Research & Innovation 2015-16 - Page 65

Thought leader
Evidence-based mental-health interventions, such as
psychological therapies, psychotropic medications
and psychosocial rehabilitation programmes in
community settings not only led to clinical and
functioning improvements, but also improved
the economic circumstances of the individuals
concerned. In some cases, the benefits extended to
their households.
‘No health without mental health’
This evidence has emerged as part of a growing field
of global mental-health research, led by innovators
such as Vikram Patel from India, Ricardo Araya from
Chile, and Martin Prince and Graham Thornicroft from
the UK. Among other things, this field has improved
the cultural relevance of mental-health assessment
instruments, developed innovative psychological
therapies in low-resource primary-care settings, and
improved our understanding of the links between
mental health and other physical health conditions,
under the slogan ‘no health without mental health’.
Armed with this new evidence, a group of global
mental-health advocates (including 65
national and international organisations)
led by the Centre for Global Mental
Health responded to the call
for contributions to the new
SDGs. Under the banner of
‘FundaMentalSDG’, this group
campaigned tirelessly to have
mental health included in the
SDGs, presenting arguments
that included human rights,
healthcare and economic
outcomes. Despite initial
setbacks, the campaign was
eventually successful, and
important commitments to
mental health were made.
Specific mental health targets
Among them, the SDGs state that mental health
must be included in universal health coverage, and
that “... we are committed to the prevention and
treatment of non-communicable diseases, including
behavioural, developmental, and neurological disorders,
which constitute a major challenge for sustainable
development”. In addition, mental health was included
in SDG 3 (the health goal), with three specific targets:
• By 2030, reduce by a third premature mortality
from non-communicable diseases through
prevention and treatment, and promote mental
health and well-being (target 3.4);
• Strengthen the prevention and treatment of
substance abuse, including narcotic drug abuse and
harmful use of alcohol (target 3.5); and
• Achieve universal health coverage, including
financial risk protection, access to quality essential
healthcare services, and access to safe, effective,
quality and affordable essential medicines and
vaccines for all (target 3.8).
In addition, there has been a commitment to track
suicide rates for all countries.
New set of challenges
This is a major victory for the field, and for the millions
of marginalised people who live with mental-health
problems, particularly vulnerable populations who live
in circumstances of poverty. But of course, these new
commitments bring a new set of challenges.
Firstly, there are new national and international
policy challenges, to invest in and scale up evidencebased mental-health care, and to address the social
determinants of mental health: poverty, violence
(particularly gender-based violence),
inequality and environmental
Secondly, there are exciting
new research challenges: to
understand more about the
mechanisms of poverty
and mental illness cycles
in LMIC; specifically,
where and when targeted
interventions can be
delivered that address the
mechanisms of poverty and
mental illness.
This requires a change of
thinking: joining the dots, to
integrate mental-health outcomes
into the evaluation of violence reduction
and poverty-alleviation interventions, and to
evaluate the economic and violence-reduction impacts
of mental-health interventions.
We are currently engaged in some of these new
challenges through research that we conduct from
UCT, including the Programme for Improving Mental
healthcare (PRIME), the Africa Focus on Intervention
Research for Mental health (AFFIRM) and Emerging
mental health systems in low and middle-income
countries (EMERALD).
Professor Crick Lund is director of the Alan J Flisher
Centre for Public Mental Health, Department of
Psychiatry and Mental Health. Image by Halden Krog.
Good health and well-being 60


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