Workshop on Strengthening Mental Health Policies and Programmes in the Western Pacific, Manila, Philippines, 31 August-2 September 2015 : report

Meeting Report

Workshop on Strengthening Mental Health Policies and Programmes in the Western Pacific

31 August - 2 September 2015 Manila, Philippines

Workshop on Strengthening Mental Health Policies and Programmes in the Western Pacific 31 August - 2 September 2015 Manila, Philippines

(WP)DNH/MHS(01)/2015-E Report series number: RS/2015/GE/38(PHL) English only

REPORT

WORKSHOP ON STRENGTHENING MENTAL HEALTH POLICIES AND PROGRAMMES IN THE WESTERN PACIFIC REGION

Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC

Manila, Philippines 31 August–2 September 2015

Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines December 2015

NOTE

The views expressed in this report are those of the participants of the Workshop on Strengthening Mental Health Policies and Programmes in the Western Pacific and do not necessarily reflect the policies of the conveners.

This report has been prepared by the World Health Organization Regional Office for the Western Pacific for Member States in the Region and for those who participated in Workshop on Strengthening Mental Health Policies and Programmes in the Western Pacific, held in Manila, Philippines from 31 August to 2 September 2015.

CONTENTS

SUMMARY ............................................................................................................................. 1. INTRODUCTION ............................................................................................................... 1.1 Meeting organization .................................................................................................... 1.2 Background ................................................................................................................... 1.3 Workshop objectives ................................................................................................... 1.4 Opening remarks ........................................................................................................... 1.5 Appointment of Chairperson, Vice-Chairperson and Rapporteur ................................. 2. PROCEEDINGS ................................................................................................................ 2.1 Mental health action plans ............................................................................................ 2.1.1 Mental Health Action Plan 2013-2020 .............................................................. 2.1.2 Regional Agenda for Implementing the Mental Health Action Plan 2013-2020 .................................................................................................. 2.2 Good practices, challenges and opportunities ............................................................. 2.2.1 Leadership and governance ................................................................................ 2.2.2 Integrated and responsive social care services in community-based settings ... 2.2.3 Strategies for promotion and prevention ............................................................ 2.2.4 Information systems, evidence and research ...................................................... 2.3 Using communications, social movement and mobilization, and partnerships .......... 2.3.1 Strategic communications for mental health ...................................................... 2.3.2 Social mobilization for mental health ................................................................ 2.3.3 Panel discussion on social movement ................................................................. 2.3.4 Partnerships in mental health ............................................................................. 2.4 Workshop outputs ........................................................................................................ 2.5 Health systems approach ............................................................................................. 2.6 Closing ......................................................................................................................... 3. FINDINGS AND RECOMMENDATIONS ...................................................................... 3.1 Findings ....................................................................................................................... 3.2 Recommendations ....................................................................................................... 3.2.1 Recommendations for Member States ............................................................... 3.2.2 Recommendations for WHO ............................................................................ ANNEXES Annex 1. List of participants ............................................................................................. Annex 2. Agenda ............................................................................................................... Annex 3. One-year action plans of 17 Member States ......................................................

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Keywords: / Mental health / Regional health planning / Health systems plans /

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SUMMARY More than 100 million people are affected by mental disorders in the Western Pacific Region. Depressive disorders, suicides and the huge treatment gap for people with severe mental disorders are major public health concerns. In response to this issue, the Mental Health Action Plan 2013-2020 was endorsed by the sixty-sixth World Health Assembly in 2013, and the Regional Agenda for Implementing the Mental Health Action Plan 2013–2020 in the Western Pacific was endorsed by the sixty-fifth session of the Regional Committee for the Western Pacific in 2014. The Workshop on Strengthening Mental Health Policies and Programmes in the Western Pacific Region was held in Manila, Philippines, from 31 August to 2 September 2015, with the following objectives:

1) to review progress in adapting and implementing the Mental Health Action Plan 2013–2020 in the Western Pacific Region; 2) to identify gaps, challenges and opportunities to accelerate action; and 3) to update national implementation plans in line with the Regional Agenda for Implementing the Mental Health Action Plan 2013–2020 in the Western Pacific The workshop covered a wide range of topics including good practices and implementation challenges, health communications, social mobilization and social movements, delivered through plenary presentations, panel discussions, case studies and group exercises. Member States were able to use the regional agenda to assess the status, importance and feasibility of mental health interventions based on the four objectives of the global action plan; prioritize interventions in the form of key deliverables to implement the action plan; identify bottlenecks and barriers that hamper achievement of deliverables; and understand social movements as a key strategy to raise the profile of mental health in national and regional agendas. Quality improvement tools and methodologies were applied to develop one-year plans for mental health, consistent with the regional agenda (Table 1). Member States are encouraged to carry out the one-year action plan they prepared during the workshop and to apply tools from the workshop to develop a more comprehensive mental health implementation plan. WHO is requested to develop strategies to support to countries based on the needs and priorities identified during the workshop, and to elaborate on the health systems approach to address complex issues and gaps in mental health programme implementation.

-2Table 1. Mental health: key deliverables and major barriers Country Japan Lao People’s Democratic Republic Objective 1. Leadership and governance Key deliverable Monitoring to see if related laws are adequately implemented Establish a multisectoral national health programme led by higher-level government officials National taskforce committee on mental health Integrated services in the community Major barrier There is no platform for better communication among many sectors Mental health information is not collected regularly and reported in a timely manner

Viet Nam 2. Integrated service delivery in communitybased settings

Australia

Cambodia China Fiji

Provide outpatient mental health services in general hospitals Human resources Strengthen capacity for mental health in Primary Health Care Strengthen community resources and services/ decrease stigma Strengthen community resources and services Strengthen capacity for mental health in Primary Health Care Phase out long-stay psychiatric care Develop and implement national mental health promotion plan

There is limited collaboration between the Ministry of Health and Ministry of Labor-Invalids and Social Affairs Health care is divided between two levels of government – the Commonwealth and the States, with different responsibilities and funding that challenge integration of health services There are no Clinical Practical Guidelines for primary and specialized mental health care services The proportion of psychiatrists in the population is very low There is no dedicated mental health awareness programme Lack of knowledge about mental health

Mongolia Philippines Tonga Republic of Korea Federated States of Micronesia Malaysia Marshall Islands Kiribati Samoa 4. Information systems, evidence and research

No mental health facility has a community-based mental health programme Lack of funding – only 2% of the recurrent health budget is allocated for mental health Lack of information on the availability and benefits of mental health rehabilitation facilities There is no strong leader in mental health for coordination at the state level No state has a community-based mental health promotion/prevention programme Referral cases are not referred to the mental health department The data on mental health disorders is not included in the current health patient information system Mental health surveillance is not included in the current patient information system Not all our organizations share information with each other

3. Promotion and prevention

New Zealand

Establish a baseline from existing source Develop a continuous mental health surveillance plan Implement the recommendations of the Youth Mental Health Project evaluation

-31. INTRODUCTION 1.1 Meeting organization The Workshop on Strengthening Mental Health Policies and Programmes in the Western Pacific Region was held in Manila, Philippines, from 31 August to 2 September 2015. Thirty-one participants from 17 Member States, as well as three WHO temporary advisors, and three observers attended the meeting. The Secretariat was comprised of nine WHO staff and consultants. The list of participants is available at Annex 1. 1.2 Background In 2013, the sixty-sixth World Health Assembly endorsed the Mental Health Action Plan 2013 2020. The following year, the sixty-fifth session of the Regional Committee for the Western Pacific endorsed the Regional Agenda for Implementing the Mental Health Action Plan 2013–2020 in the Western Pacific to guide national action and regional collaboration. The regional agenda includes core, expanded and comprehensive implementation options and key deliverables to guide development and implementation of mental health policies and programmes in Member States. It has four objectives: (1) strengthen effective leadership and governance for mental health; (2) provide comprehensive, integrated and responsive mental health and social care services in community-based settings; (3) implement strategies for the promotion of mental health and the prevention of mental illness; and (4) strengthen information systems, evidence and research for mental health. The workshop was proposed to update or jumpstart country implementation plans for mental health. 1.3 Workshop objectives 1) to review progress in adapting and implementing the Mental Health Action Plan 2013–2020 in the Western Pacific Region; 2) to identify gaps, challenges and opportunities to accelerate action; and 3) to update national implementation plans in line with the Regional Agenda for Implementing the Mental Health Action Plan 2013–2020 in the Western Pacific. 1.4 Opening remarks Dr Susan Mercado, Director, Division of NCD and Health through the Life-course, WHO Regional Office for the Western Pacific, opened the workshop and delivered the opening remarks on behalf of Dr Shin Young-soo, Regional Director for the Western Pacific. She noted the endorsement of the the Regional Agenda for Implementing the Mental Health Action Plan 2013-2020 in the Western Pacific by the sixty-fifth session of the Regional Committee for the Western Pacific as reaffirmation of the Member States' commitment to promote mental health and well-being. Citing the 2014 WHO Mental Health Atlas, she commended the progress in mental health governance: 74% of Member States reported having a mental health policy or plan and 59% have a standalone law. However, the policy and practice gap is wide. Although mental health problems continue to increase – particularly in the Western Pacific Region, which is vulnerable to disasters and the impact of climate change – millions of people continue to have limited access to appropriate services. Only 1% of the global health workforce is dedicated to mental health, less than US$ 2 per capita per year is spent on mental health in low- and middle-income countries, and up

-4to 90% of patients with severe mental illness in low-and middle-income countries do not have access to pharmaceutical treatment. The neglect has been partly due to the relative "silence" and "invisibility" of mental health. People with mental illness have no voice and are sometimes abandoned by their family and community. A social movement is needed to shift values to overcome the stigma and discrimination of mental illness and promote and protect mental health. Finally, Dr Mercado called for joint collaboration and expressed interest in learning how WHO could support country endeavours. 1.5 Appointment of Chairperson, Vice-Chairperson and Rapporteur Mr Mark Booth, First Assistant Secretary, Health Systems Policy Division, Department of Health, Australia, was appointed as Chairperson; Dr Nurashikin Ibrahim, Public Health Physician, Mental Health Unit, Disease Control Division, Ministry of Health, Malaysia, as Vice-Chairperson; and Dr Peni Biukoto, Medical Superintendent, Saint Giles Hospital Ministry of Health and Medical Services, Fiji, as Rapporteur. 2. PROCEEDINGS 2.1 Mental health action plans 2.1.1 Mental Health Action Plan 2013–2020 Dr Michelle Funk gave an overview of the WHO Mental Health Action Plan 2013–2020. She described the action plan's comprehensive vision, the four global objectives, corresponding 2020 targets, and the six cross-cutting principles. Emphasis was given to three recurring points that shift interventions from a traditional focus of medicating to reduce symptoms to a more comprehensive response to mental health and illness:  the protection and promotion of human rights of people with psychosocial disabilities;  broader support for recovery and enabling patients to live meaningful lives; and  better participation in society through income generation, educational opportunities, housing and other social services. Member States have committed to attaining the 2020 action plan targets and will be evaluated accordingly. The global baseline figures reported in the 2014 Mental Health Atlas highlight the need for more collaborative efforts (Table 2). WHO will continue to guide and support Member States through policy advice, technical assistance, capacity-building and monitoring the global and national mental health situation.

-5Table 2. Baseline values for global targets: Mental Health Atlas 2014 Action plan objective Objective 1: To strengthen effective leadership and governance for mental health Action plan target (by 2020) Target 1.1: 80% of countries will have developed or updated their policies or plans for mental health Target 1.2: 50% of countries will have developed or updated their law for mental health Target 2: Service coverage for severe mental disorders will have increased by 20% Baseline value for 2013 45% of all WHO Member States 34% of all WHO Member States Expected to be less than 25% (based on treatment gap studies; not computable from Atlas 2014 data) 41% of all WHO Member States

Objective 2: To provide comprehensive, integrated and responsive mental health and social care services in community-based settings Objective 3: To implement strategies for promotion and prevention in mental health

Target 3.1: 80% of countries will have at least two functioning mental health promotion and prevention programmes Target 3.2: The rate of suicide in countries will be reduced by 10% Target 4: 80% of countries will be routinely collecting and reporting at least a core set of mental health indicators every two years

11.4 per 100 000 population 33% of all WHO Member States

Objective 4: To strengthen information systems, evidence and research for mental health

2.1.2 Regional Agenda for Implementing the Mental Health Action Plan 2013–2020 Dr Wang Xiangdong discussed the importance of the Regional Agenda for Implementing the Mental Health Action Plan 2013–2020. To address the mental health and substance abuse burden in the Region, which account for 23% of years lived with disability (YLDs) and 9.5% of disability adjusted life years (DALYs), context-specific and phased implementation options (i.e. core, expanded, and comprehensive options) that consider the different stages of development of mental health service and care, are required. Regional priorities for collaboration and country support are focused on human resource development, management of severe disorders and depression, mental health in disasters and emergencies, and suicide prevention. Disasters increase mental health problems and cripple an already weak mental health infrastructure while suicide remains an important and yet preventable health problem. In 2012, 182 000 suicide deaths were reported in the Region. Rates in high-income countries like Japan and the Republic of Korea have been increasing in the last 10 years in contrast to significant declines observed in other Organisation for Economic Co-operation and Development (OECD) countries. Suicide rates in most low- and middle-income countries have remained the same with the exception of China, which had a reduction in rates. Rapid socioeconomic changes in other low- and middle-income countries are expected to trigger a rise in suicide rates, especially in young people. In contrast to the rest of the world, the rank of suicide as a cause of death is higher in females than males among low- and middle-income countries in the Region. Dr Yutaro Setoya presented the implementation of mental health interventions in Pacific island countries and areas according to the four global objectives. He highlighted the following achievements: the launch of the Pacific Islands Mental Health Network (PIMHnet) in 2007; the

-6prioritization of mental health articulated during the Tenth Pacific Health Ministers Meeting in 2013; the development and strengthening of community mental health services made possible through collaboration with nongovernmental organizations and increasing the number and skills of specialists and non-specialists through mhGAP trainings and a postgraduate diploma course in Fiji; public awareness activities; and the establishment of suicide registries (i.e. the Suicide Trends in At-Risk Territories (START) study) and mental health profiles of Member States (i.e. WHO Mental Health in Development Country Profiles or WHO proMIND). Despite progress in the Pacific over the past five years, huge challenges remain, particularly in access to: (a) specialists, as currently only 10 psychiatrists serve 14 Member States, and (b) health facilities, due to the geographic limitations of archipelagos. Steps are being undertaken to improve access through integrating services in primary health care and the community. 2.2 Good practices, challenges and opportunities 2.2.1 Leadership and governance Dr Michelle Funk presented the WHO QualityRights project as an example of good practice related to governance and leadership. She elaborated on the initiative's four objectives which aim to improve quality and human rights conditions in mental health services; build capacity among patients, family members and health workers to promote human rights; develop a mental health social movement; and reform national policies and laws in line with best practice and international human rights standards. The project is working on the ground to directly improve facilities, as well as at policy level. It uses materials such as the QualityRights toolkit and capacity-building modules targeting different stakeholders and covering a broad range of topics that are available to all countries and will be made interactive and online in future. QualityRights is being implemented nationwide in Brazil and Italy. A huge project in Gujarat, India is rolling out the initiative in all facilities and there is already positive feedback. For example, after training, health workers in one facility opened a closed male ward and people are now moving around freely in the facility. Malaysia is in the early stages of adoption and has encountered limited support from psychiatrists. While it is not uncommon to have initial resistance from health facilities and professionals due to fears of a negative assessment result, this fear is eventually overcome by refocusing on improving services and outcomes, and changing processes that create positive experiences. Ms Muniamma Gounder described the development of a Mental Health Decree and policy in Fiji. The process of revising the 1940s-era Mental Health Act to provide mental health care to people “in communities and least restrictive environments” was moved forward by the medical superintendent of Fiji's psychiatric hospital and the Minister of Health. The 2010 Mental Health Decree paved the way for the establishment of governance structures like the National Mental Health Advisory Council and the Mental Health Unit, which in turn facilitated the finalization and approval of the 2014 National Mental Health and Suicide Prevention Policy and the associated strategic plan. The process of passing the Decree and Policy was facilitated by champions and supported by a wide range of stakeholders who were involved in the consultative process. The involvement of stakeholders helped address issues on integration of mental health services. At time of writing, review and improvement of the strategic plan indicators and health information system are underway.

-72.2.2 Integrated and responsive social care services in community-based settings Dr Ivanhoe Escartin presented efforts in the Philippines to scale-up mental health services through integration of mental health into general and primary health care. The National Program Management Committee on Mental Health (NPMC-MH) prepared a strategic plan in 2014 to ensure comprehensive management of the country's mental health programme. By 2016, the plan will target 10 provinces for integrated mental health services and programmes at the community level and in primary and secondary health-care systems; from 2013 to 2015 six provinces have moved in this direction. Another target is for 100% of 69 tertiary hospitals to have an outpatient psychiatric clinic and/or an acute psychiatric unit; at the end of 2015, 36% of tertiary hospitals have outpatient or acute care psychiatric facilities. Other successful initiatives include the provision of free psychotropic medicines in 82 access sites under the national Medicine Access Program and at least 400 health workers in 10 out of 17 regions have been trained to manage selected mental health conditions. Challenges include the absence of a mental health law and the limited in-patient coverage of health insurance. Further work is needed to secure champions for the enactment of the proposed bill, ensure sustained access to psychotropic medications by including these in the outpatient medicine package, and to scale-up capacity-building targeting primary health care workers. Dr Ma Hong described China's Programme 686. It was a subproject funded by the central government to re-establish the public health system, specifically community-based services. The projrct has six continuous service components: training of specialists, linking hospitals and community centres, establishing community teams, ensuring management of poor patients with severe mental illness, and regular follow-up of cases by community teams. At the end of 2014, the programme covered 2317 hospitals and 227 413 community team workers, and had served 4.4 million patients. Social insurance now covers 40% of patients and more than 300 mental health hospitals have been improved. Important experiences and lessons include: appropriate training of psychiatrists is needed for effective guidance of the community team; skills transfer to community staff requires time, patience, and trust; family members need to be involved as case managers; and that reforming mental health care may start from small projects, but the evaluation should be designed to show the return on investment. Dr Lourdes Ignacio presented the challenges and opportunities for mental health programmes in the Philippines after a disaster. The first mental health taskforce in the Philippines was appointed, as a joint initiative by the Ministry of Health and the state university, after a massive earthquake hit north of the country in 1990. The taskforce developed a psychosocial programme recognized by other government agencies such as welfare, education and defense. However, interventions were limited to emergency measures. The recent disater brought about by Typhoon Haiyan in 2013 spurred a community-based mental health project called Ginhawa funded by the Christoffer Blinden Mission (CBM) and supported by the World Association for Psychosocial Rehabiltation (WAPR). Its aim was to build awareness on mental health and promote wellness in the community through assigning a trained village health worker to lead a cluster of 10 households for screening, counselling and wellness interventions. When needed, patients are referred to higher levels of care such as a trained village health worker, trained staff at the town or city health centre, the WAPR project coordinator or consultants. After one year of implementation, 165 village health workers were trained to serve 24 villages and 20 000 residents. One hundred and ten patients with depression, anxiety, panic, chronic psychosis, epilepsy or mental sub-normality were diagnosed and attended either a rural health

-8centre or were visited at home by trained village health workers and neighborhood self–help groups. The success of the project convinced the local government to purchase psychotropic medications and expand village health worker training to establish more community self-help groups. During discussions, participants acknowledged the need for a change in mindset. The community should be considered as the service provider for recovery and rehabilitation instead of just a passive recipient. Community groups that have dealt with disasters previously should be tapped. Examples of the New Zealand response to the 2011 earthquake, which focused on resilience, were shared. 2.2.3 Strategies for promotion and prevention Dr Daisuke Nishi discussed the suicide prevention programme in Japan. In 1998, there was a sudden increase in suicide deaths and the annual deaths remained above 30 000 until 2011. Of known cases, 80% were due to health reasons. The stigma of suicide was very strong but this started changing in 2000 when children who had lost their parents to suicide broke their silence by speaking out in the media about their experiences. This empowerment of survivors created a social movement to change ideas and eventually, society. Greater awareness for the need to address suicides eventually lead to the Basic Act for Suicide Prevention in 2006 and the national policy in 2007. The Center for Suicide Prevention was established for research and education, and to support local governments. It has organized public awareness campaigns, such as the national suicide prevention day every 10 September, trained social workers on case management which has been proven to reduce suicide behaviours in 17 hospitals, conducted psychological autopsy research, and supported nongovernmental organizations, such as Lifelink, to strengthen networks with other organizations and policy-makers. These measures have contributed to a consistent decline in suicide deaths over the last five years. Dr Bruce Bolam presented lessons learnt on workplace mental well-being. In Australia, chronic disease risk is increasing as a proportion of workplace-related harms and the burden of mental illness at work is costing Australian businesses AU$ 10.9 billion per year due to presenteeism, absenteeism, compensation claims and increased staff turnover. Employers are encouraged to invest in mental health in the workplace as every dollar spent on creating mentally healthy workplaces produces a AU$ 2.30 return on investment. Employees at risk of workplace stress and higher risks for mental illness and cardiovascular diseases include: women, younger workers, lower-paid or lower-skilled workers, and casual workers who have high work demands but low job control. Best practices in psychologically safe workplaces show that senior leaders in the organization engaged internal and external partners; changes happened at organizational and system-levels and in day-to-day business practice and culture; and there was wide participation across the organization. Policing is a notably stressful profession, and the issue was particularly affecting junior police. Victoria Police partnered with VicHealth and Deakin University to build organizational capacity, develop middle-management leadership, and train junior staff on managing their workload to reduce workplace stress. During the discussion, the importance of work-life balance was acknowledged by the group and a call for the health sector to be the model for healthy workplaces was made. Some examples were shared. In Australia there is comprehensive legislation on maternity and paternity leave which is viewed as a starting point for discussions on balancing home and work concerns. Burnout at work was validated as a major psychosocial issue that may be reflected in rapid staff turnover. VicHealth undertakes an anonymized annual survey of employees as a touchpoint for disclosure.

-9In Samoa, the mental health of mental health workers is a concern. Workplace stress is shown through absenteeism, drinking, smoking and impatience with clients. To address this, health workers were asked to join the art therapy sessions with patients. 2.2.4 Information systems, evidence and research Mr Booth highlighted the importance of evidence in policy and implementation and the challenge of making the huge volume of existing information accessible and useful. A large reassessment of the Australian health system is ongoing and the Primary Health Care Advisory Group is reviewing innovative models for health care provision and funding. The Mental Health Commission has produced a report on reforming the mental health system based on evidence. Key recommendations are to move to step-care models, increase community participation and suicide prevention. The Government supports the following measures to optimize health information: a secure electronic health information system, “My eHealth Record,” that allows providers to access important health information with the patient's consent; three centres of research excellence that focus on evidence for mental health; and a knowledge translation officer, familiar with research and legislation and based part-time in the health ministry and part-time in the university, to link evidence producers and policy-makers. Dr Setoya presented the mental health information system status and challenges in the Pacific islands. Information on mental health milestones and services was gathered by WHO and published on the WHO MiNDbank website. The WHO Mental Health Atlas collects information on the six Mental Health Action Plan indicators every three years. The Pacific Member States update fewer of indicators every year in a report to PIMHnet. The main challenges for evidence production encountered in the Pacific are a lack of routine data collection of general health information, more so for mental health; the mainly paper-based data collection; fragmented data sources; and the limited capacity to collect and analyse mental health data on top of competing information requests from donors and other stakeholders. The suggested way forward is to integrate core mental health indicators from the action plan into routine health data collection and to foster a research environment by collaborating with other countries. Other countries shared successful collaboration experiences with universities, nongovernmental organizations and other government sectors. 2.3 Using communications, social movement and mobilization, and partnerships 2.3.1 Strategic communications for mental health Dr Jason Ligot gave a presentation on health communication, the study and use of communication strategies to inform and influence individual and community decisions that enhance health. He demonstrated the importance of framing a message to engage the audience in a powerful way, and explained the steps to developing a single overarching communication outcome (SOCO) and the "7 Cs" of public health communication, providing examples for each using posters and videos. While health communication is a powerful tool, it cannot compensate for inadequate health care. He ended with a call to reflection by asking participants why they cared about mental health. It should serve as an inspiration to continue work in public health in spite of the challenges. 2.3.2 Social mobilization for mental health Dr Mercado shared key steps and practical tips on social mobilization for action on mental health and well-being. A core internal team is required to start the social mobilization process of

- 10 engaging individuals, groups and sectors to achieve a common goal. The internal team should conduct a situational analysis, map stakeholders and identify champions and connectors. It is important to have an understanding of how stakeholder values and interests affect mental health programme advocacy and implementation prior to the development of a mobilization plan. The plan should have medium- to long-term strategies and short-term tactics, and anticipate obstacles. 2.3.3 Panel discussion on social movement The outcome of successful social mobilization is a social movement. Dr Mercado introduced the panel discussion with a short presentation. While advances in health have been mostly attributed to biomedical and administrative improvements, social movements in health were behind reforms in water and sanitation, maternal and child health, alcohol and tobacco abuse interventions, HIV/AIDS management, and community mental health services. Various frameworks demonstrated the impact of social determinants or factors on health and well-being. One model proposes that a population's health profile be categorized into five groups – healthy, at risk, sick, sick that need hospitalization but have no access, and sick and hospitalized. However, health systems are mostly focused on costly interventions on the sick and hospitalized group. Further, causal pathways for mental health are complex, requiring a systems approach and the involvement of different sectors, groups and individuals. The four panellists reflected on the following question: how can different sectors be mobilized to keep populations mentally healthy, reduce mental health risks and provide access to quality mental health services to those in need? Dr Bolam shared VicHealth's strategy to act on the upstream determinants of mental health. The nongovernmental organization motivates groups by connecting the issue with their passions. One success story in Australia is the “RU OK?” initiative which started in 2009 as a documentary on suicide and evolved into a national campaign to inspire Australians to remain socially connected and reach out to individuals who may be having a difficult time. The campaign was founded by the son of a suicide victim who wished to prevent suicides and protect families from its devastating impact. He was then supported by many others who wanted to contribute and make a difference. The effectiveness of the initiative was due to its positive message, its simplicity and its ability to empower people to make a difference on a day-to-day basis. The initiative is a good example of the Behavioural Insights Team’s EAST Framework for influencing behaviour – easy, attractive, social and timely interventions to engage the government, community and corporate sectors to bring about behaviour change. Another successful initiative that impacted on mental health stemmed from a social issue, gender and equity. Violence against women (VAW) is a driver of disease burden and mental illness in women. Community activism in VAW has led to national action, such as the establishment of organizations focused on the issue. In Victoria, a Royal Commission into Family Violence was established as part of a whole-of-government response. Dr Ma described how China reformed mental health services starting with the health sector collaborating with the disabled persons association to expand the reach of services to the community. Thereafter, more sectors became involved: civic affairs, security, education, and finance. Government also reached out and partnered with the private sector, nongovernmental organizations and universities. These collaborative efforts are strengthened and are evolving as a result of the passage of the country’s first Mental Health Law in 2012. China’s experience can be shared with other countries and vice-versa through learning exchanges. To further engage the public, Dr Ma posed the challenge of applying marketing strategies to present “mental health” as a desirable product. Dr Ignacio shared her experiences in community mobilization in post-disaster situations in the Philippines. After a disaster, Government is under pressure and mental health services take low

- 11 priority. In situations like this, community organizations initiate partnerships with the Government to expand service coverage, to apply a collective approach for community recovery and perhaps tap into spiritual aspects that contribute to resilience and well-being. Dr Ignacio’s publication, Ginhawa, describes a person's interconnectedness with the social environment. Hence in the context of post-disaster mental health, an individual’s symptoms cannot be treated in isolation, and efforts to rehabilitate the community should be considered. Professor Malcom Hopwood presented the past and potential contributions of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) to the planning of community responses to mental health and the role of specialists in a social movement. The RANZCP has been involved in the deinstitutionalization movement, community care, development of prevention and promotion activities, and recently, youth mental health. The College is also leading a campaign to raise awareness of the main cause of premature death among patients of mental illness: poor physical condition. The unified front of the College with the Mental Health Commission, specifically on findings and recommendations on a recent comprehensive evaluation of the status of mental health services in Australia, despite differing opinions on a few aspects, sends a powerful message that multisectoral collaboration is necessary to move forward in mental health. Other sectors have also been identified as key partners – housing, social welfare, employment, and corrections. The College is working to correct the perception that clinicians are against community integration and involves family and community stakeholders is activities. It is cognizant that clinicians and the community need to work together to improve the 50% mental health service penetration rate and provide the right care at the right time, and to reduce stigma for severe disorders such as schizophrenia and bipolar disorders. Participants from other countries shared experiences. In Samoa, the Ministry of Health is working with the ministries of Police, Justice and Courts to improve treatment and rehabilitation of offenders with drug and alcohol abuse. The motivation for the collaboration is crime reduction. A similar cross-government approach to crime reduction is used by New Zealand where mental health services are involved in a “Better Public Services” initiative. There is evidence that links limited mental health services with a higher crime rate. In New Zealand, the involvement of a high-profile former rugby star and coach in raising public awareness has contributed to the success of a destigmatization programme on depression. In Australia nad New Zealand, the health and agriculture sectors, and even some banks in New Zealand, are working together to address the issue of suicides among farmers. Framing messages to effectively reach other sectors and the public is important. One approach is to have a strong economic argument: investing in mental health prevention and early intervention, particularly in young people can lead to increased workplace participation and reduced recidivism. Another approach is to translate public health targets to a more personal level, where the impact of the intervention becomes relevant and could fuel and sustain a social movement. A successful example of the latter approach is the Towards Zero road deaths campaign of Victoria's Transport Accident Commission, where citizens were interviewed about the acceptable number of deaths due to road trauma first in their state, then in their city, town and local area. Various responses were obtained but when asked to reflect on the "acceptable number of deaths" in their family, the response of all interviewees was suddenly "zero". The discussion moved from social movement to mental health resources, capacity-building, and service delivery. It was pointed out that this indicated the prevailing bias to focus on traditional issues rather than expanding perspectives to social mobilization and social movement strategies, and there was a call for all participants to reflect on this bias.

- 12 2.3.4 Partnerships in mental health Dr Wang described the partners working for mental health in the Western Pacific Region. There are 18 mental health WHO collaborating centres in the Region; of these, six are currently working on various mental health disorders while three are specifically working on suicide prevention. The media can be an effective catalyst for social change, and can save more lives than the health sector alone. On the other hand, media can cause harm through irresponsible reporting such as in the case of imitative or copycat suicide behaviour in the Republic of Korea resulting from heightened media coverage of high-profile suicides. There is a WHO guide for the media to responsibly report suicides. To engage the media further, a Media and Prevention of Suicide (MAPS) initiative was implemented in six countries involving a series of consultations to define the role of media in suicide prevention. Dr Wang then introduced existing regional mental health networks. The Suicide Trends in AtRisk Territories (START) was launched in 2005 and mainly engages national programme focal persons and researchers, to support implementation of culturally-sensitive suicide prevention in 15 Member States. The Asia-Pacific International Research And Education (ASPIRE) network, launched in 2014 and comprised of university researchers, clinicians and policy-makers, works on perinatal depression and its impact on the family, and the integration of mental health services into primary health care. Dr Setoya discussed the Pacific Islands Mental Health Network (PIMHnet). In addition to the achievements shared in earlier presentations, the 21 Pacific island countries and areas have benefitted from the network through intercountry mhGAP and mental health first aid training and workshops, and sharing of best practices through PIMHnet meetings, newsletters and email exchanges among focal persons. The network also serves as an entry point for collaboration with non-PIMHnet countries, professional groups such as RANZCP and the United Kingdom's Royal College of Psychiatrists, and international nongovernmental organizations such as All Access for Mental Health and Creating Futures. Participants added other network benefits and requested more short or diploma training options in addition to that offered by Fiji National University. Dr Setoya explained that the PIMHnet's major challenge is sustained funding and an appeal had been made to Member States for support. He also emphasized the need for stronger international collaboration and initiatives. Dr Chhit Sophal presented the Association of Southeast Asian Nations (ASEAN) Mental Health Taskforce (AMT), established to strengthen mental health in Southeast Asia. He described the taskforce's organization, objectives, 2012–2015 work plan strategies and indicators. He also shared workplan outputs such as the development of a policy brief on mental health in ASEAN lead by Thailand, the launch of the "ASEAN for Mental Health Campaign" led by Malaysia, a mental health data bank led by the Philippines, and mental health training, conferences and workshops conducted in various countries. The AMT recently proposed changes in the draft Sustainable Development Goal (SDG) 3 to clearly articulate mental health as a target. The proposal was presented and subsequently endorsed at the ASEAN Senior Officials Meeting on Health Development. More information on the taskforce can be found at amt.dmh.go.th. Mr Booth shared updates from a recent Asia-Pacific Economic Cooperation (APEC) round table on mental health which discussed progress on the APEC Roadmap to Promote Mental Wellness in a Healthy Asia-Pacific (2014–2020). The APEC member countries, acknowledging that mental health is key for sustained socioeconomic progress, endorsed the roadmap in 2014. Technical working groups are to be established based on common problems identified through strategic needs assessments in countries. Initial needs identified were suicide prevention, workplace mental

- 13 health and disaster resilience. A mental health digital data hub will also be built as an interactive resource for roadmap implementation. 2.4 Workshop outputs Participants were clustered into four groups and guided through a series of activities to review their status against the action plan objectives, prioritize key mental health deliverables in 2016, and design a social mobilization plan to achieve these deliverables. Country outputs were discussed in groups or shared in plenary. Member States presented major achievements in mental health. Most of these were achievements under objective 2 of the action plan (service delivery): better health insurance coverage, access to medicines and establishment and strengthening of community-based services. There were some achievements under objective 1 (compliance of mental health legislation and policy with human rights principles and establishment of governance structures to oversee policy development, implementation and monitoring) and objective 3 (mental health promotion plans and specific programmes for the youth). There were few achievements under objective 4 (information systems and research). These achievements were mostly championed by the ministries of health and nongovernmental organizations but other sectors (i.e. education, social welfare, labour, police and legislators), professional and patient groups were also identified. Inadequate laws, policies and community resources remained implementation bottlenecks among low- and middle-income countries. High income countries like Australia, Japan, New Zealand and the Republic of Korea, which have well-established laws and service delivery, saw bottlenecks related to health promotion and information systems. More countries opted to focus on integrating service delivery in community-based settings and will address workforce and information barriers. Countries that chose to work on mental health governance and evidence will improve multisectoral communication and data collection. A few countries will develop a national mental health promotion plan (Table 1). 2.5 Health systems approach Dr Rasul Baghirov shared reflections from a health systems perspective. Systems are complex and often self-organizing. The building blocks of systems – governance, medicines, services, workforce, financing and information – all need to be acted on for maximum impact. The performance of the health system in terms of efficiency, equity, safety, quality and resilience determines the outcomes. In terms of service delivery, integration should be viewed as a continuum. One starts with no services and moves on to existing but parallel and overlapping services, to coordinated and eventually fully-integrated services. The current scope of mental health services in a country can be mapped by plotting the level of care from primary health care to tertiary care, acute care to rehabilitation. Deciding on which aspect of the system to invest is difficult and will depend on the needs of the country. For instance, three countries, Australia, China and the Philippines, were asked whether they would invest limited resources in training more psychiatrists or multiplying the number of public health physicians, nurses and community workers. All three chose investing in the primary health care setting to ensure wider and more equitable access to care. Finally, Dr Rasul emphasized that collaboration between policy-makers, service providers, and the community is necessary to achieve people-centred care – care that is organized around the needs of people rather than interests of providers and policy-makers.

- 14 2.6 Closing Dr Peni summarized the recurring themes of the workshop: human rights and empowerment of mental health stakeholders; the use of effective communication to mobilize communities and influence individual and group behaviour; changing mindsets towards mental health care by adapting a recovery-oriented model as opposed to the medical model; and recognizing the importance of the community as a provider of care and other basic needs for successful recovery. He also referred to challenges in sustaining the commitment of governments to mental health, optimizing social mobilization to address social determinants of mental health and measuring impact in these areas. Dr Booth closed the workshop by thanking all the participants for their contributions and WHO for organizing the activity. 3. FINDINGS AND RECOMMENDATIONS 3.1 Findings The workshop was effective in guiding Member States on the use of the regional agenda as a tool:  to assess the status, importance and feasibility of mental health interventions based on the four objectives of the global action plan;  to prioritize interventions in the form of key deliverables to implement the action plan;  to identify bottlenecks and barriers that hamper achievement of deliverables; and  to understand social movement as a key strategy to increase the importance of mental health in the national and regional agenda. Member States used quality improvement tools and methodologies to develop one-year plans consistent with the regional agenda. The plans considered practical countermeasures to barriers, social mobilization of important stakeholders, and described the support needed from WHO. The event was successful in facilitating a rich exchange of experiences, best practices, and lessons learnt across countries and organizations. It also fostered ties and informal networking amongst participants who wished to continue sharing information and resource after the workshop. 3.2 Recommendations 3.2.1 Recommendations for Member States Member States are encouraged: 1) to carry out the one-year action plan prepared during the workshop; and 2) to apply the tools from the workshop to develop a more comprehensive mental health implementation plan. 3.2.2 Recommendations for WHO WHO is requested: 1) to develop strategies to support to countries based on the needs and priorities identified during the workshop; and 2) to elaborate on the health systems approach to address complex issues and gaps in mental health programme implementation.

- 15 ANNEXES Annex 1. List of participants LIST OF PARTICIPANTS, TEMPORARY ADVISERS, REPRESENTATIVES/OBSERVERS AND SECRETARIAT 1. PARTICIPANTS AUSTRALIA Mr Mark Booth, First Assistant Secretary, Health Systems Policy Division, Australian Government Department of Health, GPO Box 9848, Woden ACT 2601, Tel: (612) 6289 3944, mark.booth@health.gov.au Dr Chhit Sophal, Manager, National Programme for Mental Health, St. 271, Sangkat Tumnub Teuk, Khan Chamka Mon, Phnom Penh Tel: (855) 12 777 218, chhit_sophal@hotmail.com Dr Lo Veasnakiry, Director, Department of Planning and Health Information, Ministry of Health, 151-153, Blvd. Kampucheakrom Phom Penh,Tel: (855 23) 426 372, veasnakiry@online.com.kh CHINA Ms Niu Hongli, Deputy Director-General, National Health and Family Planning Commission, No. 14, Zhichunlu, Haidian District, Beijing 100191,Tel: (8610) 62030897; Fax: (8610) 62030881 niuhongli2310@126.com Dr Yi Lelai, Mental Health Program Officer, Department of Disease Prevention Control, National Health and Family Planning Commission, No. 1, Xi Zhi Men Wai Nan Lu Xicheng District, Beijing 100041 Tel: (8610) 68792630; Fax: (8610) 68792842, yill@nhfpc.gov.cn FIJI Dr Peni Biukoto, Medical Superintendent, Saint Giles Hospital Ministry of Health and Medical Services, Reservoir Road, Samabula, Suva, Tel: (679) 9098006; Fax: (679) 3381132 peni.biukoto@govnet.gov.fj Ms Muniamma Gounder, Acting Director, Planning and Policy Development, Ministry of Health and Medical Services, PGO Box 106, FBPS Centre, Lot 1 Jerusalem Road Vatuwaqa, Suva Tel: (679) 3388000, muniamma.gounder@health.gov.fj JAPAN Dr Matsuzaki Takanobu, Deputy Director, Mental Health and Welfare Division, Ministry of Health, Labour and Welfare, 1-2-2 Kasumigaseki, Chiyoda-ku, Tokyo 100-8916, Tel: (813) 3595 2307, matsuzakitakanobu@mhlw.go.jp Dr Daisuke Nishi, Section Chief, National Institute of Mental Health, National Center of Neurology and Psychiatry, 1-14-18, Zenpukuji, Suginami-ku, Tokyo 167-0041, Tel: (81-42) 341 2712 (ext. 6214); Fax: (81-42) 346 1950, d-nishi@umin.ac.jp.

CAMBODIA

- 16 KIRIBATI Dr Mireta Noere Batio, Psychiatry Specialist, Tungaru Central Hospital, Ministry of Health and Medical Services, Tarawa, Tel: (686) 66248 mireta.noere@gmail.com Ms Helen Murdoch, Director of Nursing Services, Ministry of Health and Medical Services, P.O. Box 268, Nawerewere, Tarawa heljmurdoch@gmail.com KOREA, REPUBLIC OF Dr Sim Minyoung, Director, Department of Psychiatric Rehabilitation, Seoul National University, 398 Neungdong-ro, Gwangjin-gu Seoul 143-711, Tel: (822) 2204 0327, minyoung.sim.yb@gmail.com Ms Park Seonhwa, Assistant Director, Division of Mental Health Policy, Ministry of Health and Welfare, 3th, 13, Doum4-ro, Sejong-si Tel: (82-44) 202 2864, parksh11@korea.kr LAO PEOPLE'S DEMOCRATIC REPUBLIC Dr Bounserth Keoprasith, Deputy Chief, Deparment of Planning and International Cooperation, Ministry of Health, Vientiane Capital Tel: (856-20) 23216888, bounserth@gmail.com Dr Lavanh Vongsavanthong, Deputy Chief, Control Hospital Division, Department of Health Care, Ministry of Health, Vientiane Tel: (856-20) 55909789, lavanh121@hotmail.com MALAYSIA Dr Nurashikin Ibrahim, Public Health Physiscian, Mental Health Unit, Disease Control Division, Ministry of Health Malaysia, 33, Jalan Kemuning Permai 33/155, Kemuning Residence 40400, Selangor, Tel: 60192730602, nurashikin@moh.gov.my Dr Salina Abdul Aziz, Consultant Psychiatrist, Hospital Selayang, Department of Psychiatry and Mental Health, Wilayah Persekutuan Tel: 60133464646, salinaziz@gmail.com MARSHALL ISLANDS Mr Adri Hicking, Mental Health Counsellor, P.O. Box 16, Majuro Tel: (692) 625 3355, adrihicking@gmail.com Ms Francyne Wase-Jacklick, PHC Administrator and Acting Assistant Secretary for the Office of Health Planning and Statistics, Bureau of Primary Health Care, Ministry of Health, P.O. Box 16 Majuro, MH 96960, Tel: (692) 625 3399/Direct: (692) 625 7251, wasejacklick@gmail.com Ms Rose Bobo, Coordinator, Human Resources, Ministry of Health P.O. Box 5683, Ebeye, MH 96970, Tel: (692) 235 3555; Fax: (692) 329 3385, rc_bobo1@yahoo.com MICRONESIA, Mr Kerio Walliby, Program Director, Behavioral Health and Wellness FEDERATED STATES OF Department of Health and Social Affairs, P.O. Box 455, Kolonia Pohnpei 96941, Tel: (691) 320 5520; Fax: (691) 320 5524, kwalliby@fsmhealth.fm

- 17 MONGOLIA Dr Taznaa Enkhzaya, Officer-in-Charge, Policy Implementation and Coordination for NCD and Mental Health, Division of Public Health, Ministry of Health and Sports, Government Building-VIII Olympic Street-2, Sukhbaatar District, Ulaanbaatar Tel: (976-51) 263925, enkhzayatazna@yahoo.com Dr Ochir Ganchuluun, Vice Director of Medical Services National Center for Mental Health, Ministry of Health and Sports, P.O. Box 1224 Central Post, Ulaanbaatar, Tel: (976-11) 70150510; Fax: (976-11) 311669 oganchuluun@yahoo.com NEW ZEALAND Mr Richard Taylor, Senior Advisor, Mental Health Programmes Ministry of Health, 1 The Terrace, P.O. Box 5013, Wellington 6145 Tel: 642108333053, Richard_Taylor@moh.gov.nz Dr Ma. Ruth Bordado, Medical Specialist II/Chief Public Health Unit, National Center for Mental Health, Mandaluyong City Tel: (63) 9175060966, ruthbordado@yahoo.com Dr Ivanhoe Escartin, Program Manager, Media and External Relations Division, Health Promotion and Communication Service, Department of Health, San Lazaro Compound, Sta. Cruz, Manila Tel: (632) 7110781, docescartin@gmail.com SAMOA Dr George Leao Tuitama, Psychiatric Registrar, Mental Health Section, National Health Service, Ministry of Health, P.O. Box 2864, Apia Tel: 7299845/7579721, George_leao@hotmail.com; georget@nhs.gov.ws Ms Josephine Afuamua, Principal Policy Analyst, Ministry of Health, Private Bag, Apia, Tel: (685) 7620581; Fax: (685) 21440 JosephineA@health.gov.ws TONGA Dr Violet Erasito, Psychiatry Registrar Vaiola Hospital, Nuku'alofa Tel: 6768747016, violeterasito@gmail.com Ms Salote Puloka, Senior Health Administrator, Ministry of Health P.O. Box 2298, Nuku'alofa, Tel: 67624536, salotewp@gmail.com VIET NAM Dr Truong Le Van Ngoc, Medical Expert/Coordinator, Prevention and Control Program of Noncommunicable Disease, including hypertension, diabestes, cancer, COPD, mental disorders, Department of Medical Services Administration, Ministry of Health, 138A Giangvo Street, Badinh District, Ha Noi, Tel: (844) 6273 2445; Fax: (844) 6273 2094 ngoctruongmoh@gmail.com Dr Vinh The Nguyen, Chief, Community Mental Health Department, National Psychiatric Hospital No. 2, Nguyen Ai Quoc Street, Bien Hoa District, Dong Nai, Tel: (84) 0613947243; Fax. No.: (84) 0613819187 thaotranthi70@gmail.com

PHILIPPINES

- 18 2. TEMPORARY ADVISERS Dr Ma Hong, National Mental Health Program Office, Peking University Institute of Mental Health, Beijing, China; Email: mahong@bjmu.edu.cn Dr Lourdes Ignacio, Professor Emeritus in Psychiatry, University the Philippines, College of Medicine, UP-Philippine General Hospital, Manila, Philippines Dr Bruce Bolam, Executive Manager of Programs, Victoria Health Promotion Foundation, P.O. Box 154, Carlton South, Victoria 3053; Tel: 03 9667 1302; bbolam@vichealth.vic.gov.au 3. REPRESENTATIVES PHILIPPINE PSYCHIATRIC ASSOCIATION THE ROYAL AUSTRALIAN AND NEW ZEALAND COLLEGE OF PSYCHIATRISTS WORLD ASSOCIATION FOR PSYCHOSOCIAL REHABILITAITON Ma. Luz S. Casimiro-Querubin, MD, FPPA, President Tel: (632) 6359858, mlcquerubin@gmail.com Professor Malcolm Hopwood, President Melbourne, Australia

Dr Felicitas Soriano, Manila Medical Center

4. SECRETARIAT WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC Dr Susan Mercado, Director, Division of NCD and Health through the Life-Course, WHO Regional Office for the Western Pacific, P.O. Box 2932 1000 Manila, Philippines Tel: (632) 5289980; Fax: (632) 5211036; mercados@wpro.who.int Dr Wang Xiangdong (Responsible Officer), Coordinator, Mental Health and Substance Abuse, WHO Regional Office for the Western Pacific, P.O. Box 2932, 1000 Manila, Philippines Tel: (632) 5289858; Fax: (632) 5211036; wangx@wpro.who.int Dr Klara Tisocki, Team Leader, Pharmaceuticals, WHO Regional Office for the Western Pacific, P.O. Box 2932, 1000 Manila, Philippines, Tel: (632) 5289026; Fax: (632) 5211036; tisockik@wpro.who.int Dr Rasul Baghirov, Coordinator, Integrated Service Delivery, WHO Regional Office for the Western Pacific, P.O. Box 2932, 1000 Manila, Philippines, Tel: (632) 5289806; Fax: (632) 5211036; baghirovr@wpro.who.int Dr Florante Trinidad, Technical Officer (TFI), World Health Organization – Philippines, National Tuberculosis Centre Building, Second Floor, Building 9, Department of Health, San Lazaro Hospital Compound, Sta. Cruz, Manila, Tel: (632) 5289774; Fax: (632) 7313914; trinidadf@wpro.who.int

- 19 Dr Jason Ligot, Communications Consultant, Division of NCD and Health through the LifeCourse, WHO Regional Office for the Western Pacific, P.O. Box 2932, 1000 Manila, Philippines, Fax: (632) 5211036; ligotj@wpro.who.int Dr Carmela Mijares-Majini, Short-term Consultant, Mental Health and Substance Abuse, WHO Regional Office for the Western Pacific, P.O. Box 2932, 1000 Manila, Philippines Tel: (632) 5289853; Fax: (632) 5211036; mijiares-majini@wpro.who.int WHO OFFICE, SOUTH PACIFIC Dr Yutaro Setoya, Technical Officer, Mental Health, WHO Office for the South Pacific, Level 4 Provident Plaza One, Downtown Boulevard, 33 Ellery Street, Suva Tel: (679) 323 4102; Fax: (679) 323 4177; setoyay@wpro.who.int WHO HEADQUARTERS Dr Michelle Funk, Coordinator, Mental Health Policy and Service Development, Mental Health and Substance Abuse, WHO Headquarters, Geneva, Switzerland, Tel: (41-22) 793855; funkm@who.int

- 20 -

- 21 Annex 2. Agenda

(1) (2) (3) (4) (5) (6)

Opening ceremony Introduction of the workshop The global Mental Health Action Plan 2013-2020 The Regional Agenda for Implementing the Mental Health Action Plan 2013-2020 Panel discussion on social movement Group work 1 – Achievement and champions 2 – Prioritization of implementation options 3 – Bottleneck analysis 4 – Overcoming bottlenecks 5 – Future actions

(7) (8) (9) (10) (11) (12)

Good practices, challenges and opportunities Partnerships in mental health Regional baseline Presentation of country social mobilization plan Conclusions and recommendations Closing ceremony

- 22 -

Annex 3. One-year action plans of 17 Member States

1. Social mobilization plan of Australia Key Deliverables INTEGRATED SERVICES IN THE COMMUNITY

Priority Barrier COUNTER MEASURE Bring the Commissioners together (Joint approach)

COMMONWEALTH VS STATE PRACTICAL METHOD Bring them to a meeting PRIMARY AUDIENCE Through Federal and State Commisioners => Governments - Elected representatives at both levels - Access via voters SOCO INDICATOR DATE DUE COST FUND SOURCE COAG1 Commisioners RANZCP2 MHA3 WHO Support Yes (Auspice)

To achieve a planned, coherent mental health care and support system

Signed Multilateral Agreement

March 2016

- Meeting costs - Draft agreement preparation

Bringing KOLs4 care/consumer's peak bodies (shared vision)

Consensus statement

To achieve a shared vision on the design of mental health care

Consensus statement

February 2016

- Meetings x2 - Writer

Philantropic

Yes (Auspice)

- 23 -

1 2

COAG – Council of Australian Governments RANZCP – Royal Australian and New Zealand College of Psychiatrists 3 MHA – Mental Health Australia 4 KOL – Key opinion leaders

2. Social mobilization plan of Cambodia Key Deliverables PROVIDE OUTPATIENT MENTAL HEALTH SERVICES IN GENERAL HOSPITALS

Priority Barrier COUNTER MEASURE Strengthening advocacy works

There is no CPG for Primary and specialized Mental Health Care Services PRACTICAL METHOD Organize advocacy forum PRIMARY AUDIENCE -Dept. of Planning -Dept of Finance -Sub-TWG1 for mental health SOCO INDICATOR DATE DUE COST FUND SOURCE - Govt. - DP2 WHO Support TA3

Put mental health in the national health policy agenda. MoH agreed

Mental health is one of the priorities in the National Health Strategic Plan

2016

- 24 -

Conduct regular meetings of Sub-TWG for mental health 1 TWG – Technical working group 2 DP – Department of Finance 3 TA – Technical assistance

Build capacity

Members of SubTWG for mental health

Improved knowledge among mental health team

# of meetings # of participants

2015

- Govt. - DP

TA

3. Social mobilization plan of China Key Deliverables HUMAN RESOURCES

Priority Barrier COUNTER MEASURE Improve quality and quantity

The proportion of psychiatrists in the population is very low PRACTICAL METHOD Family support training PRIMARY AUDIENCE Local government SOCO INDICATOR DATE DUE COST ? To support the training To start training on the programme To broadcast the video through the main media in China Until December this year FUND SOURCE Central government WHO Support

- 25 -

Publicity

Make the video about mental health

Public

To make the public know more about mental disorders and decrease stigma The Local Health officers pay more attention to mental health

The World Mental Health Day this year

46 000 dollars

Central government

Local government mobilization

The training class for Local Health officers

Local health officers

To host the training class in Beijing

13-17 September 2015

46 000 dollars

Central government

4. Social mobilization plan of Fiji Key Deliverables STRENGTHEN CAPACITY FOR MENTAL HEALTH IN PRIMARY HEALTH CARE

Priority Barrier COUNTER MEASURE Strengthen communication (creation of MH Promotion post) - Submission - Decision-making - M & E2 (funding)

No dedicated MH awareness programme PRACTICAL METHOD Face-to-face communication PRIMARY AUDIENCE Senior Health Executives (HQ1) SOCO INDICATOR DATE DUE COST FUND SOURCE MOH budget WHO Support MH promotion training

- Endorsement and approval of submission

MH promotion post created

By end of 2016

- FJD20 000 - 30 000 Per Annum (Salary)

- 26 -

Seek decision from relevant committee

Senior Health Executives (HQ)

- Clear annual allocation of funds from MH budget

Annual budget allocation

By September. 2016

-

-

-

- Strengthen consumer organization voice - Dedicated budget - Monitor policy implementation 1 2

M&E included in NACMH3 action plan

NACMH (National Advisory Council Mental Health)

- Endorsement by NACMH

Inclusion in ACP (annual corporate plan)

By November. 2016

-

-

Consumer advocacy training

HQ – Headquarters M & E – Monitoring and Evaluation 3 NACMH – National Advisory Council Mental Health

5. Social mobilization plan of Japan Key Deliverables MONITORING TO SEE IF RELATED LAWS ARE ADEQUATELY IMPLEMENTED

Priority Barrier COUNTER MEASURE Create opportunities to get to know people with mental disorders

There is no platform for better communication among many sections PRACTICAL METHOD Work with peer supporter PRIMARY AUDIENCE Ordinary people SOCO INDICATOR DATE DUE 2016 COST FUND SOURCE MOH WHO Support Technical support if possible

Accept people with mental disorders in community

Ministry of Health (MOH) make an organization to foster peer supporters

US$10 000

- 27 -

Provide relevant information

Educate primary care physicians

Primary care physicians

Treat people with mental disorders as well as ordinary people

Lectures are held at academic societies for primary care physicians

2016

US$10 000

MOH

Technical support if possible

Run an advocacy campaign

Work with NGOs

Opinion makers

Mental health should have high priority

MOH holds a symposium with NGOs

2016

US$10 000

MOH

Guest speaker

6. Social mobilization plan of Kiribati Key Deliverables Priority Barrier COUNTER MEASURE To provide knowledge related to mental health ESTABLISH A BASELINE FROM EXISTING SOURCE The data on mental health disorders is not included in the current health Patient Information System (PIS) PRACTICAL METHOD - Discussion with MH team & PIS personnel - Share our current manual of data collection Find the champions Lobby by providing information - DHS1/DPHS2 - Health PS - HOD stats dept. - HOD medical records dept Directive with full support and commitment from higher authorities Number of champions engaged Availability of equipment required for MH PIS December 2015-August 2016 AUD10 000 - MHMS3 - Taiwan PRIMARY AUDIENCE Health PIS personnel SOCO INDICATOR DATE DUE COST FUND SOURCE - MHMS WHO Support Technical assistance

The data on MH disorders are included in the Health PIS

MH data on various disorders are reported on health PIS

JanuaryDecember 2016

- 28 -

-Effective - DHS/DPHS communication - Health PS -Dialogue - HOD Stats dept. -Email and - HOD medical copying others records dept. - Visible and persevere 1 DHS – Demographic Health Survey 2 DPHS – Director of Public Health Services 3MHMS – Ministry of Health and Medical Services

Sustain MH team to follow-up with those in authority through proper communication channels

Those in authority are kept informed of progress and feedback is obtained

Commencement of work of Health PIS personnel and MH team

JanuaryDecember 2016

AUD2 000

- MHMS

7. Social mobilization plan of the Lao People's Democratic Republic Key Deliverables ESTABLISH A MULTISECTORAL NATIONAL HEALTH PROGRAMME LED BY HIGHER-LEVEL GOVERNMENT OFFICIAL

Priority Barrier COUNTER MEASURE Develop mental health training guidelines and train GP, nurses and community health workers

Mental health information is not regularly collected and reported in a timely manner PRACTICAL METHOD Restructure organization PRIMARY AUDIENCE - Health staff - Community health workers SOCO INDICATOR - % of provincial and district hospitals provide MH services and submit reports - % of villages that provide MH service and report Standard report form has been approved and printed - No. and % of higher level government official regularly receive MH report DATE DUE COST FUND SOURCE Govt. TA WHO Support

GP, nurses and community health workers able to provide MH service and reporting

- January 2016

- US$5 000

- 2016-2018

- US$200 000

ODA

- 29 -

Set up task force to coordinate with relevant departments and develop standard report form Advocate and use MH information in planning and reporting

Develop standard report form

Dept. of planning

To contribute in developing the standard report form Higher level of government official understand more and prioritize MH

September 2016

US$4 000

Govt. ODA

TA

Planning, monitoring and report MH issues to higher level of govt. official

Higher level government official

2016-2018

US$100 000

Govt. ODA

TA

8. Social mobilization plan of Malaysia Key Deliverables DEVELOPMENT OF NATIONAL MENTAL HEALTH ACTION PLAN

Priority Barrier

No state has a community-based mental health promotion/prevention programme PRIMARY AUDIENCE SOCO INDICATOR DATE DUE COST FUND SOURCE MOH NGO WHO Support Content of campaign

COUNTER PRACTICAL MEASURE METHOD Conduct mental - Engage with health awareness media for campaign/programme promotion of campaign - Obtain higher authority endorsement

- Public - Policy makers

- Convinced - Influenced - Changing behaviour - Accepting new policy

2 mental health awareness campaigns

September 2016

US$100 000

- 30 -

Strengthen collaboration in between government agencies

Propose mental health programme e.g: screening stress at workplace

- Agency leaders - Workers within agencies

- convinced - influenced - change behaviour

1 collaborative activity with Ministry of Women/Family & Development

July 2016

US$10 000

MOH

- Content of programme - Expert input

Policy for specific funding in mental health promotion activities

Blue Ocean strategy

- Government leaders - Policy makers - Corporate bodies

- Accepting new policy - Donating funds - Convinced

1 Blue Ocean Strategy with 1 corporate body

October 2016

US$200 000

Gov.t Corporate Bodies

9. Social mobilization plan of the Marshall Islands Key Deliverables PROMOTION AND PREVENTION

Priority Barrier COUNTER MEASURE Update, endorse, share policy and protocol

Referral cases are not referred to mental health department PRACTICAL METHOD Workshop with relevant departments PRIMARY AUDIENCE MOH leadership team SOCO INDICATOR DATE DUE COST FUND SOURCE WHO WHO Support Technical support to review MH referral policy N.A.

To provide quality services to people suffering from mental illness Engage management to direct and implement mental health referral protocol

4 meetings conducted annually

January 2016

US$3000

- 31 -

Implement new protocol

Establish mental health working group

Department heads

MH working group are selected and have scheduled meetings

30 October 2015

US$3 000

CMHS

Training on referral procedure

Conduct dept. meeting led by mental health staff

MOH staff

Ensuring & informed staff on uniform mental health referring system

4 trainings on MH referring procedures are conducted annually

January 2016

US$8000

Compact

Media support

10. Social mobilization plan of the Federated States of Micronesia Key Deliverables Priority Barrier COUNTER MEASURE Develop a mental health plan DEVELOPMENT AND IMPLEMENTATION OF A MENTAL HEALTH PROMOTION PLAN There is no strong leader in mental health for coordination at the state level PRACTICAL METHOD - Seek TA from WHO - Draft policy - Advocate the policy with Secretary of DHSA/Congress - Seek TA from WHO - Draft the plan - Endmnt from Sec. DHSA2 PRIMARY AUDIENCE Improve mental health services and reduce stigma SOCO INDICATOR DATE DUE COST FUND SOURCE WHO/FSM1 WHO Support TA

- Reduce the stigma - Exposure of client's rights - Improve mental health services/facilities Have the knowledge about mental Reduce stigma

WHO will review and make comments on the draft policy

March 2016

10 000

- 32 -

Develop a social mobilization plan

Media campaign about mental health for public

- Seek TA from Improve WHO knowledge and - Draft the plan skills in MOH - Training on mental health middle management management for mental health 1 Federated States of Micronesia 2 Department of Health and Social Affairs

Develop a mental health managerial plan

Effective in work force mental health activities

WHO will review and comments on the social mobilization plan To measure number of mental health workers knowledgeable about managerial work

April 2016

10 000

WHO/FSM

Yes

May 2016

10 000

WHO/FSM

Yes

11. Social mobilization plan of Mongolia Key Deliverables TO DECREASE STIGMA

Priority Barrier

Lack of knowledge about mental health; high stigma, discrimination; lack of human resource; financial barrier; no community-based network; geographical distance PRACTICAL METHOD Work with media PRIMARY AUDIENCE People (teachers) SOCO INDICATOR DATE DUE COST FUND SOURCE Govt. fund (health promotion fund) WHO Support

COUNTER MEASURE Provide relevant information

Convince leaders:" people with mental illness are normal"

TV programmes (Shtork)

October 2015

Shtork $3000x2 = $6000

Improvement of school curriculum

Work with ministry of education

Youth (children)

For the youth to be reassured that "depression is part of life" (can cope with stresses)

Developed improved curriculum

2015-2016

Curriculum development and printing $ 5000 +advocacy meeting $2000 + inclusion $20000 = $ 27 000 15 NGOs $20000 (meeting)

- 33 -

Govt.

TA

Mobilize NGOs

Advocacy meeting with NGOs

NGOs

To influence NGOs to protect the human rights of people with mental illness

Organized meetings wth NGOs

OctoberDecember 2015

Govt. + WHO

TA

12. Social mobilization plan of New Zealand Key Deliverables IMPLEMENT THE RECOMMENDATIONS IN THE MOHP

Priority Barrier COUNTER MEASURE Tailored framing of messages

Not all organizations share information with each other PRACTICAL METHOD Raising profile locally PRIMARY AUDIENCE Communities - schools - local services (health, social) - families Providers SOCO INDICATOR DATE DUE COST Indirect costs – skilled workers' time FUND SOURCE Baseline funding (Departmental expenditure) WHO Support Not required (very local work)

Buy into project

"Brand awareness" Knowledge and attitude to key messages Adoption of best practice

July 2016

Making contact between organizations

- 34 -

Recognition (showcasing awards at dinner)

Adoption of best practice

Better outcomes July 2018 Implementation shorter time frame December 2016 July 2016 to January 2017

$50k - $100k

Government funding

WHO endorsement helpful

Communicate potential improvement from wellbeing

Integrate wellbeing indicators

Schools

Adoption of indicators

Indicators used in schools

Hard to quantify but probably small

Baseline (unless longer than expected)

Not required (very local work)

13. Social mobilization plan of the Philippines Key Deliverables Priority Barrier COUNTER MEASURE Training of MH1 personnel (doctors and nurses) on comprehensive MH services STRENGTHEN COMMUNITY RESOURCES AND SERVICES No mental health facility has community-based mental health programme PRACTICAL METHOD Recommendation of PHL representatives to the workshop in the group's view that focus on curative care on MH facilities shift to CMH PRIMARY AUDIENCE Secretary of Health Executive Committee Members SOCO INDICATOR DATE DUE 2015 COST FUND SOURCE WHO Support Technical Assistance/ support

The Secretary of Health is convinced of the policy shift from curative care to CMH

Administrative Order

None

- 35 -

- Involve stakeholders on provision of training on CMH2 services - Ask from DOH3 for separate budget for CMH services of the MH facilities Provide other options (benefit/advantage of CMH) 1 2

Consultative -MH stakeholders meeting with MH stakeholders -Finance Dept. regarding training on CMH -DOH or NCD4 programme manager

DOH to convene all chiefs of MH facilities for orientation of policy shift to CMH

All chiefs of MH facilities

- MH stakeholders are convinced that they should be involved in CMH training - Finance Dept, DOH or NCD programme managers are convinced that budget allocation for CMH of MH facilities should be provided All chiefs of MH facilities are convinced of the policy shift from curative care to CMH

Memorandum of Agreement between DOH & stakeholders Allotment of budget for CMH from DOH to MH facilities

2015

P100 000 (meeting costs) None

DOH

2016

Technical assistance on mhGAP among others

Administrative order

2015

None

Technical assistance

MH – Mental health CMH – Community mental health 3 DOH – Department of Health 4 NCD – Noncommunicable diseases

14. Social mobilization plan of the Republic of Korea Key Deliverables PHASE-OUT LONG-STAY PSYCHIATRIC CARE Lack of information – availability and benefit from mental health rehabilitation facility PRACTICAL METHOD Make the guideline PRIMARY AUDIENCE Interdisciplinary team SOCO INDICATOR DATE DUE COST FUND SOURCE Government WHO Support Contents

Priority Barrier COUNTER MEASURE Do R & D

Increase in accessibility of information Active the local mental rehabilitation facilities

(1) develop the guideline (2) distribute the guideline (1) Transition rate from PU to local mental rehab. Facility (2) Number of local mental rehab. facility

August 2016

USD 8000

- 36 -

Persuade local government

Develop the indicator and reflect on the assess.

Local government

December 2016

US$1000

Government

15. Social mobilization plan of Samoa Key Deliverables Priority Barrier COUNTER MEASURE Persuade current MH staff to be interested (linked to finding champions) DEVELOP A CONTINUOUS MH SURVEILLANCE PLAN MH Surveillance is not included in the current Patient Information Systems PRACTICAL METHOD Empower, motivate and encourage MH team through information discussion/sharing PRIMARY AUDIENCE Mental Health Team SOCO Behavioural change - convinced - confident - motivated to make positive change - committed - well trained personnel - improved & updated patient information system Release of funds - Increased funding allocation towards mental health programmes - Evidence-based information available for policy makers & decision-makers INDICATOR At least 75% of surveillance coverage is empowered and motivated to make a difference DATE DUE December 2015 By end of 2016 COST FUND SOURCE WHO Support -

Training for IT Information Technology (IT) team Submit proposal for MH funding to government and development partners

Capacity building opportunities (local and international) Conduct a costbenefit analysis of mental health

- IT personnel - Info officers

- 2 overseas training conducted - 2 local trainings conducted - Cost-benefit analysis conducted - Evidence-based info available regarding severity of MH - Mental health more visible and having more recognition as an important area

- 37 -

End of 2016

US$10 000

- NHS - MOH

- Technical - Financial

- ACEO corporate services (MOH) - Finance Manager (NHS1)

End of 2016

US$25 000

- NHS - MOH

- Technical - Financial

1

NHS – National Health Service

16. Social mobilization plan of Tonga

Key Deliverables

STRENGTHEN CAPACITY FOR MENTAL HEALTH IN PRIMARY HEALTH CARE Lack of funding – only 2% of the recurrent health buget is allocated for mental health PRACTICAL PRIMARY METHOD AUDIENCE Hold a - Minister of workshop on the Health importance of - CEO Health mental health - Head of for staff Department mhGAP-A (HOD) - All HOD SOCO - That the CEO + HOD agree to approve the budget submitted for MH - to influence the HOD to deliver MH services in their everyday practice Build the confidence of MH staff in formulating proposals for MH Build the knowledge and confidence of MH staff in formulating proposal for MH INDICATOR - >80% all MOH/HOS attend the training - monthly report monitoring data sets MH HOS DATE DUE JanuaryDecember 2016 Revise March 2017 COST FUND SOURCE MOH DFAT WHO Support Technical support

Priority Barrier COUNTER MEASURE Increase staff awareness and understanding of mental health

US$10 000

- 38 -

Increase staff capacity to create a mental health proposal

Hold in-service training for staff to learn how to formulate MH proposal Hold a workshop on formulating an AMP for staff

Mental Health Team/staff

4 proposals for year from MH - one in every quarter

1 proposal due each quarter

$5 000

MOH Internal

-

Provide training on Action Management Plan (AMP) to staff that require it

- Psychiatric head of section - Psychiatric head of units

-MH AMP submitted on time -Increase recurrent budget by 4% in 2016/2017

March 2016

$4 000

MOH Internal

-

17. Social mobilization plan of Viet Nam Key Deliverables NATIONAL TASKFORCE COMMITTEE ON MENTAL HEALTH

Priority Barrier COUNTER MEASURE Provide relevant information and knowledge

There is limited collaboration between MOH & MOLISA PRACTICAL METHOD Organize collaboration on MH (MOH & MOLISA1) PRIMARY AUDIENCE - MOH - MOLISA - WHO, NGOs - Experts SOCO - Collaborated - Engaged INDICATOR 2 conferences organized DATE DUE October 2015 COST 20 000 FUND SOURCE WHO WHO Support Content of conference

- 39 -

Provide knowledge on MH leadership

Organize training on MH leadership

- Staff - Health sector and labour sector

- Changed - Confident

1 training placed

September 2015

20 000

AP

Content of training

Provide information on MH care systems and MH

Communication through mass media

Population

- Encouraged - Changed

Organized 2 times on television

November 2015

5 000

Government Budget

1

MOLISA – Ministry of Labor, Invalids and Social Affairs

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