1. The Chester M. Pierce, MD Division of Global PsychiatryThe Role of Research in Mental Health Policy David Henderson, M.D. Director

2. Leading Causes of Years Lived with Disability

3. Gender Differences in Mental Health Problems WorldwidePercentage of DALYs* Lost

4. Burden vs. Budget

5. Gap in treatment: Serious cases receiving no treatment during the last 12 months 90 85% 80 76% 70 60 50 50% 40 35% 30 20 10 0 Lower range Upper range Lower range Upper range Developed countries Developing countries (WHO World Mental Health Consortium, JAMA, June 2nd 2004)

6. ScarcityHuman Resources(N=157 to 183 countries) Figure 2: Human resources for mental health in each income group of countries per 100 000 population

7. Number of psychiatrists per 100,000 population

8. Comparing Resources

9. Mental Health systems in low and middle-income countries

11. We do not have consensus on “model” interventions, especially for low-resource contexts.

12. We have not demonstrated that we can take successful programs and go to scale

15. Organizational culture/consensus

16. IT capacity/outcomes measurement

17. Policies/procedures

18. Integration with performance/quality improvement

19. Human resource capacity/training

21. Leadership perspectives and skills are best taught alongside teaching on mental health system development / capacity building

22. Effective leadership is learned by doing, with continuing support and mentoring

23. Collaborative programs of activity (in policy development, service design and implementation, research – particularly mental health system research, education and training, and consumer, carer and civil society engagement) are the most effective way to develop effective leadership skills

25. Key Needs in Global Mental Health Research Demonstration projects tied to rigorous external evaluation and funding for generalization of programs if outcomes are positive Network of global mental health policy research centers in the developed and developing worlds Networking Centers, Researchers, and Trainees

26. Culture, Context and Western Imports Concern about imposing western approaches to psychiatry on diverse cultures – undermining indigenous healing Risk of bringing in the “worst”: old and riskier drugs, institutionalization, stigma At same time, neglect of MI is major practical/HR issue in p-c environment (Lancet 2000) Principle: High level of critical awareness in melding essentials of western psychiatry with local traditions and customs Dilemma: Is this “marriage” always feasible. Unintended dangers (stigma, adverse effects, disruption of traditional care systems).

28. Interdisciplinary

29. Basic

30. Applied

31. Surveillance

32. Local policy agendas

33. Intervention studies

35. Implementation strategies

36. Uptake

37. Going to scale

38. Sustainability

39. Financing/economics

40. Advocacy

41. Evidence bas

42. Optimal strategies

43. Recovery outcomes

45. We need explicit ways of building acceptable knowledge using different methodologies.

46. Research is limited to specific contexts or outcomes

47. Transferability and relevance of models across nations and cultures needs examination

49. Building the evidence base for advocacy interventions

50. Optimizing consumer and family member involvement

52. Individual recovery process

53. System support for recovery

54. Relationship of recovery trajectory to treatment outcomes

57. Effective innovation is occurring at the local level in many countries

58. There are a few successful national-level programs related to prevention and promotion

59. There are opportunities on the horizon such as the UN Assembly on non-communicable diseases in 2011

61. Thank You! “You must be the change you want to see in the world.” Mahatma Gandhi