Global Mental Health and Wellbeing for All Updates, Applications,

Global Mental Health and Wellbeing for All Updates, Applications, Pathways Kelly O’Donnell, PsyD and Michèle Lewis O’Donnell, PsyD Consulting Psychologists, Member Care Associates, Inc. [email protected] http://membercareassociates.org Indigenous Mental Health Care Regent University, School of Psychology and Counseling 4 November 2021 2021 Kelly and Michèle O’Donnell

GMH and Wellbeing Vision “To put it simply, the state of the planet is broken." UN Secretary General António Guterres, 2 December 2020 “Ensure healthy lives and promote wellbeing for all at all ages” (SDG 3) and “promote mental health and wellbeing.” (SDG 3.4) “A world in which mental health is valued, promoted, and protected, mental disorders are prevented, and persons affected by these disorders are able to exercise the full range of human rights and to access high-quality, culturally appropriate health and social care in a timely way to promote recovery, all in order to attain the highest possible level of health and participate fully in society and at work free from stigmatization and discrimination.” Comprehensive Mental Health Action Plan 2013-2030

Member Care AssociatesGMH-Map Project A collaborative project to research, organize, and share important GMH resources. The project seeks to further orient those involved in the health fields and other sectors to GMH on behalf of wellbeing for all people and the planet. It has three parts: a website, publications, and training. See the GMH-Map website and the 10 GMH orientation articles (2011-2021).

Global Mental Health Defined Global Mental Health (GMH) is a growing domain of study, research, and practice that promotes equitable mental health and well-being for all --locally through globally. 4

Global Mental Health Defined GMH is international, interdisciplinary, culturally relevant and multi-sectoral. GMH emphasizes the right to equity in health and encourages healthy behaviors and lifestyles. GMH is committed to preventing and treating mental, neurological, and substance use conditions (MNS) especially for vulnerable populations such as those living in poverty, conflict, and trauma and in low- and middle-income countries. GMH seeks to improve policies and programs, professional practices and research, advocacy and awareness, and social, structural, systemic, and environmental factors that affect mental health and well-being. Based on O’Donnell, 2012 and O’Donnell, Eaton, and Lewis O’Donnell, 2021

New GMH Resources Global Mental Health: Collaborating for Sustainable Development and Wellbein g (April 2021). O’Donnell, K., Eaton, J., & Lewis O’Donnell, M. A revised version is in Behavioral Science in the Global Arena (in press). Information Age Publishing WHO (2021): Comprehensive Mental Health Action Plan 2013-2030 Mental Health Atlas 2020 See also: --GMH: Three Strategic Events (5-12 October 2021) --Pathways for GMH as Mission, Member Care Update (October 2021) --Mental Health for Sustainable Development: A Topic Guide for Development Professionals (2020)

GMH Overview: Updates, Applications, Pathways We have compiled the next 40 slides and notes to further orient colleagues in MH and across sectors to GMH in the context of Global Integration (a framework for actively and responsibly engaging in our world, locally through globally). These are some of the core materials from our GMH presentations at graduate MH training 7 programs and webinars.

Part One—GMH Overview Problems Despite the fact that there are hundreds of millions of people experiencing a mental, neurological, or substance use condition, the attention paid to these conditions has been scant historically. In high income countries only 35-50% of the people with severe mental disorders receive treatment, and in low-income countries the vast majority, typically 76-85%, receive little or no effective care (Mental Health Action Plan, WHO, 2013, p. 8). The extreme neglect, human rights abuse, and social exclusion of people with mental illness means that they could be seen as the epitome of people who are “left behind.” “People with these disorders are often subjected to social isolation, poor quality of life and increased mortality.” (WHO, Mental Health, The Bare Facts). O’Donnell and Eaton, 2017 See notes for more overview info/stats. 8

GMH--Progress Mental health and wellbeing of populations is a major global concern for the first time. But this did not happen by chance Major advocacy/awareness campaigns, research, networks, etc. Example: World MH Day 2021 Broader conceptualization of mental health: –social determinants –mental health continuum: wellbeing—illness; conditions/disorder –role of lived experience –scalable psychological interventions –delivered by supervised non-specialists –“integral element of the SDGs” ( Lancet Commission’s Report on GMH and Sustainable Development, 2018, page 1561) Global Mental Health: What’s Up? Recent Developments and Directions (June 2019) Global Insights, Office of International Affairs, APA (Full version here) 9

GMH--Critiques (GMH-Map website, Perspectives section) -From 'Invisible Problem' to Global Priority: The Inclusion of Mental He alth in the Sustainable Development Goals . China Mills. Development and Change, 49(3) (published on line 6 March 2018) -Primum Non Nocere. The Case for a Critical Approach to Global Menta l Health . Patrick Bracken, Joan Giller, and Derek Summerfield. Epidemiology and Psychiatric Sciences (December 2016) --Toward a New Architecture for Global Mental Health. 10 Laurence

GMH Resources Mental Health and Psychology Global Mental Health GMH Action Network, United for GMH Mental Health Innovation Network Movement for Global Mental Health UN IASC MHPSS Reference Group MHPSS Network WHO, Mental Health World Federation for Mental Health (World Metal Health Day, 10 October) International Psychology (overlapping with Global Psychology) International Union of Psychological Science American Psychological Association: --Office of International Affairs --Division 52: International Psychology International Council of Psychologists Psychology Coalition at the United Nations (Psychology Day at the UN, 15 April 2021) Global Network of Psychologists for Human Rights 11

Global Mental Health Defined Global Mental Health (GMH) is a growing domain of study, research, and practice that promotes equitable mental health and well-being for all --locally through globally and everything in-between. 12

Global Mental Health Defined GMH is international, interdisciplinary, culturally relevant and multi-sectoral. GMH emphasizes the right to equity in health and encourages healthy behaviors and lifestyles. GMH is committed to preventing and treating mental, neurological, and substance use conditions (MNS) especially for vulnerable populations such as those living in poverty, conflict, and trauma and in low- and middle-income countries. GMH seeks to improve policies and programs, professional practices and research, advocacy and awareness, and social, structural, systemic, and environmental factors that affect mental health and well-being. Based on O’Donnell, 2012 13

Do Task Shifting and Task Sharing --SUNDAR (beautiful) Vikram Patel Simplify message UNpack treatments (core components) Deliver where people are Affordable/available human resources Reallocation of specialists -- Mental Health for All and Involving All, TedTalk (September 2012) Vikram Patel “The Friendship Bench project is an evidence-based intervention developed in Zimbabwe to bridge the mental health treatment gap. Their mission is to enhance mental well-being and improve quality of life through the use of problem-solving therapy delivered by trained lay health workers. The Friendship Bench focuses on people who are suffering from common mental disorders, such as anxiety and depression. Produced by: Nicky Wimble, United For Global Mental Health” Video Counselling on Wheels Neem Foundation Nigeria (video link above, 2021) 14

Global Integration A grid to guide and a guide to goad A framework for actively and responsibly engaging in our world —locally through globally: by connecting relationally and contributing relevantly on behalf of human wellbeing and the issues facing humanity, in light of our integrity, commitments, and core values (e.g., ethical, humanitarian, human rights, faith-based). See: Global Integration Grid: GMH and Multi-Sectors, Global Integration Updates, Suggestions for Crossing Sectors, and Trio Gatherings for mutual learning/support. 15

In addition to knowledge/skills: build supportive relationships/friendships and maintain integrity! Be the people we need—Build the world we need.

Social Determinants: war, conflict, poverty, corruption, injustice, inequity, trauma, adverse childhood experiences, etc. Video: Living Peace: The Story of Abby and Kyalu Trauma and treatment in Democratic Republic of Congo, Promundo (watch the overview here) 17

Part Two--Going Further Additional UN/WHO/GMH Materials Global Integration Applications . 19

UN SDGs (see notes below) SDG 3 “Ensure healthy lives and promote well-being for all at all ages” There are three “Targets” under Goal 3 that have important implications for not just mental health but overall health and sustainable development themselves (the SDGs have 169 Targets and nearly 250 indicators): By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being (3.4) Note 3.4.2: suicide rate is an indicator. Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol (3.5) Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all (3.8). 20

“To put it simply, the state of the planet is broken." UN Secretary General António Guterres, 2 December 2020" Ten UN Priorities for 2021 UN Secretary General António Guterres, UN General Assembly (28 Jan. 2021) Source: UN Department of Global Communications, weekly newsletters, February 2021 21

World Health Organization Working with 194 Member States, six regions, 150 offices, 7000 staff Primary role: direct and coordinate international health within UN Support countries as they: coordinate the efforts of governments and partners and implement national health policies/strategies. See: Ten Global Health Trends to Track in 2021 WHO (December 2020) Example: 8. Prevent and treat NCDs and mental health conditions 22

WHO Constitution Nine Principles (1946) Examples Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people. Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures. 23

13th General Program of Work, WHO (2019-2023) WHO Triple Billion Targets (strategies and measurements) Target: 1 billion more people benefitting from universal health coverage without financial hardship. Coverage of essential health services-14 indicators in four categories. Financial hardship is the proportion of the population that spends more than 10% of household income on health. Target: 1 billion more people better protected from health emergencies. Three categories: Emergency preparedness (SDG 3.d.1)-- average of 13 core capacities of the International Health Regulations (IHR); Emergency prevention; Emergency detection/response. Target: 1 billion more people enjoying better health and well-being. Uses 16 indicators—factors that influence health such as clean air and water, safe roads, child nutrition, and domestic violence. Note: There are 46 outcome indicators. These include 39 SDG indicators and seven Member State-approved indicators. See notes for more measurement details. 24

Examples of WHO MH Resources (2008-2020) 25

Comprehensive Mental Health Action Plan 2013-2030, World Health Organization (updated 2021) Vision: “A world in which mental health is valued, promoted, and protected, mental disorders are prevented, and persons affected by these disorders are able to exercise the full range of human rights and to access highquality, culturally appropriate health and social care in a timely way to promote recovery, all in order to attain the highest possible level of health and participate fully in society and at work free from stigmatization and discrimination.” 26

Four Objectives Mental Health Action Plan 1. Strengthen effective leadership and governance for mental health. 2. Provide comprehensive, integrated and responsive mental health and social care services in communitybased settings. 3. Implement strategies for promotion and prevention in mental health. 4. Strengthen information systems, evidence and research for mental health. 27 Proposed actions for: member states, WHO Secretariat, national and international partners.

Cross-Cutting Principles Universal health coverage. Human rights. Evidence-based practice. Life course approach. Multisectoral approach. Empowerment of persons with mental disorders and psychosocial disabilities. 28

Ten Targets *4 new for 2021-2030 Global target 1.1: 80% of countries will have developed or updated their policy or plan for mental health in line with international and regional human rights instruments, by 2030.1 Global target 1.2: 80% of countries will have developed or updated their law for mental health in line with international and regional human rights instruments, by 2030. Global target 2.1: Service coverage for mental health conditions will have increased at least by half, by 2030. *Global target 2.2: 80% of countries will have doubled number of communitybased mental health facilities, by 2030. *Global target 2.3: 80% of countries will have integrated mental health into primary health care, by 2030. Global target 3.1: 80% of countries will have at least two functioning national, multisectoral mental health promotion and prevention programmes, by 2030. Global target 3.2: The rate of suicide will be reduced by one-third, by 2030. *Global target 3.3: 80% of countries will have a system in place for mental health and psychosocial preparedness for emergencies and/or disasters, by 2030. Global target 4.1: 80% of countries will be routinely collecting and reporting at least a core set of mental health indicators every two years through their national health and social information systems, by 2030. *Global target 4.2: The output of global research on mental health doubles, by 29 2030.

Mental Health Atlas, WHO GMH Problems and Progress MH Atlas 2020: Provides global information on mental health and progress on the Mental Health Action Plan: “[It is] released every three years, is a compilation of data provided by countries around the world on mental health policies, legislation, financing, human resources, availability and utilization of services and data collection systems. It serves as a guide for countries for the development and planning of mental health services. [It] includes information and data on the progress made towards achieving mental health targets for 2020 set by the global health community and included in WHO’s Comprehensive Mental Health Action Plan. It includes data on newly-added indicators on service coverage, mental health integration into primary health care, preparedness for the provision of mental health and psychosocial support in emergencies and research on mental health. It also includes new targets for 2030.” (quote from website) Executive Summary and Key Findings pages 1-5 30

MH Atlas 2020 (summary) “Progress values for 2020 indicate that the targets committed to by WHO Member States have not been achieved. Also, the rates of progress for all targets (except suicide rate) between 2014, 2017 and 2020 were not satisfactory. Progress values for 2020 indicate that the global targets can be reached in 2030 only if there is a collective global commitment over the next 10 years across Member States to make massive investments and expanded efforts at the country level relating to mental health policies, laws, programmes and services. Despite steady progress seen in the adoption of policies, plans and laws, as well as improvements in capacity to report regularly across years on a set of core mental health indicators, the Mental Health Atlas 2020 shows massive inequalities in the availability of mental health resources and their allocation between high- and low-income countries and across regions. It also shows significant gaps globally between the existence of policies, plans and laws and the implementation and monitoring of these and the allocation of resources. Similar gaps can be seen in the implementation of mental health services at the primary health care level. While guidelines for the integration of mental health into primary health care exist and have been adopted in most countries, with activities ongoing for training and supervision, the integration of interventions for service delivery, such as pharmacological and psychosocial interventions for mental health conditions, remains limited. The Mental Health Atlas 2020 also shows significant limitations in the capacity of countries’ mental health information systems to report on specific 31 indicators such as service utilization.” (page 2)

Lancet Commission on GMH and Sustainable Development Summary of Key Recommendations (October 2018) 1. Address mental health across all the Sustainable Development Goals 2. Include MH in the essential package of services for Universal Health Coverage 3. Take a public health approach to prevention and promotion 4. Ensure inclusion of people with mental health conditions 5. Increase investment in mental health 6. Harness learning from research to help drive change 7. Measure progress against existing commitments Source: MHIN Policy Brief October 2018 32

Convention on the Rights of Persons with Disabilities (2006) Article 1--Purpose The purpose of the present Convention is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity. Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others. 33

Human Rights and Lived Experience “Nothing about us without us” Cape Town Declaration (2011) Pan African Network of People with Psychosocial Disabilities We recognize that people with psychosocial disabilities have been viewed in bad ways, with derogatory words being used to describe us such as mentally disturbed, having unsound minds, idiots, lunatics, imbeciles and many other hurtful labels. We are people first! We have potentials, abilities, talents and each of us can make a great contribution to the world. We in the past, presently and in the future, have, do and will continue to make great contributions if barriers are removed . For as long as others decide for us, we do not have rights. No one can speak for us. We want to speak for ourselves. We want to be embraced with respect and love . We wish for a better world in which all people are treated equally, a world where human rights belong to everyone. We invite you to walk beside us. We know where we want to go”. 34

QualityRights Initiative World Health Organization Improve quality of care and human rights in inpatient and outpatient mental health services. Create community based and recovery-oriented services that respect and promote human rights. Promote human rights, recovery, and independent living in the community. Develop a movement of people with mental disabilities to provide mutual support, conduct advocacy and influence policy-making processes. Reform national policies and legislation. See information on QualityRights training and tools HERE Notes: WHO launch 2021 of major guidance tools on developing quality, rights-based mental health services in community settings Global Network of Psychologists for Human Rights Photography 4 Humanity, Human Rights Exhibit, UN (2021) See notes below: Human rights are our “bloodline lifeline.frontline ” 35

Evidence-Based Practice Prioritize implementation science with cultural relevance “Mental health strategies and interventions [take] cultural considerations into account.” WHO MH Action Plan “Evidence-based psychological interventions commonly used in high-resource settings can be effective in low-resource contexts, including when they are delivered by trained and supervised non-specialists. These interventions have proved helpful in the treatment of common mental health problems, such as depression, anxiety and traumatic and chronic stress, as well as other difficulties, such as harmful alcohol use. Cultural and contextual adaptations Treatments are best delivered in local languages, using recognisable terminology and case examples, and implemented in ways that do not exacerbate stigma or exclusion.” Source: Scalable psychological interventions for people affected by adversity, Schaefer et al. (July 2018) Mental Health and Psychological Support in Humanitarian Crises, Humanitarian Exchange/HPN, ODI 36

Two MH Resources—WHO Psychological First Aid (2011) mhGAP Intervention Guide (2016, 2.0) 37

Building Back Better: Sustainable Mental Health Care after Emergencies (2013) WHO See the Executive Summary with 10 summary lessons from the 10 national case studies (pages 9-12). And the images! 38

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Common Threads Project Stitching the Unspeakable Survivors of sexual and gender-based violence Inspired by ancient cultural practices and validated by current neuro-scientific understandings of trauma, Common Threads Project has developed a unique and effective group recovery program. In a safe and supportive environment, women create story cloths to depict experiences that may be hard to express in words. This becomes an entry point for a multi-dimensional therapeutic process.” This “story cloth” was created by a woman in a “women’s circle” organized by Common Threads Project . Her teenage daughter was raped/murdered by soldiers in the forest at night. See: Fabric of Healing Gallery. (quotes and image from website)

Trauma and Violence A Global Lens for Global Action . Image: GIST-T 41

Agenda for Humanity (2016)5 Core Responsibilities Staying updated: Global Humanitarian Overview 2021, UN OCHA Updates on humanitarian action: Humanitarian Response Plans, UN OCHA. Weekly Updates/Analyses. The New Humanitarian Geneva Peace Week (every November)--MHPSS input appreciated/needed! 42

Faith-Inclusive Approaches Being Faith-based and Evidence-based A faith-sensitive approach in humanitarian response: Guidance on mental health an d psychosocial programming. Lutheran World Federation and Islamic Relief Worldwide, 2018. Trauma Healing Institute , Healing the Wounds of Trauma, ABS See also: Joint Learning Initiative on Faith and Local Communities (“an international collaboration to develop and communicate evidence on local faith actors’ roles43and

Social Determinants Society-culture impact mental health “Social justice is a matter of life and death . .These inequities in health, avoidable health inequalities, arise because of the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces. Social and economic policies have a determining impact on whether a child can grow and develop to its full potential and live a flourishing life, or whether its life will be blighted.” 44 Executive Summary, 2008 WHO Commission on SDH

. Global Mental Health and Wellbeing for All Updates, Applications, Pathways Thanks for listening and interacting! Kelly O’Donnell, PsyD and Michèle Lewis O’Donnell, PsyD Consulting Psychologists, Member Care Associates, Inc. Be the people we need—Build the world we need.