Author Archives: Dr Julian Eaton

Dr Julian Eaton

About Dr Julian Eaton

Dr Julian Eaton, a British psychiatrist, is a mental health advisor for CBM in West Africa. His task is to support projects that include Community Mental Health in their work, some Community-Based Rehabilitation and some specialist psychosocial health services. Read more http://www.cbm.org/Dr-Julian-Eaton-254556.php

Suicide – devastating, common and preventable

To mark World Suicide Prevention Day 2018 on 10 September, Dr. Julian Eaton (Senior Mental Health Advisor at CBM) shares his views on a topic that is often taboo, despite desperately needing to be talked about to raise discourse, awareness, recognition and policy priority for suicide, in turn reducing a scourge that affects far too many people.

Picture copyright: Pixabay

 

When I was 21, my thoughtful, caring, talented, beautiful friend, killed herself. I think her funeral was the most upsetting thing I have ever attended, with all of us asking how a person with the world at her feet could feel such despair that this seemed the only solution. Her death left a hole in her family, and our circle of friends still feel the painful gap in the space she used to occupy.

September 10th marks World Suicide Prevention Day, a topic that is increasingly in the news, but that people still find difficult to talk about, though many people are affected. Suicide remains a taboo subject in most parts of the world, often frowned upon by cultural and religious traditions. In fact, the term ‘committing suicide’ refers to the fact that suicide was illegal in many countries. We try to avoid using this terminology, and in countries where suicide remains illegal, it is an advocacy priority to change such laws, as part of the process of challenging stigma, making it easier to talk about the issue, being able to accurately record cases of suicide, and reducing unnecessary additional suffering of families and survivors of attempted suicide.

It is a sad and shocking fact that suicide is the second most common cause of death in young people between 15 and 29 worldwide, and is the leading cause of death among young people in many European countries. In total, almost a million people die by suicide globally each year. It is estimated that for every person who dies by suicide, at least 25 attempt suicide. As well as being an awful situation for the person themselves, a suicide has a devastating effect on friends and family, and it is estimated that typically, over 100 people are effected by a single suicide.

Many people who self-harm do not intend to die, and there are many complex reasons why people do self-harm, but it is also the case that people who self-harm are more likely to go on to kill themselves by suicide, so this is an important warning sign, that should be taken seriously, and lead to support being provided.

Why do people seek to harm themselves, and what can we do to reduce suicide?
Of course suicide is strongly associated with mental ill health, and over half of people of people who die by suicide have a diagnosis of depression at the time of death. People with alcohol and drug problems, psychotic illnesses like schizophrenia, and other mental illnesses are also more likely to self-harm and die by suicide. This means that good mental health services, systems to identify people who are distressed or depressed, and easy access to care are important elements for reducing suicide. Similarly, physical ill health (especially long-term, painful and disabling conditions, including non-communicable diseases (NCDs)) increases risk of suicide, so good care of physical health, as well as recognising a psychological component of such conditions is important.

Relationship problems, bereavement, unemployment, work or educational stress, economic hardship, loneliness, isolation and bullying (often online) increase risk of self-harm and suicide, particularly if they come together. Therefore, a comprehensive approach to addressing risk of suicide is important. The easier it is to access means of self-harm (guns, knives, toxic medicines etc.), the more likely people are to successfully kill themselves, so one of the most effective means of reducing suicide rates is to control access to such means of self-harm. Suicide is often carried out in particular moments of despair, which will almost always pass if a person is not able to find a means of harming themselves. One example is where simple measures to reduce easy access to pesticides, a particularly common cause of death among farmers in India, dramatically reduced suicide rates.

It usually helps to be able to talk to someone, and a listening ear, and supportive friendships can really help when people are feeling hopeless. We can all do what we can to support our own friends, or people we work with who are lonely or distressed, but we can also try to raise awareness of the issue, and advocate for more government and social action to implement the measures we know are effective. Suicide is an essential issue for mental health, and as such closely linked to Non-Communicable Diseases. The High Level Meeting on NCDs at the UN General Assembly is an opportunity to make sure that mental health and suicide are recognised, and we work together as a global health community to reduce the scourge of suicide that affects so many people.

Related links

Innovations:

  • RISING SUN (suicide prevention in the Arctic region) – http://bit.ly/2Np9ntY
  • Giving LIFE a chance – http://bit.ly/2NTie3Z
  • Pesticide Regulation for Suicide Prevention – http://bit.ly/2oIEToO

Toolkit:

  • RISING SUN has produced an online Toolkit on how to measure the impact and effectiveness of suicide prevention in Indigenous groups. 5 levels of intervention a) Family b) Individual c) Clinic d) National/Regional e) Community – http://bit.ly/RISINGSUNTOOLKIT

Resources:

  • Suicide Prevention Webinar from Dr Saxena Shekhar, Director of WHO Department of Mental Health and Substance Abuse – http://bit.ly/2eO6ljx
  • WHO Suicide Prevention Factsheet, available in 6 languages including info on key facts, prevention & control & challenges – http://bit.ly/2oIyREG
  • WHO’s Community Engagement Toolkit – http://bit.ly/2oKVLv1

Mental health on the global development agenda!

For the past 15 years, the global impact of mental illness has been increasingly well recognised. This has been well documented both scientifically (for example carefully measuring the disability attributable to mental illness – around 32% of total years lived with disability), and in terms of greater awareness of the appalling human rights abuse experienced in many countries.
During this time, the evidence for effective interventions has also become stronger, with a growing consensus on good practice, even in the most challenging settings, and in emergencies. For very good reason, the global health agenda has been dominated by campaigns to address communicable diseases (TB, malaria, HIV/Aids), to promote vaccination, and by a focus on maternal and child health. Mental illness is very far from being prioritised in this way (despite causing an equivalent amount of disability). Development funds for mental health are typically less than 1% of health budgets (for example in DFID or USAID, though quantifying this is difficult because expenditure on mental health is usually not measured).
The Global Mental Health community has been working hard to change this neglect. The #FundalMentalSDG campaign (which CBM supported) contributed to a greater prominence of mental health in the Agenda 2030 SDG documents. This meeting, hosted by the World Bank with the support of the WHO, was a key milestone in presenting mental health as having an essential contribution to make to global development.

Research carried out for the meeting found that for every dollar spent on mental health in development, four dollars was gained to the economy. By 2030, the world economy will have USD6 trillion a year lost to productivity due to mental illness if nothing is done.

An intense week of activities

At the high level panel discussions at the World Bank building, the President of the World Bank and Director General of the WHO both spoke, explaining their commitment to seeing mental health gaining further support in future. The opportunity of having mental health highlighted in a meeting with many key global figures in politics and finance was crucial in raising the profile of mental health. In addition to the events at the World Bank, the week attracted a number of other side events. On the first day, Carmen Valle, CBM’s Mental Health Advisor who has just left Sierra Leone after spending the last years developing services participated in an ‘Innovations Fair’ where she described CBM’s partner programme supporting the mental health and psychosocial support through the Ebola epidemic.

Other meetings included a day discussing the growing body of research around innovative services run by the (US) National Institute of Mental Health and Grand Challenges Canada. I spoke at this event about the importance of the often neglected issue of how mental ill health and disability interact. For example, people with sensory impairments have a higher prevalence of mental illness, but services are often not accessible and do not address their needs. CBM and the International Agency for the Prevention of Blindness (IAPB) reaffirmed their commitment to ensuring that their services continued to lead the way in this area.
Another day focused on strengthening our understanding of how culture and mental health interact. Global Mental Health has been, since its inception, conscious of the importance of recognising the importance of embracing culture and difference local approaches to mental health and illness. Its practitioners have also come from a range of backgrounds from social to medical, and a comprehensive approach has been promoted from the outset. This was demonstrated by the range of participants in these meetings.
The week was an opportunity to meet many of the most important actors in Global Mental Health and it really felt like the movement was coming of age, proving its capacity, and preparing for a new level of engagement in global development. It was great to see CBM playing a role in this, and motivating to build on what has already been achieved.
The full report can be read here

Mental Health is the centre of attention at the World Bank this year: “Out of the shadows; making mental health a global priority”

Momenta's Project Sierra Leone 2015

The human toll of mental illness has started to be widely recognised for its impact on individuals and families. There is now much more awareness of, for example depression, due to stories in the media about famous people who are talking openly about their problems. Even the once taboo subject of suicide is now more openly acknowledged in society.  When someone like the comedian Robin Williams dies by suicide, it has the effect of reminding us that at least 1,000,000 people die in this way every year around the world. In many countries suicide is one of the top three causes of death in young people, but is often ignored or even denied as an issue.

CBM, along with many other partners in global development have long pointed out that mental illness and psychosocial disability also has an important impact on communities and broader society. Mental illness does not only cause personal suffering, but often results in social exclusion and lack of opportunity for large sectors of the population to contribute to the economy and community development. Since 85% of the people with mental conditions live in the poorest countries in the world, the impact is particularly marked on these fragile economies.

By 2030, depression is expected to become the single largest contributor to disease burden globally, and even today, 350 million people around the world are affected by depression. The sheer scale of this issue, and the well documented impact on people’s ability to work and actively engage in the economic life of a country has led the World Bank to focus on mental illness at their annual Spring Meeting in Washington in April. At last year’s World Economic Forum, careful analysis in a report by a Harvard group resulted in an estimate that the annual global costs of mental illness to the economy was 2.5 trillion dollars in 2010, a staggering number that was expected to rise to 6 trillion dollars by 2030.

The joint meeting, called ‘Out of the shadows, making mental health a global priority’ will be run by the World Bank and WHO, from April 13th to 15th in Washington. It will be a forum to examine how the major financial actors in global development can address this issue. These key funders and politically powerful groups can hopefully start to play their role, joining development organisations like CBM, and other groups like service user organisations and activists, so make more resources available and raise prioritisation of mental health.

CBM will be well represented at the meeting. Carmen Valle will be sharing our experiences of working in Sierra Leone with partners to build resilience and reduce the psychological impact of the Ebola epidemic. This is a part of Disaster Risk Reduction that is often not sufficiently recognised. Information about this project with our partners in Sierra Leone is here. She will also be talking about how our partners ensured that access to important public health messages, for example during an epidemic like the 2014/15 Ebola outbreak, can be accessible to all people, including people with disabilities.

I will be speaking during a panel discussion on the topic of mental health and people with sensory impairments. The main points are that

  • Mental ill health is much more common in people with sensory impairments, but is often not recognised.
  • Mental health components should be integrated into services for people with sensory impairments, for example ensuring that service users themselves, and health and education personnel, are made sensitive to these needs and are aware of how to address them
  • The barriers that people with sensory impairments face should be specifically addressed in messaging relating to mental health by paying attention to accessible formats (as in any other awareness and public health work).

Carmen and Julian will be Tweeting and Blogging from the meeting. Follow our our blog, Twitter and Facebook to get all the latest news about the WHO meetings in Washington DC (the hashtag for this event is #mentalhealthnow). You can also follow Dr. Julian Eaton and Dr. Carmen Valle on Twitter who will be tweeting live from the events.

Additional information on the Innovation Fair can be found here.

 

Julian Eaton

Mental Health Advisor, CBM

The WHO increases its focus on dignity in mental health services

All human beings are born free and equal in dignity and rights…. – Article 1 of the Universal Declaration of Human Rights

I am at the WHO annual mhGAP Forum in Geneva, discussing the priorities for mental health at a global level. It is exciting to see a profound shift towards recognising the importance of the experiences that people have in services in their communities. CBM has done a lot of work in promoting the right to access decent mental health services, but we must also ensure that the way that people are treated in those services and wider society is dignified.

The theme of World Mental Health Day this year is ‘dignity’, and we spend time looking at the huge abuse of people in communities, and in mental health services. There was plenty of opportunity to hear from people with psychosocial disabilities about what dignity meant to them, and how they had challenged the system to recognise them as individuals.

One of the examples of resources being developed to promote dignity is QualityRights, which is partly supported by CBM.

The QR toolkit aims to –

  • Provide a framework for assessing and improving the quality of care offered to service users
  • Increase the capacity of persons with psychosocial disabilities to speak confidently about their priorities
  • Promote a civil society movement of people working together to improve care
  • Reform policies and law to better reflect the human rights of persons using services. This includes practical guidelines and standard operating procedures in health facilities

A major evaluation of the project is currently under way in Gujarat, India. The head of mental health for the State, which has a population of 62 million people, spoke about how the project was having an impact on the services in the State. Overall the very transformational aim of the work is to shift the emphasis of mental health services from a paternalistic and controlling environment focused on illness, to one where the priorities and decisions of service users are valued, where the environment promotes dignity, and where the focus is on recovery.

This is a dramatic and fundamental change from the tone of services in many parts of the world at present. The availability of a simple toolkit will help many countries to feel confident about practical measures that they can take to move towards meeting their commitments towards the Convention on the Rights of Persons with Disabilities.

Graham Thornicroft from FundaMentalSDG.org described the work that is being done to ensure that the importance of dignity is recognised in the new Sustainable Development Goals. Mental health and well-being now has a good recognition in the SDGs, and at this stage it is crucial to get the indicators required to hold governments to account. Here is a great film about it, produced by FundaMentalSDG.

This is one way in which we can all contribute to seeing dignity being respected in peoples’ lives.