Global health discussed at forum

It was the first time mental health on a global scope was discussed at the annual Kennedy Forum National Conference held in Boston in early June.

Tom Insel, M.D., director of the National Institute of Mental Health and moderator of a panel titled “Mental Health on the Global Stage” live streamed at the end of the conference, said it’s a topic that “has been somewhat conspicuously absent in most of the discussions about mental health in America.”

“After everything we have talked about all day, there are enormous challenges we face in the United States. Really, do we want to take on the problems of Liberia, South Africa, and Thailand?” he asked the audience. “Why would we want to expand to global mental health when there is so much to do here?”

Insel answered his own questions:

•    Mental and/or substance abuse disorders are not exclusive to the U.S., Insel said. According to the World Health Organization, 450 million people suffer from a mental or
behavioral disorder.

•    Treatments used in other countries may provide ideas for treatments in America. “Something learned in a low-resource environment in Africa could be equally applied and be very insightful for a low-resource environment in Alabama or Alaska. It’s a chance to see those experiments that are working or not working in other parts of the world.”

•    The global mental health community thinks and talks differently about mental illness, even down to terminology. A common term used outside America is “MNS disorders,” or Mental, Neurological and Substance Abuse disorders.

Kathy Pike, Ph.D., executive director and scientific co-director of the global mental health program at Columbia University, said America has some of the best trained mental health professionals in the world, but a “severely broken system.”

Global partnerships can provide the U.S. with a way to create more successful systems and training programs, she said.

Jody Silver, executive director of Collaborative Support Program of New Jersey and a longtime mental health activist, said it’s less about a system issue when it comes to fixing mental health care in America, and more of a community issue. “I thought for a while it was looking at how we can improve our system, but it’s really how can we improve our communities,” she said.

Silver said she has seen examples of countries dealing with mental health on a community level and emphasized the importance of peer support programs. A community member may be more approachable than a doctor, which is important especially when stigma may be a factor.

Gary Gottlieb, M.D., chief executive officer of Partners in Health, pointed to task shifting as a successful strategy that could be adopted in the U.S. health care system, especially in low-resource communities. This approach could be something like training community members to provide evidence-based treatments to individuals in their community.

Studies of task-sharing programs in the Congo, Pakistan and India, where community members have been trained to deliver evidence-based treatments have been shown to be successful, Pike said.

David Satcher, director of the Satcher Health Leadership Institute, touched on treatment that embraces a person’s religion and culture, especially when dealing with stigma – not just an issue in the U.S. “There is a kind of stigma related to mental illness in many countries where from a religious perspective, a person who is mentally ill is viewed as devil possessed,” he said. “Wherever you go in the world, you have to identify the values to successful treatment in that culture, in that environment.”

The Kennedy Forum was founded in 2013 by former Congressman Patrick J. Kennedy (D-R.I.) to fully implement the 2008 parity law and bring together business leaders and government agencies to work on issues of stigma, equal access to care, consumer rights and better policy.