At older ages, the interaction of risks continues: accumulating co-morbid physical conditions increase risk for poor mental health as well as other NCDs . Midlife and late life exposure to depressive symptoms, in turn, can increase risk for dementia  , whereas continued learning in older age helps prevent cognitive decline. The framework defines domains of integration: what is being integrated activities, policy, organizational structures ; level of integration, or where integration is occurring local, national, or global ; and degree of integration, or how integration is occurring e.
Table 1 proposes relevant integration actions for mental health services.
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Interventions for treatment and care of HIV were informed by rapid monitoring and evaluation; shifts in regimens; and a global, coordinated uptake of data-driven findings. This ability to rapidly study and coordinate a response to MNS disorders does not exist. The availability of research on these disorders varies dramatically across countries, in part due to the distribution of research investments, workforce, and capacity. In the case of mental health, fewer than one researcher per 1 million persons studies these issues in LMICs .
Recent investments in mental health services research in LMICs, however, are contributing to a change in the landscape  —  , although more is needed. Over the next 5 to 10 years, a growing body of evidence on the effectiveness of task-shifting interventions, scaling up of mental health service delivery, and integration of mental health into chronic disease care in LMICs will be available . Dissemination of study findings to decision makers, practitioners, managers, and advocates will be crucial to ensuring uptake of innovations.
Research partnerships that include mental health service users, government officials, and knowledgeable stakeholders can facilitate dissemination to desired audiences. NIMH has required that investigators utilize these kinds of collaboration in its global mental health research funding announcements  — .
Ideally, such collaborations would also facilitate bidirectional communication that informs researchers and policymakers of innovations and advocacy ongoing in community settings while simultaneously harnessing the combined resources of researchers, activists, civil society, and other stakeholders to generate and disseminate knowledge to meet the Grand Challenges.
The existing evidence base, however, demonstrates that parity for MNS disorders in policy development is particularly relevant as plans for health-related development targets for the agenda after progress. As universal health coverage emerges as a feasible option, equitable coverage for MNS disorders must be clearly articulated so that targets and metrics take into account the significant disability associated with these conditions in every region of the world . The fast approaching deadline for achieving the MDGs, the articulation of health-related targets for the post development agenda, the call for an AIDS-free generation, the imperative of equitable health care for all individuals regardless of co-morbid conditions , and the requisite health systems strengthening activities that enable the meeting of these goals make this an ideal time to integrate mental health care services into priority global health programs.
There are six other reasons. Just as progress toward the MDGs is in part attributable to shared global goals and vision, a clear agenda, and measurable targets  , similar progress in the mental health arena is expected. The global mental health community has come to consensus regarding priorities. The Plan is timely because the field is already prepared to move selected evidence-based interventions forward for scale-up. Donors are actively directing funding toward reducing morbidity and mortality associated with priority conditions identified by the MDGs .
Success in achieving these goals depends, in part, upon adherence to care, the ability to reduce risky health behaviors, the capability of caregivers—especially mothers—to attend to the nutritional and preventive health needs of their children, and maintaining adequate financial resources in households—all of which are actions severely curtailed by mental illnesses . The reality, however, is that some targets will likely not be met by Now is the time for innovations that will improve continued efforts to reduce child mortality, end HIV transmission, and reduce maternal mortality—and attention to mental health must be part of this effort.
As those committed to improving health and development discuss promotion of universal health coverage as a potential development target post, MNS disorders must be integrated equitably among the health conditions considered. Organizations such as Partners in Health and global development platforms such as the Millennium Villages Project are testing models of care that integrate mental health into priority programs .
The effects of the global economic crisis underscore the need for greater efficiency in health programs while maintaining maximum effectiveness to ensure sustained productivity among populations—an aim of care integration. Despite our worldwide focus, the authors acknowledge their current affiliations with institutions in high-income countries and recognize the importance of perspectives from low-, middle-, and high-income countries. In the five-part series providing a global perspective on integrating mental health, we aim to help health care providers, donors, and decision makers understand the importance of including mental health care in global health programs, identify entry points for integration, select interventions to be introduced into existing health services, and take steps toward action.
Wrote the first draft of the manuscript: PYC. Funding: No funding sources were used for preparation of this manuscript. Summary Points Mental illnesses frequently co-occur with peripartum conditions, HIV-related disease, and non-communicable diseases. Care for mental disorders should be integrated into primary care and other global health priority programs.
Integration of care for mental, neurological, and substance use MNS disorders should 1 occur through intersectoral collaboration and health system-wide approaches; 2 use evidence-based interventions; 3 be implemented with sensitivity to environmental influences; and 4 attend to prevention and treatment across the life course. Integration of care for MNS disorders with care for other conditions can occur through assimilation of activities, policies, or organizational structures at local, national, and global levels.
Plans for health-related development targets post should consider the tremendous burden of disability associated with MNS disorders and co-morbid conditions. This paper is the first in a series of five articles providing a global perspective on integrating mental health. Introduction More than a decade ago, the World Health Organization's WHO World Health Report called for the integration of mental health into primary care, acknowledging the burden of mental, neurological, and substance use MNS disorders globally; the lack of specialized health care providers to meet treatment needs—especially in low- and middle-income countries LMICs ; and the fact that many people seek care for MNS disorders in primary care .
The Grand Challenge of Integrating Care for MNS Disorders with Other Chronic Disease Care Despite the increasing burden of MNS disorders around the world and their frequent co-morbidities, affected individuals often lack access to mental health care in high-, middle-, and low-income countries . Box 1.
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Use Evidence-based Interventions Over the past decade, the potential for delivery of evidence-based packages of care for mental disorders has grown globally. Understand Environmental Influences Every attempt to integrate services or strengthen components of a health system occurs in a particular sociocultural, political, and health system environment with its unique configuration of risk factors across the population. Use a Life Course Approach Physical and social exposures at every stage of life influence risk for disease across the life cycle .
Download: PPT. Table 1. Operationalizing integration: Examples of activity, policy, and organizational integration that link MNS research and care to other health-related programs. The Time Is Right for Integration The fast approaching deadline for achieving the MDGs, the articulation of health-related targets for the post development agenda, the call for an AIDS-free generation, the imperative of equitable health care for all individuals regardless of co-morbid conditions , and the requisite health systems strengthening activities that enable the meeting of these goals make this an ideal time to integrate mental health care services into priority global health programs.
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Lancet View Article Google Scholar 7. J Acquir Immune Defic Syndr — View Article Google Scholar 9. PLoS One 7: e View Article Google Scholar Arch Intern Med — Geneva: World Economic Forum. Geneva: WHO. Nature 27— PLoS Med e Kodner DL, Spreeuwenberg C Integrated care: meaning, logic, applications, and implications—a discussion paper.
Int J Integr Care 2: e PLoS Med 9: e Accessed 16 November J Amer Med Assoc — Rahman A, Malik A, Sikander S, Roberts C, Creed F Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomized controlled trial. Problem URL. Describe the connection issue. SearchWorks Catalog Stanford Libraries. The challenges of mental health caregiving : Research - Practice - Policy.
Responsibility Ronda C. Talley, Gregory L. Fricchione, Benjamin G. Druss, editors. Physical description 1 online resource xix, pages. Series Caregiving New York, N. Online Available online. SpringerLink Full view. More options. Find it at other libraries via WorldCat Limited preview. Contributor Talley, Ronda C.
The Challenges of Mental Health Caregiving: Research, Practice, Policy | AHRQ Academy
Fricchione, Gregory, editor. Druss, Benjamin G. Contents Foreword; Rosalynn Carter Chapter 1. Elmore Chapter 3. Chapter 4. Gladstone Chapter 6. Holland Chapter 9. Research in Caregiving; Elizabeth A. McDaniel Part II. Beardslee and Tracy R. Myers and Melanie C. Harper Part III.
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