Valentina Iemmi, Research Officer at the Personal Social Services Research Unit (PSSRU) at the LSE, reports on discussions from a recent conference on mental health in low- and middle-income countries.
The Royal Society of Medicine recently hosted the event ‘The world in denial? Global mental health matters’, which highlighted the importance of raising the profile of mental health funding in low- and middle-income countries. The global mental health community was represented by stakeholders such as the WHO and WHO-Europe, as well as NGOs such as BasicNeeds and others.
According to the most recent figures, 15% of the global burden of disease is attributed to mental disorders, 30% of which is in high-income countries, 20% in middle-income countries and 10% in low-income countries. Yet, resources for mental health are still scarce, inequitable and inefficient especially in low- and middle-income countries. Only 2.14% in middle-income countries and 0.53% in low-income countries of health budgets are allocated to mental health. People from low socioeconomic backgrounds have the highest need of mental health care but the poorest access. In addition, people suffering from mental health disorders are more likely to experience socioeconomic deprivation.
The Mental Health Foundation’s annual Mental Health Awareness Week has put mental health in the spotlight since the first initiative in 2000. Mental health promotion and the prevention of mental ill health are core issues for many researchers within LSE Health and Social Care and we often collaborate with other institutions, governmental departments and charities to build the evidence base. In support of Mental Health Awareness Week, here we highlight some of the research into mental health that has been recently completed or is underway within the Centre.
Here are a few members of the Centre introducing their research.
David McDaid on promoting better mental health
Marya Saidi on mental health and housing services
Annette Bauer on the economics of mental and social wellbeing
Mental health in low and middle income countries
Addressing the burden of mental ill health in low- and middle-income countries (LAMICs) is increasingly becoming a priority but often, policy makers do not have enough information on specific risk factors, such as the relationship between social inequalities and mental ill health, that would allow for targeted interventions.
In a recent blog post, PhD student Victoria DeMenil described the example of Kenya, where NGOs are working with the government to implement mental health policy to strengthen community-based services.
In addition to our research into health systems, a wide range of research within LSE Health and Social Care aims to collate the available evidence, address gaps in the evidence base and thus contribute to the development of effective mental health services in LAMICs.
Examples include research into whether co-morbid depression and diabetes affect socio-economic status or whether it is the other way around (Leone et al. 2012).
Our investigation of the relationship between poverty and post-natal depression in low income countries highlights the need for future research to take into account neighbourhoods and communities to better understand this relationship (Coast et al. 2012), and emphasizes the key role of supportive social relationships in preventing post-natal depression (Jones and Coast 2012).
Another key area for us is suicide prevention. Research into the relationship between suicide and poverty in LMICs found evidence that unemployment, low income, low income inequalities (mass poverty), debt and macro-economic crisis can increase suicide (Iemmi et al. 2011).
Dementia
Dementia affects about 800,000 people in the UK, usually over the age of 65. Margret Perkins describes a study currently underway that looks at a group of people who often do not receive the services they need because their condition is so rare: those with early-onset dementia.
The Alzheimer’s Society estimates the total costs of dementia at GBP 23 billion per year. How can these enormous costs be reduced? Martin Knapp and colleagues reviewed the literature on cost-effectiveness of prevention, care and treatment strategies for dementia. They identified five key areas for action to achieve better value for money in dementia care (Knapp et al. 2012):
More and better quality studies of dementia care are needed
Findings need to be generalisable to a wider population
Cost measures need to be broad to capture all costs and benefits
The reluctance to implement evidence based care needs to be overcome
Coordination of health and social care provision and financing needs to be improved.
Mental health of children and young people
Much of our work in mental health focusses on children and young people because three quarters of mental health disorders start by age 18, making this a key period for prevention. The public sector costs associated with conduct disorder, hyperactivity and emotional disorders for children from age 5 to age 15 have recently been estimated by Tom Snell and colleagues to be as high as GBP 1.47bn per year, mostly because these children need additional support in their education – and this is in addition to the emotional and financial burden on the young people and their families. The costs associated with autism, including costs to wider society, may be as high as GBP 34billion per year, says Martin Knapp in a recent blog post.
Because the costs of childhood mental health problems are so high, effective interventions have a great potential to provide value for money. Early intervention for psychosis for example may save almost GBP 50k per patient (McCrone et al. 2013). Conduct problems are the most common mental health problem in childhood with negative consequences (for example, a higher risk of being unemployed) well into adulthood (Knapp et al. 2011). We recently estimated that parenting programmes that reduce conduct disorder may generate up to 6 GBP per pound invested (Bonin et al. 2011), and Madeleine Stevens won an NIHR grant to look into what type of intervention can help families in the long term.
We are also contributing economic analysis to several projects that aim to improve services for children and young people with anorexia and autism.
Low-level interventions for depression in community and primary care settings
“They are not criminals.” So asserted Samuel Anampiru, divisional police chief, to BBC reporters following the escape on Sunday 12 May of forty men with mental illness from Mathari Hospital, Kenya’s national referral hospital for psychiatry. However, conditions at the hospital were described in a recent report by the Kenya National Commission on Human Rights as “prison-like”.
The National Commission found staff to patient ratios at Mathari of 1:80. Basic hygiene was compromised: “ventilation in the buildings is poor…, sewerage blockages are common.” Furthermore, an atmosphere of insecurity was said to reign with reports of robberies from the neighbouring slum, and both patient-on-patient and patient-on-staff violence. The problems found in Mathari were equally present in other public psychiatric facilities. Occupancy rates ranged from a low of 105% to a high of 200%.
The recent Francis report into poor care at the Mid-Staffordshire Trust revealed that up to 1,200 patients died from systematic patient neglect. This involved patients not being fed, hydrated, washed, treated, acknowledged, respected, or managed with dignity. Over 200 recommendations for reducing neglect were made, and there is now a concerted drive by policy makers, the media, the public, and charities to reduce instances of patient neglect (Department of Health 2013). Solutions include reducing targets and bureaucracy, creating a culture where compassion and care are prioritised, ensuring staff feels able to report on poor care, and improving organisational management. We have investigated the processes and causes of patient neglect. Our research considers the ‘social psychology‘ of neglect, as this appears essential for aiding policy makers to understand why poor care occurs (Reader and Gillepsie 2013).
Mobility in class and education is severely limited in the UK and elsewhere and this raises concerns about inequalities of opportunity. Most recently, the Milburn report suggests that opening the doors to a university education is the only way to advance social mobility. However, while there have been many efforts made to measure mobility, to date there has been little exploration as to whether mobility is actually a good thing. That is, will being socially mobile make my life better. A recent paper released by the Centre for Economic Performance (CEP) at the LSE does just this.
The successful integration of health and social care services has been an aspiration of many governments and remains a core policy aim of the coalition government in England today. Integration of these systems aims to identify and mend fractures in existing systems, reduce the stress to service users when services overlap and to maximise the effectiveness of services within a specific cost framework (Goodwin et al. 2011, Department of Health 2011). Personalisation on the other hand has more recently become a policy priority, as reforms of the health and social care system adapt to the growing demand for more effective and efficient care and support services that respond to the needs of the user.
The call for integration and personalisation has somewhat intensified in the recent reforms of the health and care system due to current financial and demographic challenges. This has become increasingly pertinent as the average age of patients is increasing, with their troubles not limited to a single pathology (Oliver 2012), particularly in dementia care. Thus health and care services must deal with multiple pathologies that produce syndromes of frailty, vulnerability and impairment that impact on the day-to-day living of those in contact with services.
While dementia is usually associated with older people, it can affect younger people. If a diagnosis is made under age 65, this is referred to as so called early-onset or young-onset dementia. One estimate suggested that there were 15,000 younger people with dementia in the UK in 2007. This is likely to be a major underestimate by up to three times because of the way the data relies on referrals to services (Knapp and Prince 2007). Given the different place in the life course with family, financial and work responsibilities, the impacts can be particularly devastating and life changing for the whole family. A recent exploratory study undertaken in PSSRU investigated the current picture ‘on the ground’ from two differing perspectives: experiences of younger people diagnosed with a dementia and their unpaid carers, and of professionals (health, social and voluntary sector) in providing services and support for this group. We found that service availability and care pathways varied with degree of local service specialisation, and that client satisfaction was greatest where the family had an ongoing and supportive relationship with their local specialist clinical team. Financial constraints and low case numbers are the main barriers to establishing more specialist services.
The cost implications of the UK government’s recent plans to reform the funding system for care and support in England are analysed in a new research paper, which also considers the effects of options to give more help to lower income care home residents.
The paper, by the London School of Economics and Political Science (LSE) and the University of East Anglia (UEA), provides detailed estimates of the public expenditure costs of the government’s plans. It projects that the government’s current proposals, with a cap of £75,000, would add £2 billion (2010 prices) to public expenditure by 2030. This is in contrast to a projected extra £3.3 billion cost of the Dilnot Commission’s proposals, which had recommended a cap of £35,000.
Perinatal depression affects mothers during pregnancy and up to twelve months after giving birth. It can have a major impact not only on the mother’s health and wellbeing, but also on the child. On-going research at PSSRU explores some of the economic consequences of adverse child development outcomes linked to perinatal depression using data from the South London Child Development Study of mothers and children.As far we are aware, this research is the first to explore the economic consequences of perinatal depression from a child’s perspective.
Perinatal depression has a prevalence of 13% in the general population ¹ ² and is higher than 20% in lower socio-economic groups ³ ⁴. Because it not only has a major impact on mothers’ health and wellbeing but also on their children, it contributes to the intergenerational transmission of socio-economic disadvantage.
Findings from a recent report written by Grace Lordan and Debayan Pakrashi, funded by Nuffield Health, suggest that people who exercise have better mental health and physical health, lower cholesterol and blood pressure levels, are less likely to report having cardiovascular disease or Type 2 diabetes and are more likely to have a healthy weight.
It is recommended that each individual should do 150 minutes of moderate activity each week. This equates to 30 minutes of moderate activity five days a week. The average person in England does well below these levels– with the average person doing only one day of sports and exercise per week. Adding to this all other types of moderate activity (including work and housework), the average person is still only about halfway to achieving these government goals with respect to physical activity.
Articles posted on this blog give the views of the author(s), and not the position of LSE Health and Social Care, nor of the London School of Economics and Political Science.
