Orphans and other vulnerable children : what role for social protection ?

Recent estimates have provided unprecedented numbers of orphans, and vulnerable children, either brought about because of the HIV/AIDS epidemic, or carriers themselves of HIV infections, a relentless growth which has precipitated a multifaceted care burden, that will too, grow for the next twenty years. This report records the proceedings of the Conference"Orphans and Other Vulnerable Children", which sought to promote awareness of the extent of this crisis, and, to probe the role of social protection in implementing a balanced response. The social protection framework for working with orphans, and vulnerable children shaped the conference agenda. Provision of appropriate risk management instruments is crucial for lasting poverty reduction, while programs to reduce the vulnerability of orphans, and other children, should play an integral role in any national development strategy, in the context of the HIV/AIDS epidemic. Building community capacity will constitute the centerpiece of any feasible response. Within a realistic framework, programs must spread, and scale up, to address the vast, and growing need.Street Children,Youth and Governance,Health Monitoring&Evaluation,Children and Youth,Primary Education

Relevance or Excellence? Setting Research Priorities for Mental Health and Psychosocial Support in Humanitarian Settings

Background: Humanitarian crises are associated with an increase in mental disorders and psychological distress. Despite the emerging consensus on intervention strategies in humanitarian settings, the field of mental health and psychosocial support (MHPSS) in humanitarian settings lacks a consensus-based research agenda. Methods: From August 2009 to February 2010, we contacted policymakers, academic researchers, and humanitarian aid workers, and conducted nine semistructured focus group discussions with 114 participants in three locations (Peru, Uganda, and Nepal), in both the capitals and remote humanitarian settings. Local stakeholders representing a range of academic expertise (psychiatry, psychology, social work, child protection, and medical anthropology) and organizations (governments, universities, nongovernmental organizations, and UN agencies) were asked to identify priority questions for MHPSS research in humanitarian settings, and to discuss factors that hamper and facilitate research. Results: Thematic analyses of transcripts show that participants broadly agreed on prioritized research themes in the following order: (1) the prevalence and burden of mental health and psychosocial difficulties in humanitarian settings, (2) how MHPSS implementation can be improved, (3) evaluation of specific MHPSS interventions, (4) the determinants of mental health and psychological distress, and (5) improved research methods and processes. Rather than differences in research themes across countries, what emerged was a disconnect between different groups of stakeholders regarding research processes: the perceived lack of translation of research findings into actual policy and programs; misunderstanding of research methods by aid workers; different appreciation of the time needed to conduct research; and disputed universality of research constructs. Conclusions: To advance a collaborative research agenda, actors in this field need to bridge the perceived disconnect between the goals of “relevance” and “excellence.” Research needs to be more sensitive to questions and concerns arising from humanitarian interventions, and practitioners need to take research findings into account in designing interventions. (Harv Rev Psychiatry 2012;20:25–36.

A nationwide evaluation study of the quality of care and respect of human rights in mental health facilities in Ghana: results from the World Health Organization QualityRights initiative

Background In 2012, Ghana ratified the United Nations Convention on the Rights of Persons with Disabilities and enacted a Mental Health Act to improve the quality of mental health care and stop human rights violations against people with mental health conditions. In line with these objectives, Ghanaian stakeholders collected data on the quality of mental health services and respect for human rights in psychiatric facilities to identify challenges and gather useful information for the development of plans aimed to improve the quality of the services offered. This study aimed to assess psychiatric facilities from different Ghanaian regions and provide evidence on the quality of care and respect of human rights in mental health services. Methods Assessments were conducted by independent visiting committees that collected data through observation, review of documentation, and interviews with service users, staff, and carers, and provided scores using the World Health Organization QualityRights Toolkit methodology. Results This study revealed significant key challenges in the implementation of the United Nations Convention on the Rights of Persons with Disabilities principles in Ghanaian psychiatric services. The rights to an adequate standard of living and enjoyment of the highest attainable standard of health were not fully promoted. Only initial steps had been taken to guarantee the right to exercise legal capacity and the right to personal liberty and security. Significant gaps in the promotion of the right to live independently and be included in the community were identified. Conclusions This study identifies shortcomings and critical areas that the Ghanaian government and facilities need to target for implementing a human rights-based approach in mental health and improve the quality of mental health care throughout the country

Integration of perinatal mental health care into district health services in Uganda:Why is it not happening? The Four Domain Integrated Health (4DIH) explanatory framework

The Sustainable Development Goals recognise mental health and well-being as a target area, however, mobilizing funding and prioritisation of the same remains a challenge. Perinatal mental health care has the potential for incorporation and integration across the overall maternal health agenda, and can be especially relevant for low- and middle-income countries in their overall health systems strengthening strategies. This study aimed at qualitatively situating the extent to which integration of perinatal mental health care into maternal health care was considered desirable, possible and opportune within the existing policy and service-delivery environment in Uganda. A total of 81 in-depth interviews and nine focus group discussions (N = 64) were conducted with a variety of national, district, health system and community-level stakeholders. Data were analysed thematically using theory- and data-driven codebooks in NVivo 11. Analysis of the desirability, possibility and opportunity for integrating perinatal mental health care within the Ugandan district health system, highlights that concerned stakeholders perceive this as a worthwhile endeavour that would benefit the communities as well as the health system as a whole. Based on these current realities and ideal scenarios, a tentative explanatory framework that brings together various perspectives – that is, the perceived nature of the health problem, local and national health system issues, alternative systems of care and support, and international global perspectives – was constructed. The framework needs further validation but already hints at the need for global, national and local forces to concurrently rally behind the inclusion and integration of perinatal mental health care, especially at the primary care level in low- and middle-income contexts. If the global health community is poised to achieve high quality, women-centered care and people-centered health systems across the lifespan, then the sustainable integration of mental health care into general health care, is a commitment that can no longer be delayed

Cost-effectiveness of group psychotherapy for depression in Uganda

Synthesizing published data on the epidemiology of depression, treatment efficacy, and costs from developing countries where available, we developed a Markov cohort model of depression to evaluate the cost-effectiveness of group interpersonal therapy (IPT) with and without booster sessions for recurrent depression episodes in the setting of Uganda. When compared to no intervention, group IPT without booster sessions decreased average number of depressive episodes by 6.2%, while booster sessions reduced number of episodes by 15.8%. Although group IPT alone was less costly than group IPT with booster sessions, the incremental cost-effectiveness ratio (ICER) was higher, and therefore, group IPT without booster sessions was dominated. The ICER associated with group IPT with booster sessions compared to no intervention was I$1,150 per QALY, below Uganda’s per-capita GDP, a commonly-cited benchmark for cost-effectiveness. The results were most sensitive to cost of the booster sessions and health state utility for depression

Research priorities for mental health and psychosocial support in humanitarian settings.

Wietse Tol and colleagues lay out a a consensus-based research agenda for mental health and psychosocial support in humanitarian settings