NEW DELHI, INDIA / 10 – 12 APRIL 2015 Meeting of the Field Studies Coordination Group Progress of...

NEW DELHI, INDIA / 10 – 12 APRIL 2015

Meeting of the Field Studies Coordination Group

Progress of ICD-11 Development since September 2014 Meeting

Geoffrey M. ReedDEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE

Field Studies Coordination Group 10 – 12 April 2015

• Countries agree to use the ICD as a framework for health information and reporting: To monitor epidemics/threats to public

health/disease burden To assess progress toward meeting public

health objectives To define obligations of WHO Member States

to provide free or subsidized health care to their populations

To facilitate access to appropriate health care services

As a basis for guidelines for care and standards of practice

To facilitate research into more effective treatments and prevention strategies

Why is the ICD part of WHO’s core constitutional responsibilities and why do countries use it?

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• The mandate of the ICD is a pragmatic one, based on public health and clinical objectives

• Based on the best evidence that we have available today, what health categories should the world’s global health authority tell its Member States are important to track as a basis for public health reporting and as a basis for structuring clinical care?

• How should those categories be defined and operationalized?

In other words . . .

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Public Health Considerations

ICD-11 MENTAL AND BEHAVIOURAL DISORDERS

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• Neuropsychiatric disorders account for 12.3% of total disease burden

• Mental and substance use disorders responsible for loss of 184 million disability-adjusted life years (DALYs) worldwide in 2010

• They are the leading cause of disability, in terms of years of life-lived with disability (YLDs)

Global Burden of Disease Study (2010); Whiteford et al, (2013)

Mental Health in a Global Context

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Global Causes of Disability

GBD, 2010

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• Disproportionately high rates of mortality

– Cardiovascular disease

– Metabolic diseases

– Respiratory diseases

• Mortality rates are 2 – 2.5 times higher than general population

• Life expectancy is 10 – 25 years less

• Behaviour factors, and also intervention factors

Health of People with Schizophrenia and other Severe Mental Disorders - I

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Physical health disparities [among people with schizophrenia and other severe mental disorders] have rightfully been stated as contravening international conventions for the 'right to health’

WORLD HEALTH ORGANIZATION, 2014

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Adopted by the World Health Assembly in May 2013

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• To promote mental well-being, prevent mental disorders, provide care, enhance recovery, promote human rights and reduce the mortality, morbidity and disability for persons with mental disorders.

Goal

Time frame

2013 to 2020

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1. To strengthen effective leadership and governance for mental health

2. To provide comprehensive, integrated and responsive mental health and social care services in community-based settings

3. To implement strategies for promotion and prevention in mental health

4. To strengthen information systems, evidence and research for mental health

Objectives

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Field Studies Coordination Group 10 – 12 April 2015 12


Why does the ICD matter?

People are only likely to have access to the most appropriate mental heath services when the conditions that define identification, eligibility and treatment selection are supported by a precise, valid and clinically useful classification system. INTERNATIONAL ADVISORY GROUP FOR THE REVISION

OF ICD-10 MENTAL AND BEHAVIOURAL DISORDERS, WORLD PSYCHIATRY, 2011

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• To provide WHO Member States with better tool to help them reduce the disease burden of mental and behavioural disorders

• To provide health professionals with better tools for identifying people in need of mental health services and which treatments are most likely to be effective, at the point at which they are most likely to encounter opportunities for care.

Most important aims of ICD-11 MBD

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Scarcity of Human Resources(N = 157 – 183 countries)

Low Income Lower Middle Income

Upper Middle Income

High Income0

5

10

15

20

25

30

35

0.051.05

2.70

10.50

0.04 0.601.80

14.00

0.04 0.281.50

15.70

0.161.05

5.35

32.95

Psychiatrists

Psychologists

Social Workers

Psychiatric Nurses

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Does one size fit all?

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• Statistical version of ICD-11 contains hierarchical structure, category names, code numbers, brief definitions, inclusion and exclusion terms; mostly complete for MBD, available on ICD-11 beta platform

• Current focus is on Clinical Descriptions and Diagnostic Guidelines (CDDG), intended for use in clinical settings by global mental health professionals

• Primary care version being developed simultaneously, for use by a broad range of global primary care professionals

• Research version to be developed later; currently in discussions with relevant parties to formulate work plan

Current focus of development

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• The ideal: scientific validity and clinical utility

• At present, neuroscience and genetics evidence is limited in its ability to support support major changes for individual conditions or a specific classification structure

• Where evidence exists, should be considered

• WHO views current revision as major opportunity to improve clinical utility of the diagnostic manual

• Field studies of ICD-11 Mental and Behavioural Disorders guidelines focus on:

1. Diagnostic consistency

2. Clinical utility

CDDG: Focus on clinical utility

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• Health encounters are the source of aggregated health information that provide a basis for health policy decisions at system, national, and global levels

• Health classifications are the interface between health encounters and health information

• A classification that is too cumbersome to use at the encounter level or does not provide clinically useful information will not be used, and can’t provide valid data for health policy and decision-making

• Opportunities for practice improvement will be lost

Why does clinical utility matter?

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• WHO International Advisory Group and all WHO Working Groups include representation of all WHO global regions and high proportion of representatives from low- and middle-income countries

• All ICD-11 field studies are multidisciplinary and multilingual

– Case controlled studies in Chinese, English, French, Japanese, Russian, Spanish

– Capacity for Arabic, German, Portuguese for ecological implementation (clinic-based studies)

Global applicability

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TO REGISTER IN 9 LANGUAGES, VISIT:

www.globalclinicalpractice.net

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CURRENT ENROLLMENT AND CHARACTERISTICS

Global Clinical Practice Network

http://www.globalclinicalpractice.net/


11,707 GCPN Registrants from 139 Countries

(As of 1 March 2015)Americas North: 1,636

South & Central: 1,223

Europe4,302

Africa242

Eastern Mediterranean

361

Southeast Asia573

Western Pacific Asia: 2,980Oceania: 331

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Global Registrants:Distribution by Country Income Level

High62%

Upper-middle29%

Lower-middle8%

Low1%


AFRO AMRO EMRO EURO SEARO WPRO0%

5%

10%

15%

20%

25%

30%

35%

40%

2%

25%

3%

37%

5%

28%

1%

13%

5%

37%

9%

34%GCPNMH ATLAS

Global Mental Health Professionals by Region

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Case-Controlled Field Studies:Current Status


• Brazil: Universidade Federal de São Paulo• China: Shanghai Mental Health Center • France: Etablissement Public de Santé Mental, Lille-

Métropole• Germany: Heinrich-Heine University, Düsseldorf • India: All India Institute of Medical Sciences • Japan: Tokyo Medical University • Lebanon: American University of Beirut • Mexico: Instituto Nacional de Psiquiatria• Nigeria: University of Ibadan• Russian Federation: Moscow Research Institute of

Psychiatry• Spain: Universidad Autónoma de Madrid• USA: University of Kansas• Data Coordinating Center: Columbia University

International Field Study Centres(Countries represent more than 50% of world’s population)

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• Evaluate clinical utility and usability of the proposed ICD-11 diagnostic guidelines in natural conditions, in the settings in which they are intended to be used

• Will also evaluate reliability of diagnoses that account for greatest proportion of disease burden and mental health services utilization

Ecological Implementation Field Studies

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• Identify areas of lower diagnostic agreement

• Identify specific diagnostic features that contribute to confusion

• Identify lack of clarity regarding diagnostic threshold and specific differential diagnoses

• Identify features that are and are not considered to be clinically useful

• Results across languages compared to identify cultural differences and translation issues

• Will lead to specific revisions in ICD-11 diagnostic guidelines as well as targeted educational programs

Use of Field Studies Results

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• Over 200 published articles related to development of ICD-11 Mental and Behavioural Disorders

• Includes publications in top journals in the field (e.g., Lancet, World Psychiatry)

• Focus on:

– Proposals for ICD-11; evidence and rationale

– Conceptual issue in ICD-11 development

– Results of formative fields testing

– Methodological issues for field testing

– Current focus on results of evaluative field testing

Scholarly output related to ICD-11 Mental and Behavioural Disorders


Work Plan

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