Meredith Newlin , Research Fellow and PhD Candidate Centre for Mental Health Social Research

1. Translation of psychosocial interventions across economic boundaries: Preliminary results from a systematic review and feasibility study in Sierra Leone Meredith Newlin, Research Fellow and PhD Candidate Centre for Mental Health Social Research This presentation presents independent research funded by the Department of Health’s NIHR School for Social Care Research. The views expressed in this presentation are those of the author and not necessarily those of the NIHR School for Social Care Research.

2. Background “No health without mental health” Ten years after the first WHO report on the global burden of disease, mental health remains a low priority in most low and middle income countries (LMIC). The WHO has long been concerned about the gap between the high numbers of people with mental health problems and the limited availability of medication. This treatment gap is particularly large in LMIC. However, Western medicine and therapy is arguably not universally appropriate. Social interventions can help to fill the treatment gap for people with mental health problems in LMIC. Despite a low priority from funding bodies, they have the potential to improve the quality of life, social participation and well-being of people experiencing mental distress. Centre for Mental Health Social Research

3. Theoretical Background Social capital: Sum of resources (actual or potential) that accrue to a person or group from access to a network of relationships or membership in a group (Bourdieu, 1997) Community capital: Combination of capitals within a defined area or community, required to help people fulfil their potential (Hancock, 2001) Social Participation: focussed on a directly observable aspect of social capital that is seen as a means to achieve wellbeing, rather than the use of social relations to generate returns. For purposes of our study: social participation as building connections that enhance the diversity of individuals’ social networks; aiming to ensure that people know others outside of health and social care services in addition to within them Centre for Mental Health Social Research

4. Background Centre for Mental Health Social Research

5. Global Policy Context The impact of global mental health initiatives that enhance social capital is two-fold: 1. An individual’s mental health 2. Building community capacity Communities play an integral role in facilitating social interaction and inclusion in meaningful activities, which in turn supports the development of social networks World Health Organization: Mental Health and Development (2010) Fair Society, Health Lives, Marmot Review (2010) Centre for Mental Health Social Research

6. Global Policy Context WHO mhGAP Intervention Guide (2011) Highlights need to address social support, social networks and social engagement Does not provide evidence of effective interventions to achieve this Centre for Mental Health Social Research

7. Systematic review - Aims Aims: To evaluate the knowledge transfer of psychosocial interventions for adults with mental disorders across economic boundaries, specifically between high-income and LMIC. Additionally, to gain an understanding of the context-specific considerations for translating interventions between countries. Inclusion criteria: Intervention studies undertaken in LMIC are included if they primarily report a social component (as opposed to purely health) aimed to impact health or well-being outcomes for adults with mental health problems. - MeSHterms “mental disorders” - World Bank low- and middle income country classification - Interventions, evaluation, RCT, etc Centre for Mental Health Social Research

8. Systematic review Method and Results Using EPPI-Centre methodology: search terms by database, 2-phase screening process, data extraction Preliminary results: fewer than 50 studies meet inclusion criteria Many examples of mental health initiatives being developed worldwide, however few are evidence-based and locally relevant (Eaton et al., 2011). Summary: Despite widespread agreement that knowledge transfer to diverse contexts is needed, there exists a gap in published literature of the effective strategies for social interventions aimed at improving outcomes for vulnerable groups. Centre for Mental Health Social Research

9. Sierra Leone Emerged in 2002 from a civil war that severely damaged its communities Deeply entrenched challenges such as under capacity of health and social care workers A 2002 study estimated 13% of the adult population suffer from a mental health disorder Only one trained psychiatrist and a population +4 million Centre for Mental Health Social Research

10. Sierra Leone Centre for Mental Health Social Research

11. Fieldwork in LMIC Fieldwork: “Any work carried out by staff or students for the purposes of teaching, research or other activities while representing the institution off-site” (UCEA, 2011) Experience of fieldwork and plans for PhD projects Considerations for LMIC- balancing cultural sensitivities Co-production, sustainability of interventions Centre for Mental Health Social Research

12. Thank you meredith.newlin@york.ac.uk www.connectingpeoplestudy.net Acknowledgements: Wellcome Trust Funded C2D2 Dr Martin Webber (Supervisor) Dr Gillian Manthorpe (Social Care Workforce Research Unit) Dr Susannah Whitwell, Dr Oliver Johnson (King’s Centre for Global Health) Heather Weaver, Katrina Hann, Carmen Valle (Enabling Access to Mental Health) Centre for Mental Health Social Research