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  • I want you to imagine this for a moment.

  • Two men, rather and Rajiv living in the same neighborhood from the same educational background, similar occupation, and they both done up at their local accident emergency complaining of acute chest pain.

  • Raul is offered a cardiac procedure, but Rajiv is sent home.

  • What might explain the difference in the experience of these two nearly identical men?

  • Rajiv suffers from a mental illness.

  • The difference in the quality of medical care received by people with mental illness is one of the reasons why they live shorter lives than people without mental illness.

  • Even in the best resourced countries in the world, this life expectancy gap is as much as 20 years in the developing countries, the world.

  • This gap is even larger.

  • But of course mental illnesses can kill in more direct ways as well.

  • The most obvious example is suicide.

  • It might surprise some of you here, as it did me when I discovered that suicide is at the top of the list of the leading cause of death in young people in all countries of the world, including the poorest countries of the world.

  • But beyond the impact offer health condition on life expectancy.

  • We're also concerned about the quality of life lived now in order for us to examine the overall impact of a health condition both on life expectancy as well as on the quality of life lived.

  • We need to use a metric called the Dalai, which stands for a disability adjusted life here that when we do that, we discover some startling things about mental illness.

  • From a global perspective, we discover that, for example, mental illnesses are amongst the leading causes of disability around the world.

  • Depression, for example, is 1/3 leading cause of disability alongside conditions such as diarrhea and pneumonia and Children.

  • When you put all the mental illnesses together, they account for roughly 15% off the total global burden of disease.

  • Indeed, mental illnesses are also very damaging to people's lives.

  • But beyond just the burden of disease, let us consider the absolute numbers.

  • The World Health Organization estimates that there are nearly 4 to 500 million people living on our tiny planet who are affected by mental illness.

  • Now, some of you here look a bit astonished by the number, but consider for a moment the incredible diversity of mental illnesses, from autism on intellectual disability in childhood through the depression, anxiety, substance misuse and psychosis, and adult or all the way through to dementia In old age on, I'm pretty sure that each and every one of us present here today can think of at least one person, at least one person who's affected by mental illness in our most intimate social networks.

  • I see some nodding heads there.

  • But beyond the staggering numbers, what's truly important from a global health point of view?

  • What's truly worrying from a global health point of view is that the vast majority off thes affected individuals do not receive the care that we know can transform their lives.

  • And remember, we do have robust evidence that a range of interventions, medicines, psychological interventions and social interventions can make a vast difference.

  • And yet, even in the best resourced countries, for example, here in Europe, roughly 50% off affected people don't receive these interventions in the sorts of countries I work in, that so called treatment gap approaches an astonishing 90%.

  • It isn't surprising, then, that if you should speak to anyone affected by mental illness, the chances are that you will hear stories of hidden suffering, shame and discrimination in nearly every sector off their lives.

  • But perhaps most heartbreaking of all are the stories off the abuse of even the most basic human rights, such as the young woman shown in this image here that are played out every day.

  • Sadly, even in the very institutions that were built to care for people with mental illnesses, the mental hospitals, it's this injustice that has really driven my mission to try and do a little bit to transform the lives of people affected by mental illness.

  • And a particularly critical action that I focused on is to bridge the gulf between the knowledge we have that can transform lives.

  • The knowledge of effective treatments on how we actually use that knowledge in the everyday world on an especially important challenge that I've had to face is the great shortage off mental health professionals, such a psychiatrist and psychologists, particularly in the developing world.

  • I trained in medicine in India on After that I chose psychiatry is my specialty, much to the dismay of my mother and all my family members, who kind of thought neurosurgery would be a more respectable option for their brilliant son.

  • Any case I went on that soldiered on with psychiatry and found myself training in Britain in some of the best hospitals in this country.

  • I was very privileged.

  • I worked in a team of incredibly talented, compassionate but most importantly, highly trained, specialized mental health professionals.

  • Soon after my training, I found myself working first in Zimbabwe and then in India, and I was confronted by an altogether new reality.

  • This was a reality off a world in which there were almost no mental health professionals at all.

  • In Zimbabwe, for example, that were just about a dozen psychiatrists, most of whom lived and worked in Harare City, leaving only a couple to address the mental health care needs of nine million people living in the countryside in India, I found the situation was not a lot better to give you perspective.

  • If I had to translate the proportion of psychiatrists in the population that one might see in Britain to India, one might expect roughly 150,000 psychiatrists in India in reality, take a guess.

  • The actual number is about 3000 about 2% off that number.

  • It became quickly apparent to me that I couldn't follow the sorts of mental health care models that I have been trained in, one that relied heavily on specialized, expensive mental health professionals to provide mental health care in countries like India and Zimbabwe.

  • I had to think out of the box about some other model of care.

  • It was then that I came across these books, and in these books I discovered the idea off task shifting in Global health.

  • The idea is actually quite simple.

  • The idea is when you're short of specialized health care professionals, use whoever is available in the community, trained them to provide a range of health care interventions.

  • And in these books I read inspiring examples, for example, of how ordinary people had been trained to deliver babies, diagnose and treat early pneumonia to great effect.

  • And it struck me that if you could train ordinary people to deliver such complex Elka interventions, then perhaps they could also do the same with mental health care.

  • Well, today I'm very pleased to report to you that there have been many experiments in tar shifting in mental health care across the developing world over the past decade on I Want to Share With You the findings of three particular such experiments, or three of which focused on depression, the most common off all mental illnesses in rural Uganda.

  • Paul Bolton and his colleagues using Villagers demonstrated that they could deliver interpersonal psychotherapy for depression on using a randomised control design showed that 90% off the people receiving this intervention recovered as compared to roughly 40% in the comparison villages.

  • Similarly, using a randomized controlled trial in rural Pakistan, RT.

  • Freeman and his colleagues showed that Lady Health visitors who are community maternal health workers in Pakistan's health care system could deliver cognitive behavior therapy for mothers who were depressed again, showing dramatic differences in the recovery rates.

  • Roughly 75% of mothers recovered as compared to about 45% in the comparison Villagers on In my own trial in Goa in India, we again showed that lay counselors drawn from local communities could be trained to deliver psychosocial interventions for depression anxiety leading to 70% recovery rates as compared to 50% in the comparison primary health centers.

  • Now, if I had to draw together all these different experiments and are shifting on there.

  • Of course, being many other examples on try and identify what are the key lessons we can learn that makes for a successful star shifting operation.

  • I've have going to this particular acronym, Sundar.

  • What Sundar stands for in Hindi is attractive.

  • It seems to me that there are five key lessons that have shown on this slide that are critically important for effective Dar shifting.

  • The first is that we need to simplify the message that we're using.

  • Stripping away all the jargon that medicine has invented around itself.

  • We need to unpack complex health care interventions into smaller components that could be more easily transferred to Let's train individuals.

  • We need to deliver health care not in large institutions but close to people's homes on.

  • We need to deliver health care using whoever is available and affordable in our local communities.

  • And importantly, we need to reallocate the few specialists who are available to perform roles such as capacity building and supervision.

  • But for me, Dar shifting is an idea with truly global significance because even though it has arisen out of the situation of the lack of resources that you find in developing countries.

  • I think it has a lot of significance for better resource countries as well.

  • Why is that?

  • Well, in part because health care in the developed world, the health care costs in the developing world are rapidly spiraling out of control and a huge chunk off those costs are human resource costs.

  • But equally important is because health care has become so incredibly professionalized that has become very remote and removed from local communities.

  • For me, what's truly Sundar about the idea of tar shifting, though, isn't that it simply makes health care more accessible and affordable, but that it is also fundamentally empowering.

  • It empowers ordinary people to be more effective in caring for the health of others in their community and in doing so to become better guardians off their own health.

  • Indeed, for meat are shifting is the ultimate example off the democratisation, off medical knowledge and therefore medical power.

  • Just over 30 years ago, the nations of the world assembled at alma mater and made this iconic declaration.

  • Well, I think all of you can get that 12 years on, we're still nowhere near that goal.

  • Still today, armed with that knowledge that ordinary people in the community can be trained on with sufficient supervision and support, can deliver a range of health care interventions effectively.

  • Perhaps that promise is within reach now indeed, to implement the slogan of health for all we will need to involve all in that particular journey on the case of mental health in particular, we would need to involve people who are affected by mental illness and their caregivers.

  • It is for this reason that some years ago the movement for global mental health was founded as a sort of a virtual platform upon which professionals like myself and people affected by mental illness could stand together shoulder to shoulder and advocate for the rights of people with mental illness.

  • To receive the care that we know can transform their lives and to live a life with dignity and in closing when you have a moment of peace acquired in, these are very busy few days or perhaps afterwards, spare a thought for that person you thought about who has a mental illness or persons that you thought about who have mental illness and dare to care for them.

I want you to imagine this for a moment.


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B1 中級

すべての人を巻き込むことで、すべての人のためのメンタルヘルス - ヴィクラム・パテル (Mental health for all by involving all - Vikram Patel)

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    林宜悉 に公開 2021 年 01 月 14 日