The
purpose of this two-week forum is to identify problems in mental health
care and share information and experiences to come up with innovative
solutions to the problems.
Discussion
Statistics
Number of participants: 615
Number of participants' countries: 80
Number of contributions: 174
% of contributions from developing countries: 55%
Number of countries contributing: 21 countries
Contributing countries:
Australia, Bangladesh, Belgium, Cambodia, Canada, China, Colombia, El
Salvador, Ethiopia, Jordan, India, Indonesia, Kenya, Lebanon, Mongolia,
the Netherlands, New Zealand, Swaziland, South Africa, US, and the UK
Purpose
and Objectives
The purpose of this two-week forum is to identify problems in mental
health care and share information and experiences to come up with
innovative solutions to the problems.
Week 1 , Day 1. Advocating for
mental health care and the role of nurses in mental health care
Questions:
- How can we advocate for improved mental health care in low
and middle income countries?
- What are the limitations that
make it more difficult for doctors and nurses to provide appropriate
mental health care in low and middle income countries?
- What has been done and what could be done to improve this?
- What roles can nurses play in mental health care, which are
at present denied to them?
Summary:
Our first day of discussion was active with 25 contributions from 17
participants on the discussion board. Representatives from the
following locations were active in today's discussion: Australia,
Bangladesh, Cambodia, Colombia, El Salvador, India, Swaziland, US, and
the UK. These represent most but not all of the WHO regions. Topics
covered in this day's discussion include – roles of mental health
nurses, education and curricula, and barriers to care.
Full
text daily digest
Full
text daily digest addendum
Week 1, Day 2 :
Questions:
We continued to have an active discussion with 22 contributions from 20
participants on the discussion board. Representatives from the
following locations were active in today's discussion: Australia,
Belgium, China, Ethiopia, Jordan, Kenya, Lebanon, Mongolia, the
Netherlands, New Zealand, the UK, and the US. Guest experts responded
to participant contributions and topics included roles of mental health
nurses, education and curriculum, and barriers to care.
Full
text daily digest
Week 1, Day 3
Summary:
We continued to have a very active and thought provoking discussion
with 21 contributions from the following locations: Australia,
Bangladesh, Canada, Ethiopia, Kenya, New Zealand, South Africa, and the
US. The consensus of the group is that we need a drastic change to
improve mental health care. Jane Mahoney poses the thought-provoking
question: "How do we negotiate with others who are not like-minded
about this topic to co-construct an improved social view of mental
illness? How do we create a “social epidemic” for mental health
advocacy?" touches the core of the problem of stigma and mental illness
and challenges us to create a “social epidemic” for mental health
advocacy. Guest expert Dr. Tesfamicael Ghebrehiwet responds to this and
other participant contributions.
Full
text daily digest
Week 1, Day 4
Summary:
Do you consider diaphragms a cost-effective method of
family planning? Why or why not? Do you see a role for them in the
method mix in the country programs you are aware of?
What else could be done to achieve renewed interest in
diaphragms in countries where providers do not know about diaphragms
and few women currently use them?
What is needed to attract the interest of donor agencies or
governments in scaling-up the diaphragm as part of family planning
programs?
Last year, results from a large multi site study (called
the MIRA study) were released indicating no significant increase in
protection against HIV infection when the diaphragm was added to a
comprehensive HIV prevention program (i.e. comprehensive counseling and
condom provision). Have these results affected your opinion or the
opinions of others in your country about role of diaphragms for
protecting women’s health?
Work is underway to evaluate diaphragms as a delivery
system for a microbicide. Do you think using diaphragms as a
microbicide delivery system will help or hinder future introduction and
promotion of the diaphragm?
Do you see a stronger role for diaphragms in family
planning or HIV prevention programs in the future? Why?
Full
text daily digest
Week 1, Day 5
Summary:
As the first week of discussion has come to an end we are noticing the
community is proposing incredibly thought provoking questions. We are
also pleased at the increase in contributions which include suggestions
and solutions to problems. Today’s digest includes comments on the
response to the call of action, rights to prescribing medications,
mental health and substance abuse, and personal experiences.
Full
text daily digest
Week 2 : Training programs for doctors and nurses in mental
health
Questions:
- What are the examples of nurses providing effective mental
health care in low resource settings?
- Are there innovative training programmes for doctors and
nurses to give them the needed knowledge and skills for mental health
care?
- Should nurses be allowed to prescribe/continue the
prescription of psychotropic medicines especially in countries where
there are very few doctors and psychiatrists?
Week 2, Day 1
Summary:
We are thrilled with the response we have received following Dr.
Saxena's "Call to Action." We received 16 contributions from the
following countries: Australia, Ethiopia, Ghana, Indonesia, Ireland,
Jamaica, Nigeria, Panama, South Africa, UK, US, and Zambia. We have
received many emails from members noting that our colleagues from low
and middle income countries often do not have the means to communicate
with us. We are calling on those of you who have worked closely with
these more remote communities to be the voice of your colleagues. Share
what you have learned from them with us.
Full
text daily digest
Week 2, Day 2
Summary:
Week 2 began with an incredible response from the community. We
received 24 contributions from members residing in Australia, Brazil,
Ethiopia, Ghana, India, Iran, and US. Participants talked more about
prescribing rights and described innovative training programs in
several countries.
Full
text daily digest
Week 2, Day 3
Summary:
Contributions on Day 4 came from Australia, Ethiopia, India, the UK and
the US. I wish to thank you - today’s contributors - for sharing
innovative practices in mental health care. These experiences are
valuable and helpful to the 500 members of this Community who are
continuously seeking ways of providing better care to patients with
mental health problems and their families. The comments from today fall
into four categories; effective care in low resource settings,
prescribing rights, education, and policy.
Full
text daily digest
Week 2, Day 4
Summary:
We continued to have an active discussion this weekend with 13
contributions from the following countries: Brazil, Canada, India, New
Zealand, Panama, South Africa, Tanzania, and Zambia. We received
messages about mental health programs in Brazil, Canada, and New
Zealand and one participant posted a message about the importance of
nurses in research.
Full
text daily digest
Week 2, Day 5
Summary:
Our last day of discussion included 8 contributions from Ethiopia,
Spain, the US and Zambia. One participant discussed the role of primary
health care providers in regards to mental health. Other participants
shared success stories and challenges in mental health programs.
Full
text daily digest
Program Examples
NIGERIA.
Julian Eaton from Nigeria shares the in-country experience of
developing community mental health services in Nigeria. I have been
working to develop community mental health services in Nigeria for the
last 4 years, and have found the Community Psychiatric Nurse to be the
central figure in establishing practical services that work. We found
that providing some training in mental health to Primary Health Centre
(general) nurses did not result in them delivering care to many clients
with mental health problems. They were unable to gain adequate skills,
and they did not prioritize mental health in their busy schedules. Only
by having a dedicated nurse and investing in developing village-based
community health workers (volunteers) did we start to really find the
people we knew had need in the community. The main issues in keeping
the quality of service high has been to provide regular supervision and
training, providing transport (motorcycles) for community work, and to
run the Drug Revolving Fund (DRF) ourselves (i.e. a Nigerian NGO
partner). This may be a uniquely Nigerian factor (where many drugs on
the open market are fake and DRFs run in government always collapse).
JAMAICA. Donnahae Rhoden-Salmon from Jamaica shares the background
behind the success of Jamaica's mental health programme. Jamaica has
had a successful mental health programme despite a lack of resources.
This is due mainly to the following factors:
- The recruitment and training of committed individuals.
- The implementation of a community based mental health
programme.
- The establishment of a special unit dealing with mental
health in the ministry of health.
- The attempt by the government and other stakeholders to
destigmatize mental illness.
Community Mental Health was introduced to Jamaica in the 1960s. Its
main focus was prevention. This includes all forms of prevention
including primary, secondary and tertiary prevention. One of its
components was to train nurses to become mental health officers. These
persons would live in the community in which they serve and offer
advice and treatment to individuals affected by mental illness. They
would also conduct clinics usually under the supervision of a visiting
psychiatrist.
To ensure the success of programmes like these and to overcome
challenges, a concerted effort must be made by government and other
stakeholders to:
- Recruit committed individuals in these programmes for often
they have to work in substandard conditions.
- Ensure proper remuneration to staff members.
- Ensure suitable working conditions.
- Encourage the families to be a part of the care of their
family members.
- Steadfastly follow up all patients that come to the clinic.
- Maintain an efficient referral system.
- Initiate and maintain public education about mental illness.
- Expose members of staff to new forms of treatment including
medication if they have limited knowledge.
- Limit hospital stays for the care of the acute mentally ill
to not more than twenty eight days so that persons are not alienated
from their family members for a lengthy period of time.
- Provide some support to family members.
Number of
surveys completed 65
% who have
passed content to others 44%
% who have or
will use in their work 75%
% very
satisfied with forum content 72%
Suggestions
for improvement :
- Discuss further the effects of harmful effects of drug and
shock treatment as well as non-medical approaches to behaviors of the
mentally ill.
- Focus on the whole team of primary care professionals
providing mental health services rather than solely nurses.
- The forum needs to continue long term to produce real
effective results.
- Easier access to the discussion resources.
- Involve consumer groups.
- Localize topics by region of the participants.
- Longer duration of forum.
- More publicity and advertisement
References and resources
Click
here
for related resources and references in the community library
World Health Organization, Department of Mental Health and
Substance Abuse (WHO/MSD) and International Council of Nurses (ICN).
Contributing
experts/facilitators
Thomas Barrett, Senior Mental Health Consultant, Department of
Mental Health and Substance Abuse, WHO
Tesfamicael Ghebrehiwet, Consultant, Nursing & Health
Policy, International Council of Nurses
Margaret Grigg, Senior Nurse Advisor Mental Health Branch,
Department of Human Services, Melbourne, Australia
Shekhar Saxena, Coordinator Mental Health: Evidence and
Research, WHO
Jean Yan, Chief Scientist for Nursing and Midwifery, WHO
Moderators
Christina Fusco RN, MSN, FNP-BC, MPH
