scholarly journals Evidence-based practice in a multicultural world: changing with the times

2018 ◽  
Vol 15 (3) ◽  
pp. 55-57
Author(s):  
Claire Tiley ◽  
Marinos Kyriakopoulos

Evidence-based practice (EBP), which is commonly implemented in high-income countries (HICs), integrates the best research evidence, clinical expertise and patient preferences in the planning and provision of healthcare for both physical and mental health conditions. Although the same principles of EBP apply in low- and middle-income countries (LMICs), research into and implementation of such interventions in these countries remains significantly behind compared with HICs. This article presents a brief overview of the global mental health agenda and initiatives aiming to address this pressing gap through the promotion of research and scaling up services, identification of barriers to developing and implementing EBP in LMICs, and possible solutions to overcome them.

Author(s):  
Sabyasachi Bhaumik ◽  
Dasari Mohan Michael ◽  
Reza Kiani ◽  
Avinash Hiremath ◽  
Shweta Gangavati ◽  
...  

This chapter focuses on the current knowledge in public health for people with intellectual disability and recognizes the extent of health inequalities these individuals experience. The prevalence of intellectual disability worldwide is discussed with special emphasis on the prevalence of mental health problems. Also highlighted are the population health characteristics, including physical and mental health problems. The issue of barriers to accessibility and the possible reasons are discussed. There is a section on premature mortality of people with intellectual disability and measures to improve the health status for this marginalized population. Recent initiatives, including prevention strategies and health promotional aspects, are discussed and solutions suggested, including those for low-and-middle income countries (LAMICs)emphasized. Training aspects to improve quality of health care in LAMICs is highlighted with the recognition of limitations in creating a sustainable transformation of services unless they are backed by authorities.


2015 ◽  
Vol 2 ◽  
Author(s):  
W. A. Tol

The first World Health Organization's global action plan for mental health recognizes the importance of mental health promotion and prevention of mental disorders, through the inclusion of one of four objectives focused on this crucial area of research and practice. This paper aims to provide an ‘aerial view’ of the field of mental health promotion and prevention of mental disorders with a focus on low- and middle-income countries. Starting with reasons why promotion and prevention need to take center stage in global mental health efforts, the paper provides a framework and four general principles to guide such efforts: a socio-ecological perspective (place); an inter-sectoral and interdisciplinary approach (collaboration), a developmental perspective (timing), and a participatory and empowerment approach (strengths), or PaCTS. Evidence-based examples of mental health promotion, universal, selective, and indicated prevention are described.


2020 ◽  
Vol 29 ◽  
Author(s):  
Marianna Purgato ◽  
Eleonora Uphoff ◽  
Rakesh Singh ◽  
Ambika Thapa Pachya ◽  
Jibril Abdulmalik ◽  
...  

Abstract Recently, mental health and ill health have been reframed to be seen as a continuum from health to ill health, through the stages of being asymptomatic ‘at risk’, to experiencing ‘mental distress’, ‘sub-syndromal symptoms’ and finally ‘mental disorders’. This new conceptualisation emphasised the importance of mental health promotion and prevention interventions, aimed at reducing the likelihood of future disorders with the general population or with people who are identified as being at risk of a disorder. This concept generated discussion on the distinction between prevention and treatment interventions, especially for those mental health conditions which lie between psychological distress and a formal psychiatric diagnosis. The present editorial aims to clarify the definition of promotion, prevention and treatment interventions delivered through a task-shifting approach according to a global mental health perspective.


2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Richard Mpango ◽  
Jasmine Kalha ◽  
Donat Shamba ◽  
Mary Ramesh ◽  
Fileuka Ngakongwa ◽  
...  

Abstract Background A recent editorial urged those working in global mental health to “change the conversation” on coronavirus disease (Covid-19) by putting more focus on the needs of people with severe mental health conditions. UPSIDES (Using Peer Support In Developing Empowering mental health Services) is a six-country consortium carrying out implementation research on peer support for people with severe mental health conditions in high- (Germany, Israel), lower middle- (India) and low-income (Tanzania, Uganda) settings. This commentary briefly outlines some of the key challenges faced by UPSIDES sites in low- and middle-income countries as a result of Covid-19, sharing early lessons that may also apply to other services seeking to address the needs of people with severe mental health conditions in similar contexts. Challenges and lessons learned The key take-away from experiences in India, Tanzania and Uganda is that inequalities in terms of access to mobile technologies, as well as to secure employment and benefits, put peer support workers in particularly vulnerable situations precisely when they and their peers are also at their most isolated. Establishing more resilient peer support services requires attention to the already precarious situation of people with severe mental health conditions in low-resource settings, even before a crisis like Covid-19 occurs. While it is essential to maintain contact with peer support workers and peers to whatever extent is possible remotely, alternatives to face-to-face delivery of psychosocial interventions are not always straightforward to implement and can make it more difficult to observe individuals’ reactions, talk about emotional issues and offer appropriate support. Conclusions In environments where mental health care was already heavily medicalized and mostly limited to medications issued by psychiatric institutions, Covid-19 threatens burgeoning efforts to pursue a more holistic and person-centered model of care for people with severe mental health conditions. As countries emerge from lockdown, those working in global mental health will need to redouble their efforts not only to make up for lost time and help individuals cope with the added stressors of Covid-19 in their communities, but also to regain lost ground in mental health care reform and in broader conversations about mental health in low-resource settings.


2014 ◽  
Vol 28 (3) ◽  
pp. 168-185 ◽  
Author(s):  
Laura K. Murray ◽  
Stephanie Skavenski ◽  
Judith Bass ◽  
Holly Wilcox ◽  
Paul Bolton ◽  
...  

Despite advances in global mental health evidence and policy recommendations, the uptake of evidence-based practices (EBP) in low- and middle-income countries has been slow. Lower resource settings have several challenges, such as limited trained personnel, lack of government resources set aside for mental health, poorly developed mental health systems, and inadequate child protection services. Given these inherent challenges, a possible barrier to implementation of EBP is how to handle safety risks such as suicide, intimate partner violence (IPV), and/or abuse. Safety issues are prevalent in populations with mental health problems and often overlooked and/or underreported. This article briefly reviews common safety issues such as suicide, IPV, and child abuse and proposes the use of certain implementation strategies which could be helpful in creating locally appropriate safety protocols. This article lays out steps and examples of how to create a safety protocol and describes and presents data on safety cases from three different studies. Discussion includes specific challenges and future directions, focusing on implementation.


Author(s):  
Graham Thornicroft ◽  
Vikram Patel

This chapter sets the scene for the book as a whole by defining key terms, giving a brief history of randomized controlled trails (RCTs) in mental health research, explaining why RCTs can produce strong forms of evidence, and by locating trials within the translational research continuum. The authors describe criteria with which to judge the quality of pragmatic RCTs. Finally the authors discuss how the results of trials can be used to inform policy, investment, and service delivery decisions in low and middle income countries.


2015 ◽  
Vol 2 ◽  
Author(s):  
A. Lora ◽  
P. Sharan

Background.Information is needed for development of mental health (MH) services; and particularly in low- and middle-income countries (LAMICs), where the MH systems are relatively weak. World Health Organization (WHO) has worked intensively during the last 15 years for developing a strategy in the field of MH information.Methods.The paper analyzes WHO instruments developed in this area [MH Atlas series and WHO Assessment Instrument for Mental Health Systems (WHO-AIMS)].Results.Data from Atlas series and WHO-AIMS demonstrated that the role of information is often neglected at all the steps: from data collection and processing to analysis, dissemination and utilization, particularly in LAMIC. By implementing several sets of feasible MH indicators WHO has technically supported the improvement of the MH information systems in LAMICs.Conclusions.In the last few years the importance of information in MH has increased and has been successfully highlighted; but a lot of work still needs to be done for achieving a minimum set of MH indicators and reliable data that can be used by both high-income countries and LAMIC.


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