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The WHO collaborative study on strategies for extending mental health care, I: The genesis of the study
Abstract
In 1975 the World Health Organization began a multinational collaborative study of the feasibility and effectiveness of offering community-based mental health care in developing countries. Services were to be offered by primary health care workers in pilot study areas in seven countries. The authors discuss the philosophic and epidemiologic underpinnings of the study, the factors that helped the collaborative effort develop, and some of the issues that emerged. Areas for future study are outlined.
... In the backdrop of fullling this resolution, World Health Organization (W.H.O.), Mental Health Division under the leadership of the then Director Dr. Norman Sartorius had incepted the idea of national mental [6] health programme. In lieu with developing strategies for mental health in developing countries and implementation of recommendations of 1974 expert committee, 1) A pilot project on developing "Community Mental Health Unit" was rst started in around 200 villages around the Sakalwara rural mental health centre (with population around 1,00,000) by NIMHANS in 1975 with vision of developing simpler ways for identication and management of people with mental illnesses, evaluating and carrying out suitable training programmes in basic mental health care for different categories of personnel via developing mental health education material. ...
... Care (1975)(1976)(1977)(1978)(1979)(1980)(1981) was launched in the seven developing countries (Brazil, Colombia, Egypt, India, Philippines, Senegal, Sudan)" to implement the 1974 WHO recommendations at the [6] level of general health care. The department of Psychiatry at PGIMER Chandigarh was as selected as the centre in India and the model was developed in Raipur Rani Block of Haryana. ...
Community related mental health services had been limited that lead to genesis of NMHP. Why India needed it needs special attention and that we have covered in our article .
... The WHO advocated the provision of basic mental health care in primary health care both in high and low-income countries (World Health Organisation, 1975;Thornicroft, Tansella et al., 1999). This resulted in the commissioning in 1975 by the WHO of a collaborative multi-site five year study on the feasibility and effectiveness of locally designed community mental health care in developing countries (Harding, Climent et al., 1983;Harding, d'Arrigo Busnello et al., 1983;Murthy and Wig, 1983;Sartorius and Harding, 1983). Most of the interventions included the training of primary care professionals to identify and treat neuro-psychiatric disorders. ...
... The 1968 Conference on Mental Health in the Americas stressed the study of community sources of support and community solutions to mental health problems as priorities (Leon, 1972). A decade later, Brazil was among the research sites of the pioneering WHO study on the feasibility and effectiveness of locally designed community mental health care (Sartorius and Harding, 1983). ...
Common mental disorders are responsible for a significant proportion of the global burden of disease. Differences in the availability of health care resources and the relevance of culture in the acceptability of treatments for mental disorders make it necessary to develop and evaluate interventions congruent with the context of specific settings. Group psychosocial interventions are a potentially cost-effective way of dealing with CMD in primary care. However, the literature describing and evaluating these interventions in low and middle-income countries is limited. This case-study describes Community Therapy (CT), a group psychosocial intervention developed in Brazil and hypothesized to improve mental health through social support. Although it is now widespread in the Brazilian primary health care, CT has not yet been submitted to systematic evaluation. This thesis analyzed data from an observational before/after design sampling 140 incident users from 12 CT groups located in primary care clinics and community settings of Sao Paulo, Brazil. Outcomes included mental health, perceived social support, quality of life, and social capital. Semi-structured interviews with CT users and facilitators as well as observation of CT sessions were also performed. The majority of respondents were female with few years of schooling, low income and a poor mental health. After 12 weeks of follow-up, there was an average twopoints improvement in mental health SRQ-20 scores (95% CI: 1.04-3.00, p<0.001) but no significant correlation with perceived social support change. Qualitative descriptions of CT, however, coincided with the mechanisms hypothesized to improve social support. Poor adherence and the lack of integration of CT users with conventional mental health care services were likely to have contributed to the modest change in the mental health of CT attenders. The effectiveness of CT should be further investigated in the context of a stepped-care multi-component intervention, whereby CT is included as its psychosocial component.
... A second key contribution has been a focus on addressing mental health in pri mary care. In the 1970s, the WHO conduct ed a multinational collaborative study dem onstrating the feasibility and effective ness of offering communitybased mental health care, delivered by primary health care work ers, in developing countries 211 . A few years later, in 1978, the Primary Health Care Conference in Alma Ata, composed of representatives of almost all countries in the world, included the promotion of men tal health into the list of essential compo nents of primary health care. ...
Psychiatry has always been characterized by a range of different models of and approaches to mental disorder, which have sometimes brought progress in clinical practice, but have often also been accompanied by critique from within and without the field. Psychiatric nosology has been a particular focus of debate in recent decades; successive editions of the DSM and ICD have strongly influenced both psychiatric practice and research, but have also led to assertions that psychiatry is in crisis, and to advocacy for entirely new paradigms for diagnosis and assessment. When thinking about etiology, many researchers currently refer to a biopsychosocial model, but this approach has received significant critique, being considered by some observers overly eclectic and vague. Despite the development of a range of evidence‐based pharmacotherapies and psychotherapies, current evidence points to both a treatment gap and a research‐practice gap in mental health. In this paper, after considering current clinical practice, we discuss some proposed novel perspectives that have recently achieved particular prominence and may significantly impact psychiatric practice and research in the future: clinical neuroscience and personalized pharmacotherapy; novel statistical approaches to psychiatric nosology, assessment and research; deinstitutionalization and community mental health care; the scale‐up of evidence‐based psychotherapy; digital phenotyping and digital therapies; and global mental health and task‐sharing approaches. We consider the extent to which proposed transitions from current practices to novel approaches reflect hype or hope. Our review indicates that each of the novel perspectives contributes important insights that allow hope for the future, but also that each provides only a partial view, and that any promise of a paradigm shift for the field is not well grounded. We conclude that there have been crucial advances in psychiatric diagnosis and treatment in recent decades; that, despite this important progress, there is considerable need for further improvements in assessment and intervention; and that such improvements will likely not be achieved by any specific paradigm shifts in psychiatric practice and research, but rather by incremental progress and iterative integration.
... Continuing for most of the twentieth century, Western institutions supported research on populations in LMICs, often at the nexus of psychiatry and anthropology, but there was a glaring void in support and investment in mental health care and services research (Kohrt et al., 2015b). It was acceptable to observe, but the moral imperative to engage, dialogue, and support health systems and social change was mostly absent, with notable exceptions (Sartorius and Harding, 1983) that laid the groundwork for initiatives today that are working towards global access to mental health care (World Health Organization, 2008). ...
In the wake of George Floyd's killing by police in Minneapolis and the global response inspired by Black Lives Matter, it is time for the field of global mental health to reexamine how we have acknowledged and addressed racism in our institutions, our research, and our mental health services. In solidarity with street level responses, this is an important opportunity to understand and collaboratively respond to public demand for systemic change. To respond effectively, it is vital to (1) be aware of the colonial history that influences today's practices, and move forward with anti-colonial and anti-racist actions; (2) identify where and why diversity and representation are lacking in the global mental health workforce, then follow steps to combat these disparities; and (3) work with communities and institutions to end both police violence and structural violence.
Significant advances in the understanding of mental disorders, mental health and well-being have occurred in recent decades. Tracing the trajectory of diverse discourses on mental health over the previous five decades, author, through his personal and professional experiences, covers the growth of multiple frameworks in the broad context of mental health. The chapter seeks to bring newer understandings on the theme and explain the augmentation of perception regarding persons with mental disorders from the mere biological perspective towards the more eclectic ‘bio-psycho-social-spiritual’ lens. Citing various international and national polices, programmes and reports, it holistically covers both challenges (converting new knowledge into practice) as well as new opportunities (greater scope for work, wider impact) for professional social workers in India. This chapter emphasises the significance of engaging with individuals, families, communities and the Government, on mental health and analyses implications of these developments for the profession of social work. Recognising social work as a speciality and social workers as a professional group having a special position in India towards mental health and well-being of the population, the chapter envisions the scope for action by social workers in the field of mental health in India.
India was one of the first developing countries to launch its National Mental Health Programme in 1982. There have been many changes with key pillars being District Mental Health Programme, Mental Health Policy, Mental Health Care Act and recent integration of mental health services in Ayushmann Bharat. The burden of mental health illnesses continues to grow with significant impacts on the social, economic and basic human rights. Mental Health disorders contribute significantly in morbidity, disability and even mortality among affected. As we near the 40-year anniversary of the programme next year, National Mental Health Programme needs to be critically analysed in terms of its success, failures, experiences and lessons learnt, so as to further strengthen mental health services in our country to cope up with the ever-rising burden of mental health illnesses in our country.
Purpose
This paper aims to explore the value that care from a primary mental health care nurse (PMHCN) can bring to people with mental health (MH) problems in health-care delivery.
Design/methodology/approach
This study used a focus group of 20 PMHCNs working in primary care (PC) health settings in Saudi Arabia before using thematic content analysis to describe and explore their views and experiences of the integration of MH care into PC units. The researchers used a semi-structured interview format, which began with open-ended probes and proceeded to use of theoretical sampling based on emerging data related to their experiences and perceptions in the integration process.
Findings
Four main themes were derived from the thematic analysis of interviews: collaboration, knowledge and experience, awareness and orientation care and influential role.
Research limitations/implications
This study’s use of qualitative research methods has certain limitations, including the small sample size of 20 participants, which means that it may not be representative of all primary MH nurses in primary health-care centers in Saudi Arabia. To make the results applicable to a broader audience, the researcher sought to moderate this limitation by including participants with extensive experience in multiple settings and nurses of different ages.
Practical implications
The cost implications of the PMHCN service are not yet comprehensively understood, but it is apparent that this model is not only regarded extremely positively by MH practitioners but may also have significant benefits in terms of patient outcomes. The configuration of local services and relevant patient demographics will affect the extent to which this study’s findings are transferable. Meanwhile, further research in this area could seek to provide further evidence about the aspects of the PMHCN service model, such as secondary care referrals and waiting times, accident and emergency attendances and patient recovery rates and the impact of providing such a service on health-care practitioners as well as its cost-effectiveness.
Originality/value
This study’s findings suggest that PMHCNs believe that their care improves the quality of PC for patients in PC settings. Elements of the PC placement that professionals particularly valued include their ability to assist patients in their own community and the inclusion of volunteer stakeholders who act as preceptors. The participants expressed a need for improvement of policy related to referrals within the clinics.
This article explores the African Mental Health Action Group (AMHAG), one of the earliest examples of the World Health Organization’s (WHO) attempts to promote ‘ownership’ over development through the South–South cooperation envisaged in Technical Cooperation in Developing Countries. Formed in 1978, the AMHAG was intended to guide national and regional policy on mental health, while also fostering national and collective self-reliance. For a short period, between the late 1970s and the early 1990s, it was central to the WHO’s strategy for promoting policies of mental health in primary healthcare in Africa. It was a largely ineffective tool, with national governments having different opinions on the value of mental health, and poor coordination between AMHAG countries. Approaching the AMHAG as a regional project and transnational network, however, the article provides explores the importance of regions and regionalism in international health cooperation, as well as the inequities of participation in health development. Drawing on WHO archival material spanning over twenty countries and two national liberation movements, it argues that participating countries were differently positioned not only to navigate relationships between countries, but also to contend with the shifting landscape of international assistance, as well as – for some – contexts of war, violence and political and economic instability. The article not only serves as a case study of power imbalances in a failed development initiative, but also sheds light on the WHO’s engagement with mental health during a period that historians of psychiatry in Africa have tended to overlook.
The importance of national therapeutic strategies for the treatment of sub-threshold depressive disorders - Volume 8 Issue 5 - Y Lecrubier
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