The new Sustainable Development Goals represent a historic opportunity to address mental health as a global development priority. For the first time, world leaders have recognized the promotion of mental health and well-being, and the prevention and treatment of substance abuse, as health priorities within the global development agenda.
While this growing recognition is a significant step forward, the challenge that we face is substantial. Studies have shown that a mere 10 percent of people with mental disorders in the poorest low-income countries are able to access treatment and care, while nearly 90 percent go without.
We need innovation to “flip the gap” to go from 10 percent of people receiving treatment, to 90 percent of people receiving treatment.
At Grand Challenges Canada, which is funded by the Government of Canada, we know that this can be done. We have committed approximately $39 million CAD to 71 Global Mental Health innovations being implemented across 28 countries. $17 million CAD has been invested in 15 transition-to-scale projects. These projects could have a potentially transformative impact on the mental health treatment gap, as shown by the three examples below.
The Friendship Bench has the potential to make mental health care accessible to an entire African nation. It’s a simple idea: create a comfortable space where people can share their troubles with community members who listen compassionately and offer problem-solving therapy. The brief (6×45 minute) task-shifted cognitive behavioral therapy intervention is delivered by supervised lay health workers on a wooden bench within grounds of municipal clinics to address common mental disorders in primary care users.
Many of the primary care users are also living with HIV/AIDS and have experienced domestic violence or upheaval. A recent study found that among the patients at the largest primary health care facility in Harare, the prevalence of probable common mental disorders and depression were higher among people living with HIV than among those without HIV (67.9 and 68.5 % vs 51.4 and 47.2 % respectively).
During the Friendship Bench proof-of-concept project, which was supported by Grand Challenges Canada, the project achieved promising results: 2,960 people were screened for depression across 24 public clinics in Harare. Furthermore, a randomized controlled trial showed significant improvements in depression, anxiety, quality of life and functioning among the 246 participants (40% HIV+) in the intervention arm six months after engaging in therapy, as compared to the control group.
Now, with the support of Grand Challenges Canada and scaling partners, the Friendship Bench intervention is being scaled up to 72 new clinics in the cities of Harare, Gweru and Chitungwiza, and is being integrated into a Médecins Sans Frontières mental health program to treat 14,000 people by the end of 2016.
As of July 2016, 12,100 people have already accessed the Friendship Bench service in the 3 cities across Zimbabwe. In addition, The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is providing the team with an additional $150,000 USD to test changes in HIV viral load on a 1000-2000 person cohort over a period of 6 months.
Potential for Transformation: The current treatment gap for common mental health disorders in Zimbabwe is significant. If successful, the Friendship Bench will help by demonstrating how mental health care can be delivered through primary care centres, even where there is a dearth of specialists.
The Family Networks for Kids (FaNs) innovation is creating a powerful web of recruits to care for children and youths with developmental disorders by task-shifting from health workers to relatives and neighbours. The project uses interactive voice response technology to identify children with developmental delays, and empowers volunteer “family champions” to provide evidence-based interventions to their own children and others in the community.
The initial testing of the FaNs innovation, which was supported by Grand Challenges Canada, achieved promising results: 2,690 children were screened for developmental disorders via the accurate, low-cost interactive voice response system (84.4% accuracy at a cost of US$0.07, compared with US $7 for house-to-house survey). Ten trained “family champions” helped 70 parent-child dyads participate in FaNS, which led to clinically significant improvements in functioning, disability & socio-emotional difficulty for the children.
The innovation is now being refined, expanded to a population of 1 million, and evaluated with the support of Grand Challenges Canada and a wide range of partners, including the World Health Organization and Autism Speaks. It’s expected that by the end of this year, 27,500 children and adolescents will receive access to screening services for developmental disorders. 2,700 children will exhibit improved functioning, and decreased emotional and behavioural problems.
As of June 2016, 2,000 children with developmental delays have already been identified and are receiving care using the WHO Parent Skills Training Program for Families of Children with Developmental Delays/Disorders. The Human Development Research Foundation team is also working closely with the National Ministry of Health Services in the nation-wide implementation of WHO mhGAP programme in Pakistan, and is using a social franchise model to scale-up and sustain the impact across the country.
Potential for Transformation: In Pakistan, developmental disorders including intellectual disabilities and autism spectrum disorders affect over 7 percent of children — 4.3 million in total — almost all of them untreated due to discrimination, poor awareness of the medical need among family members and front line health-providers, and the lack of specialist services especially outside of urban centres. The FaNs project could substantially reduce this treatment gap and be adopted in other parts of the world.
The BasicNeeds Model for Mental Health and Development is designed to address mental illness at a community level, providing education, training, care, and livelihood opportunities, bringing together a network of organizations and individuals to provide better resources for the end users.
With funding from Grand Challenges Canada, BasicNeeds is developing and testing an innovative social franchise system which will enable local organizations to adopt and implement the BasicNeeds Model for Mental Health and Development themselves – bringing much needed services to their communities.
To date, social franchise agreements have been signed with 3 local NGOs who are currently implementing the BasicNeeds Model in Ghana, Kenya and Nigeria. Across the 3 sites, 4,165persons with mental illness and epilepsy and 3,580 carers are benefiting from the mental health and development programme. Furthermore, 573 community based workers and health workers have been trained on common mental illnesses and epilepsy, human rights of persons with mental illness, and domestic and sexual violence.
Potential for Transformation: The devastating link between mental illness and poverty has long been ignored and has contributed to a treatment gap of nearly 90 percent in the poorest low- and middle-income countries. Based on BasicNeeds’ previous experience and related data, the BasicNeeds Model for Mental Health and Development aims to ensure 90 percent of people with mental health problems in the communities targeted will have access to treatment, and that 75 percent will be able to work.
This World Mental Health Day, we celebrate the progress made in recognizing mental health as part of the global development agenda and in investing in global mental health.
Through Grand Challenges Canada, Canada is a leading funder of innovation in mental health. The three projects above, along with global mental health innovations scaling with the support of Grand Challenges Canada, have reached tens of thousands of people and have the potential to improve the lives of 1.5 million people by 2030. However, we need to do more in order to reach millions.
This can only be done with the help of partners like the World Health Organization, national and local governments, international non-governmental organizations, the private sector, and other groups. Together, we can “flip the gap” and ensure that everyone, everywhere, has access to quality, affordable, and evidence-based treatment and care for mental health conditions.