REDUCING THE TREATMENT GAP IN MENTAL HEALTH IN SUB-SAHARAN AFRICA: THE NEED TO RE-THINK THE STRATEGY

BY:

DAVID M. NDETEI Professor of Psychiatry

University of Nairobi, Kenya &

Director, Africa Mental Health Foundation (AMHF)

Mental disorders are a leading cause of disability globally representing 14% of the global burden of disease.

Of those 450 million people afflicted, more than 75% live in the developing world. Most do not receive care.

In a recent survey, the World Health Organization found up to 85% of patients in low mid-income countries with serious mental disorders did not receive any treatment in

the past year of their illness.

According to the WHO, there “can be no health without mental health.”

Mental health disorders make the largest contribution to the overall burden of non-communicable diseases, surpassing both cardiovascular disease and cancer.

Moreover, mental health disorders are risk factors for both:

1) communicable e.g.: - HIV/AIDS, malaria, tuberculosis)

2) non-communicable diseases e.g., cardiovascular disease and cancer

and are a leading cause of disability globally.

Mental illnesses are also associated with, and are risk factors for, other diseases such as HIV/AIDS, malaria, cardiovascular disease and cancer.

Integrated Innovations in Global Mental Health should involve social, scientific, and business researchers for significantly improved treatment and increased access to care for patients with mental disorders in low- and middle-income countries.

The strategy is to get solutions to those who need them most, quickly, effectively and at a low cost.”

Objective is to achieve scale and sustainability;

Mental health resources are extremely scarce in low- and middle-income countries: investment in mental health for many of these countries represents less than 1% of the total health budget

Given the shortages in trained mental health professionals (e.g., psychiatrists, clinical psychologists, psychiatric nurses, and social workers), few hospitals and clinics, accessibility of effective medications and evidence-based interventions, and the associated stigma faced by individuals with mental disorders and their families seeking treatment and care in low- and middle-income countries; there is a tremendous opportunity for new and innovative solutions to address this current gap.

Research aimed at ‘closing the treatment gap’ which exceeds 75% for most disorders in most parts of India

Range of mental disorders across the life course, from autism in childhood; depression, schizophrenia and alcohol abuse in young people and adults; and dementia in older people

Within routine health care systems

The barrier of human resourcesMental health resources in the UK

60 million people10,000 psychiatrists

Mental health resources in India 1.1 billion people3000 psychiatrists

Mental health resources in Kenya40 million people80 psychiatrists

Closing the human resource gap through task-shifting or task-sharing with community or lay health workers

DEVELOPED e.g. UK VS. DEVELOPING e.g. KENYA COUNTRIES DEVELOPED DEVELOPING Treatment gap 30-35% 75-85% Psychiatrists 10,000 for 60 million

(UK as an example) and still needs more

80 for 40 million – The country with the largest number of Psychiatrists South of Sahara and outside South Africa

Psychiatrist; population 1:6,000 1:500,000 i.e. 84 times worse off compared with UK

Reduction gap required to achieve 30%

0% 50%

Reduction gap required to achieve 0

30% 85%

Therefore it is unlikely that we will ever catch up with West for a very long time if we blindly copy and paste the Western model

WHO ARE THE STAKEHOLDERS?

Every citizen, especially in the areas of stigma

All the health delivery systems that exist – These include

both Formal and Informal

WE NEED TO SIGNIFICANTLY REDUCE THE GAP IN THE NEXT 10 YEARS: IS IT POSSIBLE?

1) NO - If we are not innovative; if we believe training more psychiatrists is the only solution e.g. In Kenya we have steadily trained psychiatrists including for the region since 1983. For the last 10 years despite increased efforts to train psychiatrists for Kenya the ratio has remained on average 1:500,000 and nearly all of them are in urban settings.

2) YES If we are innovative enough to mobilize all the resources at our disposal

If we accept that properly shifted and supervised skills can create “hands” that can be as good as those in the hands of the people with the theory

Professors of obstetrics and gynecology are not necessarily the best midwives neither are the doctors the best phlebotomists neither must you recite or even remember the Krebs cycle to be a good clinician. Why is it then psychiatrists are preoccupied with territorial protection against all the evidence??!!

If only we would move from the mind set of “territorial protection” to “commonly owned territories”; complement each other without displacing each other, focus on building whatever is positive and work on minimizing whatever divides us.

If only we could embrace the concept of global mental health bottom-up, starting from the local communities and resources all the way to all nations working together

YES – WE CAN!!!

THANK YOU ALL

FOR YOUR ATTENTION!!!