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Home » ‘Global Mental Health: policy interventions to protect young people’s mental health’, the 2024 Jack Tizard Memorial International Conference (recording)

‘Global Mental Health: policy interventions to protect young people’s mental health’, the 2024 Jack Tizard Memorial International Conference (recording)

‘Global Mental Health: policy interventions to protect young people’s mental health’, the 2024 Jack Tizard Memorial International Conference (recording)

For delegates only

Slides

Soumitra Parthe, Adolescents Suicide_India_SPIRIT_YAM_presentation

Victoria Mutiso, Presentation_Global Mental Health.ppt 26.6.2024

Siobhan Hugh Jones, ACAMH Webinar June 2024_SAMA Project

Nasim Chaudhry, NC LTP Plus dads

Nicola Shaugnessy, ATTUNE

Presentations

Day 1

Day 2

About the conference

Youth mental health is now recognised to be a critical and important component of life chances. Providing timely and effective treatment and care is essential, yet services even in high income countries are under strain. There are long waiting lists, insufficient numbers of skilled clinicians and community supports, and schools struggle to provide interventions to many who appear not to meet diagnostic thresholds. The global context offers fresh perspectives, in that 80% of the worlds young people live in low and middle income countries, where there are few services, clinicians, or infrastructure. Models from high income countries will not work there.

Global practices have to reflect this lack of resource, investment and infrastructure. Innovative low cost interventions are being pioneered in low and middle income countries, and offer invaluable lessons for high income countries, where we are unable to meet the needs of young people.

Youth mental health care is in crisis in the UK and high income countries, where we struggle to provide sufficient and appropriate care. We need new solutions and innovation in models of effective support and care and treatment. This series of talks brings together experts in child and adolescent mental health, who are innovating new ways of providing care and support instead of, or alongside, conventional psychiatric and psychological intervention where it exists. The variation in global policies, legislation, access to interventions offers new perspectives on what effective services, treatment, and care can look like. The presenters also provide lessons for culturally competent, safe, effective care for children around the world, sharing expertise and solutions for adaptation and implementation.

Learning objectives

  • Taking a transdiagnostic perspective, the speakers will set out public health, community, social and health systems evidence on what works for whom and where.
  • How might we learn to adapt our practices in high income countries to meet the needs of our communities through tasking shifting, new workforces, and novel interventions for children and parents and schools?
  • What lessons for cultural competency emerge when we interrogate the global rather than our preferred approach in the Global North?
  • How can we work in partnership with scholars and practitioners around the world?
  • How do we (communities, parents, and clinicians) provide appropriate care for eating disorders, autism, depression, in the context of multiple intersectional disadvantages.

About the talks

Professor Nasim Chaudhry ‘Culturally Adapted Partner Inclusive Integrated Parenting Programme to support Depressed Fathers – A Journey Towards Transition to Scale-Up.’ Authors: Muhammad I. Husain, Tayyeba Kiran, Rabia Sattar, Ameer B. Khoso, Ming W. Wan, Paul Bassett, Zainab Zadeh, Nawaz Khan, Shahla Naeem, Imran B. Chaudhry, Rakhshi Memon, Syed F. Jafri, Karina Lovel, Siham Sikander, Farooq Naeem, Nusrat Husain, Nasim Chaudhry

Parental depression is the most common challenge of childrearing. Existing evidence is largely focused on depression in mothers; however, fathers are also at risk of depression. There is a need to develop and evaluate partner inclusive interventions to improve parental and child health outcomes. This study aims to evaluate the clinical and cost-effectiveness of Learning through Play Plus (LTP Plus) intervention to reduce depression in fathers and improve child outcomes.
Method: A cluster randomized controlled trial was conducted across 18 towns (90 Union Councils-UCs) of Karachi, Pakistan. UCs were randomized to either LTP Plus Dads or wait-list control arm. Depressed fathers (N=2909) of young children (0-3 years) were recruited. Primary outcome was change in depressive symptom severity on the Hamilton Depression Rating Scale. Fathers in intervention arm received 12 group sessions, over four months. Assessments were completed at baseline, 4 and 6-months. Mothers (N=2611) also participated in an optional LTP Plus intervention.
Findings: Preliminary findings showed that fathers receiving intervention showed significant reduction (P= 0.000) in depression compared to control arm. There was significant decrease in anxiety and parenting stress, and improvement on health-related quality of life, self-efficacy, social support, relationship with partner, knowledge, attitude and practices about child development and bonding with child. A significant reduction was also observed in domestic violence.
Conclusion: Addressing depression in parents is hugely important due to its adverse effect for parents and children. This low-cost parenting programme will help in scaling up the innovation across health services in Pakistan and low-income settings.

Key learning takeaways

  1. To understand the burden of parental depression in low and middle income countries, specifically to the paternal depression.
  2. To understand the impact of depression on socio-emotional development of children
  3. To understand the importance of partner inclusive integrated parenting interventions in improving health and wellbeing of both parents and children.

Professor Soumitra Pathare, ‘Suicide amongst young people in India: Does anyone care?’

Sustainable Development Goals has suicide rate as an indicator for SDG3 with a target to reduce this by one-third in 2030. India, with 17 per cent of world population, accounts for nearly 26 per cent of suicides in the world.

More than 10,000 children and adolescents under 18 years die by suicide each year. In 2020, the pandemic year, while all suicides in India increased by 10% suicides amongst under 18 year olds increased by 19%. The talk focuses on the paucity of data, potential causes, (lack of) policy action to tackle children and adolescent suicides and data from intervention research projects currently being implemented by our group in India.

Key learning takeaways

  1. To better understand the demography of youth suicide in India
  2. To understand potential interventions for youth suicide prevention in India
  3. To recognize the challenges and need for policy action for suicide prevention in India.

Professor Siobhan Hugh-Jones, plus colleagues from Bangalore, ‘What do Indian young people, their schools and their families want to safeguard youth mental health? Insight from a co-design study for a whole school program in Bangalore.’

Youth mental health is of concern in India where suicide is the second leading cause of adolescent death. Access to mental health care is limited and prevention approaches are needed. This talk presents learning from Project SAMA, based in Bangalore (India) which examined the appetite and capacity for secondary schools to be sites of public mental health prevention work. As a collaborative between the University of Leeds and the National Institute of Mental Health and Neurosciences (Bangalore), the project worked with n=50 community members (adolescents, teachers, headteachers, parents and mental health professionals) to co-produce their preferred whole-systems school programme (called SAMA) targeting youth, teachers, parents and school climate. They chose to focus on mental health literacy, safer schools (physical and psychological) and nurturing teaching and parenting. The primary aim of the SAMA programme was to reduce symptoms of youth anxiety and depression. This presentation reports the results of a waitlist feasibility trial of the SAMA programme conducted in eight secondary schools in Bangalore (n=1131 14–15-year-olds, n=123 teachers and n=169 parents). Feasibility was established, with embedded lay counsellors (programme delivery agents) in school being critical to positive outcomes. Youth, parents and school staff reported significant impacts of psychoeducation on their understanding of young people and themselves as well as the importance of observable actions in school to tackle identified risks to youth mental health (including bullying and harsh teacher discipline). All constituents expressed an openness and felt need for Indian secondary schools to be sites for preventative approaches for youth mental health. Outcomes can inform Indian state and national mental health policy for young people.

Key learning takeaways

  1. To understand what preventative action for youth mental health is sought by young people and their communities in India.
  2. To appreciate how lay workers can be effective agents in mental health prevention work.
  3. To consider the challenges in progressing a public mental health approach for youth in India.

Professor Nicola Shaughnessy, ‘Providing mental health care and support for autistic people: is there a global and local consensus? Using creative methods and participatory community research for co-discovery in mental health research with neurodivergent young people.’

We discuss an interdisciplinary project investigating the impact of adverse childhood experiences on adolescent mental health (ATTUNE) with particular reference to neurodiversity as one of the project’s cross-cutting themes. As part of our commitment to participatory community research, autistic and neurodivergent young people were engaged as researchers, practitioners and participants, contributing to data collection, analysis and dissemination. The project used creative practices in conjunction with qualitative methods of data analysis to enable us to elicit and examine lived experience and youth voice as core features of our enquiry. Participants were involved in a programme of multi-modal workshops (e.g. collage, mask making, creative writing), contributing to semi-structured “creative conversations” as data for the framework analysis. The focus of this paper is on one of our core methodology questions:

Do creative and participatory arts approaches generate new and transformative experiential data to improve understanding and actions for prevention and care interventions?

Through the creative and participatory approaches, autistic participants contributed insights into what childhood adversity meant for them, how it affected their mental health and what might be done to rectify these experiences for the future. Key themes identified were the importance of safe space, the impact of school as a harsh environment, the significance of sensory experience and the role of social media (positively and negatively). The three presenters variously identify as neurodivergent or autistic and include a young person.

Key learning takeaways

  1. To understand how creative and participatory community practices were used in research on adolescent mental health, adverse childhood experiences and autism.
  2. To understand what new insights emerged from this work.
  3. To recognise the implications for education, health and care

Professor Anuj Kapilashrami and Dr Aparna Joshi,Gender-based violence among young women: Voices of young women and healthcare providers: Lessons for prevention and intervention

Gender-based violence (GBV) is widely prevalent among adolescents and young women in low and middle-income countries. The interplay among various factors situated at different levels of ecology, ranging from a young age and relative lack of experience in managing relationships to rigid gender norms, widespread societal acceptance of violence, and lack of effective socioeconomic and health policies and programmes, contribute to young women’s heightened risk of experiencing GBV (Decker et al.,2015). GBV among adolescents and young women leads to serious health and psychosocial consequences. Drawing from the research work carried out in India, the present session weaves in two strands and focuses on the theme of violence against young women. The first strand, based on a national-level qualitative study, explores young Indian women’s experiences of technology-facilitated gender-based violence, its connections with mental health and their acts of resistance. The second strand builds on another exploratory study uncovering issues of gender-based violence from the health system’s perspectives in India and the strengths and challenges confronting health systems in offering a comprehensive response. Both the strands highlight role of gender norms and its intersections with other social locations in creating layers of marginalisation and powerlessness in young women’s lives and the need for responses that are informed by feminist and social justice approaches.

Dr. Ashish Kumar, ‘Global mental health and eating disorders: the importance of accommodation and expressed emotion in young people.’

Eating disorders are complex mental health conditions which also significantly affect the physical health and mental health of patients and also affect the carers who support these patients. In this review, the authors have examined the impact of eating disorders on carer’s emotional reactions and behaviour towards the eating disorder symptoms, namely accommodating and enabling behaviour towards the illness and have also examined the impact of expressed emotions on young people and their recovery. For this review the authors have searched for published studies that have examined accommodating behaviour in carers of people with any type of eating disorder and expressed emotion on young people and the carers and recovery from eating disorders. They have reviewed studies, which includes studies such as randomized trials, longitudinal studies, cross-sectional studies and qualitative studies. Higher levels of accommodation in carers was associated with higher levels of their emotional distress, anxiety and fear. Accommodating and enabling behaviours reduced with treatment although no single type of intervention was more effective in this regard than others. There was mixed evidence for the impact of accommodating and enabling behaviour in carers on the outcome of eating disorders in the patients. Higher expressed emotion had a negative outcome on family functioning and parental mental health and recovery from eating disorders though more research is needed in this field.

Key learning takeaways

  1. To understand the concept of Accommodation and Expressed emotion in family environment and its importance in the management of Eating Disorders.
  2. How it impacts upon recovery from Eating disorders in patients.
  3. Implication for clinical intervention for parents and carers.

About the speakers

Professor Soumitra Pathare
Director, Centre for Mental Health Law & Policy, Indian Law Society

Soumitra’s primary interests are in the areas of mental health policy, scaling up mental health services, suicide prevention, and rights-based care & legislation.

In the past, he has provided technical assistance to the Ministry of Health and Family Welfare, Government of India, in drafting India’s new Mental Healthcare Act, 2017, which takes a rights-based approach to mental health care. He was a member of the Mental Health Policy Group appointed by the Government of India to draft India’s first National Mental Health Policy released in October 2014.

Soumitra has served as a WHO consultant in many low- and middle-income countries including Botswana, Seychelles, Lesotho, Samoa, Vanuatu & Eritrea, Guyana, Grenada among others, to assist them in drafting and implementing mental health legislation and national mental health policies.

He is currently the PI on multiple suicide prevention projects such as Outlive, ENGAGE, SPIRIT and Contact And Safety Planning (CASP).

Professor Siobhan Hugh-Jones
Professor in Mental Health Psychology, University of Leeds

Siobhan is Professor in Mental Health Psychology, specialising in adolescent mental health in the public health space. She works with colleagues in Bangalore, India to explore how to bring mental health knowledge and support to young people in acceptable ways, focusing on schools as sites of both risk and protection for youth wellbeing. She brings learning on engaging communities in creating their own agendas and actions for their own mental health in culturally attuned ways, and in the challenges and opportunities of bringing the voice of young people to mental health policy making in India.

Professor Nicola Shaughnessy
University of Kent

Nicola Shaughnessy, Professor of Performance at the University of Kent, specialises in creative health, socially engaged participatory arts and neurodiversity. She has been the lead researcher for several grant funded projects investigating autistic identities through creative practices and is also a co-investigator for projects using arts-based methods to research adolescent mental health. A further project is developing a digital diet to address online misogyny. She is a neurodiversity consultant working with organisations such as such as The National Theatre and Audible. She is co-presenting with Dr Annette Foster, an autistic researcher and arts practitioner and Jack Hanrahan, one of the young people participating in the research.

Dr. Ashish Kumar

Dr. Ashish Kumar
Chair, Faculty of Eating Disorders, The Royal College of Psychiatrists, Clinical Director, CAMHS, Mersey Care NHS Foundation Trust

Dr Ashish Kumar is a Consultant Psychiatrist and Clinical Director for CAMHS, at Mersey Care NHS Foundation Trust. He is also serving the Faculty of Eating Disorders of the Royal College of Psychiatrists as its Chair and was the immediate past president of the European Chapter of the Academy for Eating Disorders. In these roles he has contributed to national and international policy revisions and reviews on Eating Disorders and development of curriculum for medical students and psychiatrists. He was one of the authors of recently published MEED guideline and also worked on developmental and delivery of RCPsych pan age credentialing pilot in eating disorders.

Dr Kumar has worked extensively as lead consultant in the field of neurodevelopmental disorders such as ADHD, ASD, complex mental and behavioural disorders across age range and risk management of high-risk patients.

Dr Kumar was awarded with ‘Global Leadership Award’ at Academy for Eating Disorders Congress in Chicago in 2019. for his contribution in establishing the European Chapter of Academy for Eating Disorders. Dr Kumar is passionate about creating systems, knowledge and undertaking research in Eating Disorders and mental health. He has presented on important topics related to Mental Health, Mental Health Law, Eating Disorders and leadership at international conferences.

As a clinical lead he helped establish one of the first Children’s Eating Disorder Service in the UK at Alder Hey Children’s hospital in Liverpool, under new NHS-England initiative. He continues to lead Children’s Eating Disorder Service to deliver high quality of care and work on implementation of TRIANGLE project in Children’s ED service under supervision of Prof Janet Treasure at Kings College London.

Nasim Chaudhry

Professor Nasim Chaudhry is a consultant psychiatrist and the Chief Executive Officer of Pakistan Institute of Living and Learning (PILL). She is an Honorary Professor of Psychiatry at Dow University of Health Sciences (DUHS), head of psychological medicines Remedial Center Hospital and Associate Director of Global Mental Health and Cultural Psychiatry Research Group. She is a Member and Fellow of Royal College of Psychiatrist. She worked as a consultant psychiatrist with the National Health Service in the United Kingdom for many  years. Her main research interests are parental mental health, self-harm and suicide prevention in low and middle income (LMIC) countries, cultural psychiatry and Global Health. She is particularly interested in developing culturally appropriate services and improving access to culturally adapted cost-effective psychosocial therapies for severe mental illness. Her research is related to aspects of cultural psychiatry which are not only contributing to address the huge Mental Health Gap (MH-Gap) in LMIC’s like Pakistan but have become increasingly important for the appropriate development and delivery of psychiatric services in high income settings. She is a Chief investigator and co-investigator for several research projects funded by various grant bodies such as Medical Research Council, Welcome Trust, NIHR, CIDA and Grand Challenges Canada. Through her research, Prof Chaudhry is making meaningful impact in health policymaking in Pakistan. 

Professor Anuj Kapilashrami an Interdisciplinary social scientist trained in Public Health and Sociology and Professor in Global Health Policy and Equity in the School of Health & Social Care. She is Director of the Centre for Global Health & Health Equity Research at the University of Essex. Kapilashrami has a longstanding research experience in health policy and systems research, with particular interest in applying intersectionality to examine health inequalities and social determinants of health. Her work focuses on multiply disadvantaged populations, and the mechanisms for their meaningful engagement in policy processes.  Kapilashrami leads a NIHR funded Global Health Research group on Gender, Violence and Mental health among Migrants in precarious Situations (GEMMS) in Southern Asia & Southern Africa, and INNOVATE, a UK-based intersectionality-focused multi-stakeholder consortium tackling inequalities in mental health in Essex.  She is Chair of Medact, a UK based health charity of health workers for health justice and peace, former convenor of People’s Health Movement, Scotland and expert advisor on the Gender Equity and Rights Panel for WHO’s Sexual Reproductive Health Programme. 

Dr. Aparna Joshi

I am Dr. Aparna Joshi, an academician, researcher, interventionist, practitioner and trainer from India with 25 years of experience in the field of mental health and psychosocial well-being. Since 2010, I am an Assistant Professor with the School of Human Ecology, Tata Institute of Social Sciences (TISS), India. My teaching, research and outreach work primarily builds on the reciprocal relationship between theory, research and practice, and academics and the field. Many of my research, intervention and capacity-building projects are commissioned or supported by National and International organisations, and aim at integrating psychosocial well-being issues into existing development endeavours. I have
been a member of the advisory groups to several civil society, government and international organisations. Apart from my teaching and research work at TISS, I lead two field action projects: iCALL (since 2012), a leading National level, professionally run, free and multi-lingual telephone, email and chat-based mental health and psycho-social counselling service that also engages in mental health research and capacity enhancement initiative, and Sukoon (since 2017) a Mental health service and research initiative that aims to improve the well-being of couples and families in legal and community contexts in India.

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