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Mental Health without Borders Martin Prince Centre for Public Mental Health

Mental Health without Borders Martin Prince Centre for Public Mental Health Institute of Psychiatry, King’s College London martin.prince@kcl.ac.uk. GMH Research in HSPRD (since 2000). 23 research grants 157 papers in international peer-reviewed journals

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Mental Health without Borders Martin Prince Centre for Public Mental Health

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  1. Mental Health without Borders Martin Prince Centre for Public Mental Health Institute of Psychiatry, King’s College Londonmartin.prince@kcl.ac.uk

  2. GMH Research in HSPRD (since 2000) • 23 research grants • 157 papers in international peer-reviewed journals • One MRC, three CAFOD and 18 Wellcome Trust studentships • sponsoring research in seven Latin American countries, China, India, Sri Lanka, Thailand, Moldova, Brazil, Ghana and Ethiopia • Joint study unit and short course in ‘International Mental Health’

  3. Established priorities Mental Health Child health • Infant mortality • Nutrition/ Growth/ Development Reproductive health • Fertility • Pregnancy • HIV/ AIDS Infectious disease • Control and eradication of communicable diseases • TB • Malaria Mental Health Mental Health

  4. MDG 6 – combat HIV, malaria and other diseases (HIV/ AIDS) Risk factor for infection? • Mental disorders increase susceptibility for infection • High seroprevalence among those with psychosis (3-7%) • 10-20% infected through intravenous drug use Comorbidity • High prevalence of depression, anxiety and cognitive impairment Impact of comorbidity • Reduced adherence to ART • Faster disease progression and increased mortality Prince et al Lancet 2007

  5. UMEED study – Goa, India: Mental health and engagement with HIV services Design • Cohort study of 2000 consecutive attendees at a voluntary testing and counselling centre Comorbidity? • Association between HIV status and mental health, cognitive impairment and alcohol and substance use prior to formal diagnosis Impact? • Are MI, CI and ASUD associated with • Non-attendance for post-test counselling • Delayed uptake of ART referral

  6. Preliminary Analysis HIV-VE n=869 87% HIV+VE n=130 13% CMD n=168 19% CI n=51 6% CMD n=37 28% CI n=16 13%

  7. Maternal and Child Health (Ethiopia and Ghana) • Two large cohort studies, both nested in demographic surveillance sites • Ethnographic research, and validation of MH assessments • Effects of maternal depression on • infant health, growth and development, • infant mortality • maternal mortality and morbidity

  8. 10/66 Dementia Research Group 10/66 aims to provide a detailed evidence–base to contribute to the improvement of the health and social welfare of older people in low and middle income countries … www.alz.co.uk/1066

  9. People on the Move – research into the consequences of displacement and migration in AsiaMelanie Abas, Samanthika EkanayakeTawanchai JirapramukpitakCraig Morgan, Martin PrinceRob StewartJianmin ZhangCentre for Public Mental Health, IoP, King’s College London

  10. The Lancet Global Mental Health Series • No health without mental health • Scarcity, inequity inefficiency • Evidence base for mental health interventions • Resources for mental health care • Barriers to progress • A Call for Action

  11. The new Centre for Global Mental Health (KHP AHSC and LSHTM) • 51 academics • 23 current PhD students • An established GMH research portfolio • Planned new MSc in Global Mental Health • Strategic focus on service evaluation • Promoting the new discipline of GMH

  12. What research is needed? • to develop and evaluate interventions for people with mental disorders to be delivered by non-mental health professionals, • to evaluate how health systems can scale up feasible and effective interventions across all routine care settings • PACKAGES -> PROGRAMMES • HORIZONTAL INTEGRATION

  13. The WHO Mental Health Global Action Plan • Increasing the coverage of evidence-based community interventions in low and middle income countries • Seven priority areas – depression, psychosis, epilepsy, dementia, child and adolescent disorders, alcohol use, suicide • Development of evidence-based practice guidelines for non-specialists in LAMIC • Implementation • Evaluation!!!!

  14. Implementation science – e.g. constructing a district community mental health service Regional hospital (n = 1 million) District hospital (n = 250,000) Health Centre (n = 25,000) HP HP HP HP HP Existing mental health provision (in some regions)

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