From plan to framework: the process for developing the regional framework to scale up action on mental health in the Eastern Mediterranean Region

Abstract Globally there is a substantial burden of mental health problems among children and adolescents. Task-shifting/task-sharing mental health services to non-specialists, e.g. teachers in school settings, provide a unique opportunity for the implementation of mental health interventions at scale in low- and middle-income countries (LMICs). There is scant information to guide the large-scale implementation of school-based mental health programme in LMICs. This article describes pathways for large-scale implementation of a School Mental Health Program (SMHP) in the Eastern Mediterranean Region (EMR). A collaborative learning group (CLG) comprising stakeholders involved in implementing the SMHP including policymakers, programme managers and researchers from EMR countries was established. Participants in the CLG applied the theory of change (ToC) methodology to identify sets of preconditions, assumptions and hypothesized pathways for improving the mental health outcomes of school-aged children in public schools through implementation of the SMHP. The proposed pathways were then validated through multiple regional and national ToC workshops held between January 2017 and September 2019, as the SMHP was being rolled out in three EMR countries: Egypt, Pakistan and Iran. Preconditions, strategies and programmatic/contextual adaptations that apply across these three countries were drawn from qualitative narrative summaries of programme implementation processes and facilitated discussions during biannual CLG meetings. The ToC for large-scale implementation of the SMHP in the EMR suggests that identifying national champions, formulating dedicated cross-sectoral (including the health and education sector) implementation teams, sustained policy advocacy and stakeholders engagement across multiple levels, and effective co-ordination among education and health systems especially at the local level are among the critical factors for large-scale programme implementation. The pathways described in this paper are useful for facilitating effective implementation of the SMHP at scale and provide a theory-based framework for evaluating the SMHP and similar programmes in the EMR and other LMICs.

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Mental Health Burden Increasing in Eastern Mediterranean Region

JAMA ◽

10.1001/jama.2017.15458 ◽

2017 ◽

Vol 318 (15) ◽

pp. 1431

Author(s):

M.J. Friedrich

Keyword(s):

Mental Health ◽

Mediterranean Region ◽

Eastern Mediterranean ◽

Eastern Mediterranean Region ◽

Health Burden

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Implementation of WHO Recommended Policies and Interventions on Healthy Diet in the Countries of the Eastern Mediterranean Region: From Policy to Action

Nutrients ◽

10.3390/nu12123700 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3700

Author(s):

Ayoub Al-Jawaldeh ◽

Asmus Hammerich ◽

Radhouene Doggui ◽

Kaia Engesveen ◽

Krista Lang ◽

...

Keyword(s):

Mediterranean Region ◽

Eastern Mediterranean ◽

Scale Up ◽

Eastern Mediterranean Region ◽

Absolute Number ◽

Overweight And Obesity ◽

Healthy Diet ◽

Salt Reduction ◽

Nutrition And Diet ◽

Concrete Action

Non-communicable diseases (NCDs) are responsible for almost two-thirds of the deaths in the 22 countries and territories of the WHO Eastern Mediterranean Region and unhealthy diets are a major contributor. Prevalence of overweight and obesity has increased among adults, adolescents and older children in recent decades. Among countries with the highest prevalence there are signs that the increase is slowing down or even that prevalence is declining. There has been no increase in the prevalence rate in younger children, although the absolute number of children under five years affected by overweight has increased. This review summarizes prevalence data and examines current implementation of regulatory, fiscal and voluntary measures to promote healthy diet across the Region. The last decade has seen a step up in such action. Ten of the Region’s countries have policies relating to trans-fatty acids and they are increasingly implementing specific regulatory measures. Thirteen countries had fully or partially implemented national salt reduction policies by 2019. Only four countries had adopted policies relating to aspects of marketing food to children by 2019, and concrete action in this area is still lacking. Eight countries have introduced taxes—sometimes at a rate of 50%—on carbonated or sugar-sweetened beverages. In order to meet the agreed global and regional goals relating to nutrition and diet-related NCDs, countries will need to build on this progress and scale up action across the Region while intensifying efforts in areas where concrete action is lacking.

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15.3 USING TECHNOLOGY TO ADVANCE SCHOOL MENTAL HEALTH: EXPERIENCE FROM THE EASTERN MEDITERRANEAN REGION

Journal of the American Academy of Child & Adolescent Psychiatry ◽

10.1016/j.jaac.2019.07.095 ◽

2019 ◽

Vol 58 (10) ◽

pp. S22 ◽

Cited By ~ 2

Author(s):

Syed Usman Hamdani ◽

Naila Muzaffar ◽

Zille Huma ◽

Affan Hamdani ◽

Rabia Rauf ◽

...

Keyword(s):

Mental Health ◽

Mediterranean Region ◽

Eastern Mediterranean ◽

School Mental Health ◽

Eastern Mediterranean Region

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The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990–2013

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2023 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S156-S157 ◽

Cited By ~ 3

Author(s):

R. Charara ◽

A. Mokdad

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Disorders ◽

Low Income ◽

Mediterranean Region ◽

Eastern Mediterranean ◽

Eastern Mediterranean Region ◽

Low Income Countries ◽

Years Of Life Lost ◽

Life Years

The eastern Mediterranean region (EMR) is witnessing an increase in mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the global burden of disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost–YLLs) and nonfatal outcomes (years lived with disability–YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of total disease burden in EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years. The highest proportion of DALYs occurred in the 25–49 age group. The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Depressive disorders accounted for most DALYs, followed by anxiety disorders. Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to global level. Our findings call for EMR health ministries to increase provision of mental health services and to address stigma of mental illness. Our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability.

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Mental health in EMRO: the future is now

Eastern Mediterranean Health Journal ◽

10.26719/2001.7.3.332 ◽

2001 ◽

Vol 7 (3) ◽

pp. 332-335

Author(s):

B. Saraceno

Keyword(s):

Mental Health ◽

Mediterranean Region ◽

Community Care ◽

Eastern Mediterranean ◽

Eastern Mediterranean Region ◽

Mental Health Disorders ◽

World Health ◽

The World ◽

Health Disorders ◽

Health Organization

Recognizing the magnitude of the problem of mental health disorders globally, the World Health Organization has made mental health the focus of the year 2001. In this paper three priority areas for action in the Eastern Mediterranean Region are suggested, namely: human rights, mental hospitals and community care, drug abuse, and reconstruction of the health care system in Afghanistan.

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Development of a World Health Organization Programme for School Mental Health in the Eastern Mediterranean Region

Eastern Mediterranean Health Journal ◽

10.26719/emhj.22.022 ◽

2022 ◽

Author(s):

Hesham M. Hamoda ◽

Sharon Hoover ◽

Jeff Bostic ◽

Atif Rahman ◽

Khalid Saaed

Keyword(s):

Mental Health ◽

World Health Organization ◽

Mental Health Professionals ◽

Mediterranean Region ◽

Eastern Mediterranean ◽

School Mental Health ◽

Eastern Mediterranean Region ◽

World Health ◽

Health Priorities ◽

Health Organization

Background: Schools provide an exceptional opportunity for mental health promotion and intervention. Aims: To describe the development of a World Health Organization (WHO) School Mental Health Program (SMHP) in the Eastern Mediterranean Region. Methods: Two tenets guided development of the SMHP: (1) it used a multitiered system of support framework including 3 tiers of interventions (universal, early and targeted); and (2) interventions must be feasible for implementation by non-mental health professionals. Results: The WHO SMHP is organized into a background section, followed by 3 modules: Social–Emotional Childhood Development; Mental Health Promoting Schools (Promotion and Prevention); and Addressing Student Mental Health Problems in Your Classroom, including specific classroom strategies and case examples. Conclusion: Developing an appropriate curriculum sensitive to the needs of individual countries requires involvement of those familiar with schooling in those countries, with mental health priorities and practices that promote mental health, and to coalesce school staff, parents and community members in the service of their children.

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