Mental, neurological, and substance use disorders are common, highly disabling, and associated with significant premature mortality. The impact of these disorders on the social and economic well-being of individuals, families, and societies is large, growing, and underestimated. Despite this burden, these disorders have been systematically neglected, particularly in low- and middle-income countries, with pitifully small contributions to scaling up cost-effective prevention and treatment strategies. Systematically compiling the substantial existing knowledge to address this inequity is the central goal of this volume. This evidence-base can help policy makers in resource-constrained settings as they prioritize programs and interventions to address these disorders.
Mental, neurological and substance use (MNS) disorders are highly prevalent, accounting for a substantial burden of disease and disability globally. In order to bridge the gap between available resources and the significant need for services, the World Health Organization launched the Mental Health Gap Action Programme (mhGAP). The objective of mhGAP is to scale-up care and services using evidence-based interventions for prevention and management of priority MNS conditions. The mhGAP Intervention Guide version 1.0 for MNS disorders for non-specialist health settings was developed in 2010 as a simple technical tool to allow for integrated management of priority MNS conditions using protocols for clinical decision-making. With uptake in over 90 countries, mhGAP-IG 1.0 version has had widespread success. It is our pleasure to present mhGAP version 2.0, with updates incorporating new evidence-based guidance, enhanced usability, and new sections to expand its use by both health care providers as well as programme managers. It is our hope that this guide will continue to provide the road-map to deliver care and services for people with MNS disorders around the world and lead us closer to achieving the goal of universal health coverage.
The mhGAP Intervention Guide (IG) is a clinical guide on mental neurological and substance use disorders for general health care workers who work in non-specialized health care settings particularly in low- and middle-income countries. These health care workers include general physicians family physicians nurses and clinical officers. The mhGAP programme provides a range of tools to support the work of health care providers as well as health policy makers and planners The proposed guide is an adaptation of the mhGAP Intervention Guide to be used in humanitarian settings. These settings include a broad range of acute and chronic emergency situations arising from armed conflicts natural disasters and industrial disasters and may include mass displacement of populations (eg refugees and/or internally displaced people).
Mental, neurological, and substance use (MNS) disorders are prevalent in all regions of the world and are major contributors to morbidity and premature mortality. In 2008, the World Health Organization (WHO) developed the Mental Health Gap Action Programme (mhGAP), to facilitate scaling up of care for MNS disorders. A key part of mhGAP is the evidence-based guideline, published in 2010 and available through the mhGAP Evidence Resource Centre (http://www.who.int/mental health/mhgap/evidence/en/). The objectives of the guideline are: 1) To provide up-to-date WHO guidance to facilitate delivery of interventions by non-specialist health care providers in low- and middle-income countries (LAMICs); 2) To assist with the scale up of care for MNS disorders identified as conditions of high priority in LAMICs, specifically: depression, psychosis (including schizophrenia and bipolar disorders), epilepsy, child mental disorders, dementia, alcohol use disorders, drug use disorders and self-harm/suicide; 3) To provide up-to-date WHO guidance that will facilitate the implementation of the WHO Comprehensive Mental Health Action Plan 2013-2020 by health care planners and programme managers in LAMICs.
This manual attempts to provide simple, adequate and evidence-based information to health care professionals in primary health care especially in low- and middle-income countries to be able to provide pharmacological treatment to persons with mental disorders. The manual contains basic principles of prescribing followed by chapters on medicines used in psychotic disorders; depressive disorders; bipolar disorders; generalized anxiety and sleep disorders; obsessive compulsive disorders and panic attacks; and alcohol and opioid dependence. The annexes provide information on evidence retrieval, assessment and synthesis and the peer view process.
Over the course of the last decade, political and mental entities at large have embraced global mental health: the idea that psychiatric health is vital to improved quality of life. Physicians globally have implemented guidelines recommended by the National Institute of Mental Health (NIMH) in 2007, thereby breaking down barriers to care and improving quality of life in areas where these practices have been implemented. Programs for training and education have expanded as a result. Clinicians benefit more from both local resources in some regions as well as in international collaboration and technological advancements. Even amidst all of these positive outcomes, clinicians still face some stumbling blocks. With worldwide statistics estimating that 450 million people struggle with mental, neuropsychiatric, and neurological disorders—25 percent of the world’s non-communicable disease burden—rising to these challenges prove to be no small feat, even in wealthy Western nations. Various articles and books have been published on global mental health, but few of them thoroughly cover the clinical, research, innovative, and social implications as they pertain to psychiatry; often, only one of these aspects is covered. A comprehensive text that can keep pace with the rapidly evolving literature grows more and more valuable each day as clinicians struggle to piece together the changes around the world that leave open the possibility for improved outcomes in care. This book seeks to boldly rectify this situation by identifying innovative models of service delivery, training, education, research funding, and payment systems that have proven to be exemplary in implementation and scalability or have potential for scalability. Chapters describe specific barriers and challenges, illuminating effective strategies for improved outcomes. This text is the first peer-reviewed resource to gather prestigious physicians in global mental health from around the world and disseminate their expertise in the medical community at large in a format that is updateable, making it a truly cutting-edge resource in a world constantly changed by medical, scientific, and technological advances. Innovations in Global Mental Health is the ultimate resource for psychiatrists, psychologists, primary care physicians, hospitalists, policy makers, and all medical professionals at the forefront of global mental health and its implications for the future.
About four out of five people in low- and middle-income countries who need services for mental, neurological and substance-use conditions do not receive them. Even when available, the interventions often are neither evidence-based nor of high quality. WHO recently launched the mental health Gap Action Programme (mhGAP) for low- and middle-income countries with the objective of scaling up care for mental, neurological and substance-use disorders. This mhGAP Intervention Guide has been developed to facilitate mhGAP-related delivery of evidence-based interventions in non-specialised health-care settings. The Intervention Guide is brief so as to facilitate interventions by busy non-specialists in low- and middle-income countries. It describes in detail what to do but does not go into descriptions of how to do. It is important that the non-specialist health-care providers are trained in using the mhGAP Intervention Guide in assessing and managing people with mental, neurological and substance-use disorders.
