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Global Mental Health Editorial BULLETIN of the NETHERLANDS SOCIETY for TROPICAL MEDICINE and INTERNATIONAL HEALTH N O 0 4 / DECEMBER 2 0 2 0 - V O LUME 5 8 GLOBAL MENTAL HEALTH EDITORIAL THERE IS NO HEALTH WITHOUT MENTAL HEALTH nited Nations Secretary- MHPSS is at the top of the Netherlands’ General António Guterres international development agenda. rightly reiterated this We are fully committed to an MHPSS- CONTENT simple but powerful mes- inclusive approach in humanitarian Usage in May 2020, when Covid-19 had as well as conflict-prevention and EDITORIAL - 2 been with us for only a few months. peacebuilding efforts. We promote Mental health and psychosocial support and ensure this through international REVIEWS (MHPSS) are vital for our individual political and diplomatic efforts, through Psychosocial rehabilitation: and collective well-being, particularly policy dialogue with our partners, a global perspective - 3 in these disturbing Covid-19 times. and by supporting a number of initia- Indeed, MHPSS is a powerful tool tives to facilitate MHPSS-inclusive Collaboration between to unlock our human resilience and responses in humanitarian and traditional healers and strengthen human capital. This is even peacebuilding work on the ground. psychiatrists to improve care more crucial for the most vulnerable for people with psychotic people hit by conflict or disaster. The e therefore very much welcome disorders - 5 Netherlands therefore strongly advocates Wthis special edition of MTb recognising the importance of MHPSS dedicated to global MHPSS, and are Stigma, schizophrenia, suicide: for people and communities affected by grateful to its guest editors Rembrant a global perspective - 7 crisis. We work hard to promote integra- Aarts and Hans Rode for bringing tion of MHPSS into all crisis response together such a varied pool of authors Mental health and psychosocial from the very beginning. We encourage with varied expertise in the field, both support: hidden potential and integrating basic psychosocial skills academically and on the ground. This harm - 10 into the training of every humanitarian issue of MTb is an excellent gateway worker. Finally, we stress the impor- to disseminate a rich body of knowl- Mental health care in tance of attending to the psychosocial edge and expertise that is needed so Cambodia: history, status and a well-being of humanitarian staff, first urgently. After all, MHPSS helps to personal report - 12 responders and volunteers themselves. keep our minds and societies at peace. Art aimed at understanding the These principles are high on the agenda Paul Bekkers mentally ill - 15 of the MHPSS Reference Group[1], which Special Envoy Mental health and psychoso- is part of the Inter-Agency Standing cial support CONSULT ONLINE Committee, the longest-standing and Ministry of Foreign Affairs, the Netherlands Anxiety disorder in Accra, highest-level humanitarian coordina- Ghana - 17 tion forum of the UN. They are also reflected in the December 2019 resolu- 1. Inter-Agency Standing Group [Internet]. IASC Reference Group on Mental Health and Psychosocial Support [2] BOOK REVIEW tion on MHPSS of the International in Emergency Settings; [accessed 8 December 2020]. Available from: https://interagencystandingcommittee. Een goede geest bestaat niet Red Cross and Red Crescent Movement, org/iasc-reference-group-on-mental-health-and- - 19 which endeavours to provide staff and psychosocial-support-in-emergency-settings 2. International Conference of the Red Cross and Red volunteers with the necessary skills to Crescent [Internet]. Resolution addressing mental health and psychosocial needs of people affected ANNOUNCEMENT recognise and respond to psychosocial by armed conflicts, natural disasters and other More global mental health in needs. Staff and volunteers are often emergencies, adopted at the 33rd International Conference, Geneva, 9-12 December 2019; [accessed the upcoming NVTG symposium rooted in the communities they serve, 8 December 2020]. Available from: https:// rcrcconference.org/app/uploads/2019/12/33IC- and webinar - 20 giving them unique access to these R2-MHPSS-_CLEAN_ADOPTED_en.pdf communities as well as knowledge of local context and dynamics. Not only is MHPSS crucial at the individual level, it is also needed and effective at the community level. It helps individuals, ‘THERE IS families, and communities to release NO HEALTH their potential to recover, maintain or WITHOUT regain their resilience and perspec- MENTAL tive, rebuild social cohesion, resume livelihoods, and foster reconciliation. HEALTH’ 2 MT BULLETIN OF NVTG 2020 DECEMBER 04 REVIEW Psychosocial rehabilitation: a global perspective ore than half a billion PSYCHOSOCIAL REHABILITATION part in the lives of African people.In people worldwide suffer IN LMICS rural Ethiopia, only 10% of people with from neuropsychiat- In most LMICs, mental illness carries schizophrenia have access to biomedi- ric disorders. The vast a stigma that is just as debilitating as in cal care, a treatment gap largely due to Mmajority of these individuals live developed countries. The labelling of an an inadequate number of mental health in Africa, Asia and Latin America. individual as ‘mentally ill’ is associated specialists.[5] The Gefersa Mental Health Most of these persons lack access with important social consequences Rehabilitation Center near Addis Ababa to appropriate treatment or care, within the community and among is the only Ethiopian facility that exclu- and many are subject to stigma, relatives, friends, neighbours and sively provides PSR services for individ- discrimination and marginalisation. employers, and this hinders the process uals with severe mental disorders. This This adds up to a serious psycholog- of recovery. Because of non-existent or facility is largely inaccessible to most ical, physical, social and economic very rudimentary health insurance and patients who live hundreds of miles burden. Neuropsychiatric disorders social welfare, individuals with mental away in rural areas, making the estab- can lead to chronic disability and illness in LMICs are often economi- lishment of similar facilities for severely therefore represent an important cally dependent on their families. When affected patients living in different health issue across the globe.[1] doing PSR, one has to be aware of the regions essential through large financial Although there are effective and local system and other conditions, and investment for infrastructure develop- inexpensive treatments for many not necessarily assume support from ment and trained manpower. The prom- neuropsychiatric illnesses, most intact extended families. In many cases, ising results of a pilot study of a trained patients in low- and middle-income growing urbanisation in developing lay workers’ community-based reha- countries (LMICs) are deprived of countries means that the extended bilitation intervention for people with treatment and psychosocial reha- family system is fast disappearing.[3] schizophrenia present a realistic model bilitation. Ultimately, the burden of For at least 80% of rural inhabitants in of PSR for most patients in LMICs.[6] It mental illness, in terms of suffer- LMICs, traditional healers are the main is important to note that such models ing and monetary costs, is high for source of help for people with mental are feasible in LMICs as they do not patients and their families.[2] disorders.[2] Based on our own clinical require expensive infrastructures and experience and observations in LMICs, can be delivered by trained lay workers. PSYCHOSOCIAL REHABILITATION patients with severe neuropsychiatric Psychosocial rehabilitation (PSR) is a disorders do not improve by resorting A successful community-oriented reha- process of restoring well-being, and only to traditional treatment options; bilitation programme for persons with social and occupational functioning they usually need neuroleptic, antide- chronic schizophrenia was developed affected by mental or emotional disor- pressant or antiepileptic medication. in Malaysia in 1978. It prepares indi- ders. Although PSR was long neglected viduals with chronic schizophrenia for as an intervention, it has gained wider COUNTRY-SPECIFIC EXAMPLES gainful employment in the community: recognition in the last decades. The The first attempt to establish commu- in a follow-up analysis seventeen years establishment of the World Association nity-oriented treatment and rehabilita- later, 56% of patients had spent five or for Psychosocial Rehabilitation (WAPR) tion in Africa was in 1954 by Thomas more years making their own living in in 1986, with the mission to strengthen Adeoye Lambo,[4] who developed the their original community settings.[7] rehabilitation worldwide, marked an Aro Village system in Nigeria. Briefly, important milestone. Besides mental Lambo’s aim was to integrate the In India there is a large PSR gap health professionals, patients, family traditional village community with largely due to the shortage of special- members and voluntary organisations traditional healers and modern psy- ist mental health care. Thanks to the are also involved in WAPR activities chiatry, by offering patients modern involvement of NGOs, there are some (www.wapr.org). Over the years, PSR psychiatric care locally, within a familiar outstanding examples of PSR in India has made its way from institutions into social environment. Lambo stressed such as Jyothi Nivas in Kerala. Besides communities, taking account of specific that the strength of this approach was good PSR, it provides innovative
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