Heller School for Social Policy and Management, Brandeis University

HS503f Global Mental Health

International Health Policy and Management, Master of Science

HS 503f.Global Mental Health: Policy, Programs and Country Plans

Module II, Spring 2018

Wednesdays 9:00 am-11:50 am

Room G53

Instructor and Location: Mary Jo Larson, PhD, MPA, Senior Scientist, Room 251, , telephone 6-3834.

Office Hours: Tuesdays and Thursdays 10-11AM; I welcome your visit anytime. Please drop an email to schedule an appointment

Course Description:

Global mental health (GMH) is an emerging discipline with a growing body of literature, research, and practice examples. GMH topics are currently neglected in health care discussions of many regions and countries. There is an urgent need for policy and program practitioners that are well-trained in GMH including knowledgeable about topics ranging from alcohol and drug abuse, severe mental illness, and illnesses commonly seen in primary care settings (depression, anxiety).

Students who want to work with non-governmental organizations in international settings, work for international health policy organizations, or work with health ministries at the national or local level will be able to engage in discussions and formulate solutions to improve the reach of effective mental health services. We will focus on concepts, policy and programmatic responses that are appropriate for low-and middle-resourced countries. This course will:

Introduce thekey concepts of mental health disorders including stigma
Expose students toprinciples of evidence based and cost effectivepractices
Examineapproaches to improve the mental health status of a country’s population

Course Objectives:

Upon successful completion of this module, students will be able to:

Analyze how the burden of mental health conditions contributes to a country’s total disease burden
Develop the case for increased country investment in informal and formal mental health care
Describe cost-effectivepackages of mental health services and strategies to increase the coverage or reach of a country’s mental health system

Recommended Prerequisites:

Non-MS/IHPM students are invited to take this course.

Course Requirements:

See also on Latte – Latte supercedes this syllabus.

Attendance: Please email me in advance if you must miss a session. You may be permitted to do an extra assignment for missed sessions.
Assigned Video or Readings: Expect to spend about 3 hours each week reading required and supplementary materials.
Participation: Good class participation includes sharing your own thinking and listening to others, asking clarifying questions, and restating what you think you have heard. Debate is welcome and must respect the dignity of others.
BriefForum Assignments: Four sessions ask you to prepare a brief assignment in advance of class based on the readings. You will submit one page of comments on Sunday before midnight. You are then asked to return to the Latte to comment on another student’s observations. You will submit a paragraph in response by Tuesday at midnight.
Policy Analysis Paper: You will submit a Policy Analysis Paper on Latte before class 6, approx. 10 pages, double-spaced. References should be cited and are not part of the page count. The required outline is on Latte.

University Notices:

If you are a student with a documented disability on record at Brandeis University and wish to have a reasonable accommodation made for you in this class, please see me immediately.
You are expected to be honest in all of your academic work. The University policy on academic honesty is distributed annually as section 5 of the Rights and Responsibilities handbook. Instances of alleged dishonesty are subject to possible judicial action. Potential sanctions include failure in the course and suspension from the University. If you have any questions about my expectations, please ask.

Academic integrity is central to the mission of educational excellence at Brandeis University. Each student is expected to turn in work completed independently, except when assignments specifically authorize collaborative effort. It is not acceptable to use the words or ideas of another person – be it a world-class philosopher or your roommate – without proper acknowledgement of that source. This means that you must use footnotes and quotation marks to indicate the source of any phrases, sentences, paragraphs or ideas found in published volumes, on the internet, or created by another student. If you are in doubt about the instructions for any assignment in this course, you must ask for clarification.

PLEASE EVALUATE THIS COURSE

I seek 100% participation in the Brandeis course evaluation system. Your feedback will help me improve my teaching and the course content for future students. Also, I welcome your private visit during office hours if you would like to offer additional feedback or make a request.

Student Evaluation

Essentially, I will look for evidence of your thoughtful engagement in the course. Your regular attendance, active participation, and research effort demonstrated in your final paper is most important.

Classroom Attendance/Participation. 25%

Excused absences may require a brief assignment for credit.
Unexcused absence no credit.
Active participation - Ask clarifying comments, offer examples, active engagement in case study discussions.

Brief Forum Assignments - judged based on being timely and thorough. I will look for you to use examples from what you read, be thoughtful in observations, raise questions about what you did not understand. I will look for you to make comments on one other student’s observations.

Forum Session 2 10%
Forum Session 3 10%
Forum Session 4 10%
Forum Session 5 10%

Session 6 – Policy Analysis Paper- 25%

See outline for expectations
Submitted on time
Addresses each recommended section
Discussion of a specific narrow policy problem
Uses data to describe the problem
Draws information from primary source literature (from the country, from peer-reviewed journals)

Session 7 - Infographic or poster based on paper – 10%

Uses a persuasive approach to communicate to policy-makers
Includes data where appropriate – communication purpose is clear

Course Planner

See also on Latte – Latte supercedes this syllabus.

SESSION ASSIGNMENT DUE BEFORE CLASS / ASSIGNMENT AND RESOURCES TO USE
Session 1. No assignment / Remember to watch Videos
Session 2. FORUM participation

Sunday Midnight – one page comments
Tuesday Midnight – brief paragraph response to another student’s post (ideally, one without a prior response)

/ 1. Prince et al. identifies 3 possible mechanisms for interactions between mental disorders (MD) and other health conditions. Choose a specific other health condition. Give at least one 1 example of the possible mechanism for the interaction of that health and MD interaction. Describe at least one implication of that interaction for the organization of health services.
2. In Patel et al. Four figures/tables provide data on how, on average, each WB income group is associated with its resources for mental disorders. Look up the WHO Atlas report or WHO AIMS report for a specific country of interest to you. Compare its data on at least one indicator to the data in Patel on the average for its income group.
Session 3. FORUM participation

Sunday Midnight – one page comments
Tuesday Midnight – paragraph response to another student’s post (ideally, one without a prior response)

/ Drew et al. describes the global crisis of human rights violations towards people with mental disorders (MD). The article also describes the UN Convention on the Rights of Persons with Disabilities. Describe 3 examples of different kinds of human rights violations from the articles you read. Describe a potential strategy to improve the dignity and protect the rights of persons with MDs for each of these examples. Cite the articles from where you drew your examples.
Session 4. FORUM participation

Sunday Midnight – one page comments
Tuesday Midnight – paragraph response to another student’s post (ideally, one without a prior response)

/ 1. Ferrari et al. describes the factors that contribute to Years Living with Disability (YLD) from depression. A) Looking at Figure 1, which age groups and gender have the greatest burden? Based on what you read, what factors may explain this burden? B) Looking at Figure 2, which regions of the world have the greatest burden and lowest burden? What factors may explain this burden?
2. Discuss how cultural differences may contribute to the differences you described above?
Session 5. FORUM participation

Sunday Midnight – one page comments
Tuesday Midnight – paragraph response to another student’s post (ideally, one without a prior response)

/ Describe one or more examples of how a country adapted an intervention to its circumstances from 3 different readings of the required or supplemental reading list. For each example, name the country, the problem being addressed, and the adaptation they made. Remember to cite the articles from which you drew the example(s).
Session 6. Policy Analysis Paper Due

Choose 1 country or region
Choose narrow MH/SUD topic

/ See Policy Analysis Rubric: 10 double-spaced pages; Data tables; References in correct format
Session 7. Bring and present your Infographic or Poster / One page using professional format

WEEKLY SCHEDULE & READINGS

See also on Latte – Latte supercedes this syllabus.

General References:

World Health Organization.(2010) mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings.[Online]. Available from: [Accessed: 10th March 2017].

World Health Organization."Mental Health Atlas-2014, WHO, Geneva."Switzerland: World Health Organisation (2014).

Patel, V., Chisholm, D., Dua, T., Laxminarayan, R., Medina-Mora, M.E. (2015). Mental, Neurological, and Substance Use Disorders. Disease Control Priorities. Third Edition.Accessed February 21, 2018.

Class 1: Introduction to Course Expectations & Global Mental Health, March 7

If possible, before March 7:

Watch Vikram Patel TED Talk:

Read Thu-Houng Ha “How should we talk about mental health?”

Class 2: State of the Global Mental Health Field, March 14

Readings:

Prince, M., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, M.R., & Rahman, A. (2007) No health without mental health.Lancet, 370(9590), pp. 859-877.

World Health Organization.Investing in Mental Health: Evidence for Action. Geneva: WHO, 2013.

De Silva, M. J., Lee, L., Fuhr, D. C., Rathod, S., Chisholm, D., Schellenberg, J., & Patel, V. (2014).Estimating the coverage of mental health programmes: A systematic review.Int J Epidemiol, 43(2), 341-353.

In Patel et al. textbook: PellabMaulik et al. (2014) Global Mental Health Resources (Chapter 9, pp. 167-191)

Supplemental:

Victoria de Menil. 2015. "Missed Opportunities in Global Health: Identifying New Strategies to Improve Mental Health in LMICs." CGD Policy Paper 068. Washington DC: Center for Global Development.

World Health Organization and United Nations High Commissioner for Refugees.Assessment and Management of Conditions Specifically Related to Stress: mhGAP Intervention Guide Module (version 1.0). Geneva: WHO, 2013.

Eaton J, Kakuma R, Wright A, and Minas H.A position statement on mental health in the post-2015 development agenda. International J of Mental Health Systems 2014, 8:28.

Mendenhall, E., De Silva,M.J., Hanlon, C., Petersen, I., Shidhaye, R., Jordans, M., Luitel, N., et al. (2014). Acceptability and feasibility of using non-specialist health workers to deliver mental health care: Stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa,, and Uganda. SocSci & Med, 118, 33-42.

World Health Organization.(2013). Mental health action plan 2013-2020.

Class 3: Stigma and Human Rights, Drug Use Disorders, March 21

Readings:

Read on-line. Human Rights Watch. World Report: Philippines, Events of 2017. (accessed 2/16/2018).

Patel et al. Global Mental Health, Ch. 18 – Stigma, Discrimination, and Promoting Human Rights

Drew, N., Funk, M., Tang, S., Lamichhane, J., Chavez, E., Katontoka, S., Pathare, S., Lewis, O., Gostin, L., & Saraceno, B. (2011) Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis. Lancet, 378(9803), pp. 1664-1675.

Ola, B., Crabb, J., et al. (2014) The State of Readiness of Lagos State Primary Health Care Physicians to Embrace the Care of Depression in Nigeria.Community Ment Health J.,50(2): pp. 239-244.

United Nations Office on Drugs and Crime (2014).Technical Report GLOK42.Preventing illicit drug use and treating drug use disorders for children and adolescents.

Supplemental:

Windle, J. (2016). Drugs and Drug Policy in Thailand. Improving Global Drug Policy: Comparative Perspectives and UNGASS. Center for 21st Century Security and Intelligence – Latin America Initiative.

Lunze, K., Idrisov, B., Golichenko, M., Kamarulzaman, A.(2016). Mandatory addiction treatment for people who use drugs: Global health and human rights analysis. BMJ, 353:i2943.

Curing the stigma of mental health in rural India – A young leader’s response.

Class 4: Cross-Cultural Prevalence and Burden of Illness, March 28

Readings:

Patel et al. 2014 Global Mental Health Chapter 3 – Kirmayer and Swartz. Culture and Mental Health, pp. 41-49 ONLY

Bertolote, J.M., Fleischmann, A., DeLeo, D., Bolhari, J., Botega, N., DE Silva, D., et al. (2005). Suicide attempts, plans, and ideation in culturally diverse sites: The WHO SUPRE-MISS community survey. Psychol Med, 35(10), 1457-1465.

Shibre, T., Teferra, S., Morgan, C., & Alem, A. (2010) Exploring the apparent absence of psychosis amongst the Borana pastoralist community of Southern Ethiopia.A mixed method follow-up study.World Psychiatry, 9(2), pp. 98-102.

Patel et al. 2014 Global Mental Health Chapter 5 – Kirmayer and Swartz. The epidemiology and impact of mental disorders, pp. 82-100

Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, et al. (2013) Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study 2010. PLoS Med 10(11):

Supplemental:

Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., . . . Vos, T. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet, 382(9904), 1575-1586.

Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness.Lancet Psychiatry 2016; 3: 171–78; Read also the Appendix supplement.

Rehm J, Mathers C, Popova S, et al. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet.2009; 373:2223–33.

Ferrari AJ, Norman RE, Freedman G, et al. The burden attributable to mental and substance use disorders as risk factors for suicide: findings from the Global Burden of Disease Study 2010. PLoS One. 2014 Apr 2;9(4):e91936. doi: 10.1371/journal.pone.0091936. eCollection 2014. (see the supplemental tables as well)

Class 5: Country Contextualization: Building Country Capacity to Address Mental Health, April 11

Readings:

find Shoba et al., 2012 from 2017 syllabus.

Keynejad, R.,Semrau, M., Toynbee, M., Evans-Lacko, S., Lund, Cr., Gureje, O., Ndyanabangi, S., Courtin, E., Abdulmalik, J.O., Alem, A., Fekadu, A., Thornicroft, G., & Hanlon, C. (2016). Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: A systematic review. BMC Health Services Research. 16:601, 1-11.

Petersen, I et al. MhaPP Research Programme Consortium.(2011). Lessons from case studies of integrating mental health into primary health care in South Africa and Uganda. International Journal of Mental Health Systems 5:8. DOI:10.1186/1752-4458-5-8.

deMenil V, Knapp M, McDaid D, et al. (2015) Cost-effectiveness of the mental health and development model for schizophrenia-spectrum and bipolar disorders in rural Kenya. Psychological Medicine . ISSN 0033-2

Abdulmalik, J., Kola, L., Fadahunsi, W., Adebayo, K.,et al. (2013). Country contextualization of the Mental Health Gap Action Programme Intervention Guide: A case study from Nigeria. PLOS Med,10(8), 1-6.

Minoletti, A., Sepulveda, R., and Horvitz-Lennon, M. (2012). Twenty years of mental health policies in Chile – Lessons and Challenges. Inter J Ment Health,41(1), 21-37.

Supplemental:

Chisholm D on behalf of WHO CHOICE (2005). Choosing cost-effective interventions in psychiatry: results from the CHOICE programme of the World Health Organization. World Psychiatry4(1): 37-44.

Saxena, S., Thornicroft, G., Knapp, M., & Whiteford, H. (2007). Resources for mental health: scarcity, inequity, and inefficiency. Lancet, 370(9590), 878-889.

Selamu M, Asher L, Hanlon C et al. (2015). Beyond the Biomedical: Community Resources for Mental Health Care in Rural Ethiopia. PLoS ONE 10(5): e0126666. doi:10.1371 /journal.pone.0126666.

Class 6: Task-shifting and Cultural Adaptation of Interventions, April 26

Readings:

Patel et al. 2014 Global Mental Health Chapter 3 – Kirmayer and Swartz. Culture and Mental Health, pp. 49-62 ONLY

Williams, et al., (2006).Cultural consideration in using CBT with Chinese People.New Zealand J of Psychology 35: 3 (153-162).

Balaji M, Chatterjee S, Koschorke M, et al. (2012). The development of a lay health worker delivered collaborative community based intervention for people with schizophrenia in India. BMC Health Services Research, 12:42-54.

Ertl V, Pfeiffer A, Schauer E, Elbert T, Neuner F. Community-implemented trauma therapy for former child soldiers in Northern Uganda: a randomized controlled trial. JAMA. 2011;306(5): 503-512.

Supplemental:

Piwowarczyk, L. et al (2014). Congolese and Somali beliefs about mental health services.The J of Nervous and Mental Disease, 202(3):209-216.

Patel V, Weiss HA, Chowdhary N, et al. Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet. 2010; 376 (9758):2086-2095.

Betancourt, T et al., (2014). Family-based prevention of mental health problems in children affected by HIV and AIDS: an open trial. AIDS 2014, 28 (Suppl 3):S359–S368

Gadit, A.A. (2003). Health services delivery by Shamans: A local experience in Pakistan. Int J of Ment Health, 32(2), 63-83.