Tips to get mental health programs right

CANBERRA — Mental health continues to play too small a role in development programs and assistance, according to Dr. Julian Eaton, a senior mental health adviser for CBM. But how can donors and development organizations begin supporting better mental health services in developing countries? We have Eaton’s tips to shift development programs in the right direction. 1. Invest money. Insufficient funding is the single biggest barrier to achieving nationwide transformation of mental health support in developing countries. Mental health is often allocated a minute proportion of overall health budgets — both within developing countries and through development assistance. “Money really counts,” Eaton said. “To date, the struggle has been going from what we can afford — piloting or doing work in one part of the country — to scaling up, which demands substantial government commitment and investment or really big international commitment and investment at the country level. And to date, there just has not been the case.” Increasing a focus on mental health within budgets and programming will create more opportunities for larger, bigger, and more impactful mental health programs — including building the capacity of a mental health workforce. “Money will really help, but it hasn’t been available.” 2. Build advocates — especially within government. “Making people recognize that this is a common issue for many people” is key, Eaton explained. “People change their minds when they have a brother, a sister or a child with a particular problem.” If the sister of a minister for health within a country died of cancer, this would result in a national cancer campaign. For mental health, building similar personal connections needs to happen. “In Sierra Leone, we had a huge jump and success in advocacy when a new president came in whose wife was a psychiatric nurse,” Eaton said. “She really supported us in a way that we have never had before. There was a personal link and recognition that stigma is a real issue.” Eaton said bringing the issues of mental health home are important in creating change and building demand in developing countries. But there is still social stigma to address. “If someone’s brother has schizophrenia and is in hospital or locked up at home, it is a family embarrassment. We do have that problem to overcome.” 3. Ensure the people making decisions on national health hear about mental health. Building demand in developing countries also requires outside encouragement — and the more a minister for health goes to international meetings and hears “mental health,” the better, according to Eaton. The Sustainable Development Goals, he said, have been important in helping to create this external momentum for mental health. “It is generally becoming much easier for us to be writing policy briefs and engaging with governments who take the SDGs seriously in various areas where mental health has been identified as an important contributor to development,” Eaton said. And by hearing it more often at international forums — including from the World Health Organization, development players can build strong awareness as well as well as the case for improved mental health supports within their health systems. 4. Empower local advocates. Just as leaders need to be empowered with information to change approaches to mental health, so do communities. For many people, community groups can be an avenue to information on support and community health care workers can be the frontline for mental health support. “Community groups are very important,” Eaton said. “Just providing mental health services, even at primary care, even affordable is not enough. People don’t seek them out to use them. They do gradually grow as word of mouth, but you need to engage.” Expanding the capacity of health care workers in communities to go beyond maternal health and vaccinations to support mental health is an important avenue into communities — and to identify people in need. Religious channels can be particularly important in some countries where mental health problems are mixed up with spirituality, or even considered curses or possession at the more severe end. Building awareness within these networks of mental health issues and how sufferers can be supported is critical. “They do some good things, and they do some harm,” Eaton said. “So there is definitely important work in educating pastors, ministers, and imams around mental health to help them make the right decisions around where they should be providing support and where they need to refer people.” Other informal social networks, including groups for women, youth groups, farmers, unions, and schools are also important avenues to building awareness and encourage mental health resilience. And any organization working in communities can assist in building this local capacity. 5. Support campaigns. Campaigns such as World Mental Health Day help build awareness of mental health and help to reduce social stigma. Supporting these campaigns, Eaton said, is an easy and important way to help. “What typically tends to happen is that these campaigns create a lot of demand,” he said “People who are untreated come out quickly or are identified among communities. There is an increasing evidence base on how to engage communities to support campaigns and the outcomes they achieve.” 6. Help break down the barriers. Social stigma toward people with mental health is the greatest barrier to better support in developing countries. And any work that helps break down these barriers is essential support. “What is difficult is the profound changes we need to make in making communities more accepting of people with mental health,” Eaton said. “This is a field that is not about an ill person getting better — it is about a recovering journey, probably with symptoms and a continuing struggle in some periods. So it is very important that communities are accepting of them. And that they can go back to their job when they get better and any family that they want to marry into doesn’t completely reject the idea because of mental illness.” “But behavioral changes are very difficult, and we need support to achieve this.”