Strengthening global mental health by prioritizing prevention

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Pamela Collins’ journey into global mental health began on a bus in Haiti in 1987.

The young medical student worked for the first time in a predominantly black country, sometimes took public transport and enjoyed blending in with the majority. “What really struck me that summer was how important social context is to health,” says Collins, MD, MPH, Bloomberg Centennial Professor and chair of Mental Health Services.

“Our daily experiences, how we move through the world, as members of majority or minority groups – all of this impacts our health outcomes and certainly our mental health status.”

She left Haiti with a promise to pursue global mental health – and would later lead research on HIV and mental health, stigma and discrimination, and the mental health of urban adolescents.

Collins, who became chair in July 2023, shares her insights on the challenges of accessing mental health care, preventing mental illness and the priorities for her department in this question-and-answer session.

Why don’t more people get the mental health care they need?

Access is a problem everywhere. This is a story where the problems are global, where the challenges are truly global. There are huge differences in resources between countries, but surprisingly similar challenges: only a minority of people receive minimally adequate care once it is recognized that they are suffering from depression, anxiety or substance abuse. That’s something we really need to solve.

Also, the history of mental health care in many parts of the world is tainted by negative experiences with colonialism and its consequences. The services that have developed are often not ones that people are typically comfortable with, and that’s compounded by the fact that these services are extremely underfunded.

I think many people in most parts of the world, including this country, have a lot of reservations about specialist mental health care. And given a history of human rights abuses and abuse of these services, as well as discrimination and poor care, that’s understandable.

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So even if access were universally available, would people still be hesitant when it comes to care?

If you know you’re going to have access to poor quality, overly restrictive mental health care, most people don’t want that. In the United States, overly restrictive care often means jails and prisons, right? A large percentage of people in jails and prisons live with mental health problems.

For example, the National Alliance on Mental Illness points out that Chicago’s Cook County Jail is one of the largest providers of mental health care in the country. And the road to prison can sometimes be linked to a lack of services in the community. The goal is to create and deliver quality, community-based care that will meet most needs.

How are you approaching improving global mental health?

That’s a complex question because there are biological, social and environmental factors that increase vulnerability to poor mental health. We can start with the felt need: how do we prevent and reduce the risk of mental illness? And when they occur, how can we provide care and reduce disability? These are the most important questions for global mental health care.

What can the US learn about mental health care from other countries?

There is no country in the world that has enough mental health providers for its population. One of the exciting things about the last fifteen years has been the opportunity to watch people innovate in places around the world with very different levels of resources and very different types of healthcare systems.

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When I led the work in global mental health at [the National Institute of Mental Health]Some of our early initiatives focused on whether non-specialists can provide mental health care that is evidence-based and culturally congruent across settings. Health workers and community colleagues – for example, if you are a woman suffering from perinatal depression – can be equipped to provide mental health care.

What can we do now to prevent mental disorders?

In 2022, researchers conducted a rigorous global meta-analysis to identify key risk factors for mental disorders that, if addressed, could reduce mental illness at the population level. They found that childhood adversities topped the list. If you could reduce childhood adversity – a wide range of problems ranging from war crimes to neglect and child abuse – you could potentially reduce the global incidence of schizophrenia spectrum disorders by about 38%.

That’s just one example, but it means we really need to think about the causes of childhood adversity. About 50% of mental disorders begin in the teenage years. We must intervene then and sooner! One of the responsibilities of public health is to continually ask ourselves what we can do at the population level to keep children and young people safer and reduce their exposure to adverse events that are likely to affect both their physical and mental health.

Your recent Nature analysis aimed at creating mental health-friendly urban areas. Why?

As humans, we survive adversity, but it still leaves a scar. That newspaper takes an ambitious look at the things a city could do to prevent the scars. What resources do people in a city need to build strength and support their development? We want to ensure that the trajectory of youth is not limited by the fear of violence, by intimidation, by injustice, by discrimination, by the kinds of things that hinder people’s ability to develop freely as human beings.

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These require complex actions, but we can take simpler steps. We can create non-judgmental spaces for young people, where you can truly be authentically yourself.

What is your main priority for the department?

Our priority is to respond to the current mental health crisis and anticipate the mental health needs of the population over the next decade. I recently met a group of young people on the West Coast and they said, “We can’t get attention without a crisis. How can we get help before we get into a crisis?”

Part of our work helps respond to these crises by designing, testing and studying interventions. But how can we avert the crisis? This brings us back to the theme of prevention, which remains a priority for our department.

Provided by Johns Hopkins University Bloomberg School of Public Health

Quote: Q&A: Strengthening Global Mental Health by Prioritizing Prevention (2024, May 11) Retrieved May 11, 2024 from -health.html

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