Member Care and Lausanne 3: Blog Four

Global Mental Health
and Unreached People Groups

The Lausanne 3 Conference brought together some 4000 people this past October in South Africa. Here are excerpts from one of the seven MCA blogs at the Global Conversation portal at Lausanne 3.

The main question of this particular blog:
How do mental disorders affect those in Unreached People Groups--and other vulnerable groups? Is the mission/aid community, like other social sectors and governmental bodies, focusing adequate resources on identifying and helping the millions of people who struggle with psychological conditions? Yes, No, or Probably?!

“Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”
World Health Organization, October 2009 http://www.who.int/features/factfiles/mental_health/en/index.html

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Mental disorders: What exactly are the issues, who has the responsibility to help, and what has been done and can be done? Have a look at these statistics as well as the resources below from the World Health Organization (WHO). See also our 20 March 2010 entry on Well-Being for All.

Global Mental Health Statistics—The Quick Overview

**According to WHO, mental, neurological, and substance use disorders “are common in all regions of the world, affecting every community and age group across all income countries. While 14% of the global burden of disease is attributed to these disorders, most of the people affected—75% in many low-income countries—do not have access to the treatment they need.” (WHO, launch of the mhGAP program)

http://www.who.int/mental_health/mhgap/en/index.html

WHO estimates (2002):

• over 150 million have depression

• 25 million have schizophrenia

• 50 million have epilepsy

• over 100 million have drug or alcohol use disorders

• over one million suicides/year.

**In addition, “people with these disorders are often subjected to social isolation, poor quality of life and increased mortality. These disorders are the cause of staggering economic and social costs.” (WHO Department of Mental Health, The Bare Facts).

**Ten Facts on Mental Health (click link for a quick overview)

http://www.who.int/features/factfiles/mental_health/en/index.html

Some Core Resources—The Big Picture

**The WHO Report on Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group. “The WHO report demonstrates that people with mental health conditions are vulnerable – not because of any inherent weakness, but as a result of the way they are treated by society. It illustrates how people are not only missed by development programmes, but can be actively excluded from these programmes, this despite the fact that an explicit goal of development is to reach the most vulnerable. It also presents a number of evidence-based strategies which are known to improve development outcomes for persons with mental health conditions and all vulnerable groups. The WHO report is a call to action to all development stakeholders – multilateral agencies, bilateral agencies, global partnerships, private foundations, academic and research institutions, governments and civil society – to focus their attention on mental health. By investing in people with mental health conditions, development outcomes can be improved.” (Dr. Michelle Funk, WHO Department of Mental Health and Substance Abuse)

**The mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings is a technical tool developed by WHO to help health care providers who are non-specialists manage primary conditions like depression, psychosis, bipolar disorders, epilepsy, developmental and behavioural disorders in children and adolescents, dementia, alcohol use disorders, drug use disorders, self-harm/suicide and other significant emotional or medically unexplained complaints. It is a model guide to be adapted for national and local needs.

**Integrating Mental Health into Primary Care: A Global Perspective is a special report by WHO/Wonca on how mental health has been integrated into primary health care systems in different countries (e.g., India, Iran, South Africa, Brazil). The report also outlines skills needed to help people with mental disorders.

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Reflection and Discussion

1. Based on the opening video and your own perspectives, whose responsibility is it to help those in “Unreached People Groups” who struggle with various mental conditions?

2. Can a focus on mental health conditions, like other major areas of human need, be a distraction from the more “spiritual” emphasis of mission and the more physical emphasis of aid? Or can mental health needs get lost between these two emphases? What do you think?

3. Share an observation or a practical example about how mental health, as defined by the WHO towards the top of this entry, has been practically integtrated into mission/aid work.

Ethics and Confidentiality

When is information considered “confidential”?

The basic consensus among professional codes of ethics is that any information shared during the course of professional services is considered to be “privileged” information. This means that only the “client” (the person asking for help/receiving services) can determine when and how this information can be shared by the helper/member care worker. There are a few important exceptions however (see below). Confidentiality is a core part of the helping relationship, and a foundation for trust and good practice. Here are two examples of confidentiality statements.

Example One

Member Care Associates
Confidentiality (from Service Agreement)
We want you to know that what you share with us is confidential. The only exception, in compliance with most laws (e.g., American and European), is when: a) you or someone’s life may be in danger (e.g., child/elder abuse, suicidal/homicidal threat, gravely disabled); or b) explicit written permission by you has been given to waive confidentiality. Other types of personal struggles can significantly interfere with one’s work role and/or credibility of one/s organization (e.g., abusive leadership, addictions, major depression, moral failure, serious marital conflict.) In such cases we usually encourage you to inform a leader whom you trust within your organization(s). We see such struggles as being larger than the helping relationship, and thus usually best handled with the involvement and support of others.

Note for group or debriefing services: The material shared by others during the group/debriefing sessions will be kept strictly confidential by the participants.

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Example Two

American Association of Marriage and Family Therapists
Confidentiality (Code of Ethics July 2001)

www.aamft.org/resources/lrm_plan/Ethics/ethicscode2001.asp

Marriage and family counselors/therapists often work with more than one person in a family. It is important to guard each client’s confidence but it can be challenging at times. The AAMFT has developed six points relating to confidentiality. The main ideas in each point are listed below. Be sure to see the full code at the AAMFT site listed above.

1. Discuss the nature of confidentiality to clients and any others involved in the case

2. Do not disclose information without written authorization or when required by the law.

3. Confidentiality is protected when using examples for teaching, writing, research ,etc.

4. Clarity about how to safeguard and destroy records of clients

5. Clarity about how to deal with client records when closing a practice, moving, or dying

6. When/how to disclose information if one consults with colleagues about a case

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Reflection and Discussion
In what ways are the above standards relevant to member care workers who provide more “informal” services, or those who do not have a “professional” certification, or for those who come from different countries?

• How is confidentiality applicable if a colleague asks you for a referral or for some “friendly advice over a cup of coffee as friends”?
• Confidentiality can sometimes lead to misunderstandings. For example confidentiality can be seen as being secretive and withholding important information from an organisation about its staff. How can this misunderstanding be minimised?
• How do confidentiality standards apply to children in your work—i.e. when and how should parents be informed about their children who are receiving help?
• In what ways do the specific standards from the AAMFT above apply to your member care work (e.g., written authorisations, keeping/safeguarding files, using client cases in writing/teaching)?