Integrating Mental Health and NCDs Welcome!

Integrating Mental Health and NCDsWelcome! World Mental Health Day Symposium Contributions for Action on NCDs and Global Health Following-Up the UNGA Health Debate and Challenges for the Future

Goals • Share reflections and resources about mental health and NCDs. • Review the process of working together to prevent and control NCDs and advocating for mental health’s inclusion at the UN General Assembly High-Level Meeting. • Consider future contributions for mental health in NCDs and the global health agenda.

Panelists • Dr Kelly O’Donnell Consulting Psychologist, Member Care Associates Global Mental Health: Contributions for NCDs and Beyond • Dr. OdileFrank Health Services Officer, Public Services International Getting Mental Health on the NCD Agenda • Dr. Ashley Bloomfield Partnership Advisor, World Health Organisation Partnership Lessons from Working Together on NCDs • Dr.Curtis Doebbler International Human Rights Lawyer A Human Rights-Based Approach to NCDs • Ms.NyaradzayiGumbonzvanda General Secretary, World YWCA; President, UN Geneva NGO Committee on the Status of Women Sharing Personal Experiences about NCDs

Global Mental Health:Contributions for NCDs and Beyond Dr. Kelly O’Donnell Notes and Quotes: Two weeks of Global Health Events related to NCDs--September 2011, New York 1. NGO Committee on Mental Health (CoNGO, New York) Global Challenge of Chronic Disease: Interaction of Physical + Mental Health Risks (8 Sept) 2. World Federation for Mental Health et al MH as a Global Priority (17 Sept.) MH: The NCD that Cannot be Forgotten (18 Sept.) 3. UN General Assembly HLM (19 -20 Sept) Three Roundtables and three WHO Side-Events 4. Conclusion: Five Suggestions for Global Mental Health

The NGO Forum for Health is a Geneva-based consortium of health organizations, committed to promoting human rights and quality care in global health. Our origins lie in the 1978 Alma Ata Conference on Primary Health Care. The Forum’s mission is to contribute to making health for all a reality by advocating for protection and realization of the right to health; by promoting equity and justice in access to health for all persons at all stages of their life; and by promoting and encouraging healthy life choices. Our Mental Health-Psychosocial Working Group (MH-PS) focuses on advocacy, equity, and resources for mental health. It promotes the right to health; endorses health policies that integrate objectives for mental and psychosocial wellbeing; and contributes to the development of global health policy that is founded on the affirmation in the WHO Constitution (1948) that “health is a state of complete physical, mental and social well-being...”.

Mommy, guess what? Today in kindergarten I learned how to write. Here look at this page! • That’s great dear, said the mom. I am so proud of you. So what does it say? • Well, mommy, how should I know? I don’t know how to read.

World Mental Health Day (1992-current, 10 October) • Putting GMH in historical context, remembering and building on history. • This is an international effort to promote greater public awareness and understanding of mental health and mental illness. Every year, thousands of people across the world share information and raise awareness and funds for mental health causes. • 2011: The Great Push: Investing in Mental Health • 2010: Mental Health and Chronic Physical Illnesses • 2009: Mental Health in Primary Care • 2008: Making Mental Health a Global Priority: Advocacy/Action • 2007: Mental Health in a Changing World: Culture and Diversity • 2006: Building Awareness–Reducing Risk: Mental Illness/Suicide • 2005: Mental and Physical Health Across the Life Span • 2004: The Relationship between Physical and Mental Health • 2003: Emotional/Behavioral Disorders of Children/Adolescents • 2002: The Effects of Trauma/Violence on Children /Adolescents • 2001: Mental Health and Work • 2000: Mental Health and Work • 1999: Mental Health and Ageing • 1998: Mental Health and Human Rights? • 1997: Children and Mental Health • 1996: Women and Mental Health • 1995: Mental Health and Youth • 1994: Improving Mental Health Services throughout the World • 1992-1993 (general themes)

NGO Committee on Mental Health Global Challenge of Chronic Disease: Interaction of Physical + Mental Health Risks (8 Sept) Notes: 30 participants, five panelists • Medical background of 4 of the 5 presenters 2. MH is a risk factor for many diseases including NCDs: a precursor and consequence [mental state/condition, illness/disease, disorder/problem etc. ] inactivity (lack of exercise), poor diet (including high intake of tans-fats, salts, and sugars), tobacco use, and alcohol abuse. Added to these risk factors is the key area of mental healthand also poverty. Quotes: • Train health care students/profs in MH [and vice versa] 2. UN GA Political Declaration (par. 18): “Recognize that mental and neurological disorders, including Alzheimer’s disease, are an important cause of morbidity and contribute to the global NCD burden for which there is a need to provide equitable access to effective programs and health care interventions;”

Paragraph 17 “Note further that there is a range of other NCDs and conditions for which the risk factors and the need for preventive measures, screening, treatment and care are linked with the four most prominent NCDs;”

Dr. Elizabeth Carll, UN NGO Committee on Mental Health • “What matters is that the recognition of MH as a risk factor for NCDs has been agreed by 193 countries. This is an important outcome as previously MH has not been recognized by many countries as a significant factor affecting health and social and economic development…. • When governments establish [health] programs, we can expect that MH will be included, and if not, we have a UN Declaration to show that a country’s actions may not be consistent with agreed upon and appropriate methods for prevention and control of NCDs.”

World Federation for Mental Health et alMH as a Global Priority (17 Sept.)Cornell University Medical Hospital

World Federation for Mental Health et alMH as a Global Priority (17 Sept.) Notes: 30 people, 10 organisational sponsors 1. Large input from younger professionals/grad students (YPCDN)—we are serious, we have a permit to demonstrate in front of UN/ HLM 2. Don’t forget neurology: epilepsy, stroke, dementia, traumatic injury all part of MNS conditions and should be part of priority conditions 3. The “science” of developing effective political action Quotes: 1. We must align together for GMH 2. Some hindrances: It is hard to work together when there is competition for funding/money (Liberia example and generalised to many settings)—get money sorted first; “Guild issues” keep us from working together (protecting our turf) 3. Special interest group agenda or strategic support to humans in need: Let’s consider a Special Rapporteurfor MH in the UN and a Special Resolution in the future for GA to consider on MH.

2b. WFMH et alMental Health:The NCD that Cannot be Forgotten (18 Sept.)

WFMH et alMental Health:The NCD that Cannot be Forgotten (18 Sept.) • Notes: • MH and NCDs: The Facts (yet another pleasant surprise!) • 2. Letter from MoHIndia about integrating MH into NCDs • Quotes: • 1. Not integrating MH into NCDs and the struggle to get to the main table is “short-sighted and insane”. • 2. Off the record: ‘A MH focus and Resolution for the UN GA is very unlikely in the next several years; build upon and flow with the world visibility and gains in health via NCDs’

3. UN General Assembly HLM (19 -20 Sept)

UN General Assembly HLM (19 -20 Sept) Multimedia: Live Webcasts and Videos • NCDs and UN GA HLM (90 second video, Youtube) 2. Various videos on Youtube (example) Unite in the Fight Against NCDs WHO Video (80 seconds) 3. UN News Centre--archives of speeches meetings

UN General Assembly HLM (19 -20 Sept) Notes: 1. A deafening silence: Where is the voice of MH—resources, handouts, people? Was there a “political” agreement to exclude it (not because anyone is anti-MH but because of the “need” (or self-serving agenda?)to focus on the four NCD entities) 2. Bingos and Pingos—Business interest vs public interest that are part of the “Civil Society” umbrella 3. Comic strip—three scenes about a ‘caramel-coloured beverage Quotes: [Strong words:] • Ban Ki-moon: ‘Disgraceful actions of some [industry, marketing, etc] ; accountability for all needed and tough action on NCDs; • Margaret Chan: Watershed event, wake up call. We agonize over NCDS… Obesity rates are a signal that something is terribly wrong in policy… 3. Princess Dina Mired (Jordan, Civil Society rep): Why were NCDS left to flourish? NCDs—even the name makes it sound like they are not so important. Reduce NCDS by 25% by year 2525. 4. Thomas Frieden (Director, CDC) ‘What gets measured can [perhaps] get managed…’

Pulling it All Together: Seven Suggestions for Global Mental Health 1. Get (further) organised 2. Partnerships 3. Keep current 4. Global Niche and Global Network 5. Getting Dirty without Playing Dirty 6. Great Push--Grand Challenges etc. for MH 7. Other Character, competence, and compassion, united, on behalf of our “raison d’etre”

1.Getting (further) organised Note: image is from the game, Psychopoly, available from: www.thepsychstore.com, created by Amy Sweetman “who sincerely hopes you have as great of a time playing it as she did designing it…”

1. Getting (further) organised • Who are the main influencers? • Who should be at the GMH table? (can there be too much or too little inclusivity?) • What are the goals and principles that bind us together? • “More than evidence is needed to mobilise society on a mass scale. Those committed to the goals of the [MGMH] need to show that we all agree on basic principles.”

….. Virtue need not be so painful, provided that it is sensibly organised. Charles Handy Understanding Voluntary Organisations (1988)

2. Partnership Principles: • “Let’s discuss ways to prevent the GMH movement from evolving into a self-serving industry; overly politicized with rivalries and an ethos preserving positions, power, and status quo; with the default to providing the majority of resources to the higher income countries, etc. • Are good will and common goals enough to keep the diversity of people in GMH connecting and contributing together?”

2. Partnership principles “For any social movement, flexibility and trust are vital to bind its diverse communities to a central goal.” (Patel, Collins et al, 2011)

2. Partnership Principles • Example: Global Humanitarian Platform (July 2007) (agreement between UN/non-UN Organisations) • Equality • Transparency • Results orientation • Responsibility • Complementarity vs. hindrances/realities such as: • respect for power/hierarchical authority; pragmatism, maintaining livelihoods/survival, dependency on funding

3. Cross sectors • Ongoing connections • Staying au courant • GMH in the context of human health, development, issues, etc—the academic domain of “international relations”?

The United Nations is a 20th-century organization facing a 21st-century challenge as an institution with impressive achievements but also haunting failures, one that mirrors not just the world’s hopes but its inequalities and disagreements, and most important, one that has changed but needs to change further…. • The single greatest problem facing the United Nations is that there is no single greatest problem; rather there are a dozen different ones each day clamoring for attention. • Some, like the crisis in Lebanon, the Palestinian situation and the nuclear programs in Iran and North Korea, are obvious and trying. Others we call “problems without passports”— issues that cross all frontiers uninvited, like climate change, drug trafficking, human rights, terrorism, epidemic diseases, and refugee movements. • Their solutions, too, can recognize no frontiers because no one country or group of countries, however rich or powerful, can tackle them alone.ShashiTharoor, The Good for Something United Nations, Newsweek, September 4, 2006

3. Crossing sectors • Example: Where was and is the active, ongoing involvement and support of GMH in the NCD Alliance? • Bubbles, borders, biases • “Sector-connectors”

4. Global Niche and Global Network Finding your global niche(s) and your global networks Majoring on your work, minor on the world…..

5. Get Dirty without Playing Dirty

Sending an SMS to the World Selfless Moral Struggle (Vikram Patel, Pamela Collins et al, 2011) (and service and successes) “The [MGMH’s] members believe that a selfless moral struggle built on a partnership of professionals and civil society is essential to mutually strengthen all global mental health communities.”

6. Great Push, Grand Challenges, etc. • The Great Push for Mental Health has four themes to help maximise the impact of the global mental health community and to support those who struggle with mental, neurological, and substance use conditions (MNSs): Unity, Visibility, Rights, and Recovery. • “We want…governments to see the importance of mental health not only for the millions which still go untreated but also for the economies of countries, individual poverty and lack of well-being.” • Your endorsement of the Great Push represents your commitment to further connect with the global mental health community in advocating for and improving mental health.

Message from Dr. John CopelandChair, Great Push for MH • “Proposals will be presented to the board of the World Federation and to the Movement for Global Mental Health to bring together the 480 organisations so far signed up to the WFMH Great Push for Mental Health to make a statement on behalf of the mental health community and we hope to be able to provide more details in a few days’ time."

7. Other suggestions

Character, competence, and compassion, united together, on behalf of our “raison d’etre” • “Be open to the ongoing exploration of our lifestyle choices, values, and barriers in our own minds including fears and prejudices in light of GMH realities.” (excerpt from ‘GMH Resource Map, 2011)

Integrating Mental Health and NCDs Welcome!