Health-e (Cape Town)

9 October 2012

Africa: Grand Challenges Canada Tackles Mental Health in the Developing World

Photo: IPS
Mental health issues often leads to isolation.

press release

Grand Challenges Canada, which is funded by the Government of Canada, announced a landmark $19.4 million in support of 15 innovative, pioneering projects designed to improve mental health diagnosis and care in developing countries, many of them nations ravaged by conflict and disaster as well as poverty.

The projects were selected through competitive scientific peer review from among 97 ideas submitted in response to a Grand Challenge that focuses on increased access and improved treatment, and addresses stigma for people with mental health disorders in developing countries.

Globally, close to 450 million people have mental health disorders; more than 75 percent of that number live in developing countries. In addition, according to the World Health Organisation, 85 percent of developing world patients with serious mental disorders receive no treatment at all.

"Mental health disorders are a leading cause of suffering and disability everywhere, but the problem is especially acute in the developing world," said Dr Peter A. Singer, Chief Executive Officer of Grand Challenges Canada. "There is very little funding for mental health innovations in low- and middle-income countries, where mental illness is the most neglected of many neglected diseases. It's a terrible denial of human potential."

"Canada has a long and proud tradition of fostering innovation to improve the lives of people living in some of the most desperate situations," said the Honourable Jim Flaherty, Minister of Finance for Canada. "Global Mental Health is a significant challenge which, left unaddressed, could undermine the health, social and economic futures of developing countries."

Fifteen projects in 14 low- and middle-income countries will test bold new ideas for addressing mental health issues, where patients are often severely stigmatised – even chained or locked up in the absence of understanding or care.

Afghanistan has suffered through 30 years of conflict in the recent past. Over one million people have been killed; one million are disabled and millions of others are refugees. Most Afghan families have lost one or more family members during the conflict. As a result, it is estimated that about 50 percent of Afghanis over 15 years of age are suffering from mental health problems – depression, anxiety or post-traumatic stress disorder. Outside of Kabul, there is no mental health care system. The Grand Challenges Canada grant will help support improved awareness of mental health problems in rural areas through simple technologies, such as text messages and information technology, including web-based tools, and teleconferencing to enable community health practitioners to reach patients in need, especially young people.

Haiti, the poorest country in the Western Hemisphere, was traumatised by the 2010 earthquake that killed as many as 316 000 people, injured 300 000 and left 1.6 million homeless. Almost every person in this small country was affected. Later that same year, there was more misery when a cholera outbreak struck. As a result, it is estimated there is a high prevalence of mental health conditions in Haiti, yet mental health services are limited and of poor quality. With the support of Grand Challenges Canada, local health care organisation Zanmi Lasante will increase treatment and care to Haitians through developing and testing culturally appropriate initiatives for community health workers to implement.

Ethiopia. Der biaber anbessa yaser is an Amharic saying meaning, "Together, a spider web will tie a lion." Dr Clare Pain of Toronto and Dr Dawit Wondimagegn of Ethiopia are leading the Biaber project, which plans to help tame the lion of mental illness in Ethiopia. One contributing factor to mental health disorders is domestic violence which, according to a recent study, occurs in 72 percent of rural Ethiopian families. The violence can lead to depression, anxiety and suicide; furthermore, those who suffer are often severely stigmatised. This project will test improved screening for mental health disorders and make treatments available to many who previously could not access care.

Nigeria. As many as 25 percent of patients seen in local health centres suffer significant depression symptoms, yet few are diagnosed and only about one in six of those diagnosed get treatment of any kind – lower than the African average of 30 percent. Depression has a major impact on productivity and mortality, and compounds other health problems. Researchers will test low-cost innovations to improve recognition and diagnosis of the problem, improve patient adherence to treatment, and make interventions for depression more available and accessible with decentralised mental health services.

"Canada is to be congratulated for its bold new initiative to improve global mental health," said Dr Shekhar Saxena, Director of the Department of Mental Health and Substance Abuse at the World Health Organisation. "This area of health often remains ignored in health planning and resource allocation; for example, most low-income countries currently spend less than 25 cents US per person on mental health. Grand Challenges Canada is now making one of the largest ever investments in mental health innovations in the developing world, so WHO is very pleased indeed to support the initiative and help to ensure the most effective utilisation of these vital investments."

"These bold ideas will bring hope to so many who suffer from mental disorders in the developing world," said Dr Pamela Kanellis, Programme Officer for Grand Challenges Canada. "Each of the projects underscores the importance of innovation to making mental health care available in low- and middle-income countries, which are so desperately underserved and where stigma can result in people being locked up, even kept in chains, not receiving the care that they need. These projects will have a significant impact on the mental well-being of individuals, their families and their communities."

"Grand Challenges Canada is taking a global leadership position by funding innovation to address mental health disorders in the developing world. The $19.4 million we are putting into these projects is the largest single investment in global mental health innovation for this sadly under-resourced area of health," said Dr Abdallah S. Daar, Chief Science and Ethics Officer at Grand Challenges Canada and co-leader of a defining study, "Grand Challenges in Global Mental Health", published in Nature in 2011. http://grandchallengesgmh.nimh.nih.gov/Grand%20Challenges%20in%20Global%20Mental%20Health.pdf

Projects will be conducted in the following countries (some are in more than one country):

Africa: Nigeria (three projects), Kenya (two projects), Zimbabwe, Ethiopia, Malawi, Zambia, Uganda (two projects)

Asia: Afghanistan, Pakistan, Nepal, Sri Lanka

Latin America and Caribbean: Haiti, Belize, Guyana

The projects include a wide array of mental health innovations, which include:

1) Using cell phones, care for Nigerian women suffering from perinatal depression

2) Promoting mental health in Kenyan children

3) Training non-specialist workers in Nigeria to increase the availability of care for people suffering from depression

4) In Pakistan, improving care for children with autism and intellectual disability

5) Identifying and treating people with dementia in Nigeria and Sub-Saharan Africa

6) In Zimbabwe, counselling depressed and anxious patients on the "Friendship Bench"

7) Identifying and treating problem drinking in Belize and Guyana

8) In Ethiopia, spotting and encouraging treatment for domestic violence and mental disorders

9) Addressing youth depression in Malawi and Zambia

10) Treating severe post-war mental disorders in Uganda, Liberia and Nepal

11) Screening for alcohol and substance abuse in Kenya

12) Using local health networks and telemedicine to help Afghans with mental health challenges, estimated at 50 percent of the population over 15 years old

13) In post-conflict northern Uganda, bridging the traditional and modern approaches to treating mental health problems

14) In Haiti, bringing mental health treatment to rural Haitians to speed recovery from the 2010 earthquake

15) In Sri Lanka, expanding global access to online mental health care.

For more information about the 15 projects, click here. http://www.grandchallenges.ca/globalmentalhealth-grantees-en/

Grand Challenges Canada is funded by the Government of Canada through the Development Innovation Fund announced in the 2008 Federal Budget.

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