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

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 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.


Tracking Down Ernst Christoffel

During a trip to speak at a Social and Cultural Psychiatry Congress in Tehran, Iran, I took the opportunity to try to find Ernst Christoffel’s grave. Pastor Ernst Christoffel was CBM’s founder and director for many years. With a little investigation, I had learnt that he was buried, in 1955, in the Armenian Cemetery in Isfahan. He had returned to Iran in 1951 at the age of 70 years, to continue the work he had started in the region almost 50 years earlier.

Pastor Ernst Christoffel

Pastor Ernst Christoffel


Christoffel's grave

Christoffel’s grave

The Armenian community is well established, having first been invited by Shah Abbas 1, in 1605 to live and trade in Isfahan, the then capital. They made Isfahan the centre of a huge trading network, and have been protected by law and allowed to practice their faith, although their numbers are significantly declining now. Isfahan has several beautiful churches, including Vank Cathedral, and a museum showing the fascinating history of Armenians in the region.

After a day of chasing bureaucracy with my guide (we had to visit the Ministry of Islamic Culture, and the Armenian Church to have written permission), we were allowed into the cemetery, and eventually located the area that was reserved for foreigners. There we found an interesting mix of nationalities, who had been in Isfahan for a variety of reasons (missionaries, diplomats etc), over the past four centuries.


Writings on the grave

Christoffelâs grave in the Armenian Cemetery in Isfahan/Iran

Ernst Christoffel’s grave was one of the largest there, surrounded by flowering bushes. On his grave was written (in German, Persian and Armenian);

Here rests in God’s peace Pastor Ernst J. Christoffel the Father of the blind, orphans, cripples and deaf-mute born.

Born 4.9.1876 IN Rheydt, died 23.4.1955 in Isfahan after more than 50 years of missionary work in Siwas, Malatia, Tabris and Isfahan. “I have fought the good fight” 2. Tim. 4.7. “But thanks be to

God who gives us victory through our Lord Jesus Christ.” 1 Cor. 15.57


Images of the city of Isfahan

Masjed-e Shah, Isfahan/Iran Masjed-e Shah, Isfahan/Iran