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Regan M.,London School of Hygiene and Tropical Medicine | Gater R.,University of Manchester | Rahman A.,University of Liverpool | Patel V.,London School of Hygiene and Tropical Medicine | Patel V.,Center for Chronic Conditions and Injuries
Eastern Mediterranean Health Journal | Year: 2015

Investment in research on the prevention and treatment of mental health disorders is disproportionately low in the WHO Eastern Mediterranean Region (EMR) relative to the disease burden. Scaling-up mental health research in the EMR could generate enormous returns in terms of reducing disability, improving outcomes and preventing premature death, through early diagnosis, better management and community-based rehabilitation. EMR countries must therefore work to identify research priorities, mobilize resources, develop human and infrastructure capacities and institutionalize use of research findings to guide development of policies and service delivery models. Several key strategic interventions for EMR Member States are recommended: adopt a prioritized national mental health research agenda; systematically map national and international research funding to identify and secure resources to support the implementation of the agenda; strengthen national capacity to undertake prioritized research; periodically map research output in mental health; and foster dialogue between researchers and policy-makers/programme managers. © 2015, World Health Organization. All rights reserved.

Fazel M.,University of Oxford | Patel V.,London School of Hygiene and Tropical Medicine | Patel V.,Center for Chronic Conditions and Injuries | Thomas S.,United Nations Childrens FundNY
The Lancet Psychiatry | Year: 2014

Increasing enrolment rates could place schools in a crucial position to support mental health in low-income and middle-income countries. In this Review, we provide evidence for mental health interventions in schools in accordance with a public mental health approach spanning promotion, prevention, and treatment. We identified a systematic review for mental health promotion, and identified further prevention and treatment studies. Present evidence supports schools as places for promotion of positive aspects of mental health using a whole-school approach. Knowledge of effectiveness of prevention and treatment interventions is more widely available for conflict-affected children and adolescents. More evidence is needed to identify the many elements likely to be associated with effective prevention and treatment for children exposed to a range of adversity and types of mental disorders. Dissemination and implementation science is crucial to establish how proven effective interventions could be scaled up and implemented in schools. © 2014 Elsevier Ltd.

Patel V.,London School of Hygiene and Tropical Medicine | Patel V.,Center for Chronic Conditions and Injuries | Chatterji S.,World Health Organization
Health Affairs | Year: 2015

Mental disorders such as depression and alcohol use disorders often co-occur with other common noncommunicable diseases such as diabetes and heart disease. Furthermore, noncommunicable diseases are frequently encountered in patients with severe mental disorders such as schizophrenia. The pathways underlying the comorbidity of mental disorders and noncommunicable diseases are complex. For example, mental and physical noncommunicable diseases may have common environmental risk factors such as unhealthy lifestyles, and treatments for one condition may have side effects that increase the risk of another condition. Building on the robust evidence base for effective treatments for a range of mental disorders, there is now a growing evidence base for how such treatments can be integrated into the care of people with noncommunicable diseases. The best-established delivery model is a team approach that features a nonspecialist case manager who coordinates care with primary care physicians and specialists. This approach maximizes efficiencies in person-centered care, which are essential for achieving universal health coverage for both noncommunicable diseases and mental disorders. A number of research gaps remain, but there is sufficient evidence for policy makers to immediately implement measures to integrate mental health and noncommunicable disease care in primary care platforms. © 2015 Project HOPE- The People-to-People Health Foundation, Inc.

Singla D.,McGill University | Lazarus A.,Sangath Center | Bhatia U.,Sangath Center | Patel V.,Sangath Center | And 3 more authors.
Journal of Affective Disorders | Year: 2014

Background Peer-led psychosocial interventions are one solution to address the great paucity of skilled mental health human resources in South Asia. The aim of this study was to explore peer-delivered care for maternal depression in two diverse contexts in South Asia. Methods The study was carried out in the urban setting of Goa, India and rural setting in Rawalpindi, Pakistan. In total, 61 in-depth interviews (IDIs) and 3 focus group discussions (FGDs), and 38 IDIs and 10 FGDs, were conducted with multiple stakeholders in urban Goa and rural Rawalpindi respectively. We used the framework approach to analyze data. Results Peers from the same community were the most preferred delivery agents of a community-based psychosocial intervention in both sites. There were contextual similarities and differences between the two sites. Preferred characteristics among peers included local, middle-aged, educated mothers with similar experiences to participants, good communication skills and a good character. Key differences between the two contexts included a greater emphasis on the peer's family social standing in rural Rawalpindi and financial incentives as motivators for individual peers in urban Goa. Limitations Generalizability of our findings is limited to two specific contexts in a vast and diverse region. Discussion Our study demonstrates that peers have the potential to deliver maternal psychosocial interventions in low-income settings. There are contextual differences in the preferred characteristics and motivators between the sites, and these should be carefully considered in program implementation. © 2014 Elsevier B.V.

Ivbijaro G.,Wood Street Medical Center | Patel V.,London School of Hygiene and Tropical Medicine | Patel V.,Center for Chronic Conditions and Injuries | Chisholm D.,World Health Organization | And 5 more authors.
Eastern Mediterranean Health Journal | Year: 2015

For EMR countries to deliver the expectations of the Global Mental Health Action Plan 2013–2020 & the ongoing move towards universal health coverage, all health & social care providers need to innovate and transform their services to provide evidence-based health care that is accessible, cost-effective & with the best patient outcomes. For the primary and community workforce, this includes general medical practitioners, practice & community nurses, community social workers, housing officers, lay health workers, nongovernmental organizations & civil society, including community spiritual leaders/healers. This paper brings together the current best evidence to support transformation & discusses key approaches to achieve this, including skill mix and/or task shifting and integrated care. The important factors that need to be in place to support skill mix/task shifting and good integrated care are outlined with reference to EMR countries. © 2015, World Health Organization. All rights reserved.

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