Routledge Handbook of Global Mental Health Nursing

Evidence, Practice and Empowerment

Edilma Yearwood, Vicki Hines-Martin

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317702214
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

Awarded second place in the 2017 AJN Book of the Year Awards in Psychiatric and Mental Health Nursing.

"I welcome, at long last, a book on global mental health targeted to nurses, the front-line health worker for billions of people around the world. The roles that nurses can, and should, play in mental health care are diverse and this book addresses both well-trod as well as emerging concerns across the continuum of care from promotion to prevention to treatment. Importantly, at the heart of this diversity is the foundation of compassion and care, the hallmark of the nursing profession." – Vikram Patel, Professor of International Mental Health and Wellcome Trust Principal Research Fellow in Clinical Science, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, UK

Psychiatric disorders have consistently been identified as serious and significant global burdens of disease, yet meeting the needs of people in mental distress has not often been a priority in health care. This important reference work sets out the knowledge base for understanding the state of mental health care globally, and translating that into effective practice.

The Handbook provides a historical and contemporary context of mental health care, identifies and discusses evidence-based standards of care and strategies for mental health promotion and explores the need to deliver care from interdisciplinary and community-based models, placing these imperatives within a human rights and empowerment framework. It is made up of four core sections which look at:

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• Key and emerging issues that affect global mental health practice and research, including the social context of health;

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• Evidence-based health promotion strategies for major areas of practice internationally;

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• A range of country studies, reflecting different problems and approaches to mental health and mental health care internationally; and

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• What constitutes empowering practice.

The only comprehensive work looking at global perspectives on mental health nursing, this is an invaluable reference for all students, academics and professionals involved in mental health research with an interest in global or cross-cultural issues.

Part I
Historical and contemporary mental health nursing

1
Overview of Mental Health in Low-, Middle- and High-Income Global Communities

Edilma L. Yearwood and Spencer R. Case

Arthur Kleinman asserted that a significant barrier to global mental health is moral in that individuals with mental illness exist within poor environmental conditions and that governments, as stewards of its citizenry, have failed to protect them (2009).

Introduction

Global mental health is an emerging science and the scientists and clinicians engaged in this work are aggressively working to bring this neglected issue to the forefront. Their actions are motivated by the knowledge that the extent of poor mental health is widespread with catastrophic public health impact, and that significant challenges to well-being exist for individuals, families and communities particularly those living in poorly resourced environments. More than 450 million people globally suffer from mental health challenges with 1 in 4 individuals affected by a mental illness (WHO, 2010a); however, two thirds of those in need of mental health treatment never receive it (WHO, 2001a). Mental illness constitutes roughly 13 percent of the global burden of disease, outpacing cardiovascular disease and cancer (WHO, 2001a) with depression expected to be the second highest cause of disease burden in middle-income countries by 2030 (WHO, 2010a). Suicide is ranked as the third leading cause of death in 15- to 44-year-olds and the second cause of death in 10- to 24-year-olds (WHO, 2014), a statistic that translates into 800,000 to one million deaths annually.

Globally, more than 40 percent of countries have no mental health policy (WHO, 2001a) and additionally, one-third of countries allocate less than 1 percent of their health budgets to mental health. There are fewer available mental health beds to address existing needs, with ranges of 5–50 beds per 100,000 population depending on low-, middle-, or high-income country status (WHO, 2014). Globally, nurses are the most prevalent health care professionals and constitute the largest group working in mental health (Morris, Lora, McBain, & Saxena, 2011). However, we argue that nurses are not being fully utilized as resources in mental health promotion and prevention efforts across all countries.

The assertion made in 2005 that, “there can be no health without mental health,” (WHO, 2005, p. 11) endorsed and supported by the World Health Organization (WHO), appears to have been a timely catalyst for an increased focus on obtaining prevalence data on mental, neurological and substance use disorders globally, and for bringing about widespread discussion of mental health and prevention of mental ill health. However, variability exists across countries at multiple levels when looking at drivers known to promote or impede mental health or well-being. At the macro system level, areas that are the responsibility of governments include ensuring healthy economic conditions, developing and enforcing humanistic policies, valuing comprehensive well-being of its citizenry and promoting knowledge by making education accessible for all. These factors provide a basic underlying framework for health, including mental health. Building on these, safeguarding human rights as a fundamental underpinning of well-being, early case finding, ensuring availability of treatment resources (human, materials and services), stigma elimination, supportive cultural attitudes, consumer awareness, mental health literacy and mental health promotion strategies are critical ingredients to further support mental health. The process of global mental health awareness and promotion, research, and developing evidence-based treatment strategies to fit specific resource-able and culturally distinct contexts is developmentally in its infancy across different global communities. New models of treatment must be developed, including intentional integration of mental health care in primary care, task sharing through the use of traditional healers and non-specialist workers in low resourced environments, and expanded use of technology to begin to meet the vast mental health needs that exist and that cannot be managed with the existing number of trained mental health care providers who primarily reside in cities or more populated regions within countries. Without healthy human contributors to societal development, the specific community, state, region or country remains at a disadvantage, fails to flourish and lags behind comparable entities across multiple measures of overall health, including mental health.

Non-communicable disease burden, of which mental health is a component, increased from 36 percent to 49 percent in low- and middle-income countries from 1990–2010. During the same time frame, non-communicable disease burden in high-income countries saw only a 4 percent increase (Charlson et al., 2015). Cause specific deaths (one underlying cause) resulted in 775,000 deaths attributable to Alzheimer’s and other dementias, alcohol abuse and epilepsy. Excess deaths (due to multiple factors) accounted for over 8 million deaths and were associated with alcohol use disorder, schizophrenia, Alzheimer’s and other dementias and opioid misuse. Other mental disorders such as bipolar, major depression, autism, and intellectual disability resulted in 4.5 million deaths (Charlson et al., 2015).

This chapter will provide the framework for understanding the emergent field of global mental health as will be described throughout this text, define common terminology, discuss incidence and prevalence of major neuropsychiatric disorders, describe characteristics of low-, middle-, and high-income countries, illustrate consequences of unmet mental health needs and identify individuals and organizations leading the global mental health movement.

The purpose of this textbook is to provide a nursing perspective on the global mental health crisis, describe prevention, mental health promotion and evidence-based treatments, and present several in country exemplars with individuals and groups experiencing mental and behavioral health challenges. Nurses, as the largest health care profession globally can make significant contributions to improving mental health across all income communities and the profession can play a more significant role in the movement for global mental health and the evolution of global mental health science.

Low-, middle-, and high-income countries

On an annual basis the World Bank determines Gross National Income status of World Bank members and other countries with populations greater than 30,000. The three factors examined are country income level, region of the world in which the country is situated and country lending status.

Low-income countries are defined as countries with citizen incomes of $1035 or less annually. Examples of countries in this category include the Central African Republic, Democratic Republic of the Congo, Cambodia, Afghanistan, Ethiopia, Haiti, and Uganda.

Middle-income countries are countries in which citizens on average earn between $1036 and $12,615. Examples of countries in this category are Angola, Brazil, China, Columbia, Costa Rica, Cuba, Turkey, and the Dominican Republic.

High-income countries are countries in which citizens on average earn greater than $12,616 annually. Countries in this category include the United States, Canada, England, Australia, France, Germany, Belgium, and Argentina (World Bank, n.d.).

Mental health and mental illness

Mental health has been defined as, “a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community” (WHO, 2001b, p. 1). While mental health is achievable in individuals across the lifespan, it is increasingly clear that overall psychological wellness or mental well-being is dependent on factors frequently outside the control of the individual. These external factors termed social determinants of health (SDH) include environmental conditions that exist where people are born, live, work, and play; socio-economic status such as poverty; access to education and subsequent health literacy; race and gender; early childhood experiences associated with social advantages or disadvantages; availability of and access to resources including health care services; lack of or ineffective policies, and individuals and communities who have been disempowered (Braverman et al., 2011; Friel & Marmot, 2011). In addition, biological risk for mental illness exists, rendering some more vulnerable as most psychiatric disorders have a genetic basis and frequently originate in childhood or adolescence. Recently there has been a push to replace the term mental health simply with well-being due to the stigma associated with the terminologies of mental health and mental illness. Both terms, mental health and well-being will be used in this textbook.

Mental illness, at times referred to as mental ill health, is a brain disease manifested when the individual experiences alteration in thinking, mood or behavior often accompanied by distress and/or impairment in functioning, disability or mortality (WHO, 2013). Addressing and ameliorating individual vulnerabilities across multiple areas must become the focus of effective interventions to avoid or mitigate mental ill health. The burdens associated with mental disorders include poor health literacy, poor quality of life, inability to achieve one’s potential, isolation, and potential for shorter life expectancy. There are an estimated 450 million people worldwide living with a mental illness and of that number, approximately 50–85 percent who are in need of mental health services do not receive them (Demyttnaere et al., 2004). In low-income countries less than 1 percent of health spending is allocated to mental health. In middle-income countries approximately 2.5 percent is spent on mental health, and in high-income countries, 5 percent of health care dollars are earmarked for mental health services (WHO, 2011).

Along with the sparse allocation of financial resources dedicated to mental health promotion and treatment, many countries are either missing written policies or plans, or have outdated documentation outlining a vision for ensuring the mental health of its citizenry. In addition, accurate data collection on prevalence, monitoring of services and research on treatment effectiveness are missing, primarily in low- and middle-income countries. Variability across countries in the area of data collection methodology impacts the quality, accuracy and completeness of what truly exists and what is known. Without these data, it is difficult to make a compelling case for reallocation of funds even if they were available (WHO, 2013). Global mental health scientists are aggressively striving to rectify this situation.

Global Burden of Disease (GBD) represents epidemiological data reflecting risk factors, mortality, morbidity, health and injuries associated with disease burden. GBD incorporates prevalence and disability to arrive at an estimate of years lived with disability (YLDs). In addition it collects data on number of years that are lost to premature mortality (YLLs). The sum of both of these factors yields to disability-adjusted life years (DALYs). The 2010 GBD survey indicated that mental, neurological, and substance use disorders were the leading cause of YLDs, accounting for more than 10 percent of the global burden of disease (Whiteford et al., 2013; Whiteford, Ferrari, Degenhardt, & Feigin, 2015). These chronic and non-communicable diseases more significantly impact low- and middle-income countries. Table 1.1 illustrates the WHO GBD for neuropsychiatric disorders and Table 1.2 provides a comparison between WHO and the Institute for Health Metrics and Evaluation (IHME) across neurologic, mental, behavioral, self-harm, and inter personal violence dimensions.

Table 1.1 Global burden of disease: how the WHO Mental Health Atlas 2011 calculated the global burden of disease for mental ill health

WHO
Neuropsychiatrie disorders (as reported in the WHO Mental Health Atlas 2011 Country Profiles)
The following disorders were used to calculate the global burden of disease (DALYs) for mental ill health in the WHO Mental Health Atlas 2011 country profiles. (Note: the WHO does not use the term “neuropsychiatric disorders” in the most recent classifications for the GBD.)
Unipolar depressive disorders Bipolar affective disorder Schizophrenia Epilepsy Alcohol use disorders Alzheimer and other dementias Parkinson’s disease Multiple sclerosis Drug use disorders Post-traumatic stress disorder Obsessive-compulsive disorder Panic disorder Insomnia (primary) Migraine
www.who.int/healthinfo/global_burden_disease/2004_report_update/en/ www.who.int/mental_health/evidence/atlas/profiles/en/

Table 1.2 Comparison between WHO and the Institute for Health Metrics and Evaluation (IHME) across neurologic, mental, behavioral, self-harm, and interpersonal violence dimensions

...

Organization: IHME	Organization: WHO
Classification: “neurological disorders”	Classification: “neurologic conditions”
Alzheimer’s disease and other dementias	Alzheimer’s disease and other dementias
Parkinson’s disease	Parkinson’s disease
Epilepsy	Epilepsy
Multiple sclerosis	Multiple sclerosis

Table of contents

• Cover
• Title
• Copyright
• CONTENTS
• List of figures
• List of tables
• About the editors
• Notes on contributors
• List of reviewers
• PART I Historical and contemporary mental health nursing
• PART II Promoting mental health nursing within social and cultural contexts: research, best practices and clinical perspectives
• PART III Cultural voices and human rights: case exemplars
• PART IV Empowerment strategies
• Index