illness. This is a long-term investment and requires substantial negotiations with authorities to make it possible.

Support for people with an intellectual disability

Persons with an intellectual disability have a disturbance in their intellectual functioning either starting at birth or developed at a later age. They often have difficulty in communicating, living and working independently, taking care of their health and safety and in making decisions. In many countries, these people are ostracized by their families and/or locked up in institutions. GIP works together with parents and caregivers to provide this group of people with a dignified human existence, thereby enabling them to participate in society as well.

HIV/AIDS and mental health

Approximately 33 million people live with HIV/AIDS globally; three-quarters of them live on the African continent where almost twelve million children have been orphaned because of the epidemic. If these children grow up without adequate support, there will be huge consequences for the children themselves and, eventually, also for the socio-economic development of their country.

The issue of the psychological effects of AIDS is one of the main target areas in the work of GIP. Problems in the mental domain can lead to increased risky behavior and thus to more likelihood of being infected with HIV. However, infection also can lead to mental health problems. Approximately 40% of the people who are HIV positive have a serious form of depression. Good psychosocial care and support for people with HIV/AIDS is, for that reason, of crucial importance for the improvement of the quality of life for people with HIV/AIDS and, also, to counter the spread of the infection.

GIP initiated the opening of nine “Expert Centers on Mental Health and HIV/AIDS” in Eastern Europe, the Caucasus and Central Asia. These centers organize and coordinate training and research programs and represent the interests of persons with HIV who have psychosocial problems. The goal is to reduce stigma and to improve care for people with HIV/AIDS and mental health problems.

GIP and human rights

During the first ten years of our existence, we fought for the release of dissidents and religious believers who had been incarcerated in psychiatric hospitals for political reasons, particularly in the Soviet Union. But also in subsequent years, human rights has remained a core issue for our organization. Many of the people who were hospitalized in psychiatric institutions had their human rights violated on a daily basis, because of bad living conditions and maltreatment, but, in particular, because they were often locked up for the rest of their lives far away from urban areas. Even now it is estimated that approximately half a million people are residing in these institutions in Eastern Europe and the former Soviet Union, with virtually no chance of returning to the community.

When GIP expanded into other regions, we encountered the same – and sometimes even worse – conditions, and naturally also in our new target countries, defending human rights in mental health is a core element of our work. GIP is concerned about human rights everywhere and will promote them whenever local psychiatric systems are violating the spirit of the International Declarations, such as UN Convention on Human Rights and the UN Convention on the Rights of Persons with Disabilities.

Since the beginning of this century, we also work in prisons and forensic psychiatric institutions. What we encounter there is often heartbreaking and brings us back to the work that we did in the 1980s. Still, we often manage to bring about change.

Last but not least, we also pay much attention to the rights of patients and support people with mental illness or a mental disability standing up for their own rights. Although it is often a long and difficult road, we can look back and conclude that a great deal has been accomplished; but there is still a great deal to be done.

Example: Georgia

GIP has been present in Georgia for the past fifteen years, the past eight with a regional center based in the Georgian capital, Tbilisi. After many years of investing a new reform program started in the fall of 2010, changing the highly institutional mental health care service into a community oriented one, introducing best practices from around the globe. Currently the first new services have opend their doors, Soviet-style institutions have closed their doors and training programs focus on upgrading the professional level of all mental health professionals in the country. The program is carried out in close collaboration with the Ministry of Health and is supprted by many of GIP’s international partners. It will alter the landscape of mental health services in Georgia altogether and help the country to catch up with international standards in mental health care service delivery.

Information Sheet to WHO mhGAP Forum 10 October 2011

HimalPartner is a Norwegian based mission organisation working in Nepal and the Tibetan areas of China since 1938. HimalPartner is known to contribute to new development areas such as when it pioneered rural hydro power development in Nepal in the 1960s. The area of mental health was identified as a focus area after having supported local projects for some year and increasingly being made aware of the complexity of the problem through local partners and Norwegian professionals. We will most probably be receiving Norwegian governmental funding and therefore also able to contribute globally. (See www.himalpartner.no )

History

HimalPartner (former Tibetmisjonen/Norwegian Himal-Asia Mission) was founded in 1938, and began working in Tibet in what is now the province of Sichuan in China. Due to the Second World War and the subsequent Communist revolution, the mission shifted its work to Nepal, through the international umbrella organization United Mission to Nepal (UMN). HimalPartner (via UMN) has contributed to community and national development in Nepal since the boarders opened in the 1950’s. It has contributed to the building of hydropower stations and training of nationals in technical and industrial skills, through development and participation in community health services and hospitals, as well as through primary and higher education of nurses and engineers. From the late 1980's it has again been possible to initiate community developing work within the Tibetan areas of China.

Aims and values

HimalPartner is a mission organsation that aims to share the testimony about Jesus Christ with the people in the Himalayan region, through practical work and everyday life. Our field workers are Christian professionals, working closely with the local population of all faiths. HimalPartner wants to contribute to the development of local communities and to build the capacity of local leaders and organizations, while respecting local culture and customs. We work closely with people from other agencies and nations as well as with the national church. We are financially supported by individuals and churches in addition to government grants given to specific projects, mainly through the Norwegian Agency for Development Cooperation (Digni/NORAD).

Focus on Mental Health

In 2010 HimalPartner instigated a Professional Committee for Mental Health, as the organization was already involved in various projects related to mental health both directly and indirectly. The committee constitutes of volunteers in Norway with a mental health profession (including adult and child psychiatrists, clinical psychologists and nurses). The committee aims to contribute to

networking, increase competence and to mobilize mental health resources within HimalPartner as well as within other NGOs in Norway working with mission and development. Through this, we want to increase the emphasis on and quality of mental health related development work. A special focus is placed on Nepal and the Tibetan areas in China.

HimalPartner will assist in the implementation of the MhGAP goals through awareness raising, networking and partnerships between local NGOs in Norway, Nepal and China. Our focus will be on capacity building through the training of local mental health trainers, support to local mental health advocacy groups as well as assistance in research. From 2012, HimalPartner will most probably be trusted to receive Norwegian governmental funding (via Digni/NORAD) to further develop and strengthen our involvement in mental health work in Himalaya and putting it on the theme on the Norwegian agenda.

As part of this, HimalPartner will arrange a conference in Oslo (March 7-8, 2012) for Norwegian development organizations, mental health professionals and mental health advocacy groups to inspire the integration of mental health into international development work. The conference is supported through a grant given by Digni (NORAD), and has contributors from the WHO (Dr Michelle Funk) as well as from London School of Hygiene and Tropical Medicine/Sangath (Prof. Vikram Patel). A representative from a mental health advocacy group in Nepal (Mr. Matrika Devkota) will give input from the users’ perspective. The conference will enable clinicians and development organisations to network and finding opportunities to engage in and enhance the focus on mental health globally. A special emphasis will be on the Himalayan region, as this will serve both as a pilot project and as inspiration for mental health work in other parts of the world.

For more information: http://www.himalpartner.no/om-himal-partner/information-in-english

Relevant publications in English:

Dørheim S, Eberhard-Gran M: Transcultural aspects of screening and early intervention for postnatal depression – a systematic review. (Submitted sept 2011)

Ho-Yen S Dørheim, Bondevik GT, Eberhard-Gran M, Bjorvatn B: “Factors associated with depressive symptoms among postnatal women in Nepal.” Acta Obstetricia et Gynecologica Scandinavica, 2007; 86: 291-298

Ho-Yen S Dørheim, Bondevik GT, Eberhard-Gran M, Bjorvatn B: “The prevalence of depression in the postnatal period in Lalitpur district, Nepal.” Acta Obstetricia et Gynecologica Scandinavica, 2006; 85: 1186-1192.

Board on Health Sciences Policy Forum on Neuroscience and Nervous System Disorders

BUILDING PARTNERSHIPS FOR SCALING UP CARE FOR MENTAL, NEUROLOGICAL AND SUBSTANCE USE DISORDERS IN SUB-SAHARAN AFRICA

BACKGROUND CRITICAL BARRIERS

Sub-Saharan Africa (SSA) has one of the largest The workshop will focus on two activities that have treatment gaps for mental, neurological and substance been identified as critical barriers to strengthening use (MNS) disorders in the world. These three groups services for MNS disorders: of disorders cause a substantial burden to the Medical Education: Increasing the number of continent’s population, and in the absence of both the health care workers with expertise in MNS necessary numbers of specialists and access to essential disorders, strengthening medical neuroscience medicines for each of these, any remedy of the gap education systems, building clinical and research should target the MNS disorders together. neuroscience capacity in African medical schools and clinical training programs for nurses, medical In 2009, an Institute of Medicine (IOM) workshop in officers, and primary care workers. Uganda initiated enquiry into what needs to be done to Essential Medicine Access: Issues, such as, local bridge this gap and to prioritize steps based on production, bulk purchasing, pricing, supply chain, feasibility and impact. However, the lack of resources drug banks and drug donations will be targeted in and understanding of the remediable burden of MNS order to achieve sustainable models for providing disorders remain major obstacles. Critical to the access to essential medicines success of any effort is a demonstration that ignoring MNS disorders is not only devastating for overall 2012 BUILDING PARTNERSHIPS WORKSHOP population health but that it also undermines efforts to prevent and treat other causes of disease burden. In An ad hoc planning committee will plan and host a addition, workshop participants emphasized that efforts workshop inviting key stakeholders to discuss potential in this area should not try to complete for resources opportunities for establishing new collaborative used to combat infectious diseases, but should, instead, relationships for the purpose of developing try to leverage those ongoing activities with initiatives synchronized approaches. Participants will include targeted to MNS disorders. Given the need for a representatives from countries in SSA, mental health synchronized approach to reduce the disease burden, a professionals/researchers, policy advisers, and reasonable next step is to build partnerships to scale up prospective partners. In addition non-governmental care. organizations, foundations, development agencies, and for-profit groups with mental health and infectious To establish new collaborative relationships for the diseases focused efforts will also be invited to purpose of aiding in the development of synchronized participate. approaches to reduce the burden of disease, the IOM’s Forum on Neuroscience and Nervous System Disorders Workshop objectives: will host a workshop in 2012 in conjunction with the Present the ‘case’ for investing in the scale up of World Health Organization (WHO) and the National care for MNS disorders in SSA including Institutes of Health (NIH). providing information on current disease burden. Explore immediate needs and opportunities around the two identified critical barriers. Identify resources and potential partners within each selected country and formulate strategies for collaboration. Develop specific pilot projects for scale-up in 2-3 countries. Establish a process for systematic follow up for at least 3 years following pilot project initiation.

500 Fifth Street, NW Phone: 202 334-3984 Washington, DC 20001 Fax: 202 334-1329 E-mail:[email protected] www.iom.edu/neuroforum

Board on Health Sciences Policy Forum on Neuroscience and Nervous System Disorders

WORKPLAN ABOUT THE NEUROSCIENCE FORUM

July – October The IOM in 2006 established the Forum on Collect information on current mental health and Neuroscience and Nervous System Disorders. The infectious disease efforts in targeted countries. Forum is designed to provide its members with a Create and disseminate surveys to: neutral venue for exchanging information, sharing ▫ Identify both barriers and opportunities for individual views, and allowing a structured opportunity scale up of care; for dialogue and discussion while scrutinizing critical ▫ Identify potential partners and resources. and possibly contentious scientific and policy issues. Begin solicitation of country representatives, Representatives from government, industry, academia, partners and participants. patient advocacy organizations, and other interested parties serve as Forum members. It convenes three October – January times a year to confer on subject areas of mutual Develop workshop agenda and solicit speakers. interest and concern. At its meetings, the Forum Collect and analyze data from surveys and begin identifies and discusses emerging scientific and policy drafting “white paper” to be presented at the issues related to basic neuroscience and nervous workshop. system disorders, as well as effective clinical interventions and policy options. The Forum also January - June sponsors workshops (symposia) as an additional Finalize and publish the “white paper”. mechanism for informing the membership of the Disseminate materials to all participants. Forum, other relevant stakeholders, and the public.

July/August ABOUT THE INSTITUTE OF MEDICINE Workshop in SSA (Country to be determined). The Institute of Medicine serves as adviser to the nation to improve health. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The mission of the Institute of Medicine embraces the health of people everywhere

500 Fifth Street, NW Phone: 202 334-3984 Washington, DC 20001 Fax: 202 334-1329 E-mail:[email protected] www.iom.edu/neuroforum

Contributions of Maudsley International to the Mental Health Gap Action Programme (mhGAP)

September 2011

Introduction

Maudsley International is a joint project from the Institute of Psychiatry (King’s College London) and South London and Maudsley NHS Foundation Trust. It is based in London, UK.

The Institute of Psychiatry is known across the world for its international collaborative research; for providing basic and advanced training to professionals; for high quality translational research; and for supporting policy making in the field of mental health.

South London and Maudsley NHS Foundation Trust provides the most extensive portfolio of mental health services in the UK, and has a history that dates back to the foundation of the Bethlem Royal Hospital in 1247. The organisation offers pioneering teaching and training and is a key provider of clinical experience to international students and professionals.

Many world leaders in mental health have studied or trained at one of the two organisations. Staff at both have been commissioned in the UK and overseas to contribute their expertise to the planning, organisation, development and evaluation of mental health services.

Contributions of Maudsley International to International Mental Health

Maudsley International aims to improve global mental health by sharing local expertise with overseas colleagues. Maudsley International was founded on the principle of integrating academic and clinical interests and at its heart is the concept of translating expertise in research and training into high quality practice on the ground. Maudsley International does this in an international context by providing access to a wide range of expertise through programmes designed to bring Institute of Psychiatry and Maudsley NHS Foundation Trust colleagues together to describe best practice and how this may inform developments in other countries. Maudsley International offers a range of services tailored to the needs of colleagues working in very different environments around the world.

• Maudsley International has been undertaking teaching and training, and consultancy related to research, clinical practice and policy in mental health, across the world.

• Maudsley International harness the expertise and experience of leading clinicians, managers and scientists at the Institute of Psychiatry and South London and Maudsley NHS Foundation Trust, two renowned centres of excellence in the field of mental health.

• Maudsley International has been collaborating with research institutions, healthcare providers, governments and non-governmental organisations.

• Maudsley International has been providing opportunities to learn best clinical practice, best practice in change management and leadership in mental health, clinical governance and ethics, organisation of training and management.

How Maudsley International can further assist in the implementation of mhGAP

Maudsley International could support the mhGAP work by offering the knowledge, skills and support necessary to help plan, develop, implement and evaluate cost-effective and locally appropriate training, services and policies, tailored to meet the specific mental health needs of neighbourhoods, regions and countries, anywhere in the world. Maudsley International can collaborate with research institutions, professionals, policy makers and non-governmental organisations to help promote mental health, prevent illness and treat and support individuals and their families. Maudsley International can also undertake to organise training in generic mental health practice: Psychiatry, Occupational therapy, Psychology, Nursing and Social work and training in sub-specialties, including: Forensic psychiatry, Child and adolescent mental health, Substance and alcohol use disorders, Older age mental health and Intellectual disabilities. Maudsley International can support capacity development to assist mental health services and clinical teams, service diagnosis, assessment, evaluation and redesign

Visit www.maudsleyinternational.com or email [email protected]

2. Mental health and trauma relief TORY OF THE KONFLICT It is common knowledge that post traumatic stress disorder (PTSD) is a major pathology linked to wars or other man-made or natural disasters. By breaking down the delicate balance of the nervous system, it can completely disable a person from normal functioning in society. IAHV programmes have been offered in the war-torn and disaster areas of the world for many years with high success rates, including in Kosovo, Iraq, Afghanistan, Kashmir, and Pakistan, natural disasters of Hurricane Katrina, 2004 South Asian tsunami, earthquakes in Orissa, Gujarat, Bam, and the terrorist attacks of 9/11, Madrid, and Mumbai. A recently published study on the South Asian tsunami documented that IAHV programmes significantly help reduce PTSD symptoms.

3. Mental disorders in children and young adults An age group in which mental disorders are most rapidly increasing is our children. This is giving rise to unprecedented use of medication in children as early as a few years of age. The result of increased mental problems in youth is easy to see in the form of violence in schools. For this reason, IAHV has a major focus with specially designed programmes for children and young adults with very encouraging results from around the world where mental stability, physical well- being, sociability and Human Values are supported. Recent scientific research indicate that this programme helps to eliminate depression, mental disorders, fear, anxiety, and other negative emotions, as well as help curb substance abuse.

4. Suicide Mental disorders of different kinds can result in suicide which is on the rise in EU countries. This has been an issue directly addressed by IAHV. Among the farmers of the Indian states of Karnataka, Andhra Pradesh and Maharashtra, more than 1,920 people have committed suicide between January 2001 and August 2006 due to increasing challenges of agriculture. IAHV spearheaded a special programme in villages of this region and as a result the suicide rate was reduced dramatically. Special programs were carried out for village youth to inspire them to become part of a sustainable solution. In the 308 villages where IAHV has worked so far, there has not been a single reported incidence of suicide after implementation of IAHV programmes. Encouraged by the results, the Government of Maharashtra has requested to take up the work in all affected districts. This work can be applied to EU countries as well.

Possible collaboration of IAHV with mhGAP participants The issue at hand is so large that collaborative efforts are required for any meaningful success to curb the tremendous mental health problems of today. IAHV is ready for such collaborative efforts by making available its programmes and the large volunteer base to effectively prevent and help treat mental health problems in all communities. These programmes are cost-effective, easy to implement, and sustainable, and as such can be easily combined with other efforts.

Invitation to form partnerships We therefore formally invite international organizations, national and local governments, NGOs, academic institutions and other entities that are dedicated to achieving the goals of mhGAP to collaborate with IAHV. Together we can: - develop pilot programmes to assess the efficacy of IAHV modalities for mhGAP goals, - help educate and support people attending existing mental health services, - facilitate further research on natural evidence based modalities and other interventions.

For further information please contact Werner Peter Luedemann [email protected], Tel +49 -7804-973.911, Bad Antogast 1, D-77728 Oppenau, Germany

International Association for Human Values P.O. Box 2091, CH-1211 Geneva 2; Tel. +41 – 22 – 738 28 88; eMail: [email protected] International Non-Governmental Organization (NGO) in special consultative status with the Economic and Social Council (ECOSOC) of the United Nations Member of the UN Global Compact

WHO mhGAP FORUM, Geneva 10 October 2011

The International Association for Human Values (IAHV) IAHV is an international humanitarian and educational Non-Governmental Organization committed to promote resurgence of Human Values in all aspects of life across the globe. The Association partners with governments, educational institutions, other NGOs, corporations, businesses and individuals, to develop and promote programmes of personal development and to encourage the practice of Human Values in everyday life. IAHV, along with its sister organization Art of Living Foundation, has one of the largest volunteer based networks in the world. It has reached over 20 million people in over 140 countries from all walks of life with a wide range of social, economic, cultural and educational activities. The organization works in special consultative status with the Economic and Social Council (ECOSOC) of the United Nations, participating in a variety of committees and activities, related to health and conflict resolution. IAHV is known for its low overhead and strong organizational capacity facilitated by the large volunteer base around the world.

IAHV Programmes The key to all of IAHV activities is the effective programmes of self development and stress elimination that have been successfully implemented around the world over regardless of race, culture or religion. These programmes are directed at individuals and communities at all levels of society and taught by certified instructors. The practices are natural, do not carry any side-effects, are easily accepted and integrated into one’s daily routine and can complement any existing medical regimens. They are cost-effective and can be taught to people from all walks of life, including children and vulnerable adults. Scientific research on these practices have shown them to be very effective in relation to mental health issues, both in apparently healthy as well in clinically ill people. These are briefly reviewed below.

Possible Contributions of IAHV to the mhGAP Goals 1. Depression Sudarshan Kriya and accompanying practices (SK&P), the core self development and stress elimination programme implemented by IAHV, have been studied in open and randomized trials, both in healthy populations and in populations with psychopathology. This research, published in international peer-reviewed journals, suggest that SK&P reduces depression, anxiety, and stress, and that it increases well-being, optimism, and mental focus. For example, SK&P was shown to have a success rate of 68-73% in treating clinical depression, regardless of severity. Substantial relief was experienced in three weeks, and by one month, patients were considered to be in remission. At three months, the patients remained asymptomatic and stable. These effects may be mediated, at least in part, by beneficial effects on the endocrine system, the antioxidant system, and the nervous system, based on other research findings.

IASSID is an international and To further support the implementation of interdisciplinary non-governmental mhGAP, IASSID may be in a position to: organization that seeks to promote the development and exchange of  Help build local research knowledge about intellectual disabilities. capacity by supporting the Founded in 1964, IASSID is the first and development or evaluation of only world-wide group of scientists mhGAP activities (e.g., the focusing on intellectual disability. development of screening tools to identify children with intellectual The association organises a rolling disability, the evaluation of the programme of World and Regional impact of community based Congresses, specialist meetings and rehabilitation [CBR] and family training events. support interventions); IASSID is in official relations with the  co-ordinate and/or provide World Health Organization. We are training to health professionals committed, as part of our work plan and other relevant groups to with WHO, to supporting the support the implementation of implementation of the mental health mhGAP interventions. Gap Action Programme (mhGAP). We have undertaken reviews for WHO of To discuss the possible involvement of the evidence in support of interventions IASSID please contact Professor Eric for children with intellectual disability Emerson [email protected] and advised on the content of the mhGAP Intervention Guide in relation to intellectual disability.

http://www.iassid.org

Submission for mhGAP Forum

IFPMA represents the research-based pharmaceutical companies and associations across the globe. The research-based pharmaceutical industry’s 1.3 million employees research, develop and provide medicines and vaccines that improve the life of patients worldwide. Based in Geneva, IFPMA has official relations with the United Nations and contributes industry expertise to help the global health community find solutions that improve global health. IFPMA manages global initiatives including: IFPMA Developing World Health Partnerships Directory catalogues the research-based pharmaceutical industry's long-term partnership programs to improve health in developing countries, IFPMA Code of Pharmaceutical Marketing Practices sets standards for ethical promotion of medicines, IFPMA Clinical Trials Portal IFPMA sees mhGAP is an optimal forum to exchange views, and coordinate projects in partnership to address issues relating to mental health. IFPMA and its Members are committed to engage all health partners in conversation and support initiatives to lessen the burden of mental illness at the regional and global levels. Evidence suggests the cost to society of mental health illnesses will dramatically increase over the next years—calling for action from all mhGAP partners. To tackle this growing issue particular attention should be devoted to strengthening primary care as well as to health promotion and prevention programs. IFPMA supports high-level initiatives such as mhGAP that will increase awareness, inform policy, and reduce the incidence of mental health disorders.

Web: www.ifpma.org

IFPMA / FIIM I Chemin Louis-Dunant 15 I P.O. Box 195 I 1211 Geneva 20 I Switzerland Tel: +41-22-338 32 00 I Fax: +41-22-338 32 99 I E-mail: [email protected] I Web: www.ifpma.org ILAE/IBE/WHO Global Campaign Against Epilepsy “Epilepsy – Out of the Shadows” Secretariat: Stichting Epilepsie Instellingen Nederlands P.O. Box 540, 2130 AM Hoofddorp, The Netherlands

Tel.: + 31 23 558 8412, e-mail: [email protected]

INTRODUCTION

The International League Against Epilepsy (ILAE) The ILAE is the world's preeminent association of physicians and other health professionals working towards a world where no persons' life is limited by epilepsy. ILAE's mission is to ensure that health professionals, patients and their care providers, governments, and the public world-wide have the educational and research resources that are essential in understanding, diagnosing and treating persons with epilepsy. The vision of ILAE is: A world in which no person's life is limited by epilepsy. ILAE has 109 national chapters.

The International Bureau for Epilepsy (IBE) IBE is the world’s leading organisation for people with epilepsy, their families and professionals interested in the medical and non-medical aspects of epilepsy. Although the advances in medical treatment have brought the opportunity for a normal life to a substantial majority of people with epilepsy, social factors complicate this process and frequently limit the person with epilepsy from participating fully in society. This varies from country to country, because of the diverse degrees of prevailing prejudice, lack of understanding and cultural backgrounds. It is the commitment of the national epilepsy associations to change and improve this situation. The IBE offers support to reach this goal. IBE’s goal is: To improve the quality of life of all people with epilepsy and their carers. IBE has 122 members in 92 countries.

The World Health Organization The Constitution of the World Health Organization (WHO) came into force on 7 April 1948. WHO's objective is the attainment by all peoples of the highest possible level of health. The Constitution defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. WHO has 193 Member States.

The ILAE/IBE/WHO Global Campaign Against Epilepsy (GCAE) In 1997, the three afore mentioned organisations, ILAE, IBE and WHO, joined forces in an attempt to, in partnership, raise epilepsy to a level of awareness that had not been achieved ever before, despite all efforts by each of the separate organisations and their affiliates. This partnership is the ILAE/IBE/WHO Global Campaign Against Epilepsy, which has as its mission statement: To improve the acceptability, treatment, services and prevention of epilepsy worldwide. The collaboration between IBE, ILAE and WHO has given the Campaign the opportunity to build a framework for concerted action on a global, regional and national level to raise awareness and diminish the treatment gap. The ultimate goal of the Campaign is to close the treatment gap in epilepsy1. Activities under the Campaign, organised by the local members and chapters of IBE/ILAE, have been developed in over 100 countries. Activities under the Campaign are listed below showing to what expected mhGAP results they will contribute to.

mhGAP Closing the GAP between what is urgently needed and what is currently available to reduce the burden of mental, neurological, and substance use disorders worldwide

1 Internatioonal The differenceLeague Againstbetween theEpilepsy number of people International with active Bureau epilepsy forand Epilepsythe number whose seizures World are being Health appropriately Organisa tion treated in a given population at a given point in time, expressed as a percentage.

1 ACTIVITIES

Global Campaign Taskforce A Task Force for the GCAE was set up in 2009 and developed a strategic plan by which progress within the GCAE could be achieved over a four year period. The strategic plan has four main goals; 1. To improve the visibility of epilepsy and the activities of the Global Campaign in all countries 2. To promote activities of all epilepsy projects on a country and regional level 3. To assess and strengthen health care systems for epilepsy 4. To increase partnerships and collaboration with other organisations The Global Campaign Taskforce works in close collaboration with the ILAE/IBE Global Outreach Taskforce which works on global projects which are outside the scope of the Global Campaign Taskforce.

Regional Activities on Epilepsy

AMRO

During the 6th Latin American Congress, a meeting was organised involving stakeholders in the region, IBE and ILAE Presidents, representatives of the Global Campaign and of PAHO with the aim to develop a strategic epilepsy plan for the Americas. The purpose of this plan is that the regional leadership of PAHO which involves all Ministers of Health of all Stakeholders meeting the member states will include epilepsy as a health priority for Cartagena, Colombia the next 10 years The plan will hopefully be approved In September, during the Annual Meeting of all Health Ministers from the Americas and will lead to the commitment of all countries in the region to develop, based on the national realities, a national plan for epilepsy. All countries will be obliged to submit an annual progress report to WHO/PAHO. This document may be a model which can be used in the other regions of the world. The entire process was initiated under the auspices of the Global Campaign Against Epilepsy.

EURO The Global Campaign Co-ordinator participated in Epilepsy Advocacy Europe (EAE), a joint taskforce of ILAE and IBE aiming at the facilitation of initiatives to enhance public awareness and support to research in epilepsy in Europe. EAE seeks to make epilepsy a priority in political and research establishments across Europe The first initiative of this Taskforce was the establishing of a European Epilepsy Day, which was launched on 14 February 2011 in the European Parliament in Strasbourg, France. Following this, a number of meetings took place between Taskforce representatives and Members of the European Parliament (MEP’s). A special working group of Members of European Parliament with an interest in epilepsy was formed and a first action of this Group was to support ILAE and IBE in having a Written Declaration on Epilepsy approved by the European Parliament. This was a major project as it required a minimum of 369 signatures of MEP’s which had to be obtained within 3 months. At the end of the three months a total of 459 MEPs had signed and the Declaration was passed in the European Parliament on 15th September 2011. The Declaration is a very important document to use at local and EU level, for example, in  advocating for increased research funding  advocating for improved healthcare facilities and services provision for people with epilepsy  building other significant initiatives at European level

2 mhGAP: Greater investment in care for mental, neurological, and substance use disorders

Assessment of Country Resources on Epilepsy In collaboration with the WHO Regional Office, a draft instrument for epilepsy resource assessment in Tajikistan has been developed within the Global Campaign Against Epilepsy. The draft has undergone multiple revisions to incorporate the comments from the working group and local stakeholders from Tajikistan. This will help in detailed situation analysis, better planning and strengthening of health care for better delivery of epilepsy services. This instrument will also be helpful to later develop a generic version that can be used in other countries for resource and need assessment for epilepsy.

Demonstration Projects General Objectives are to reduce the treatment gap and the social and physical burden, educate health personnel, dispel stigma and prevention. Demonstration projects have been completed in Senegal, Zimbabwe, Brazil and China. The ultimate goal is to develop a variety of successful models of epilepsy control that will be integrated into the health care systems of the participating countries and regions and, finally, applied on a global level. Such projects are being finalised in Georgia and have been initiated in Honduras whilst the means are being sought to also initiate one in Cameroon

As part of an epilepsy Demonstration Project (under the aegis of the Global Campaign Against Epilepsy), carried out in rural areas of six non-contiguous provinces of the People’s Republic of China, it was estimated that the number of people with epilepsy in China is almost 9 million with a treatment gap of 63%. The Demonstration Project was successful in implementing treatment and management of convulsive forms of epilepsy in rural areas of the country. Physicians with basic training were shown to be able to treat people with epilepsy. This cost-effective approach was successful in reducing the treatment gap by about 13%. Dr Hans Troedsson, WHO Representative WHO Country Office, China*

The epilepsy project in China is an example of successful partnerships: in the first place, the partnership between IBE, ILAE and WHO, but more importantly the partnership with China’s Ministry of Health, national chapters and members of IBE, ILAE and other scientific societies, WHO regional and country offices, other NGOs and WHO Collaborating Centres. Mike Glynn, President, IBE Solomon L Moshé, President, ILAE Benedetto Saraceno, Director, Department of Mental Health and Substance Abuse, WHO*

* Epilepsy Management at Primary Health Level in rural China: WHO/ILAE/IBE Demonstration Project: WHO China Office 2009

mhGAP 1. A comprehensive and result-oriented programme for mental health implemented in targeted countries. 2. Increase in the proportion of primary health facilities that have trained health professionals for diagnosis and treatment of mental, neurological and substance use disorders. 3. Greater coverage with essential interventions for people with mental, neurological, and substance use disorders.

3 MhGAP: Enhanced implementation of human rights standards in care facilities for mental, neurological, and substance use disorders.

Teaching teachers in Georgia Technical meeting in Cameroon Clinic in Honduras

Project on the burden of epilepsy The Global Burden of Disease, Injuries, and Risk Factors Study (GBD) (1990) provides a complete systematic assessment of the data on all diseases and injuries. Within a new GBD project, comprehensive estimates of the burden of epilepsy, its disabling sequelae and its role as a risk factor for other diseases and injuries will be developed. Specific aims: 1. To generate comprehensive estimates of the burden of disease due to idiopathic epilepsy 2. To generate comprehensive estimates of the burden of disease due to epilepsy 3. To generate comprehensive estimates of the mortality and burden of disease due to epilepsy. The Global Campaign Against Epilepsy continues to contribute to the above process. mhGAP Greater investment in care for mental, neurological, and substance use disorders.

Development of guidelines on the treatment of epilepsy in children and adolescents An algorithm was developed for diagnosis and treatment of neonatal seizures especially in resource limited settings, aiming at clinicians in developing countries in collaboration with the WHO Department of Child and Adolescent Health and Development and published in Epilepsia. The Guidelines will be published shortly. mhGAP 1. Increase in the proportion of primary health facilities that have trained health professionals for diagnosis and treatment of mental, neurological, and substance use disorders. 2. Greater coverage with essential interventions for people with mental, neurological, and substance use disorders.

Project on legislation The results of this project will be useful for policy makers, health planners, administrators, legislators, lawyers, health professionals and patient groups at a national, regional as well as international level. A document on the subject has been developed and is ready for publication Even during its execution the project served as a source of information and offered support to IBE/ILAE members involved in the development of anti-discriminatory legislation in connection with epilepsy. For instance the Campaign co-ordinator and others have been instrumental in the development and approval process of a law for the protection of the rights of people with epilepsy in Colombia, which was signed for approval by the President. the law for protecting the rights of people with epilepsyresident signed the law for cting mhGAP: Enhanced implementation of human rights standards in care facilities for mental, neurological, and substance use disorders.

INTERNATIONAL MEDICAL CORPS: MENTAL HEALTH PROGRAMMING

Overview

The impact of mental illness on many of the world’s nations, coupled with an alarming shortfall in accessible treatment options, led International Medical Corps to make sustainable, accessible mental health care a cornerstone of our relief and development programming. We have developed our capacity to both address the immediate psychosocial needs of communities struck by disaster or crises and help those with pre-existing mental health disorders. Whether in relief or development settings, our mental health and psychosocial programs are informed by local needs, build on existing community resources and structures, involve training of national counterparts, and are designed to be integrated into existing services such as health or nutrition. This ensures that services are community-driven, accessible, non-stigmatizing, and sustainable. We have implemented mental health and psychosocial programs in Asia, Africa, Latin America, and the Middle East, as well as in the United States after Hurricane Katrina.

Our Approach to the Integration of Mental Health into General Health Care Using the mhGAP

Aside from being cost-effective, offering services through existing primary health care centers at the community level is an accessible, non-stigmatizing way to offer local populations assistance. International Medical Corps has implemented mental health programs integrated into general health care in Sierra Leone, Haiti, Aceh, Sri Lanka, Afghanistan, Jordan, Syria, Gaza, Iraq, and Lebanon. International Medical Corps has been involved in the development of the mhGAP program, particularly the essential mental health package curriculum to improve service delivery. We are also currently involved in the WHO working group developing an additional module focused on disorders specific to stress. International Medical Corps is committed to supporting the use of the mhGAP curriculum, and our approach includes:

• Advocacy: Highlight to stakeholders, including donors and operational agencies, that the international community has the tools available, such as the WHO mhGAP, to improve care for individuals with mental, neurological, and substance abuse disorders, thereby closing the gap between the needs and what is currently available. • Government Partnerships: Work in partnership with governments to assess existing health systems and policies and design programs that maximize the use of existing government health care infrastructure and resources, are consistent with national capacities and strategies, and promote sustainability. For instance, International Medical Corps is currently working with the transitional government in Libya to explore short- and long-term capacity building for mental health service provision using the mhGAP guidelines. • Training: Adapt the WHO mhGAP guide to the local context and training needs and provide intensive theoretical training sessions to local health professionals over several months to recognize, treat, and refer cases of mental disorders. International Medical Corps has used and adapted mhGAP training materials in Gaza, Haiti, and Lebanon and is planning to use mhGAP for new programming in Jordan and Libya. • Supervision: Follow-up theoretical training with mentorship, on-the-job supervision, and case discussions to ensure that the content of training is effectively put into practice. • Institutional Capacity Building: Work with clinic management to integrate mental health into service provision through implementing quality standards, supporting HMIS data collection, and holding referral workshops to strengthen networks among service providers. • Program Evaluation: Evaluate the results of our programming through KAP (knowledge, attitudes, practices) tests, on-the-job-supervision checklists, institutional quality checklists, client and family satisfaction surveys, and feedback from trainees. Our mental health-primary health care integration program in Lebanon has included refresher trainings using the mhGAP and is now informing national policy. A description of this project will be featured in a special issue of Intervention, the International Journal of Mental Health, Psychosocial Work and Counselling in Areas of Armed Conflict.

INTERNATIONAL UNION UNION INTERNATIONALE OF PSYCHOLOGICAL DE PSYCHOLOGIE

SCIENCE SCIENTIFIQUE FOUNDED / FONDÉE EN 1951

EXECUTIVE COMMITTEE Mission COMITÉ EXÉCUTIF The mission of the Union is the development, representation and President/Président advancement of psychology as a basic and applied science Rainer K. Silbereisen University of Jena nationally, regionally, and internationally.

Past President/ Basic Facts about the International Union of Psychological Président sortant Science Bruce Overmier University of Minnesota • IUPsyS serves as the global organization for psychology and psychological organizations. It is a member of two major Vice President/Vice- Président science organizations, the International Council for Science Kan Zhang and the International Social Science Council. Chinese Academy of Sciences • Within the United Nations family, IUPsyS has official Secretary-General/ Secrétaire général relations with the World Health Organization (WHO) and Pierre L.-J. Ritchie special consultative status with the Economic and Social Université d’Ottawa Council (ECOSOC). Through its other affiliations, it also Treasurer/Trésorier realtes to UNESCO and UNICEF. Michel Sabourin Université de Montréal • IUPsyS members are 79 national psychology associations or

Deputy Secretary-General/ national psychology federations, representing over 500,000 Secrétaire Générale psychologists, on all continents. adjointe Ann Watts • IUPsyS is governed by its Assembly (100+ Delegates from Entabeni Hospital National Members); by its Executive Committee (16

MEMBERS members presently from 13 countries); and its Officers (6

Helio Carpintero from 5 countries). Un. Complutense de Madrid • IUPsyS was founded officially in 1951, but existed earlier Peter Frensch ashe International Psychology Committee; as such, it Humboldt University sponsored the very first International Congress of Laura Hernandez-Guzman Psychology in Paris,in 1889. Uni. Nacional Autónoma de México • IUPsyS today addresses the full breadth of psychology as a profession and a science. James Georgas University of Athens • The Union’s priorities are set by its Strategic Plan which is

Maria Larsson established every four years. In addition, to Strategic Stockholm University Planning, there are only two Standing Committees refelcting Pamela Maras their central importance to the sustained priorities of IUPsyS: University of Greenwich Capacity-building and Communications & Publications. Janak Pandey • The 2008-12 SP identifies two areas for dedicated strategic University of Allahabad reviews of current activities and setting the stage for new Gonca Soygut initiatives. In 2009, the strategic review of the publications Hacettepe University and communications led to launching two new products: Barbara Tversky Columbia University Psychology Resources Around the World serves as an encompassing web portal of those within and outside Executive Officer psychology; a book series on ‘Applications of Psychology’ Nick Hammond IUPsyS Secretariat with the intended audience being practitioners, scholars and

students in other fields. The second strategic review in 2011 addressed capacity-building. It re-affirmed the high importance of this area and provides the framework for

continuing and new initiative focused both on individuals and institutional / organizational development. ______Member of the International Social Science Council and of the International Council for Science In consultative status with the Economic and Social Council (ECOSOC) of the United Nations In formal associate relations with UNESCO In official relations with the World Health Organization (WHO)

INTERNATIONAL UNION UNION INTERNATIONALE OF PSYCHOLOGICAL DE PSYCHOLOGIE

SCIENCE SCIENTIFIQUE FOUNDED / FONDÉE EN 1951

EXECUTIVE COMMITTEE COMITÉ EXÉCUTIF The Global Mental Health Gap Action Programme (mhGap) President/Président and Rainer K. Silbereisen University of Jena The International Union of Psychological Science (IUPsyS)

Past President/ Président sortant WHO approved Official Relations with IUPsyS in 2002 and Bruce Overmier University of Minnesota periodically renewed based on a series of Work Plans. In its work with WHO and other international organizations, IUPsyS has Vice President/Vice- Président determined that it is better to focus on a small number of Kan Zhang collaborative activities that are mutual priorities of both. The Union Chinese Academy of Sciences concluded that this approach offers greater possibility of making a Secretary-General/ Secrétaire général value-added contribution compared to peripheral contributions to a Pierre L.-J. Ritchie larger number of activities. Université d’Ottawa

Treasurer/Trésorier The Global Mental Health Gap Action Programme (mhGap) is Michel Sabourin emerging as a flagship activity for WHO in the domain of mental Université de Montréal health. IUPsyS supports the WHO objective to pursue a significant Deputy Secretary-General/ scaling-up of activities related to this programme. Preliminary Secrétaire Générale adjointe discussions have been held on the contribution IUPsyS can make to Ann Watts this endeavour. There is an agreement in principle that this will be a Entabeni Hospital prominent component of the current Work Plan. MEMBERS The specific focus for IUPsyS work on mhGap is being set partly by Helio Carpintero Un. Complutense de Madrid the outcome of the Union’s recent strategic planning for capacity-

Peter Frensch building. One focus under consideration is the development of Humboldt University evidence-based intervention packages for priority conditions. In Laura Hernandez-Guzman particular, IUPsyS would collaborate with WHO on the relevant Uni. Nacional Autónoma de psychological and psychosocial evidence base pertinent to the México capacity-building priority in the three targeted mhGap priorities James Georgas University of Athens (Health Systems, Human Rights, Health Delivery). Initially, the area of Health Delivery will likely be the IUPsyS primary focus. Maria Larsson Stockholm University The initial task will likely be one or more scoping documents that will Pamela Maras identify pertinent knowledge and knowledge transfer potential in University of Greenwich primary care as well as adaptations from tertiary and secondary Janak Pandey University of Allahabad care to primary care. Careful attention will be given to culturally mediated attenuations and adaptations that may be required to Gonca Soygut Hacettepe University enable the effectiveness of primary care. At a later stage, it is Barbara Tversky anticipated that guidelines will be developed according to the criteria Columbia University established by WHO for the adoption of guidelines. Executive Officer The Union recognizes the magnitude of the challenge involved in Nick Hammond IUPsyS Secretariat meeting the goals of mhGap. This will require a significant concentration of diverse resources. IUPsyS will strive to use its www.iupsys.net internal resources to leverage other resources in order to meet the

challenge in those areas where its contribution can bring a clear value-added dimension to the mhGap programme.

______Member of the International Social Science Council and of the International Council for Science In consultative status with the Economic and Social Council (ECOSOC) of the United Nations In formal associate relations with UNESCO In official relations with the World Health Organization (WHO)

Japanese Association of Psychiatric Hospitals

President The Japanese Association of Psychiatric Hospitals (JAPH) was founded in 1949 to Manabu Yamazaki promote the mental health in Japan, to

provide appropriate medical and welfare Vice-President services to people with mental disorder, to protect human rights, and to help social Tatsuhito Kawasaki reintegration. As of April 1st, 2009, the total number of Teruyoshi Nagase JAPH member hospitals is 1,213, with

Masaru Tomimatsu 294,972 psychiatric beds, accounting for 72.8% of all psychiatric hospitals and Executive Board 84.1% of the total psychiatric beds in Japan. (These figures indicate that mental health care Takao Mori is primarily provided by private hospitals in Japan.) Hisomu Chiba

Takashi Kanno Our Contribution to WHO in 2010-2011: We contributed to the implementation of Michihiko Hayashi Mental Health Gap Action Programme, especially for making training materials for the Yoshitake Minami Intervention Guide.

Iori Oka Our Contribution to WHO in 2012-2013: Hiroshi Matsuda We would like to continue the contribution for 2012-2013, focusing on mental health Katsuhiro Fuchino situation analysis and scaling up care for mental, neurological, and substance use JAPH 3-15-14 Shibaura, Minatoku, disorder, by helping the process of Tokyo, Japan implementation of mhGAP, primarily in the http://www.nisseikyo.or.jp (Japanese) Asia-Pacific countries.

Main Activities of Japanese Association of Psychiatric Hospitals

1. Improvement of management of psychiatric hospitals and other facilities for person with mental disorders 2. Establishment and management of psychiatric hospitals, other medical institutions, and counseling facilities for person with mental disorders 3. Establishment and management of psychiatric rehabilitation facilities for persons with mental disorders 4. Mutual aid among facilities for persons with mental disorders 5. Education, improvement of working conditions, and awards for those who work at member hospitals 6. Studies of systems and legislation for persons with mental disorders and their facilities, and facility standards 7. Enlightment and dissemination of mental health and welfare philosophy 8. Organizing JAPH annual meeting 9. Survey, grants and awards for Psychiatric hospitals and related activities 10. Books, newsletters, and other relevant organizations on mental health and welfare recommendations 11. Liaison with government and other relevant organizations on mental health and welfare and recommendations 12. International activities related to psychiatric hospitals 13. Study of the supply and demand of materials at facilities for persons with mental disorders as well as procurement 14. Welfare, mutual aid, and friendship among member hospitals and staff 15. Training of psychiatric care providers 16. Emergency psychiatry 17. Prevention of medical accidents 18. Other necessary activities to achieve the JAPH's objectives

The Center for Mental Health Services in Pediatric Primary Care is one of five child mental health services centers funded by the US National Institute of Mental Health; it is the only one with a mission to promote access to mental health services via primary care services for children and youth.

The Center is based at Johns Hopkins University in Baltimore, Maryland, but its faculty are located at several other US universities and research institutes. Its projects take place at local, state, national, and international levels – its primary international partners are in Brazil and Ethiopia.

The Center’s goal is to develop models of mental health diagnosis and treatment that can be readily integrated into primary medical care settings. Thus, the Center is working on primary-care friendly ways to classify mental health-related concerns, elicit them from families in the course of routine medical care, provide brief but effective first-line treatment, and identify which individuals may need urgent or specialty care.

The Center carries out a variety of research, service, and training projects, trying to balance attention to current needs with the desire to improve services based on rigorous scientific evidence. Current projects relate to screening processes, engaging children in mental health care, developing logic models for efficiently managing mental health problems in primary care, and testing models for increasing primary care providers’ mental health skills.

The Center has helped review some of the child mental health aspects of mhGAP, and has had an active role in the integration of both child and adult mental health services into HIV care as part of the PEPFAR program in Ethiopia. We welcome the opportunity to form new partnerships and to work with other agencies and scholars. Additional information is available from:

Center for Mental Health Services in Pediatric Primary Care Department of Health, Behavior and Society Johns Hopkins School of Public Health 624 North Broadway, Rm. 707 Baltimore, MD 21205 USA P +1 410.955.1924 F +1 410.955.7241 www.jhu.edu/pedmentalhealth AZIENDA PER I SERVIZI SANITARI N.4 “MEDIO FRIULI” Via Pozzuolo n. 330 - 33100 UDINE http://portale.ass4.sanita.fvg.it Dipartimento Salute Mentale TEL. 0432 806500 -FAX 0432 806522 e -mail [email protected]

S.O.C. CSM Udine Nord Udine - Via Comessatti 5 - Tel.0432 – 542 496 fax 0432/542 445 e -mail: [email protected] Udine 29.09.2011

In the region Friuli Venezia Giulia the Mental Health Services network is mainly based on the 24 hour Trieste Model. The Udine Health district (belonging to the “Medio Friuli Health Agency”)covers an area of approximately 160.000 inhabitants and there are two Mental Health centers (Udine Nord and Udine Sud). In the same area work about 130 General Practitioners.

About 2 years ago some representatives of the GPs and of the MH centers started to meet monthly with the aim of improving the collaboration between the 2 health institutions (GPs and MHCs). The topics were: difficulties in communication, in defining priorities, in reaching effective collaborative patterns of work.

In our Region we have a generally good standard in the health system, according to usual indicators, but anyway we agreed on defining some problems as relevant:

1. The need of stressing in the health system the human rights issue, related to minorities as MH patients, immigrants, elderly people, women and young peoplke, the increasing number of victims of the general economic crisis, people with chronic diseases. 2. In connection with point 1): the risk of pushing all these people in the MH system, with the possibility of building a new total institution hidden in the community . These problems are also related with: a. Confusion about mental health issues and priorities among workers in health and social agencies (GPs included). b. We have a strong mental health network with a low threshold in selection but , facing a stronger stigma, this can produce some contraddictions. c. Misunderstanding on which are the more relevant and frequent mental health issues (many health and social workers are targeted only on addictions, dementia, violent behavior, forgetting all the other way of mental suffering).

3. The need of understanding the issue of social determinants of health, still far from Italian medical culture as an important background. 4. The need of learning the “role” of team working in the MH work. 5. The need of sharing the issue of General Principles in Care (use summarized in mh GAP) 6. Difficulties for GPs (used to work alone) in “team working” with the other health services. 7. Need of a common, evidence based, and simple framework . 8. Pharmacological “do-it-yourself” (75 % of the AD depressive drugs prescription done by GPs) 9. Difficulties for GPs in taking in charge their patient’s health problems if they have also MH problems

Moreover a GPs regional congress in September 2010, dedicated to Mental Health issues, stressed some critical evidences

• Bad communication in the health system, generally and between GPs and psychiatrist • Misunderstanding on priorities • Lack of knowledge on reciprocal organization, priorities, resources, targets • Problems on general health issues for mental health patients A decision was taken to start, in each health district of the Region Friuli Venezia Giulia, pilot experiences between GPs and MH centers, targeted in the beginning on one theme (young people mental health problems, first psychotic episodes or depression)

The already working group in our district decided to work on depression , starting with some case studies, done in collaboration between GPs and psychiatrists, reconstructing the history of the cases and then trying to read them again using the mh GAP. From the beginning the mh GAP resulted connected with many relevant issues : evidence based, clear, based on the continuity between assessment, decision, managing, including topics usually not well recognized by GPs, or often misunderstood (as depression), stressing the human rights issue and the general principles of care issue and so on.

Moreover when we tried to work together with the mh GAP, the outcome was a very high interest because of the good results (easy to use, reassuring because evidence based, simple, good way to promote the discussion between the doctors using concrete situations, but also offering a general theoretical framework etc.). Moreover the region Friuli Venezia Giulia Health Ministry accepted to translate in Italian the mh Gap, offering an easier way to use it (the translation is in progress).

A congress is planned in February for 130 GPs about the case studies, introduction to mh Gap, planning new and more extensive pilot projects between mhc and GPs. The work should be under the umbrella of the supervision of an external expert of social determinants of health (an epidemiologist from the Bologna Medicine Faculty), who should offer an introduction to the community health issue and should conclude the meeting with highlights and suggestions. The target of the congress should be to introduce the mh GAP as a possible relevant tool for GPs in managing MH issue in collaboration with the MH teams. In future we planned to involve also the neurologists in our Health Agency, for their participation in areas of their interest as epilepsy or dementia.

Dr. Renzo Bonn

Psychiatrist

Director CSM Udine Nord via Comessatti 5, 32100 Udine Italy e-mail: [email protected] phone: +39 0432 542 496 mobile +320 437 9585

mhGAP & Multiple sclerosis – a global challenge Multiple sclerosis (MS) is one of the most prevalent diseases of the central nervous system amongst young people. It occurs as a result of immune damage to the myelin sheath, which insulates the central nervous system’s nerve fibres. It also damages the fibres themselves. This damage hinders or blocks the passage of nerve impulses from the brain to other parts of the body.

Currently, there is no cure for MS and it is not yet known how the damage occurs. Environmental factors and genetic predisposition are almost certainly involved. MSIF - www.msif.org The Multiple Sclerosis International Federation (MSIF) is a membership organisation that serves the needs of 87 MS organisations around the world. MSIF’s mission is to lead the global MS movement to improve the quality of life of people affected by MS and to support better understanding and treatment of MS by facilitating international cooperation between MS societies, the international research community and other stakeholders. MhGAP Contributions MSIF and its members contribute to MhGap through a variety of activities:

1. Mapping the prevalence of the condition and health resources MSIF in cooperation with the WHO has produced the Atlas of MS, published in 2008 as a source for governments NGOs and health providers. It presented for the first time information and data on the global epidemiology of MS and the availability and accessibility of resources for people with MS at the country, regional and global levels. In common with other neurological disorders in relation to MS, a lack of neurologists provides for under- diagnosis and lack of treatment in many countries.

Whilst the publication has a set range of data, MSIF has developed an additional searchable database Error! Hyperlink reference not valid. www.atlasofms.org MSIF will add countries and update the database by 2013. Global prevalence of MS, Atlas of MS, WHO/ MSIF 2. Support Training of health professionals

There is little research undertaken into MS in emerging countries. The absence of MS research programmes contributes to the limited data available about MS, to the low numbers of health professionals who specialise in MS, and to the under-diagnosis of MS. MSIF therefore provides grants to promising young researchers in emerging countries to undertake research projects in centres of excellence in other parts of the world so that they can develop their skills and bring those back to their countries of origin. We aim to Leaders, who will break the cycle of under-diagnosis in emerging countries, attract funding to initiate the development of research centres and, finally, help tens of thousands of people with undiagnosed MS. Dr Kanitta Suwansrinon, Bangkok

3. Capacity building - to reinforce commitments of governments

Active patient organisations and public awareness programmes are one essential ingredient in reinforcing the commitments of governments. MSIF therefore runs capacity building programmes for emerging MS organisations, with a present focus on the Middle East and North Africa. A capacity building seminar on advocacy was organised for representatives of MS organisations in the region in May of this year and a comprehensive translation program in Arabic of MSIF’s magazine, MS in focus is underway. http://www.msif.org/en/resources/msif_resources/msif_publicati ons/ms_in_focus/index.html

MSIF aims to step up this work over the next years, particularly ‘I found a job with an electricity in Asia and Latin America. company but I had to leave it when they asked me to move to MSIF’s major contribution to global awareness of MS is its another state away from the annual World MS Day campaign. Taking place every last support of my family. It would Wednesday in may, MSIF’s member organisations and many have been very difficult to cope other MS groups develop awareness and advocacy activities alone if I had another relapse. on the last Wednesday of May each year. During the last two years this has focused on what can help people with MS stay in ‘I was certainly subject to work longer. As part of this effort we published two global discrimination in many surveys. Our literature study of the economic impact of MS interviews because I chose to http://www.msif.org/docs/Global_economic_impact_of_MS.pdf declare my disease.’ found that early retirement was the single biggest contributor to the cost of MS. Mostafa Ezzat, Cairo, Egypt

4. Partnerships

MSIF will aim to form partnerships with other organisations focusing on neurological conditions to tackle certain aspects of the mhGAP, such as training and access to treatment..

MSIF September 2011 DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

National Institutes of Health National Institute of Mental Health 6001 Executive Boulevard Bethesda, Maryland 20892

The National Institute of Mental Health (USA) is one of the 27 institutes and centers that constitute the National Institutes of Health, the nation’s medical research agency and the largest source of funding for medical research in the world. Each Institute has a specific research agenda, and the NIMH is the lead Federal agency for research on mental and behavioral disorders.

NIMH envisions a world in which mental illnesses are prevented and cured. The mission of NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure. To fulfill its mission, the Institute: • Conducts research on mental disorders and the underlying basic science of brain and behavior, • Supports research on these topics at research settings throughout the United States and the world, • Collects, analyzes, and disseminates information on the causes, occurrence, and treatment of mental illnesses. • Supports the training of more than 1,000 scientists each year to carry out basic and clinical mental health research. • Communicates with scientists, patients, the news media, and primary care and mental health professionals about mental illnesses, the brain, behavior, and opportunities and research advances in these areas.

The Institute’s overarching Strategic Objectives are to 1) promote discovery in the brain and behavioral sciences to fuel research on the causes of mental disorders; 2) chart mental illness trajectories to determine when, where, and how to intervene; 3) develop new and better interventions that incorporate the diverse needs and circumstances of people with mental illness; and 4) strengthen the public health impact of NIMH-supported research.

The work of the Institute is carried out by the 7 offices that form the Office of the NIMH Director and the 7 research Divisions that oversee extramural and intramural research activities. The NIMH Office for Research on Disparities and Global Mental Health (ORDGMH) coordinates the Institute’s efforts to reduce mental health disparities both within and outside of the United States. The office’s combined focus on local and global mental health disparities reflects an understanding of how the rapid movements of populations, global economic relationships, and communication technologies have created more permeable borders and new forms of interconnectedness among nations and people. These trends both require and enable researchers to address the variations in incidence, prevalence, and course of mental disorders and access to care across diverse populations using a global perspective. ORDGMH oversees research on global mental health, health disparities, and women’s mental health. The office works in close collaboration with NIMH’s Office of Rural Mental Health Research to address the mental health needs of people living in rural areas.

The activities of the WHO Mental Health Gap Action Programme (mhGAP) activities align with the mission of NIMH and the activities of ORDGMH. NIMH will support the establishment and

maintenance of an mhGAP electronic reference library that will facilitate access to 1) the best clinical and non-clinical information on evidence-based interventions for MNS disorders, 2) best practices relevant to mental health and social care for treatment decision-makers in varied care settings, and 3) a reference library on scaling up successful intervention in low- and middle-income countries. NIMH will also support the development of normative tools to assist implementation of mhGAP in countries. These tools will include an adaptation guide, training materials for different cadres of health planners and non- specialist care providers, and monitoring and evaluation tools for planning and implementation of the program.

Selected Recent Publications of the NIMH and the National Advisory Council for Mental Health:

National Institute of Mental Health Strategic Plan http://www.nimh.nih.gov/about/strategic-planning-reports/index.shtml

From Discovery to Cure: Accelerating the Development of New and Personalized Interventions for Mental Illnesses shttp://www.nimh.nih.gov/about/advisory-boards-and groups/namhc/reports/fromdiscoverytocure.pdf

Selected Recent Global Initiatives of NIMH and Partners

The Grand Challenges in Global Mental Health The results of the Grand Challenges in Global Mental Health initiative appear in the July 7 issue of Nature. http://grandchallengesgmh.nimh.nih.gov

Visit the NIMH Web site at http://www.nimh.nih.gov

Integrating Mental Health and NCDs

Tuesday, 11 October 2011 from 12.00-14.00 World Council of Churches, 150 rte de Ferney, Geneva

World Mental Health Day Symposium Contributions for Action on NCD's and Global Health Following-Up the UNGA Health Debate and Challenges for the Future

MplementingThis symposium Evidence builds upon- Based the WHO Mental mhGAP Health Treatments Forum/Programme and World Mental Health Day (10 October—investingin in Low mental- Resource health). Guest panelistsCountries from various health sectors will share reflections and resources about mental health and NCDs . We will emphasise the recent UN General Assembly High-Level Meeting (HLM) on NCDs and related events. Two brief videos will also be shown of the HLM opening remarks by Ban Ki-moon and Margaret Chan. We encourage discussions before, during, and after the symposium! Opening session of the UN GA, 19/09/2011

Sandwiches/drinks provided by the Pan Pacific and South East Asia Women’s Association. Places are limited. Please confirm your participation by 7 October at: [email protected]

The NGO Forum for Health is a Geneva-based consortium of health organizations, committed to promoting human rights and quality care in global health. Our origins lie in the 1978 Alma Ata Conference on Primary Health Care. The Forum’s mission is to contribute to making health for all a reality by advocating for protection and realization of the right to health; by promoting equity and justice in access to health for all persons at all stages of their life; and by promoting and encouraging healthy life choices.

Our Mental Health-Psychosocial Working Group (MH-PS) focuses on advocacy, equity, and resources for mental health. It promotes the right to health; endorses health policies that integrate objectives for mental and psychosocial wellbeing; and contributes to the development of global health policy that is founded on the affirmation in the WHO Constitution (1948) that “health is a state of complete physical, mental and social well-being...”.

Our Objectives:  Raise awareness of mental health as a priority health issue, locally and globally;  Confront stigma and discrimination related to mental health in all their manifestations; and advocate for systematic consideration of the social determinants of health and issues of rights, gender equality, poverty, and conflict as relates to mental health and psychosocial wellbeing.

The MH-PS works with a wide range of bodies, including governmental and inter-governmental health authorities, civil society organizations, business and worker organizations, academic and research institutions, mental health service users, as well as individuals with an interest in mental health and psychosocial support.

Our Activities:  Consultations United Nations organisations and, specialized agencies, permanent missions of the UN Member States ministries of health, experts in research and policy, and concerned non- governmental organizations;  Partnerships and strategic exchange of views with important stakeholders, notably WHO’s Mental Health Gap Action Programme (mhGAP), the Movement for Global Mental Health, the World Federation for Mental Health; and the Committee on Mental Health (CoNGO, New York)  Mental Health Briefings held four times a year to provide a forum to present and discuss current mental health issues and to promote wider understanding of evidence-based mental health research and practice (click here for recent examples: MH in low-resource countries and EMDR);  Advocacy on issues of mental health and psychosocial wellbeing under current consideration, for example our Joint Statement on MH and NCDs prepared for UN General Assembly High-Level Meeting on NCDs (signed by 100 organisations);  Events that highlight issues of mental health and psychosocial wellbeing on the occasion of international venues, notably the World Health Assembly, World Mental Health Day (10 October), the biennial Geneva Health Forum;  Website promoting materials/resources on issues of mental health and psychosocial wellbeing.  Research and writing to further advance knowledge and good practice in global mental health, with current examples being a study on mental health components of INGOs development programmes and a compilation of major resources in global mental health (GMH Resource Map)

Membership of the Working Group is open to all members of the NGO Forum as well as other NGOs and colleagues active in the MH-PS field.

Alan Leather: President, NGO Forum for Health Ann Lindsay: Counsellor and Psychotherapist; Chair of the MH-PS Working Group Kelly O’Donnell, Consulting Psychologist; Coordinator of the MH-PS Working Group

Email: [email protected] Website: www.ngo-forum-health.ch

Contributions of the Royal College of Psychiatrist to the Mental Health Gap Action Programme (mhGAP) September 2011

Introduction The Royal College of Psychiatrists is the professional and educational body for psychiatrists in the United Kingdom. We are committed to improving the understanding of psychiatry and mental health and strive for a greater understanding of the interaction between mental and physical health and the social and cultural context in which people live. We are at the forefront in setting and achieving the highest standards through education, training and research. We lead the way in developing excellence and promoting best practice in mental health services.

Contributions of RCPsych to International Mental Health • International Members The College has almost 16,000 members and over 2,500 of these members are based outside the UK. The College has established 6 International Division, coterminous with the WHO regional offices, to support these members. The International Divisions span a global outreach, advancing mental health advocacy and better services in each continent. The potential to harness such a distributed network of mental health leaders, in strategic unison with the WHO, is considerable.

• International Committees The College has an international Advisory Committee (IAC) which oversees all the international activities of the College, including the work of the Iraq Sub Committee which is dedicated to improving mental health standard in Iraq. This subcommittee has contributed to the Iraq Mental Health Survey conducted by WHO, the 2008 5 years Mental Health Strategy for Mental Health in Iraq and is continuing to work on areas of quality improvement, focusing on patient rights, tranquilisation, patient records and ECT.

• Volunteer Scheme The College is committed to supporting mental health services in Low and Middle Income countries and runs a successful Volunteer Scheme which links psychiatrists wanting to donate their time and expertise with international projects and services who require a mental health expert in the short or medium term. College volunteers have been involved with WHO projects in Sudan and in the Pacific Islands as well as other projects in places such as Ghana, Malawi, Kenya, Haiti and India. Members of the IAC have been working with the WHO in using the mhGAP teaching materials on some of these volunteer placements. Details of the scheme and reports from completed placements can be viewed on the College website: http://www.rcpsych.ac.uk/members/internationalaffairsunit/volunteersprogramm.aspx

• Publications The Royal College of Psychiatrists publishes four journals, including International Psychiatry , which is circulated each quarter and provides an overview of current policy and practice in psychiatry in different countries and helps all mental health professionals to learn about and keep abreast of what is happening across the globe. This journal provides opportunities to authors from around the globe to have their work published and recognized. The African Journal of Psychiatry and the Arab Journal of Psychiatry are affiliated to International Psychiatry, encouraging its global appeal and influence. Copies of all issues of the printed journal are available to download as PDF

files on our website: http://www.rcpsych.ac.uk/publications/journals/ipinfo1.aspx . The College has also recently published “International Perspectives on Mental Health”; a collection of overviews of the mental health policy, activity, training, and legislation from over 90 countries round the globe.

Outlines of other specific projects and initiatives addressing inequalities in mental health are outlined below:

• Social Inclusion The College’s Position Statement on Mental Health Services and Social Inclusion (http://www.rcpsych.ac.uk/pdf/social%20inclusion%20position%20statement09.pdf ) states that a socially inclusive approach should be a key driver for the practice of individual mental health professionals and for the working and culture of mental health services in the 21st century. Psychiatrists must play a leading role in this.

• Public mental Health: The Royal College of Psychiatrists believes that mental health is a central public health issue and that it should be a priority across all government departments. The College has worked with the public and parliament to promote the importance of public mental health and has published both a position statement (http://www.rcpsych.ac.uk/PDF/Position%20Statement%204%20website.pdf ) and a parliamentary briefing (http://www.rcpsych.ac.uk/PDF/Final%20PS4%20briefing_for%20website%20A4.pdf ) These statements set out the contribution that public mental health makes to a wide range of health and social outcomes for individuals and society.

• Economic downturn and debt In September 2009 a 1-day meeting on mental health and the economic downturn was held in London. The meeting was convened by the Royal College of Psychiatrists, the Mental Health Network, NHS Confederation and the London School of Economics and Political Science. The meeting explored the impact the downturn was having on mental health as well as where some of the solutions may lie for those working at a local and national level in service provision and policy. The outcomes of that meeting were published in a position statement, outlining the priorities for the NHS: http://www.rcpsych.ac.uk/pdf/economicdow.pdf

• The importance of Gender equality and cultural diversity The College promotes leadership and excellence in mental health services and stresses the importance of its members b eing sensitive to gender, ethnicity and culture as well as having a commitment to equality and working with diversity. The College has produced materials for its members on these areas, including Good Psychiatric Practice (http://www.rcpsych.ac.uk/publications/collegereports/cr/cr154.aspx ) and the Role of the Consultant Psychiatrists ( http://www.rcpsych.ac.uk/files/pdfversion/OP74.pdf ).

How the RCPsych can further assist in the implementation of mhGAP The College will continue to work in the areas listed above in order improve mental health standard, practice and understanding across the globe. Many senior Members and Fellows of the College are working with international agencies, including the WHO, to improve the recognition of mental health. Earlier this month, a senior Fellow of the College addressed the UN assembly which had gathered to discuss the burden of non-communicable diseases, in order to stress the importance of including mental health and neurological disorders as a significant contributor to the burden of non-communicable diseases.

mhGAP Forum Geneva, 10 th of October 2011

Brief Presentation of NGO EPAPSY The Scientific Association for Regional Development and Mental Health (EPAPSY) is one of the leading non-governmental, non-profit organizations which 1 acts in the field of psychosocial rehabilitation and mental health promotion for more than 20 years. It constitutes a legal entity governed by private law with a public service mission and is supervised by the Ministry of Health. EPAPSY is funded by the Ministry of Health, the European Union and private donations. It operates 15 units, which provide psychosocial rehabilitation and mental health services (Mental Health Mobile Units, Half-way houses, Community Apartments etc.). EPAPSY employs 218 people and hosts 165 users in residential and rehabilitation facilities. Also, EPAPSY Mental Health Mobile Units meet the needs of more than 6.000 people in the Cyclades Islands. EPAPSY is aiming at: the promotion and implementation of innovative mental health policies connected to the local development and the fight against social exclusion; the promotion of activities for the empowerment and defense of the individual rights of the mentally ill, their families and other vulnerable or high-risk groups; the dissemination of know-how and the provision of training on the effective implementation of mental health and psychosocial rehabilitation services in Greece and abroad.

MH GAP Implementation in Greece In the last decade, the ministry of health in Greece has focused on implementing policies which promote mental health reform through the integration of mental health in Primary Health Care (PHC). EPAPSY, led by Dr. Stelios Stylianidis, Associate Professor of Social Psychiatry at Panteion University and Greek Counterpart of WHO for mental health, in cooperation with other major Greek bodies, undertook the challenge of materializing the mhGAP-IG project in Greece.

Within this context, EPAPSY developed and began implementation of the mhGAP-IG project in Greece in February 2011. The mhGAP-IG project was divided in 6 phases. During the first phase, a selected team of experts from EPAPSY, led by Dr. Stelios Stylianidis, Dr. Elena Bagourdi (clinical/health psychologist) and Dr. Dimitris Kavalieros (psychiatrist) carefully reviewed the mhGAP Guide, translated it, back-translated it and then finally edited it, adapting it to national and local standards.

The adaptation was a very significant part of this process, aiming at ensuring that the Guide covered conditions that contribute significantly to the burden of mental health on the PHC system in Greece, and addressed its inadequacies, as well as geographical parameters that could affect appropriate dissemination and implementation of the mhGAP-IG guidelines. During this phase, the project team selected a group of islands, namely the Cyclades, where the pilot project would be implemented. This 2 process was completed three months later, in May 2011.

Beginning the second phase, Dr. Stylianidis, Dr. Bagourdi and Dr. Kavalieros selected a group of experienced mental health professionals to be trained on the mhGAP-IG principles, guidelines and implementation. Ten mental health professionals were carefully trained on the Guide, while also offering valuable feedback on the recommended implementation guidelines of the mhGAP-IG in Greece. Due to this process, the mhGAP-IG was re-evaluated and further adjusted to the needs of the Greek PHC system. During this phase, the project team contacted the local authorities and respective officials of the PHC system in the islands of the Cyclades, informed them of the mhGAP-IG project, and obtained their agreement in collaborating with the mhGAP trainers during the third phase of the pilot project. At this time, the mhGAP-IG project team, along with the Greek Ministry of Health, initiated a collaboration with the Panhellenic Organization of General Practitioners in Greece (ELEGEIA). The goal was to train GPs across the country on the principles, guidelines and implementation of the mhGAP-IG, once the pilot project is completed.

During the third phase, which began in September 2011, the mhGAP-IG project team of EPAPSY is working on finalizing the schedule for the training sessions. The mhGAP-IG trainers are responsible for training primary health care professionals, specifically General Practitioners, Resident Physicians, and in some cases (where a physician may not be available) the Directors of Nursing at public PHC facilities at the respective islands. Approximately 20 PHC professionals are expected to receive training for an average of 12-15 hours per person. This phase is scheduled to last 3 months and will be completed by November 2011.

During the fourth phase, the mhGAP-IG team will conduct an evaluation of the pilot program and its effects, as well as potential risks and benefits. The evaluation process will be supervised and monitored by an external evaluator and is expected to be completed by May 2012.

During the fifth phase, and once the evaluation is completed, Dr. Stylianidis, Dr. Bagourdi and Dr. Kavalieros will announce the results of the pilot project in a Panhellenic conference planned to be held in Athens in September 2012. Dissemination of the results will be pursued both within national and international scientific journals, as well as through the local media.

3 During the last phase, the results of the pilot project will be further utilized to inform the planning and implementation of the next project at hand, specifically training GPs across the country on mhGAP-IG, in collaboration with the Ministry of Health and ELEGEIA. The mhGAP Guide will be published and distributed in collaboration with the Greek Ministry of Health to any and all public and private health organizations that are part of the PHC system in Greece.

Some of the challenges and resistances that may arise in the implementation of the mhGAP-IG project in Greece pertain to the difficulty in effectively distinguishing between primary and secondary healthcare, given the prevailing fragmentation of services, in combination with the lack of resources and staff under the current financial crisis and the overall poor quality of the healthcare system in Greece. Additionally, under these circumstances a reduction in community resources, as well as in human and material capital, may be anticipated, rendering some of the suggested interventions within the mhGAP Guide difficult to realize. Furthermore, health professionals in Greece are not accustomed to the logic and use of algorithms, nor to detailed record-keeping; therefore following the algorithms of the mhGAP-IG may appear especially complicated. Lastly, medical professionals may be negatively biased against some of the proposed treatment interventions, and favor others that are more common in their everyday practice. Nonetheless, the completion of the pilot project will irrefutably become a landmark for the integration of mental health in PHC in Greece, aiming at bridging the existing gap between PHC and mental health in Greece.

Dr. Stelios Stylianidis, Associate Professor of Social Psychiatry, Panteion University Greek counterpart in mental health, WHO Scientific Director of EPAPSY

THE SIR DORABJI TATA TRUST AND ALLIED TRUST (SDTT & AT) The Sir Dorabji Tata Trust, one of the oldest, non-sectarian philanthropic organisations in India, was established in 1932 by Sir Dorabji Tata with the prime purpose of encouraging learning and research in the country, of meeting costs of relief during crises and calamities and of carrying out worthwhile charitable activities. The Trust’s vision of constructive philanthropy has been sensitive to the fast- growing needs of a developing nation, while the work initiated by it holds contemporary relevance as it continues to support innovative enterprises in development. In addition to the Sir Dorabji Tata Trust, there are a number of Allied Trusts which also focus on overall developmental issues. Together reffered to as the Sir Dorabji Tata Trust and the Allied Trusts are administered and viewed as one donor entity. The grant-making pattern of the Trusts involve three broad areas: Institutions; NGOs; Individuals NGO/Programs Overview: The Trusts support a range of NGOs working in different sectors across the country. Based on the parameters of innovation, timeliness, sustainability, adding value and promoting linkages, geographic spread and the felt needs of the community, grants are made in the six major sectors of social development: Natural Resource Management and Rural Livelihoods: The focus of support is on improving food security at the household, local and national levels and on issues concerning climate change and ecological security. The Trusts also recognize the importance of the increasingly scarce water resources and support the implementation of programs that work towards equitable and efficient use of water for meeting basic human needs. Urban Poverty and Livelihoods: Improving working conditions for promoting sustainable urban livelihoods, improving the health and hygiene of the urban poor and promoting efforts to improve the reach, equity and effectiveness of government programs in urban development are the focus areas of this sector. Education: Several innovative initiatives in education – within and outside the formal system have been supported by the Trusts. The Trusts’ work looks at improving the quality of school education for disadvantaged groups such as Dalits, tribals, Muslims, girl children, urban slum dwellers, etc.; the education and development of adolescents; and the up-gradation of the profession of education itself. Civil Society, Governance and Human Rights: The focus areas of this sector are support to Civil Society institutions/organisations that promote the implementation of the 73rd and 96th Amendments to the Constitution, contributing to good governance including through the use of RTI and legal means and efforts that help in the protection of the rights of the child, women, Dalits, tribals, under-trials and prisoners. Media, Art and Culture: The focus is on promoting arts scholarship, efforts at conserving endangered cultures and support to archival work. In addition, innovative approaches of the media in development and the research and development activities of the Arts are also promoted. Health: The engagement of the Trusts in the field of Health has an old and rich history, dating from the time when the Trusts started extending support to research in leukemia and other forms of cancer as well as projects meant for the welfare and health of mother and child. Tata Memorial Hospital, established by the Trusts in the late forties became the first cancer hospital in the country. While its financing and management has since passed to the Atomic Energy Commission, the Trusts maintain organic links with the hospital and have contributed to its activities from time to time. The Trusts have made contributions, too numerous to mention, to various prominent health service providers including hospitals to up grade their facilities, to innovate and expand their activities and to in particular direct their services to those who cannot afford them. While equipment support and support to hospitals has been one stream of engagements in the field of health, Trusts have located their work in health to fit with the emerging needs of the country with a constant focus of reaching care to the most needy. The Trusts’ approach has been largely focused on community based modalities across the various thematic areas Locating itself within this evolving mosaic the Work of the Trust covers areas such as primary health care strengthening, reproductive and maternal health, and specific focus on Malaria amongst infectious diseases. The emerging trend of Non-communicable diseases is addressed through work in a few strategic areas such as Cancer, meeting the ‘treatment gap’ for mental illness, cardiovascular illness and eye disease. Apart from these the Trusts’ thematic areas also include working on disability, addressing malnutrition with a special focus on the 0-3 age group and addressing issues of violence against women from a public health perspective. The thematic areas of the portfolio are aligned to the needs of the country with program initiatives being designed not only to meet the needs but to demonstrate innovations with a view to replicability and scale. The portfolio has four major areas of engagement which are • Community Health interventions which include primary care, reproductive health, meeting the treatment gap for mental illnesses, action against malaria, addressing malnutrition especially in the 0-3 age group • Non Communicable Diseases include Cancer, cleft lip and palette conditions, eye diseases such as diabetic retinopathy and cardiovascular diseases. • Violence against Women as public health issue and • Disability with a special focus on employability Trust supported partners are present across India but predominantly in north and western part of the country Partnerships in East, North East and Central parts of India are being augmented in consonance with the overall Trust strategy of focusing on regions with low development indices. The basic approach in grant making in the field of health is as follows: • The Trusts believe that their support should be directed in those specific areas where other donors have major programs. Thus the Trusts do not support work connected with communicable diseases in general and HIV /AIDS in particular. • Barring the cancer treatment centres, the Trusts generally prefer not to support creation of physical infrastructure. The first instance of partnership with a new partner is rarely about physical infrastructure. • The Trusts increasingly seek to engage in developing programs that strengthen existing public health systems rather than parallel services creation. The focus is strongly on community based approaches. • The Trusts believe that their funds are best used when directed towards those entities which work for the under-served people in remote territories, rather than proliferating services in well endowed and urban regions. Neuropsychiatric disorders: account for nearly 14% of the global burden of disease. 1 and form 28% of the burden of non communicable diseases. 2 Scaling up services in the community for people with mental illnesses is a priority international public health concern, especially in low-income countries where the treatment gap is appalling. The Trusts response to this is in keeping with its basic philosophy of creating a different and better world for people living with a mental illness through community’s understanding of mental health and the resulting positive response of inclusion and ownership. The Trusts’ work on addressing the ‘treatment gap’ for mental illness is based on a multipronged strategy built into an innovative model based on the principles of public health and development. The overarching goal of the program is to develop an evidence base about the feasibility and acceptability of mental health interventions within existing community health programs. Through this process, the aim is to develop replicable and evidence based model(s) for integrated mental health programs within diverse population contexts. The Trusts have also initiated a pioneering effort within the country to take mental health care from a strictly institutional format to the sphere of community based management. A program in partnership with two of the largest Mental Healthcare institutions in the country was sanctioned launched in 2011. The Trusts support a range of projects offering services for mental illness through clinical services, working with care providers, addressing stigma and discrimination through community participation and mainstreaming specially in context to livelihoods. The trust also supports innovative modalities of service reach using technology such as tele-psychiatry. The engagement of the Trusts in this field is expected to grow.

1 No Health Without Mental Health; Prince et.al; The Lancet, Series on Global Mental Health; 2007 2 mhGAP; Scaling up care for mental neurological and substance use disorders; World health Organization; 2008

Sneha, a non-political, non-religious NGO, was established in the year 1986 in Chennai, Tamilnadu. The seed of inspiration was sown in the mind of Dr Lakshmi Vijayakumar. a psychiatrist, during a visit to the IASP conference at Vienna, and at a meeting with Vanda Scott of the Samaritans. With able support from her psychiatrist husband and a few like-minded friends, the first chapter of Befrienders India was born and became operational on April 13 th ,1986 in a small rented building.

Sneha offers befriending services to the distressed, depressed and suicidal on the lines of the Samaritans in UK. Befriending is offering emotional support, unconditionally and uncritically to those in need of it. People who call, write, visit or e-mail Sneha are offered total confidentiality and anonymity. The organization is managed entirely by carefully chosen volunteers, who offer their services free. Sneha is open to callers 24 hours a day. Till date, approximately 200,000 people have contacted Sneha and have hopefully been helped.

Sneha has immense goodwill among the various sections of society, which include general practitioners, psychiatrists, press and the police Many awareness campaigns have been conducted in schools, hospitals, colleges and for the film fraternity. Sneha networks with other social service organizations to reach out to the depressed and suicidal.

A two day international workshop on Suicide Prevention in which eminent suicidologists from UK, USA and Australia delivered lectures. In 2001, Sneha became the first and till date the only NGO to be chosen to organize the biennial conference of the International Association of Suicide Prevention, which was held for the first time in Asia, in which 400 luminaries from the fields of medicine, psychiatry, psychology and social work participated. The then President of India, Sri Venkatraman was the patron of the conference. In 2006, Sneha signed an MOU with the Griffith University, Australia, to provide and teaching in suicide prevention.

The year 2011 is a milestone in the history of the organization. Sneha has completed 25 years of service. It has helped start similar organizations in the other parts of the country.

Syngenta

Syngenta is one of the world's agribusiness leading companies operating in over 90 countries dedicated to our purpose: Bringing plant potential to life. Our products help farmers produce higher and better yields, grow crops that are more resilient in harsher climates, and conserve limited resources. Corporate Responsibility is part of everything we do, and we have a strong commitment to assure the ethical and responsible use of our solutions. We continuously engage with stakeholders around the world, like WHO to cooperate and develop innovative ways to address the issues that we face in our business. Syngenta has worked with WHO, particularly supporting the Mental Health program , with the aim to develop strategies and actions to prevent the suicide. The program currently running has made progress and is in the process to prove in the field the secure storage of pesticides as one of the tools to be used in the prevention of suicide.

The Trimbos Institute is a knowledge centre that conducts research in mental health and addictions and transfers research findings into practice, in partnership with health care providers in primary care and specialist services. We seek to contribute to the improvement of mental health and enhance the quality of life of the population by engaging in the development and application of knowledge about mental health, addiction and co-morbid physical illnesses, both in the Netherlands and abroad. We carry out work encompassing the following areas: mental health promotion and disease prevention, mental health primary care, long-term treatment, recovery and reintegration, surveillance of population mental health status, monitoring quality of mental health care, mental health of young people and of older people. The Trimbos Institute is a leader in the field of e-mental health and e-learning. Our Institute has been investing for many years in the development of e-mental health and currently makes available a large number of interventions, ranging from interventions designed to promote the mental health of population and improve their resilience, to interventions for prevention and management of common mental health problems, or tools for self- management for people with severe mental health problems. We believe that e-health interventions are viable evidence-based, cost-effective alternatives for people mental health problems, that can facilitate narrowing the substantial treatment gap in resource-limited settings. Since 2009, Trimbos Institute has been working with the World Health Organization on a pilot project aimed at making e-health multi-component and interactive self-help interventions for problem drinking available to people in four pilot countries (Belarus, Brazil, India and Mexico). We would like to expand this experience to e-mental health interventions covering depression and anxiety, and make them available, both computer- based and on mobile devices, to people in countries targeted by the mental health Gap Action Programme (mhGAP).

Trimbos-institute | P.O. Box 725 - 3500 AS Utrecht - The Netherlands T +31 30 29 59 214 F +31 30 297 11 11 E [email protected] | www.trimbos.nl | ING Bank 5782525

CERTIKED ISO 9001: 2008 ACKNOWLEDGED BY THE ACCREDITATION BOARD | ACKNOWLEDGED BY INVESTORS IN PEOPLE NEDERLAND B.V.

Department of Psychiatry

The Universidad Autónoma de Madrid (UAM) is a public university offering graduate and postgraduate degrees in a wide variety of programmes at its 63 departments and eight research institutes. Although founded barely four decades ago, it has already achieved an outstanding international reputation for its high-quality teaching and investigation. It recognized as one of the best Spanish universities in both national and international rankings. The UAM has a well-established tradition in the area of cooperation with other universities from the rest of Spain and abroad, being one of the Spanish universities with the highest rates of student mobility in international programmes, including 170 bilateral agreements with universities outside of Europe.

International teaching and research activities at the Department of Psychiatry Faculty members of the UAM Department of Psychiatry are currently participating in mental health training programmes for health care providers in several developing countries. For the last 10 years the Department has had an international PhD Programme the University of Carabobo in Venezuela. The Department also has an established collaboration for postgraduate training in mental health with the University of Health Sciences in Phnom Penh, and for a children’s crisis support programme in Battambang, Cambodia. Moreover, through the Banco Santander Endowed Chair, the Department has an ongoing collaboration with UNAM University in Mexico City for research and training in mental health

The UAM Department of Psychiatry is also involved in international projects funded by the European Commission, including:

- Psycho-social Aspects Relevant to Brain Disorders in Europe: PARADISE (http://paradiseproject.eu); - Collaborative Research on Ageing in Europe: COURAGE in Europe (www.courageineurope.eu ); - Road Map for Mental Health Research in Europe ROAMER; - Scaling up services for mental, neurological and substance use (MNS) disorders within the WHO mental health Gap Action Programme (mhGAP).

The Department plays a leading role in the International Mental Health Research Network, and launched the Madrid Declaration , aimed at promoting a coordinated European-wide effort in mental health research (http://www.cibersam.es/MadridDeclaration .), which was subscribed by representatives from seven nationally-funded mental health research networks, as well as leaders of ongoing EU-funded mental health projects.

Collaboration with the World Health Organization The UAM Department of Psychiatry has a long history of cooperation with the WHO’s Department of Mental Health and Substance Abuse, and has been involved in a number of WHO initiatives, including the Choosing Interventions that are Cost-Effective (WHO-CHOICE) programme. This project has generated cost-effectiveness data in 14 epidemiological sub-regions of the world for key health interventions able to reduce leading contributors to disease burden. In addition, the Head of the Department, Prof. J.L. Ayuso-Mateos is currently a member of the Essential package for mental, neurological and substance use disorders Guideline Development Group and of the International Advisory Group for the revision of the ICD 10.

The UAM Department of Psychiatry is one of the four institutions participating in the project Scaling up services for mental, neurological and substance use (MNS) disorders within WHO mental health Gap Action Programme (mhGAP), funded recently by the EuropeAid program of the European Comission. In this project, led by the WHO’s Department of Mental Health and Substance Abuse, the UAM collaborates with the Health Ministries of Ethiopia and Nigeria. The main objectives of this project are to expand service coverage for mental and neurological disorders in pilot areas of these two countries under the WHO mhGAP programme. It also includes capacity- building for health planners/programme managers and health care providers to develop and implement care and services for people with MNS disorders.

Relevant Publications:

• Ayuso Mateos JL, Wykes T, Arango C. Madrid declaration: Why we need a coordinate European-wide effort in mental health research. British Journal of Psychiatry 2011; 198: 253-255.

• Arana A, Wentworth C, Ayuso-Mateos JL, Arellano F.Suicide-Related Events in Patients Treated with Antiepileptic Drugs. New England Journal of Medicine 2010; 363:542-551

• Nuevo R, Chatterji S, Verdes E, Naidoo N, Arango C, Ayuso-Mateos JL. The Continuum of Psychotic Symptoms in the General Population: A Cross-national Study. Schizophr Bull . 2010 Sep 13. [Epub ahead of print]

• Ayuso-Mateos JL, Nuevo R, Verdes E, Naidoo N, Chatterji S. From depressive symptoms to depressive disorders: the relevance of thresholds. British Journal of Psychiatry 2010 May;196(5):365-71.

• Chisholm D, Gureje O, Saldivia S, Villalon CM, Wickremasinghe R, Mendis N, Ayuso-Mateos JL, Saxena S . Schizophrenia treatment in the developing world: an interregional and multinational cost-effectiveness analysis. Bulletin of the World Health Organization 2008; 86, 542-551

Address: Departamento de Psiquiatría Facultad de Medicina Universidad Autónoma de Madrid C/ Arzobispo Morcillo 4 28029 Madrid, Spain Tel: 34 91 4972716 www.uam.es www.trastornosafectivos.com www.prevencionsuicidio.com

UNIVERSIDADE NOVA DE LISBOA Faculdade de Ciências Médicas Departamento de Saúde Mental http://www.unl.pt/

The Department of Mental Health, Faculty of Medical Sciences, NOVA University of Lisbon (DMH/FCM), is a university department with teaching, research and clinical activities. DMH/FCM is responsible for the mental health services in the western part of Lisbon, with a catchment area of 400.000 people. It was one of the first services to have created a comprehensive, community-based system of services in the country. DMH/FCM has developed in the past 20 years a large range of activities on mental health policy and services development at the country and international level. Members of DMH/FCM had a key role in the implementation of the Portuguese mental health policy and legislation in the 90´s, as well as in the formulation and implementation of the National Mental Health Plan (2008-2016), led by members of DMH/FCM (1). At the international level, the DMH/FCM collaborated with WHO, participating in several WHO missions in Europe, Africa and Latin America, providing technical collaboration to countries on policy and services development (2, 3). DMH/FCM has a large experience on psychiatric epidemiology and mental health policy/services research at the international level. It was responsible for the national coordination of the European Alliance Against Depression (EAAD), and several other European studies (on effectiveness of treatment and needs assessment for schizophrenic patients, family burden and family interventions in severe mental disorders, suicide prevention, mental health care in primary care, and quality of mental health services for people with long term mental disorders, among others themes) (4, 5, 6). It was responsible for the national mental health survey, developed in 2008-2011 in collaboration with the World Mental Health Surveys Initiative, and is a member of the European consortium that produced reports on the burden of mental disorders, gender and mental health, and inequalities in mental health and in unmet needs for mental health care in Europe ( http://www.eu-wmh.org/ ) Teaching activities of DMH/FCM include a master programme and a PhD programme on mental health policy and services. DMH/FCM offers, with technical collaboration of WHO, the International Master in Mental Health Policy and Services (http://www.fcm.unl.pt/gepg/images/stories/gepgrochura%20Site.pdf ):

Campo Mártires da Pátria, 130 – 1169-056 Lisboa – http://www.fcm.unl.pt

UNIVERSIDADE NOVA DE LISBOA Faculdade de Ciências Médicas Departamento de Saúde Mental http://www.unl.pt/ The Master Course in International Mental Health (Coordinated by JM Caldas de Almeida and Benedetto Saraceno) is addressed to health professionals willing to develop public health skills in the area of mental health. The Master aims to provide general training in areas related to: • Formulation, implementation and evaluation of mental health policies plans and programmes; • Organization and evaluation of mental health care and related services; • Formulation and implementation of Mental Health Service research; • Mental Health Law and Human Rights.

Collaboration with MhGAP DMH/FCM can give further contributions for mhGAP in the future on policy development, capacity building and research. Its experience on policy and services can be used in the provision of technical cooperation to countries. The experience from the International Master, which has proved to be an effective instrument to train leaders in the areas of mental health policy and services, can be used in other capacity building initiatives related to mhGAP objectives. Finally, the experience on services research and delivery of innovative care can be applied on studies on the effectiveness of new services and interventions, particularly those for severe mental disorders and those based on the integration of mental health in primary care.

References 1. Ministry of Health of Portugal. National Mental Health Plan – Executive Summary. Lisbon, 2008. 2. Caldas de Almeida JM, Horvitz-Lennon M. - Mental health care reforms in Latin America: An overview of mental health care reforms in Latin America and the Caribbean. Psychiatr Serv. 2010 Mar; 61(3):218-21 3. Caldas de Almeida JM. Mental health services for victims of disasters in developing countries: a challenge and an opportunity. World Psychiatry Vol.2 (3) Oct 2003: 155-157. 4. Cardoso G, Caldas de Almeida JM The model of collaborative care in Portugal, efficacy and its application.. J. Psychosomatic Research 2010; 68: 6. 5. Killaspy H, White S, Wright C, Taylor TL, Turton P, Schutzwohl M, Schuster M, Cervilla JA, Brangier P, Raboch J, Kalisová L, Onchev G, Alexiev S, Mezzina R, Ridente P, Wiersma D, Visser E, Kiejna A, Adamowski T, Ploumpidis D, Gonidakis F, Caldas-de-Almeida J, Cardoso G, King MB. The Development of the Quality Indicator for Rehabiliative Care (QuIRC): a European Measure of Best Practice for Facilities for People with Longer Term Mental Health Problems. BMC Psychiatry 2011,11:35 . 6. King M, Walker C, Levy G, Bottomley C, Royston P, Weich S, Bellón-Saameño JA, Moreno B, Svab I, Rotar D, Rifel J, Maaroos HI, Aluoja A, Kalda R, Neeleman J, Geerlings MI, Xavier M, Carraça I, Gonçalves-Pereira M, Vicente B, Saldivia S, Melipillan R, Torres-Gonzalez F, Nazareth I Development and validation of an international risk prediction algorithm for episodes of major depression in general practice attendees: the PredictD study..Arch Gen Psychiatry. 2008 Dec;65(12):1368-76.

Campo Mártires da Pátria, 130 – 1169-056 Lisboa – http://www.fcm.unl.pt

United States Agency for International Development (USAID)

USAID is a United States federal government agency responsible for administering civilian foreign aid. Our work supports economic growth and trade; agriculture and the environment; democracy and governance; global health; global partnerships; and humanitarian assistance. We operate in four regions of the world: Sub-Saharan Africa; Asia and the Near East; Latin America and the Caribbean; and Europe and Eurasia. With headquarters in Washington D.C., USAID’s strength is in its field offices around the world. We work in close partnership with private voluntary organizations, indigenous organizations, universities, American businesses, international agencies, other governments, and other U.S. government agencies.

Since the inception of its HIV/AIDS program in 1986, USAID has been on the forefront of the global AIDS crisis, investing more than $7 billion to fight the pandemic. USAID is a key partner in the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the largest and most diverse HIV/AIDS prevention, care, and treatment initiative in the world. Our experiences in providing a continuum of services for people living with HIV (PLHIV) have made us increasingly aware of the role of mental health in meeting the needs of PLHIV and affected populations.

AIDSTAR-One is USAID’s global HIV/AIDS project providing support and technical assistance to teams and partners working across the world. This project has documented successful case studies for scaling up services for mental, neurological and substance use disorders in low- and middle-income countries. It has also provided technical briefs for recognizing the linkage between HIV and mental health and integrating these two health needs and services.

Addressing the Mental Health Needs of People Living with HIV

As HIV treatment becomes increasingly accessible on a global scale, people living with HIV (PLHIV) are living normal and active lives for many years. However, the mental health needs of PLHIV are often overlooked in care, treatment, and support programs. Undetected and untreated mental health problems have a profound effect on antiretroviral therapy (ART) adherence, symptom severity, and quality of life, which in turn can influence HIV progression. Visit www.AIDSTAR-One.com for a collection of resources to facilitate integration of these two health services.

Resources Focused on Adults

Case Study | Mental Health Care and Support: A step-by-step example of how a program in Vietnam integrated mental health services into 1) an HIV care and treatment program and 2) methadone maintenance treatment to improve the quality of life among PLHIV. These two examples show how mental health services can be integrated into the health system through technical, financial, and policy support to improve the well-being of PLHIV. http://j.mp/ppANcS

This was produced by the AIDS Support and Technical Assistance Resources Project, Sector 1, Task Order 1 (AIDSTAR-One), USAID Contract # GHH-I-00-07-00059-00, funded January 31, 2008.

Case Study | Prioritizing HIV in Mental Health Services Delivered in Post-Conflict Settings: An in-depth look at the Peter C. Alderman Foundation's efforts to integrate HIV services and referrals into their mental health program in the post-conflict area of Northern Uganda. This case study provides concrete recommendations for programs to increase the links between mental health and HIV services thus providing holistic care for PLHIV. http://j.mp/ptDc21

Technical Brief | Mental Health and HIV: Highlights the key mental health issues in the continuum of HIV care and reviews promising programmatic practices for addressing these issues in resource-constrained settings. This brief provides links to important resources and tools for program planners and health care providers concerned about mental health issues in HIV care and support. http://j.mp/oSyxI3

Resources Focused on Children

Technical Brief | Meeting the Psychosocial Needs of Children Living with HIV in Africa: Documents promising practices in critical services related to the psychological and social well-being of perinatally-infected children in Africa. These include the identification, testing, and counseling of children so that they are linked to appropriate support as early as possible, as well as on-going support to help children and their families manage disclosure, stigma, and grief and bereavement processes. http://j.mp/qxpGYb

Technical Report | Equipping Parents and Health Providers to Address the Psychological and Social Challenges of Caring for Children Living with HIV In Africa: Provides information to better understand the psychological and social challenges faced by perinatally-infected children in Africa, their caregivers, and their health providers. Learn about the factors that contribute to the ability of children living with HIV to cope and thrive and approaches being used to help caregivers and health providers provide psychosocial support to these children. http://j.mp/pQkgfx

Visit www.aidstar-one.com/mental_health to access these resources

This was produced by the AIDS Support and Technical Assistance Resources Project, Sector 1, Task Order 1 (AIDSTAR-One), USAID Contract # GHH-I-00-07-00059-00, funded January 31, 2008.

PSYCHOSOCIAL & MENTAL HEALTH (PSS MH) PROGRAMME – UNHCR Syria

Psychosocial difficulties experienced by refugees in Syria have steadily increased due to deepening socio-economic vulnerabilities and prolonged uncertainty. Many refugees had already experienced/ witnessed traumatic events in Iraq. According to ProGres (registration data), more than 4,800 registered cases or around 8.4% of active registered cases are identified as having severe psychosocial and mental health vulnerabilities. Over 21,000 of the registered Iraqi refugees are either survivors of torture or survivors of sexual and gender-based violence, making them a high risk group in addition to women at risk and persons with serious medical conditions and disabilities. Due to a scarcity of qualified professionals and implementing partners, UNHCR has established a pilot Psychosocial and Mental Health (PSS MH) Programme that adopts a three-fold approach: case management of the most vulnerable; an urban outreach volunteer programme; and a national capacity building project. The PSS MH Programme has undergone an external evaluation and has been nominated as a Good Practice example. Efforts are being made for documentation and dissemination.

Case Management The UNHCR PSS MH Programme has received and followed up over 2,800 very vulnerable cases with psychosocial and mental health concerns since it was established in 2008. 18% of the referred cases are identified as having diagnosed mental disorders. Throughout 2009 and 2010 more than 1,400 cases have been handled by the psychosocial focal point each year. Monthly more than 150 cases are referred to the PSS MH team. Around 1,400 of those cases were referred to community-based psychosocial support and specialized mental health treatment (see graph below).

Outreach Volunteer Programme & Counseling Centre Community-based support has been enhanced with the creation of a Psychosocial Outreach Volunteer Support Group and the opening of an Outreach Counseling Centre. Managed by refugee volunteers, the Centre offers specialized activities such as peer support groups, psychosocial and recreational activities and skills-training to over 800 refugees. It provides a safe environment, counters isolation and supports personal and identity development as well as resilience and empowerment. National Capacity Building The Psychosocial Support and Mental Health Capacity Building Project aims at building sector capacity and strengthening national services. It includes the development of: a comprehensive ‘Handbook for Psychosocial Support and Mental Health for Refugees’; concise training curricula for frontline workers; a Training of Master Trainers for senior Syrian and Iraqi psychosocial and mental health professionals, who will consequently train frontline workers. Co-Chaired by UNHCR and the Ministry of Health, members of project include the Syrian Arab Red Crescent (SARC), GIZ/EU, UNICEF, the International Medical Corps (IMC), WHO, UNFPA, the Syrian Ministry of Education and the University of Damascus. The project has been selected as a One UN Case Study for interagency collaboration and is now preparing for a transition to national ownership and the establishment of a National MH PSS Council. 2009 2010

Table 1: PSS Assessments 650 Total 847 (+23%)

Emergency 182 PSS Outreach Volunteer Follow -up 293 ⇑⇑⇑ (583) 21 Referrals 9

N/A PSS Outreach Counseling Center 1 27 ⇑⇑⇑ 2009 22 Home Visits 106 2010 In-Office PSS Counseling 188 SA RC/UNICEF Child & Family Unit 217 ⇑⇑⇑ 54 115 160 Speci alized Mental Health Care 123 ⇓⇓⇓ 58 Intensive Follow-up Cases 87 75 TdH Family Counseling Center 57 ⇓⇓⇓ 228 Phone Counseling 427 (20-30 min assessments on the phone) 25 Psychiatric Hospital 10 ⇓⇓⇓ 905 Psychosocial Counseling 1561 11 Vocational Training 13 (10-15 min during Counseling Days 5 Women’s Shelter 2 360 Psychosocial Assessments 244 (1-1.5 hr assessments per case 4 Psychiatric 5 Nursing 894 Backlog Cases 275 (home- (No action Taken) based) Table 2: Service Referrals by PSS 1648 / 1354 Total Service Points/New Cases 2549 (+35%) / 1461

Table 2: Service Referrals by PSS The NSW Institute of Psychiatry (NSWIOP)

• Perinatal & Infant Mental Health • Adult Mental Health • Older Persons Mental Health • Child & Adolescent Mental Health • Family Therapy • General Practitioner Postgraduate Program and • Postgraduate Psychiatry.

Continuing Professional The NSW Institute of Psychiatry (NSWIOP) Development Workshops based in Sydney, Australia, is a World Health and Customised Organization Collaborative Centre in Mental Programs Health and Substance Abuse. The NSWIOP is a major provider of professional education in NSWIOP off ers an mental health in Australia. extensive range of Continuing Professional NSWIOP is a statutory body, directly responsible Development (CPD) to the NSW Minister for Health. NSWIOP is learning opportunities independent of any individual university or for people working teaching institution. NSWIOP is registered and in the mental health accredited by the NSW Department of Education fi eld, primary carers and Training for the delivery of higher education and those whose courses. Degrees awarded by NSWIOP are work involves contact equivalent in standard to a qualifi cation of the with clients with same level in a similar fi eld in other Australian mental health issues. higher education institutions, including NSWIOP also conducts universities. Many of our programs attract state, national and continuing education recognition from relevant international projects professional associations. and Customised Training on specifi c Postgraduate Education topics requested by contractors delivered on by Distance Education campus or off -site.

An extensive postgraduate program is off ered A few examples include: for people working in • Introduction to Mental Health – for the mental health fi eld Immigration Offi cers or related areas. Students • Safe Custody Course – NSW Police can undertake a Graduate • Mental Health Literacy Certifi cate, Graduate • Mental Illness and Substance Abuse Diploma or Master of • Introduction to Child & Adolescent Mental Health via distance Mental Health education in the following • Suicide Assessment and Management. specialty areas: www.nswiop.nsw.edu.au Projects

The Institute has been involved in a number of state, national and international projects including: • School Link Statewide Training Program • Supporting Families Early & Safe Start • Supporting Parents Training • Mental Health Act Training • MHPOD – Mental Health Professional Online Development • Infant Communication DVDs. Dr Ros Montague travelled to Majuro, Marshall Islands and Koror, Palau in January 2011 and Supporting provided 2 days of training in both countries using Parents mhGAP as the basis for the training. The training Training was very well received and follow-up training will be conducted using mhGAP and additional resources to address each country’s mental health education needs.

The NSWIOP hopes to also deliver training using mhGAP to the Federated States of Micronesia and Papua New Guinea in 2012.

The NSWIOP off ers up to 3 scholarships annually to eligible staff from Pacifi c Island countries.

The NSWIOP has applied to AusAid for a grant that will enable the NSWIOP to work closely with Marhsall Islands, Palau, the Federated States of Micronesia and Papua New Guinea, to address mental health training needs using mhGAP resources.

Evauation of training will allow NSWIOP to provide The NSW Institute of Psychiatry feedback on the eff ectiveness of the mhGAP and mhGAP resoruces and to provide future recommendations - Past and Future Collaboration resulting from use of resources.

NSWIOP has been asked to work with the WHO Pacifi c Island Mental Health Network (PIMHnet) Further Information to develop a sustainable relationship with Marshall Islands and Palau, providing ongoing Further information on all NSWIOP programs can training, mentoring and support in mental health be found at the Institute’s website: according to their human resource development plan. www.nswiop.nsw.edu.au

www.nswiop.nsw.edu.au

Stichting Epilepsie Instellingen Nederland (SEIN) – Epilepsy Institute in the Netherlands

INTRODUCTION SEIN - The Epilepsy Institute in the Netherlands was founded in 1882 and strives at improving the quality of life of people with epilepsy globally. It provides multi-disciplinary care to people with complex forms of epilepsy. SEIN provides its services in two clinical facilities in Heemstede and Zwolle, twelve outpatient clinics providing care to about 11,000 patients a year, and also provides long stay sheltered residential accommodation (Heemstede, Cruquius and Zwolle) for over 400 people with epilepsy and complex needs. SEIN’s main catchment area is the northern, eastern and western part of the Netherlands although patients may come from any part of the country. Core functions  Diagnostics and treatment (out-patient and in-patient)  Long-stay ( central and de-centralised)  Research (clinical and basic)  Public and professional education  Special education SEIN has been designated a WHO Collaborating Centre for Research, Training and Treatment in Epilepsy since 2004.

ACTIVITIES WITHIN THE FRAMEWORK AS A WHO COLLABORATING CENTRE 1. Providing comprehensive epilepsy care. Number of people with epilepsy in The The Netherlands have a population of 16.000.000 of Netherlands whom an estimated 120.000 have epilepsy. SEIN has: • 510 beds at three sites 17% Seizure-free with – 100 short/medium stay medication Refractory epilepsy – 410 long stay 17% Good QoL 66% Refractory epilepsy • 1.300 employees In Need of Care • 1.300 admissions (per annum) • 11.000 out patients • 60 patients for neurosurgery (per annum) mhGAP Greater coverage with essential interventions for people with mental and neurological disorders

2. Develop special education and fellowship programmes for young researchers from resource-poor countries.  SEIN organises an annual 2-week course in clinical epileptology for young doctors with a general interest in neurology and more specifically in epilepsy from resource-poor countries in order to pass on much needed knowledge and expertise in comprehensive epilepsy care.  SEIN offers fellowships to young researchers from resource-poor countries  SEIN offers training placements lasting up to three months to post doctoral fellows regarding clinical and basic research, professionals working in social areas and others

Students and course Participating in folkloristic activities At SEIN organisers

mhGAP Increase in the proportion of primary health facilities that have trained health professionals for diagnosis and treatment of mental and neurological disorders

1 3. Collaborate with other institutions in the area of health care, nationally and internationally.  SEIN has entered into a Memorandum of Understanding (MoU) for research with the CAAE (China Association Against Epilepsy) involving two more WHO Collaborating Centres (WHO- CC) in China (Beijing Neurosurgical Institute and Fudan University Hospital in Shanghai).  Institute of Neurology, Fudan University, WHO Collaborating Centre for Research and Training in Neurosciences  UK Division of Neurosciences of UCL, (WHO-CC)  Simon Khechinashvili University Hospital, Georgia  Medical Centre of the Free University of Amsterdam Negotiations regarding collaboration with other institutions both nationally and internationally are in progress. mhGAP A comprehensive and result-oriented programme for mental health and neurological disorders implemented in targeted countries

4. Assist in carrying out the project on Epilepsy and Legislation A document “Basic principles for Epilepsy Legislation and Guidance Instrument for developing, adopting and implementing epilepsy legislation” is ready to go to print. mhGAP Enhanced implementation of human rights standards (in care facilities) for mental and neurological disorders

5. Organise a regional conference on epilepsy as a public health issue in Eastern Europe. Such an event, consisting of a symposium and a workshop under the titles “Scaling Up Epilepsy Care in Georgia” and “Delivering Epilepsy Care through the Primary Health Care System”respectively is being organised in Tbilisi, Georgia, marking the finalisation of the Demonstration Project in Georgia, involving all principal investigators of the demonstration projects, ILAE/IBE presidents, WHO representatives (WHO Regional Advisor for Mental Health, Head WHO Country Office, repesentatrion from WHO Headquarters), SEIN representatives (Chair Board of Directors), and other collaborators in the GCAE as well as, the Dutch Ambassador, the first Lady of Georgia and a number of Georgian politicians.

Techical meeting re Demonstration Project Out-patient clinc mhGAP Greater investment in care for mental and neurological disorders

6. Assist in the carrying out a demonstration project in epilepsy in the Eastern European Region. The Demonstration Project, aiming at reducing the treatment gap, was completed at the end of 2010. At the request of WHO SEIN had taken the lead in this project. The data of a second epidemiological survey has been analysed and a report will be prepared for publication in a peer reviewed journal showing the results of the project. The continuation of the collaboration with the present partners in Georgia was a logical next step in order to ascertain sustainability of improving epilepsy care in Georgia. mhGAP Increase in the proportion of primary health facilities that have trained professionals for diagnosis and treatment of mental and neurological disorders

7. Research at SEIN SEIN has a long tradition of providing care to people with epilepsy on a national and an international level. Research is an indispensible part of SEIN’s future for ultimate benefit of people with epilepsy.

ASS 1 Triestina - Dipartimento di Salute Mentale di Trieste Centro Collaboratore OMS per la ricerca e la formazione in salute mentale

World Health Organisation Collaborating Centre for Research and Training in Mental Health (WHO CC)

WHO COLLABORATING CENTRE, TRIESTE

In September 2010, the World Health Organization designated the Mental Health Department (MHD) of the Azienda per I Servizi Sanitari n. 1 Triestina (ASS1), as WHO Collaborating Centre for Research and Training in Mental Health with the following terms of reference:

support and guidance in various countries for deinstitutionalisation and development of integrated/comprehensive Community Mental Health services: collaboration, partnership and networking with some countries/areas which demonstrate the willingness and capacity to deliver community based services; diffusion of Whole Systems & Recovery approaches: innovative practices in community MH.

The designation is effective for a period of four years.

In the workplan the Centre has a specific activity on Mental Health GAP.

Activity 4 – Support to WHO Headquarters for mhGAP Project

Responsible person Dr. Roberto Mezzina/Dr Giuseppe Dell’Acqua

Description Provision of technical support to the project entitled “Mental Health GAP” promoted by WHO Headquarters. WHO Director General for Mental Health and Substance Abuse dr. Benedetto Saraceno intended that the activities with Palestine and South America outlined in this workplan are the Trieste Centre concrete and practical contribution to that programme, and other actions in that activity depend on the development of that programme and were not already communicated to us.

Concrete expected outcome As defined by WHO headquarters (see description/specific and related activities in this workplan) Organisation of an international conference to be held in Trieste in 2010

Links with WHO activities As defined by WHO headquarters (see description/specific and related activities in this workplan)

Source of funding of the activity As defined by WHO headquarters (see description/specific and related activities in this workplan)

Dissemination of the results

Time frame of the activity 2010-2013

Outcomes (1 st year)

- During the international meeting “Beyond the walls”, Trieste, April 2011, experiences in pilot countries for mhGAP have been presented (Jordan, Iran, Palestine, Mozambique).

ASS 1 Dipartimento di Salute Mentale - via Weiss, 5 – 34142 Trieste (Italy) e mail: [email protected] tel. +39 040 3997439 fax +39 040 3997439

ASS 1 Triestina - Dipartimento di Salute Mentale di Trieste Centro Collaboratore OMS per la ricerca e la formazione in salute mentale

World Health Organisation Collaborating Centre for Research and Training in Mental Health (WHO CC)

WHO CC started the translation into Italian and a pilot implementation of the Intervention Guide in Udine.

- In Iran our collaboration will include support to mhGAP implementation.

During two group visits, 27 September-1 October 2010 and April 2011 (during the International Meeting “Beyond the Walls”) representatives of top institutional level of MH in Iran (MoH&ME) and the Director of WHO CC in at the University of Teheran, under the aegis of WHO Representative IR Iran dr. Manenti, Head of Office, had a first hand knowledge of the model of MH Dept Trieste and Udine. Then a mission as WHO consultancy (encompassing field visits, lectures and meetings) has been organised from 26 June to 1 July 2011 with the aims of:

Assisting the Ministry of Health and Medical Education of Iran to develop a Community Mental Health Pilot project; Providing lectures in different workshops with key mental health managers and mental health workers on Community -Mental Health and on the “Deinstitutionalization” experience of Trieste and the Italian Psychiatric Reform; Visiting Mental Health facilities in Iran; Participating in advocacy activities on Community Mental Health. A workplan has been proposed for a follow-up, with pilot projects and related on-site and off-site training.

Activity 3 - Latin America Network. Support to good practices in collaboration with PAHO, WHO-HQ and WHO-Euro

In Latin America, WHO CC has supported practically the South America Network either in Argentina – with initiatives related to the new mental health act of December 2010 - or in Brazil . Delegations from Brazil and Argentina came to Trieste during the international conferences promoted by WHOCC in 2010 and 2011. As one of the main actions, there is an ongoing training activity for about 60 young professionals per year coming mainly form these two countries which have the possibility to stay free up to three months (see activity 5).

Formal agreements have been developed in partnership through Italian Association “Permanent Conference for Mental Health Worldwide - ConfBasaglia ”, that signed particularly two agreements: 1) with the National Institute of mental Health and Addictions of Argentina (Direccion Nacional de Salud Mental y Addicciones – DndSMyA) in order to sustain policies, service development, training for implementation of the new Act; 2) with the Health Departament of the Municipality of Belo Horizionte (Minas Gerais, Brasil) for the development of community services and of practices and policies supporting the rights of vulnerable groups.

Project with Bahia University – Cooperation for research with WHO CC and the University of Trieste. On 06.07.2010, the Rector of the University of Trieste and the Rector of the Federal University of Bahia have signed the bilateral agreement between the two universities. This agreement provides for exchange of their expertise and field research to compare different business models and reality, but who are inspired by the same principles and the same determinants of health in the community: organization of health services for citizens fighting exclusion and social injustice through integrated

ASS 1 Dipartimento di Salute Mentale - via Weiss, 5 – 34142 Trieste (Italy) e mail: [email protected] tel. +39 040 3997439 fax +39 040 3997439

ASS 1 Triestina - Dipartimento di Salute Mentale di Trieste Centro Collaboratore OMS per la ricerca e la formazione in salute mentale

World Health Organisation Collaborating Centre for Research and Training in Mental Health (WHO CC) health interventions, the eagerness of the people and solidarity. The axes of research are: 1. Deinstitutionalization and the closure of mental hospital, 2. Establishment and implementation of alternative mental health community services for the construction of a territorial network, 3. Development of cooperatives and social housing options, 4. Development of community health services with particular emphasis on vulnerable groups: elderly, children, adolescents, people with disabilities, 5. Rationalization of costs for the conversion of human resources and services, 6. Leading role of social movements, in particular users in the process of deinstitutionalization.

Also institutions in Colombia (e.g. Nazareth Hospital – Sumapaz) established a twinning collaboration with ASS n. 1 Trieste. All these activity has at the moment no dedicated international financement for cooperation but only local funds for travels and Argentinean and Brazilian funds. A recent financement of the Region FVG (September 2011) is aimed at supporting the process of reform in Argentina. - It has to be clarified whether mhGAP will be included in this Activity, to which countries and how.

Activity 8 – Support to the WHO Office in Palestine.

Collaboration with WHO in order to assist the Palestinian Ministry of Health in developing a rehabilitation strategy and programme in Bethlehem Psychiatric Hospital, in order to establish a model of best practice and improving opportunities for social inclusion for service users and their families. A study visit with a training component took place in November 2009 in Bethlehem (4 staff from Trieste WHOCC) and in June (6-11) 2010 in Trieste a subsequent visit of ten staff from Gaza and West Bank, accompanied by the WHO Project Officer, was hosted for a study visit which included a training for social entreprise. WHO Project Officer for West Bank and Gaza was invited to present the outcomes of that cooperation at the International meeting “Beyond the walls”, 13 – 16 April 2011. The University of Naublus invited a colleague of the MH Dept. / WHO CC (dr Barbara Bavdaz), to teach at their course for CMHealth in 2009 and 2010.

This also intended as an activity for WHO mhGAP

Moreover: the mhGAP intervention guide is in translation in Italian and has been used for training of GPs in the Region Friuli Venezia Giulia. There is a plan for national presentation with our Minister of Health.

Dr Roberto Mezzina Head of the WHO Collaborating Centre

ASS 1 Dipartimento di Salute Mentale - via Weiss, 5 – 34142 Trieste (Italy) e mail: [email protected] tel. +39 040 3997439 fax +39 040 3997439

WHO Collaborating Center for Psychosocial Rehabilitation and Community Mental Health 4 Sangha-Dong, Giheung-Gu, Yongin-City, Gyeonggi-Province, Korea 446-769 Tel: +82-31-288-0233 Fax: +82-31-288-0363 E-mail: [email protected] ------

Introduction WHO Collaborating Center for Psychosocial Rehabilitation and Community Mental Health of Yongin Mental Hospital is a leading, global mental health organization in psychosocial rehabilitation program, community mental health services, and researches in mental health. The vision of the center is to increase capabilities of mentally ill people as community members by providing services and recovery-oriented approaches to them. Since the designation of Yongin WHO CC in 2003, all staffs have worked with this vision by developing psychosocial programs and community mental health system from the institution to the community .

Mission The mission of the Yongin WHO CC is to provide extensive psychosocial rehabilitation programs through the advancement of research; to develop national mental health policy through affiliated community mental health centers; to provide the high quality of education to mental health professionals, mentally ill people, and their families; to conduct and disseminate evidence-based best practice and information; and increase awareness of mental health and fundamental human right issues.

Programs and Projects of the WHO CC ▶ PEPS(Patient Empowerment Program for People with Schizophrenia) ▶ Family Psychoeducational Program - Family Link Korea Project ▶ Depression Awareness Campaign - SEBoD(Socio-Economic Burden of Depression) Korea ▶ Psychoeducation Program for Mentally Ill – Alliance Programme ▶ Training Young MH Professionals in Asia with support of WHO, WPRO - Yongin WHO Mental Health Fellowship ▶ International Conference on Mental Health and Rehabilitation ▶ Program for development of professional Academic Skills of Young Psychiatrists

Yongin WHO CC will support the implementation of mhGAP in the following ways ▶ By reinforcing existing partnership with WHO, WPRO, Yongin WHO CC would involve in the implementation of mhGAP actively in the Western Pacific Region. ▶ By strengthening basic education and training for mental health professionals from middle and low income countries in Asia, Yongin WHO CC will help them to upgrade their skills and knowledge, and contribute to the implementation of mhGAP in their own countries. ▶ By developing and promoting programs for mental health care, Yongin WHO CC will try its best to promote of mental health by Depression Awareness and Suicide Prevention and others. ▶ By joining the WHO’s advocacy efforts of mental health, Yongin WHO CC will continue to increase awareness of mental health issues among policymakers and general population. ------For more information about Yongin WHO CC , please visit the following websites: http://www.yonginwhocc.or.kr or http://www.yonginwhocc.or.kr/english.php

WORLD ASSOCIATION FOR PSYCHOSOCIAL REHABILITATION

WAPR is registered as a non-profit organization in France and Italy; it is recognized as a charity in Madras (India) and Edinburgh, (Scotland, U.K), registered as a voluntary, non- profit organization in New York State (U.S.A.) WAPR has a constitution approved at Vienne in 1986, amended at Barcelona in 1989, at Montreal in 1991, and at Dublin in 1993.

World Association for Psychosocial Rehabilitation (WAPR) is a WHO collaborating NGO with consultive Status since 1996.

WAPR is organising regularly local and a regional meeting to fulfil its aims (last in India, Spain, UK, Pakistan, Philippines and Argentina). WAPR has 27 active national branches, and 10 national secretaries. WAPR has organised 10 world congresses (Next in 2012, in Milano, Italy)

WAPR is collaborating with WHO by sending delegates and participating in WHO regional meetings. WAPR has participated in and endorsed the document “Psychosocial Rehabilitation, a Consensus Statement (WHO/MNH/MND/96.2)”, and has disseminated its principles globally the last 15 years.

WAPR also expresses its endorsement to mhGAP Program, considering the tuning of shared principles and philosophy. WAPR specially highlights the importance of the shared vision regarding: • The importance of community based principles and strategy, and in particular the need of tackling stigma and discrimination of the affected people. • The need of supervising Human Rights and tackle its violations. • The need of scaling up resources at the level of the importance of the burden. • The need of reducing the gap to attention for the mentally ill and give people opportunities for treatment, psychosocial rehabilitation and social inclusion. • The need of political commitment, adequate policy and legislative infrastructure, human resources with appropriate training, access to medicines.

The purpose and affirmative mission of WAPR it to promote the personal, social and vocational rehabilitation of persons affected by serious psychiatric disorders throughout the world.

Specifically, it shall, in relation to such persons: A. Promote the adoption of policies and legislation by national governments. B. Serve as a medium for exchange of ideas, knowledge, skills and experiences for the compilation and dissemination of information relating to rehabilitation methods and techniques. C. Sponsor or co-sponsor or assist the planning of international, national or regional congresses, symposia, training seminars and research projects. D. Collaborate with existing organizations, including parent and self-help organizations, research and training institutes E. Provide, to the extent possible, technical assistance to public or private authorities or agencies F. Initiate and encourage educational programs as a means to ensure maximum public, professional and governmental understanding of these needs and rights, and to overcome stigma and discrimination. G. Promote the further development of mutual and self-help groups, and foster dialogues between them and appropriate professionals and policy makers. H. Identify and promote appropriate and humane living, working and social environments. I. Promote constructive dialogue between and amongst professionals, policy makers, researchers, direct service workers from various disciplines and the families and individuals directly affected by major mental illness. J. Fostering the development of national associations linked to WAPR.

As expressed in the document “Psychosocial Rehabilitation, a Consensus Statement (WHO/MNH/MND/96.2)” we understand that:

Psychosocial rehabilitation is a process that facilitates the opportunity for individuals – who are impaired, disabled or handicapped by mental disorder – to reach their optimal level of independent functioning in the community.

It implies both improving individuals’ competences and introducing environmental changes in order to create a life of best quality possible for people who have experienced a mental disorder, or who have an impairment of their mental capacity, which produces a certain level of disability.

PSR is complex because it aims to encompass many different sectors and levels, from mental hospitals to homes and work settings, legal protection, empowerment oriented to enhance the possibility of choice and self-determination. Hence, it encompasses society as a whole. In consequence, the bodies evolved in PSR are also varied, e.g. consumers, professionals, families, employers, managers and administrators of community agencies, and the overall community itself.

PSR involves an array of different and coordinated targets that desirably may include:

• Access to continuous treatment, through appropriate pharmacotherapy, psychological treatments and psychosocial interventions. • Reducing iatrogeny by diminishing and eliminating, whenever possible, the adverse physical and behavioural consequences of the above interventions, as well as - and in particular – of prolonged institutionalization. • Improving social competence by enhancing individuals’ social skills, psychological coping and occupational functioning. • Reducing discrimination and stigma by dissemination of appropriate information, training and educational means addressed to consumers, families, professionals, policymakers and community in general. • Providing information and support to families. • Providing social support by creating and maintaining a long-term system of social support, covering basic needs related to housing, employment, social network and leisure. • Consumers’ empowerment by enhancing consumers’ and carers’ autonomy, self- sufficiency and self-advocacy capabilities.

In Madrid (Spain), September 30th 2011. Dr. Ricardo Guinea. WAPR Secretary General. www.wapr.info

The World Federation of Neurology mhGAP Programme 10 October 2011

The World Federation of Neurology is an association of national and regional neurological societies representing over 114 countries each with a delegate to its governing council. It was founded over 50 years ago.

The WFN’s mission is to foster quality neurology and brain health world wide. Its emphasis is on education, prevention, and care, particularly in countries with limited resources. This mission has been pursued by:

• Fostering the best standards of neurological practice. • Educating, in collaboration with neuroscience and other international public and private organisations. • Facilitating applied research through its Interest Groups and other means • Working with the World Health Organisation [WHO] in specified areas

Recent WFN sponsored or WFN assisted accomplishments include: o Publication of free access monographs on stroke, epilepsy, multiple sclerosis, and the neurologic consequences of malnutrition o Providing project team members for the production of the WHO monograph, Neurological Disorders. Public Health Challenges [2006], the first major publication on the topic o Assisting the establishment of the first neurology training program in Honduras o Co-authoring, with WHO, the Atlas: Country Resources for Neurological Disorders o Collaborating with other major international neurological societies to provide and sponsor intensive courses for health care providers on the care of neurological disorders, in sub-Saharan African countries o Organisation of biennial world congresses bringing together experts in the neurosciences from around the world o Chairing the WHO’s Task Force Advisory Group on Neurological Disorders for the revision of ICD10, the diagnostic and procedural coding system used globally for the reporting of health statistics o Establishing a Patient Advocacy Commission made up of neurologists from many countries, trained in empowering patients with brain disorders economically, socially, and politically

The WFN has established, and continues to widen, a network of other international neuroscience organisations who share our mission, for the purpose of seeking opportunities for collaboration, promoting international cooperation, and strengthening working relationships among practitioners and researchers in neurology. These include: o The World Brain Alliance, bringing together neurologists, neurosurgeons, psychiatrists, neuroscientists, and others o A Subspecialty Neurology Liaison, encouraging dialogue and collaboration among international subspecialty organisations with overlapping interests o WFN Interest Groups, made up of neurologists from many countries engaged in educational projects mainly in low income countries o WFN Regional Initiatives, currently in Latin America, Africa, and Asia

The WFN is therefore positioned to inform, engage, and promote collaborative action among many neurological organisations. With its emphasis on global public health issues, prevention of neurological disorders, and professional training, the WFN is prepared to promote, implement, advocate for, and provide expertise for mhGAP initiatives.

References: Atlas. Country Resources for Neurological Disorders 2004; Geneva: World Health Organisation. http://www.who.int/mental_health/neurology/epidemiology/

Neurological Disorders. Public Health Challenges. 2006; Geneva: World Health Organisation. http://www.who.int/mental_health/neurology/neurodiso/en/

Medina M et al. Neurologic Consequences of Malnutrition. 2008; NY: Demos Publishing http://wfneurology.org/pdfs/SeminarsInClinicalNeurology/wfn_demos_malnutrition.pdf

Oger J et al. Multiple Sclerosis for the Practicing Neurologist. 2007; NY: Demos Publishing http://wfneurology.org/pdfs/SeminarsInClinicalNeurology/wfn_demos_ms.pdf

WORLD PSYCHIATRIC ASSOCIATION www.wpanet.org

The WPA is an association of national psychiatric societies, presently 135, spanning 117 different countries and representing more than 200,000 psychiatrists. It aims to advance psychiatry and mental health worldwide. The WPA organizes the World Congress of Psychiatry, WPA International and Regional Congresses, and Thematic Conferences. With its 65 scientific sections, it disseminates information and promotes collaborative work in specific domains of psychiatry. It has developed ethical guidelines for psychiatric practice, including the Madrid Declaration. Its website is currently visited from 195 countries across the world with a daily visit of nearly 350. The WPA News, the official quarterly newsletter of the association, is widely disseminated to the international mental health organizations besides the WPA Components. The WPA E-Bulletin is also disseminated to nearly 50,000 personal email addresses of psychiatrists across the world. Various educational programmes had been developed including an E-Learning long distance educational programme. Major scientific meetings are accredited with the WPA CME through an evaluation and self-report process. World Psychiatry, the WPA official journal, is the most widespread psychiatric journal in the world, reaching more than 33,000 psychiatrists in 121 countries. The journal has now an impact factor of 5.562, ranking 9 out of 126 psychiatric journals. It is regularly translated in seven languages and individual papers or abstracts are translated in further languages. All issues of the journal can be freely downloaded from PubMed Central and the WPA website.

WPA has ….. implemented an initiative to support the development of national psychiatric journals in low- and middle-income countries; implemented a programme of one-year research fellowships for early-career psychiatrists from low or lower-middle income countries, in collaboration with centers of excellence in psychiatry; developed guidance papers on issues of great practical interest to psychiatrists worldwide; funded several international collaborative research projects; produced a series of books, along with sets of slides in various languages, dealing with the comorbidity of depression with diabetes, heart disease and cancer; developed an educational module on physical illness in patients with severe mental disorders, and educational material for continuing education of psychiatrists, and education of the general public; developed a template for undergraduate and postgraduate education in psychiatry and mental health; developed a set of recommendations for relationships of psychiatrists, health care organizations working in the psychiatric field and psychiatric associations with the pharmaceutical industry, and a set of recommendations on best practices in working with service users and family carers; established a WPA Early Career Psychiatrists Council; organized in 2009 and 2010 a series of train-the-trainers workshops aimed to contribute to the integration of mental health care into primary care in Nigeria and Sri Lanka, in collaboration with the national governments. They targeted nurses and clinical officers working in dispensaries and health centers, and were followed by a phase of supervision of participants; organized educational courses dealing with issues of great relevance to psychiatric practice in Abuja, Nigeria; Sao Paulo, Brazil; Dhaka, Bangladesh; St. Petersburg, Russia; Beijing, China; Cairo, Egypt; Yerevan, Armenia; and Istanbul, Turkey; co-sponsored workshops on leadership and professional skills for young psychiatrists in Singapore, Nigeria and Turkey.

World Psychiatric Association & World Health Organization Collaboration WPA has collaborated, especially in the last triennium, with the WHO, having in mind two general objectives: to help as much as possible some countries in need, and to enhance the image and increase the political influence of our discipline and profession in the international health arena. The revision of the chapter on mental and behavioural disorders of the ICD-10: WPA Member Societies have participated in the WPA-WHO Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification. Many WPA officers or experts have been appointed as chairpersons or members of ICD-11 Working Groups. The WPA is represented by its Past President in the ICD-11 International Advisory Board. Several WPA Member Societies and experts were involved in ICD-11 field trials and in the various translations / adaptations of the diagnostic system. The Mental Health Gap Action Programme (mhGAP): The WPA provided assistance to the WHO in the preparation of the mhGAP intervention packages and supported the WHO in the country implementation of the programme on a case by case basis. WPA experts contributed to the production of the WHO’s mhGAP Intervention Guide and the WHO’s Atlas of Resources for the Prevention and Treatment of Substance Abuse. A policy roundtable in Africa: In October 2009, the WPA and the WHO co-organized in Abuja, Nigeria a Policy Roundtable bringing together ministers of health, senior policy makers and professional leaders of the nine African countries identified in the WHO’s Mental Health Gap Action Programme (mhGAP) as needing intensified support to scale up mental health services: Burundi, Cote d’Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Liberia, Malawi and Nigeria. The outcome of the roundtable was the development of road maps for mental health care in those countries. WHO-WPA partnership on mental health care in emergencies: A series of train-the-trainers workshops and sensitization courses aimed to train psychiatrists of the various regions of the world to address the mental health consequences of disasters were organized. The first of these train-the- trainers workshops was co-organized with the WHO in Geneva in July 2009. Further train-the- trainers workshops have been held in Bangladesh, China, Russia, Egypt, Brazil and Argentina. Sensitization courses have been held within all major WPA meetings in 2010 and 2011. Partnership on involvement of users and carers: The WHO made available to the WPA its experience and access to its network of users and carers towards assisting the WPA in its project to draft guidelines about best practices in working with users and carers.

Submitted by Levent Kuey, WPA Secretary General, to be included in the mhGAP Forum File, October 10, 2011

World Vision International

Briefing for Mental Health Gap Action Programme (mhGAP) Forum, October 2011

About World Vision International (WVI) “Our vision for every child, life in all its fullness. Our prayer for every heart, the will to make it so”. World Vision is a Christian relief, development and advocacy organisation dedicated to working with children, families and communities to overcome poverty and injustice. Inspired by our Christian values, we are dedicated to working with the world’s most vulnerable people. We serve all people regardless of religion, race, ethnicity or gender. World Vision is a federal partnership working in almost 100 countries worldwide, serving more than 100 million people.

WVI’s work in Mental Health and Psychosocial Support (MHPSS) WVI strongly acknowledges that both the tangible and intangible aspects of peoples’ lives contribute to poverty, disempowerment, but also to the recovery from crises. In the past decade, WVI has increased its attention to the mental health and psychosocial support (MHPSS) needs of people in emergency and developing contexts. In recent years, WVI has established a WVI MHPSS Working Group that provides strategic direction to our organisational approaches to MHPSS programs, and to gradually expand our work in this area. The goal of this group is “To build the World Vision partnership’s interest and expertise in MHPSS programming to support children, families and communities to reach their full potential and experience ‘life in all its fullness’.” mhGAP features strongly in WVI’s workplans with the intention of ensuring mhGAP’s inclusion in a range of WVI’s MHPSS programs.

Strategic approaches to MHPSS programs – Do, Don’t Do, Assure (DADD) Framework WVI has developed a Do, Assure, Don’t Do (DADD) framework to ensure our sectoral interventions, particularly during emergencies, follow international guidelines, recommended interventions and protect communities from potentially harmful practices. WVI has developed a MHPSS DADD framework that is based on the IASC Guidelines for Mental Health and Psychosocial Support in Emergency Settings (IASC, 2007). mhGAP has been included as part of this MHPSS strategy as well as part of our Emergency Health sector DADDs. WVI is yet to analyse the best ways for supporting mhGAP in emergency contexts so this will be an area of field-testing in future WVI emergency responses.

Interpersonal Psychotherapy for Groups (IPT-G) Over the past 10-15 years WVI has developed and validated an Interpersonal Psychotherapy for Groups (IPT-G) program for people living with depression, anxiety and/or significant symptoms of trauma. Recently, IPT-G was piloted in our Haiti earthquake recovery program and it has now been established as a formal integrated program model for our Area Development Programs. WVI is also exploring a partnership with the World Health Organization (WHO), Makere University in Uganda and the Uganda Ministry of Health (MoH) to possibly incorporate IPT-G as a part of a planned mhGAP and community mental health program in Uganda (see below for more details). mhGAP in Uganda Starting 1 January 2012 WV Australia is planning to work in partnership with WV Uganda, WHO, Uganda MoH and Makere University to scale up the care for people with mental, neurological and substance use disorders in Uganda – specifically using the mhGAP tool as the program framework. This project, valued at USD 750,000 over 3 years, aims to further develop mhGAP training materials and methods, and to support the integration of mental health care through the Ugandan primary health systems.

Psychological First Aid WVI was proud to work in partnership with WHO and War Trauma Foundation (WTF) and to provide funding and technical support for the development, field-testing and publication of the Psychological first aid: Guide for field workers tool1. Working in partnership with WTF, ongoing activities for the translation, contextualisation, training and distribution of this guide is planned over the next 2 years.

1 The Psychological first aid: Guide for field workers (WHO, WTF, WVI, 2011) is available for free download in PDF format or available for order from the WHO Bookshop: http://www.who.int/mediacentre/news/releases/2011/humanitarian_relief_20110819/en/index.html

Mainstreaming MHPSS WVI recognises that MHPSS programs can function as an individual sector but it is also crucial to be mainstreamed across other non-MHPSS focused programs. To encourage mainstreaming and consideration of MHPSS issues across WVI programs, we have ensured MHPSS has been included in other sector strategies (and DADDs), such as emergency health, child protection, education, humanitarian protection, water and sanitation, and nutrition. WVI has established communications guidelines to encourage appropriate language about MHPSS, a briefing document linking humanitarian accountability to MHPSS and well-being, and the organisation continues to work on ways we can better monitor, measure and evaluate the MHPSS impacts of our programs.

Programming MHPSS – Sri Lanka, Gaza, Horn of Africa Crisis In Sri Lanka, WVI is engaged with the College of Psychiatrists to train community support officers who are providing community-based psychosocial support to people affected by conflict in the north. They are also working on strengthening referrals to psychiatric care and offering support to individuals and families directly impacted by mental illness. A planned extension of this project to 2014 will attempt to incorporate mhGAP into the program.

In Gaza, WVI has focused on an integrated and mainstreamed approach for improving the MHPSS and well-being of people who are part of a 4-year livelihoods recovery program. MHPSS activities include strengthening referrals, Child Friendly Spaces for children, gender awareness with local partners, disaster preparedness (including psychological first aid) and provision of community information about MHPSS issues. WVI is engaged with MHPSS Cluster in Gaza where the potential for mhGAP is being explored.

As part of WVI’s response to the current Horn of Africa crisis, we have provided psychological first aid to field- facing staff working with displaced people in the camps, and working towards the inclusion of psychosocial support officers in our nutrition programs.

Researching MHPSS WVI recognises that ongoing research in MHPSS is essential to refining our programs and improving our support to children, families and communities. WVI will be researching the protective and restorative aspects of Child Friendly Spaces; we are developing plans for a more targeted psychosocial support component to the Timed and Targeted Counselling model used in Maternal, Newborn and Child Health programs, as well as considering links between spirituality and MHPSS in emergency contexts. We are also eager to learn more about mhGAP as we work towards its implementation in Uganda, Sri Lanka and future emergency responses.

Global partnerships and engagement with the IASC MHPSS Reference Group WVI continues to be an active participant with the IASC MHPSS Reference Group and partners with a range of other UN agencies, NGOs, CBOs and academic institutions. We have provided input to emerging mhGAP materials and look forward to ongoing learning about the development of this tool.

Future MHPSS work There are many areas of MHPSS that WVI plans, over the long term, to explore further – including the links between MHPSS and spirituality, WVI’s role in supporting people affected by sexual and gender-based violence, MHPSS in disaster preparedness programs (particularly in the Pacific region), ways mhGAP can be incorporated into emergency responses, CBT for children and adolescents and more. We are also planning to build capacity of our WVI field-based staff in MHPSS programs, which will certainly include aspects of the mhGAP tools. WVI will continue working in partnership with others to achieve these goals and ensure our continued commitment to MHPSS in the future.

For more information please contact Megan McGrath, [email protected] WVI Geneva, [email protected]