Eastern Mediterranean Health Journal | Past issues | Volume 21, 2015 | Volume 21, issue 7 | Proposed regional framework to scale up action on mental health in the Eastern Mediterranean Region

Proposed regional framework to scale up action on mental health in the Eastern Mediterranean Region

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Strategic interventions

Establish/update a multisectoral national policy/strategic action plan for mental health

Embed mental health and psychosocial support in national emergency preparedness and recovery plans

Review legislation related to mental health in line with international human rights covenants/ instruments

Integrate priority mental conditions in the basic health delivery package of the government and social/private insurance reimbursement schemes

Proposed indicators

Country has an operational multisectoral national mental health policy/plan in line with international/regional human rights instrumentsa

Mental health and psychosocial support provision is integrated in the national emergency preparedness plans

Country has updated mental health legislation in line with international/regional human rights instruments

Inclusion of specified priority mental health conditions in basic packages of health care of public and private insurance/reimbursement schemes

Enhanced budgetary allocations are in place for addressing the agreed upon national mental health service delivery targets

Health care

Strategic interventions

Establish mental health services in general hospitals for outpatient and short-stay inpatient care

Integrate delivery of cost-effective, feasible and affordable evidence-based interventions for mental conditions in primary health care and other priority health programmesb

Provide people with mental health conditions and their families with access to self-help and community-based interventions.

Downsize the existing long-stay mental hospitals

Implement best practices for mental health and psychosocial support in emergenciesc

Proposed indicators

Proportion of general hospitals which have mental health units, including inpatient and outpatient units

Proportion of persons with mental health conditions utilizing health services (disaggregated by age, sex, diagnosis and setting)

Proportion of primary health care facilities with regular availability of essential psychotropic medicines

Proportion of primary health care facilities with at least one staff trained to deliver non-pharmacological interventions

Proportion of mental health facilities monitored annually to ensure protection of human rights of persons with mental conditions using quality and rights standards

Proportion of health care workers trained in recognition and management of priority mental conditions during emergencies

Promotion and prevention

Strategic interventions

Provide cost-effective, feasible and affordable preventive interventions through community and population-based platformsd

Train emergency responders to provide psychological first aid

Proposed indicators

Proportion of schools implementing the whole-school approach to promote life skills

Proportion of mother and child health care personnel trained in providing early childhood care and development and parenting skills to mothers and families

Proportion of mother and child health care personnel trained in early recognition and management of maternal depression

Availability of operational national suicide prevention action plan

Regular national campaigns to improve mental health literacy and reduce stigma using multiple delivery channels

Psychological first aid (PFA ) training is incorporated in all emergency responder trainings at national level

Surveillance, monitoring  and research

Strategic interventions

Integrate the core indicators within the national health information systems

Enhance the national capacity to undertake prioritized research

Proposed indicators

Routine data and reports at national level available on the core set of mental health indicators

Annual reporting of national data on numbers of deaths by suicide

aOperational: refers to a policy, strategy or action plan which is being used and implemented in the country, with resources and funding available to implement it with a unit /department which has a specifically delineated budget, human resource allocation and authority to monitor the implementation of the policy/strategy in the country.

bCost-effective, feasible and affordable evidence-based interventions (“best buys”) for management of mental disorders include: treatment of epilepsy (with older first-line antiepileptic drugs), depression (with generic antidepressant drugs and psychosocial treatment), bipolar disorder (with the mood-stabilizer drug lithium), and schizophrenia (with older antipsychotic drugs and psychosocial treatment). However, there are a number of interventions for management of mental disorders starting in childhood and adolescence, anxiety and stress-related disorders and suicidal behaviours which can be classified as “good buys” and which are also part of the mhGAP intervention guide (mhGAP-IG) http://www.who.int/mental_health/mhgap/en/.

cBest and good practices for mental health and psychosocial support in emergencies include: strengthen community self-help and social support; support early childhood development (ECD) activities; train and supervise staff in the management of mental health problems that are relevant to emergencies; provide evidence-based psychological interventions through lay workers; ensure regular supply of essential psychotropic medications; address the safety, basic needs and rights of people with severe or chronic mental illness in the community and institutions; encourage dissemination of information to the community at large.

dBest practices (cost-effective, feasible and affordable evidence-based interventions) for prevention of mental disorders and promotion of mental health include: early child development and parenting skills interventions and laws and regulations to restrict access to means of self-harm/suicide. Mass information and awareness campaigns for promoting mental health literacy and reducing stigma; early recognition and management of maternal depression; identification, case detection and management in schools of children with mental, neurological and substance use (MNS) disorders; integrating mental health promotion strategies, such as stress reduction, into occupational health and safety policies; regulations to improve obstetric and perinatal care, strengthening immunization; salt iodization programmes; folic acid food fortification; and selective protein supplementation programmes to promote healthy cognitive development are recommended as “good practices