Report of the first meeting of the Strategic and Technical Advisory Group for Mental Health, Brain Health and Substance Use
Report of the first meeting of the Strategic and Technical Advisory Group for Mental Health, Brain Health and Substance Use Report of the first meeting of the Strategic and Technical Advisory Group for Mental Health, Brain Health and Substance Use ISBN 978-92-4-006580-2 (electronic version) ISBN 978-92-4-006581-9 (print version) © World Health Organization 2022 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. 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This publication contains the report of the first meeting of the Strategic and Technical Advisory Group for Mental Health, Brain Health and Substance Use and does not necessarily represent the decisions or policies of WHO. Introduction Although mental, neurological and substance use (MNS) conditions comprise over 10% of the global disease burden and 30% of the non-fatal disease burden, they receive very low priority on the public health agenda worldwide. Most countries dedicate only a small fraction of their health care budgets to mental health; and their spending is disproportionately low to their needs. As a result, all over the globe, mental health systems are failing to meet their populations’ needs. In May 2021, during the 76th World Health Assembly, delegates endorsed the extension of the Comprehensive mental health action plan 2013-2020 out to 2030, including updated implementation options and indicators. Other relevant mandates from the World Health Assembly include: the Global alcohol action plan; the Global action plan on the public health response to dementia; and the Intersectoral global action plan on epilepsy and other neurological disorders. In the context of the sustainable development goals (SDGs) agenda and WHO’s triple billion goals to maximise country impact, a Strategic and Technical Advisory Group on Mental Health—WHO established a Brain Health and Substance Use (STAG-MNS) to advise the WHO Director-General on matters related to MNS conditions. The STAG-MNS will support WHO’s goal to advance SDG 2030 health-related targets, in particular, targets 3.4 and 3.5 to promote mental health and wellbeing and strengthen the prevention and treatment of substance 1 STAG-MNS: role, function and composition The Terms of Reference for the STAG-MNS can be found here. In its advisory capacity to the Director-General, the STAG-MNS will fulfill the following functions related to mental health, brain health, substance use and addictive behaviours: Strategic direction, intersectoral coordination and programme management of public health aspects of MNS services at national level (policy, planning and leadership); Innovation in and/or integration of MNS service delivery and organization at the programmatic or sectoral level; Comparative epidemiology of MNS conditions (trends, future projections); Measurement, monitoring and surveillance of MNS service outputs and outcomes; Strategic advocacy, partnership promotion and making the case for MNS conditions; Ethics, equity, human rights and gender in the context of MNS health services. Identify and describe current and future challenges; Advise WHO on strategic directions to be prioritized; Advise WHO on the development of global strategic documents; Propose other strategic interventions and activities for implementation. The STAG-MNS is multidisciplinary, comprising members with a range of technical knowledge, skills and experience relevant to MNS. Accordingly, WHO sought expressions of interest from individuals with substantial, high-level expertise and experience (including those with lived experience of an MNS condition) in the following areas: 2 15% 35% 25% 10% 15% Comparative epidemiology of MNS conditions Ethics, equity, human rights and gender in MNS health services Innovation in and/or integration of MNS service at programmatic or sectoral level Strategic direction, programming or partnerships Many/all areas First STAG-MNS meeting: objectives: WHO organized a first round of meetings with selected STAG-MNS members to discuss and define thematic priorities for the coming year. The meeting was held virtually via an online meeting platform (meeting agenda: Annex 2). Following introductions, nomination of the Chairperson (Dr Rabih El-Chammay, Ministry of Health, Lebanon) and an overview of the purpose, expected outcomes and composition of the STAG-MNS — members were provided with an overview of the main areas of work on MNS by the WHO Secretariat. The remainder of the meeting was dedicated to discussing key requirements and challenges related to WHO’s work in the MNS area, as well as strategic opportunities and directions that WHO could pursue. Members were selected from across WHO regions and a diverse array of professions and backgrounds, as illustrated in the figure below (selected STAG-MNS members: Annex 1). 3 The first STAG-MNS meeting included strategic discussions around critical issues, needs and future directions that, in time, could be formulated into a set of recommendations for the Director-General (discussion higlights in box below). STAG-MNS members provided positive feedback on WHO’s work in MNS, including the relevance and utility of guidelines and tools for programmatic implementation at the country level. Strategic assessment of requirements, challenges and opportunities MH literacy or awareness as a vital need and response to stigma and negative attitudes, e.g. as expressed in the media and among community resource persons, including religious and traditional leaders. The importance of a human rights based, biopsychosocial approach to prevent abuse, discrimination and stigma and to reverse bad practices (e.g. over-medication) and lack of trust in services. Awareness and sensitization among law enforcement officers (i.e. police, immigration, and drug enforcement officers) to reduce abuse and increase access to treatment through appropriate referral. How to enhance accountability with regard to access, availability and quality of MNS care at the country or service level? Empowerment of persons with lived experience to advance advocacy and enhance peer support. Programmatic priorities and integration How are MNS programmatic priorities identified by WHO? What is the process or approach? Is there an overall conceptual framework? How is the full spectrum of needs considered or voices heard (e.g. children)? Determinants Looking across the MNS programme areas, are there shared, upstream determinants that we should be looking into as a basis for more integrated and sustainable approaches? How well are MNS determinants differentiated in different contexts; is evidence that is generated in high-income contexts applicable to lower-income settings? Are actions to address MNS determinants contextually and culturally adapted before application or adoption? Stigma, discrimination and human rights Governance and leadership: how to strengthen and nurture this at the country level, both in government and WHO country offices? What are sustainable models of care? How to integrate the range of WHO guidelines in practice or at the level of service delivery in countries? Mental health financing: what are potential or applicable mechanisms for more equitable and sustained resource allocation for MNS services? Workforce development, pre-service, in-service training, and supervision needs of specialists and non-specialists Access to or affordability of essential psychotropic medications UHC as a unifying force for MNS service development; is SDG 3.8 on UHC underplayed by MNS, relative to other SDG targets that directly cover MNS (SDG 3.4 and 3.5)? Health system issues 4 On the second day, STAG-MNS members were split into three small groups to consider the issues (and guiding questions) set out below. Coherence: Avoid silos; improve coherence by showing links between MNS conditions (e.g. common solutions to shared determinants or consequences) Leadership: Improve engagement of national decision-makers (in or outside the health sector); getting information and guidance to the right people. Build and foster leadership at the country level Cultural context: Account for different cultural contexts and situations Priority areas: Retain or strengthen work on child and adolescent mental health, and long-term care Strategic Directions for WHO and its partners in the MNS area Is WHO’s work on MNS too spread out, too much/too little, or about right? Are there missing areas of work? Are priorities logical or misaligned? What are the strategic shifts or needs that WHO needs to consider in its work on MNS? Issues raised and discussedSmall group topic Obstacles: MNS services not seen as a priority at national level, resulting in low financial allocation Weak administrative /or governance structures for mental health Regulatory differences across countries (e.g. with respect to data protection or collection) Structural stigma Industry interferences (in particular, alcohol) Lack of commitment to implement policies/plans Impacts: Impact measurement is compromised by low data collection capacity and resourcing (e.g. suicide; weak health information systems in low-income settings) There is a need for more uniform evaluation at the programme level, using a common set of indicators Challenges: Stigma, in all its different forms Addressing the social and other determinants of mental health, brain health and substance use (since they typically fall outside the realm or responsibility of the health sector) Strategic Challenges for WHO and its partners in the MNS area What are key obstacles or impediments for WHO’s normative and country support work? How well is WHO able to demonstrate impact or change over time? Is WHO’s work on MNS sufficiently integrated into other agendas (e.g. PHC, UHC, SDGs) or the work of its partners? What are key challenges and threats to WHO’s work in the future? Partnerships: Increase level of partnership at the country level Increase collaboration with: multi-lateral institutions (e.g. development banks); academic institutions in countries/regions where country support is taking place; and private sector / corporations where applicable (e.g. mental health in the workplace) Improve coordination between different levels of WHO (HQ, Regions, Country Offices) Media: Harness the use of social media to better communicate needs, messages and activities Increase the role of media in data flow/exchange Human rights: Make continued or greater use of international human rights frameworks and instruments to promote, inform and enable service reforms and development Strengthen the use of a rights-based approach to rehabilitation Digital: Harness the use of digital technologies to inform and advance workforce development Strategic Opportunities for WHO and its partners in the MNS area How can WHO do better, e.g. with respect to partnerships and networks; investment and resource mobilisation; integration with other programmes or priority areas; communications and advocacy? Are digital and other innovations being sufficiently-well deployed by WHO? Based on these discussions, as well as concluding remarks and reflections at the end of the meeting by STAG-MNS members and the WHO Secretariat, the following thematic areas emerged as potential priority issues or concerns for more in-depth consideration by the STAG-MNS: Issues to be addressed by STAG-MNS What are key commonalities or shared determinants across the MNS space, and how can these be better understood, communicated and acted upon? Should WHO develop a conceptual framework or guidance for countries that highlights links between the different areas of work (and associated action plans) for MNS? Are there significant gaps in the WHO’s work on MNS issues? Do WHO’s priorities align well with the world’s needs? How could MNS be better positioned as an accelerator for SDG goals achievements? Strategic value and policy coherence How could WHO better support the development and capacity of national leaders and decision-makers (in and beyond the health sector)? How can WHO contribute to or support mechanisms for strengthened governance of MNS systems and services? How could WHO guidance and tools be better targeted, packaged and presented to those who could benefit from them on the ground? Governance and leadership Thematic area How can WHO and its partners better engage with other sectors and non-state actors, both globally and nationally? Could WHO do more to develop strategic relationships with leading media outlets to help change the discourse on mental health, brain health and substance use, e.g. with respect to stigma and discrimination? If so, through what mechanisms? Communications, partnerships and media 6 By defining its main areas of work, the STAG-MNS considered creating a series of subgroups (thematic groups), each responsible for a particular topic. It was suggested that the issues and questions collectively identified by the group could be further explored in the form online, with a view to developing responses and draft recommendations that could be shared at an interim online meeting of the STAG-MNS in early 2023. This would then be followed by further reflection and development of final recommendations, to be presented at a face-to-face meeting in the second quarter of 2023. The first meeting of the STAG-MNS was brought to a close by its Chairperson, Rabih El-Chammay, and by Dévora Kestel, Director of the Department of Mental Health and Substance Use. Both thanked the members of the group for their time and inputs, as well as the WHO Secretariat for its assistance in planning and facilitating the meeting. 7 Leonardo Cubillos Director, Centre for Global Mental Health Research National Institute of Mental Health (NIMH) United States of America Kirsty Donald Professor of Pediatric Neurology University of Cape Town South Africa Chencho Dorji Professor of Psychiatry Bhutan S. Benedict Dossen Lead, Country Mental Health Program, The Carter Center Liberia Rabih El Chammay Head, National Mental Health Programme Ministry of Health Lebanon Cleusa Ferri Department of Psychiatry Universidade Federal de Sao Paulo Brazil Chan Lai Fong Assistant Professor of Psychiatry Nation University of Malaysia Malaysia Shayni Geffen Project leader, South African Federation of Mental Health South Africa Wei Hao Professor of Psychiatry, Central South University Head of WHO Collaborating Centre on Drug Abuse China Olga Kalina Advocate and Consultant on Mental health Georgia Kairi Kolves Professor, Australian Institute for Suicide Research and Prevention Australia Chido Madzvamutse Senior Associate, HIV/Mental Health Integration Zimbabwe Neo Morojele Honorary Professor, School of Public Health and Family Medicine, University of Cape Town South Africa Pratima Murthy Professor of Psychiatry and Director, National Institute of Mental Health and Neuro Sciences India Michael Pietrus Director, Opening Minds Mental Health First Aid Canada Canada Kameshwar Prasad Director and CEO, Rajendra Institute of Medical Sciences India Afarin Rahimi-Movaghar Professor of Psychiatry, National Centre of Addiction Studies Islamic Republic of Iran Kiran Teresa Thakur Assistant Professor, Division of Critical Care and Hospitalist Neurology, Columbia University United States of America Graham Thornicroft Professor of Psychiatry, Institute of Psychiatry, Psychology and Neuroscience United Kingdom of Great Britain and Northern Ireland Chahnez Charfi Triki Head, Child Neurology Department Tunisia Annex 1 List of Participants STAG Members WHO Secretariat Headquarters Office: Dévora Kestel Director, Department of Mental Health and Substance Use (MSD) Dan Chisholm Mental health specialist, MSD Tarun Dua Unit Head, Brain Health, MSD Michelle Funk Unit Head, Policy Law and Human Rights, MSD Mark van Ommeren Unit Head, Mental Health, MSD Vladimir Poznyak Unit Head, Alcohol, Drugs and Addictive Behaviours, MSD Giovanni Sala Consultant, Office of the Director, MSD Regional Offices Florence Baingana Regional Advisor for Mental Health WHO Regional Office for Africa Renato Oliveira E Souza Unit Chief, Mental Health & Substance Use Unit WHO Regional Office for the Americas Khalid Saeed Regional Advisor for Mental Health WHO Regional Office for the Eastern Mediterranean Carina Ferreira-Borges Regional Advisor, Alcohol, Illicit Drugs and Prison Health WHO Regional Office for Europe Ledia Lazeri Regional Advisor for Mental Health WHO Regional Office for Europe Andrea Bruni Regional Advisor for Mental Health WHO Regional Office for South-East Asia Martin Vandendyck Regional Advisor for Mental Health WHO Regional Office for the Western Pacific Annex 2 Agenda Day 1 – November 1, 2022 13.00 – 13.05 13.05 – 13.10 13.10 – 13.30 13.30 – 13.45 13.45 – 14.25 14.25 – 14.55 14.55 – 15.00 Welcome by MSD Director (including introduction of WHO Secretariat) Introduction of Chairperson STAG Members’ introductions Introduction to the STAG • Terms of Reference • Scope and modalities of work • Expected outputs MSD Unit Head presentations • Alcohol, Drugs and Addictive Behaviours • Brain Health • Mental Health • Policy Law and Human Rights Q&A and discussion: • What are key needs, gaps and challenges for WHO’s work on MNS? Closure Dévora Kestel (WHO) Rabih El-Chammay STAG Chairperson All STAG members Dan Chisholm (WHO) WHO secretariat: Vladimir Poznyak Tarun Dua Mark van Ommeren Michelle Funk Dévora Kestel Rabih El-Chammay (facilitator) All participants Rabih El-Chammay, Dévora Kestel Time (CET) Session Facilitator/Speakers Day 2 – November 2, 2022 13.00 – 14.00 Group work: Strategic Directions for WHO and its partners in the MNS area Strategic Challenges for WHO and its partners in the MNS area Strategic Opportunities for WHO and its partners in the MNS area • Group discussions (30 mins) • Report back (5 mins per group) • Discussion (15 mins) Plenary: Identification of main priorities of work for the STAG Next steps for STAG • Creation of thematic groups • Thematic groups workplans Closure Each group will be led by a STAG Member and supported by a member of WHO secretariat team Rabih El-Chammay, with support from WHO team as requested Giovanni Sala Dévora Kestel Time (CET) Session Facilitator/Speakers 14.00 – 14.40 14.40 – 14.55 14.55 – 15.00