Mike Davies OBE (Head of Programme Development, CBM UK) was one of the key speakers at The Cambridge Post-UN Summit Conference on Noncommunicable Diseases and Mental Health in Developing Countries. The outcomes from the Conference (held on 20th January 2012) were translated into key messages and brought to the attention of MPs, Parliamentarians, civil servants, and other policy-makers, researchers, activists and practitioners, at a reception in the House of Commons at the end of January 2012. Conference sessions included: - Critical reviews of the outcomes of the UN Summit on Noncommunicable Diseases - Short- and long-term strategies for addressing gaps in prevention, treatment, policy and 'public awareness' on noncommunicable diseases and mental health (NMH) in developing countries - Highlights from a growing number of successful 'linking' and 'capacity-building' programmes, which assist individuals and organisation in the developing world to strengthen their own sustainable NMH research, treatment and care programmes. - Different models of partnership to advance best practices and policies on NMH research, interventions, treatment and care - including multidisciplinary, multisectoral and multinational partnerships.

1. MENTAL HEALTH IN LOW- AND
MIDDLE-INCOME COUNTRIES
NEEDS, RESOURCES, ISSUES AND
APPROACHES
MIKE DAVIES OBE
cbm
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2. CBM
• Formerly the Christian Blind Mission or
Christoffel Blindenmission
• Founded 104 years ago
• Today, providing technical and financial
support to 740 disability-related programmes
in 89 countries
• Reaching > 23 million people in 2010
• Mostly funded by individual donations
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3. NATURAL DISASTERS HAVE ACCELERATED
CBM’S INVOLVEMENT IN COMMUNITY
MENTAL HEALTH
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4. NEEDS
• 450 million people worldwide have psycho-
social problems , including -
• 150 million with depression
• 90 million with substance abuse disorders
• 25 million with schizophrenia
(World Health Report 2001)
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7. RESOURCES
• Europe : One psychiatrist for 10,000 people
• Africa : One psychiatrist for 200,000 people
IN LOW- AND MIDDLE INCOME COUNTRIES
LESS THAN 1% OF THE HEALTH BUDGET IS
SPENT ON MENTAL HEALTH
(WHO Mental Health Atlas 2005)
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8. MASS GRAVE
- ACEH
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9. TREATMENT RATE
• cbm estimates that in developing countries,
between 80 and 90% of persons with
psychosocial problems do not get treatment
of any kind
• For the vast majority, no accessible or
affordable treatment option exists
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10. HOW TO BRIDGE THE
GAP BETWEEN NEEDS
AND RESOURCES?
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11. NCD SUMMIT (Sept 2011)
• Focused mainly on cancers, cardiovascular
disease, chronic respiratory disease and
diabetes.
By 2020, depression alone will be the second
ranked disease burden, after cardiovascular
disease
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14. CBM’S RESPONSE
• A paradigm shift towards community mental
health work, with treatment emphasis at
primary and secondary levels
• Multi-tiered intervention strategy focused on
local capacity development, access to
appropriate treatment, social integration, family
counselling & support, livelihood development,
advocacy to reduce stigma and prejudice, and
empowerment of users and carers groups.
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15. UNCHAINING
PEOPLE
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17. DUAL MODELS
1. Community mental health services,
concentrating exclusively on people with
psychosocial problems
2. Inclusion of persons with psychosocial
problems in cross-disability, multi-
intervention community-based rehabilitation
(CBR) programmes
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18. CBM UK 5th January 2012 18
CBR guidelines April 16, 2012

19. IN 2010 cbm…
• Helped 101,000 people with psychosocial
problems in 31 countries
• Supported the work of 18 local mental health
professionals
• Met the training costs of 44 mental health
professionals
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20. The mayor’s solution?
Put him on the bus to the
next town…
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21. STRENGTHS
• Strong network of partners at all levels (local,
national, international)
• Support for users groups and self-help
groups
• The move towards inclusive approaches
• Cost-effective interventions at community
level
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22. WEAKNESSES
• Not enough ‘care for the carers’
• Preventive and promotional work remains
weak
• Partner overload
• Not enough time to do training
• Insufficient evidence that inclusive
approaches work
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23. OPPORTUNITIES
• Emergency relief work
• Involving community and religious leaders
• Advocacy to influence policy/funding support
• More central roles for user groups
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24. THREATS
• Biomedical orientation of government
systems
• Lack of public/private partnerships
• Professional resistance to community-based
MH approaches
• Focus on 3ry care as first choice intervention
• Many professionals don’t want to work where
they are most needed
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25. PEOPLE WITH PSYCHOSOCIAL PROBLEMS ARE
INCREASINGLY INVOLVED IN PLANNING
COMMUNITY MENTAL HEALTH PROGRAMMES
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26. THE WAY FORWARD
• Empowering user organisations & SHGs
• Promotion of positive mental health
• Capacity-building at all professional levels
• Balance between medical, social and
livelihood interventions
• Structured monitoring & evaluation leading to
systematic improvements of services
• Stronger advocacy with governments
• Staff care/burn-out prevention
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27. QUOTES FROM A ‘USER’
• “There are two critical issues in mental health
today – a) the excessive medicalisation of
human suffering and distress, and b) the
widespread human rights abuses of people
society labels as ‘mad’, ‘disturbed’ or ‘mentally
ill’”
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28. QUOTES FROM A ‘USER’
• “The primary crisis in mental health is not the
lack of economic resources or the need for
better technologies… the crisis is a social,
cultural and political one that requires
changing how we think about madness,
suffering and emotional pain”
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29. QUOTES FROM A ‘USER’
• “The UN Convention on the Rights of Persons
with Disabilities is a clear and comprehensive
blueprint … a human rights and social inclusion
framework that represents a shift away from
the medical model to a social model of
disability. This is precisely what is needed in
mental health”
In 2006, David Webb completed his PhD on suicide – the first
thesis of its kind by someone who has attempted suicide. David
has been a board member of the World Network of Users and
Survivors of Psychiatry. His book ‘Thinking About Suicide’ was
published in the UK in 2010, by PCCS Books
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30. BEFORE
Chained to
a tree
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31. AFTER
Growing vanilla
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32. THANK YOU
cbm UK
www.cbmuk.org.uk
Tel – 1223 - 484700
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33. GLOBAL DISEASE BURDEN
• Of the 15 main types of disease affecting
women in LOMICs, six are psychosocial –
depression (ranked 1), schizophrenia (4),
bipolar disorder (7), self-inflicted injury (8),
panic disorder and substance abuse
(WHO, Global Disease Burden, 2004)
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