Better mental health, and a better world

Better mental health, and a better world

image of a road in Rwanda

UK development professionals finding our way in global mental health

A call to action

I can hardly believe it was four years ago, in February 2016, that we were squeezing alongside sixty development professionals into a small Committee Room of the Houses of Parliament, for a heavily oversubscribed meeting of the All-Party Parliamentary Groups (APPGs) on Global Health and Mental Health. Sitting elbow to elbow, some perched on radiators and leaning in doorways, representatives of non-governmental organisations (NGOs), advocacy groups and research and development funders gathered to consider their role in enacting the recommendations of the 2014 Joint APPG report, Mental Health for Sustainable Development.

Two recommendations in particular were the focus of discussion: one directed at the Department for International Development (DFID), the government department responsible for administering the UK’s overseas aid; and one for NGOs and others working on the ground in low- and middle-income countries (LMICs).

  • Recommendation 1: The Department for International Development (DFID) to ‘integrate’, ‘evaluate’ and ‘replicate’ global mental health in its programmes in order to support countries to implement the World Health Organisation (WHO) Mental Health Action Plan.
  • Recommendation 2: NGOs and others working in international development should support staff to understand the needs and capacities of people with mental health problems, encourage the inclusion of people with mental disorders in their general development programmes, set up new mental health-specific programmes, and measure the impact of their programmes on mental health.

The key take-away message from this meeting was simple: “Join us.” Representatives of NGOs already working in mental health argued passionately that it is only through collective and concerted efforts across organisations, sectors and disciplines, that we can make mental health in LMICs a priority in international development.

The joint APPG meeting was followed the next day by a technical workshop for NGOs to develop a united call to action and social media campaign (#NGOs4MentalHealth) in advance of the April 2016 World Bank-WHO meeting “Out of the Shadows: Making Mental Health a Global Development Priority”. The call to action was launched during one of the April meeting’s panel discussions, and then formally endorsed by twenty-nine organisations and signed by more than 700 people. Several of the NGOs at the technical workshop went on to establish a Mental Health Sub-Group of Bond’s Disability and Development Group, for longer-term advocacy and support.

These were promising developments, but not quite the radical change that many of us—quite optimistically and perhaps a bit naively—expected to come out of these high-level “policy moments” in Westminster and Washington, D.C. Instead of hoisting pints in celebration, many of us could be found grumbling in our local pubs after Bond meetings, asking where the development funding was, why there were still so few NGOs working on mental health, and whether all our efforts were—in the end—just for show.

Seeing change in the small things

As our friends at the Overseas Development Institute kept reminding us, change is neither fast, nor linear. Today, it seems like global mental health as a field is growing exponentially—more meetings, more reports, more organisations, more people. Certainly, the inclusion of mental health in the 2030 Sustainable Development Agenda has fuelled this momentum, but I find it difficult to identify the exact turning-point when it felt like mental health had finally “made it” in the development community. Or at least when we stopped grumbling so much down the pub.

The obvious answer should probably be the 2018 Global Ministerial Mental Health Summit in London, where the Duke and Duchess of Cambridge could be seen posing for photographs on a replica of Zimbabwe’s Friendship Bench. Or perhaps the inclusion of mental health in the United Nations General Assembly and World Economic Forum meetings in 2019. But for me, those aren’t quite it. What we learned the hard way back in 2016 is that high-level policy “moments” are necessary—but not sufficient—to make real change on the ground.

What I’ve been more excited by these past four years are the often-times small, quiet, technical steps that we as a development community have been making toward achieving those APPG recommendations from back in 2014. The new faces at Bond meetings. More sophisticated intervention and implementation guidelines. Constructive debates on indicators. These are the sorts of supply-side changes that will prepare development professionals to respond—and do it well—when the funding and opportunities that result from higher-level advocacy do trickle down to the rest of us.

And these small wins shouldn’t be overlooked. Doing good with what we are given increases the confidence of the funders and other decision-makers on whom we will depend for continued support in future. Quality and sustainability are intimately linked.

With that in mind, I’d like to take an opportunity here to celebrate not just the big, impressive-sounding things that the Mental Health Innovation Network accomplished in 2019 (though of course we’re all very proud of those, too). Instead, I want to talk about something we’ve been doing slowly and quietly for a couple of years now, in collaboration with several wonderful colleagues: A “Learning Journey” on mental health and sustainable development for DFID.

A journey for us all

“Learning Journeys” are one of the ways that K4D (Knowledge, Evidence and Learning for Development) supports DFID’s organisational capacity-building. Instead of providing one-off trainings, “Learning Journeys” offer a number of different “facilitated learning activities” on “complex, interdisciplinary development issues of strategic importance”.

Our “Learning Journey” with DFID started in 2018, after we had completed an internal scoping report on DFID’s work in mental health. One of the recommendations of that report was to build DFID’s capacity in order to respond to the APPG’s recommendations. However, after long enough working in development, you grow accustomed to making recommendations that no one seems to actually heed. So we were surprised—and very pleased—to be asked to co-design with DFID staff a series of learning activities on key topics in mental health.

But what would those topics be? We started with an online survey to understand the learning needs of DFID staff. They ranged from the highly specialised—like how to provide mental health and psychosocial support in schools to children affected by conflict—to the very basic—like what mental health is and how to talk about it. In the end, we decided to offer one training on each of three topics: mental health in social protection, health systems, youth and humanitarian settings.

First, in November 2018, Lancet Commissioners Sir Professor Graham Thornicroft, Professor Crick Lund and Dr. Julian Eaton used the opportunity of their October report launch to offer DFID staff a basic overview of current thinking on mental health as part of the Sustainable Development Agenda. Then in February 2019, Dr. Soumitra Pathare and Jasmine Kalha from the QualityRights Gujarat project came together with Professor Lund and Dr. Eaton to deliver a training on health systems approaches to mental health, with a focus on rights-based reform. In March, trainers from the London School of Hygiene and Tropical Medicine (Dr. Tara Beattie, Dr. Eaton), Oxford University (Victoria de Menil), University of Cape Town (Dr. Marguerite Schneider) and the Bond Disability Sub-Group on Mental Health (Adrian Sell) spoke to social development advisors about the relationship between mental health and gender equality, poverty reduction and other key goals of the Sustainable Development Agenda, as well as how to measure inclusion and impact on mental health outcomes. Barely a week later, trainers from King’s College (Dr. Tatiana Salisbury and Dr. Kelly Rose-Clarke) and a special guest from the youth advocacy organisation Mentally Aware Nigeria (Victor Ugo) spoke about child and adolescent mental health and youth involvement. Finally in May, Dr. Mark van Ommeren and Alison Schafer came to London from the World Health Organisation to provide an overview on mental health and psychosocial support in humanitarian settings.

It was inspiring as always to see the passion of the trainers—many of whom volunteered their time and energy. But it was equally encouraging to hear DFID staff speak with a real sense of curiosity and zeal about their work and how mental health might (or already does) fit. Often it was the trainers who were being challenged with pointed technical questions, and who took away new learning about how priority-setting and decision-making works “in the real world”. Although we were invited as technical experts, I think it’s safe to say we learned as much from these trainings as the participants did.

Despite the obviously high level of expertise among DFID staff, we recognised that there was never enough time to go over “the basics” on mental health—which might represent a barrier to entry for those less familiar with this area. So we capped off the “Learning Journey” with one final output: a new Topic Guide on Mental Health for Sustainable Development specifically targeted at development professionals and co-authored by academics (Valentina Iemmi), policy-makers (Dr. Fahmy Hanna) and staff of NGOs focussed on disability-inclusive development (Dr. Eaton from CBM, and Hannah Loryman from Sightsavers).

Not the end of the line

While our “Learning Journey” has officially drawn to a close, this certainly isn’t the end of the line. Public outputs—including training materials, talking-head videos and of course, the Topic Guide—are all available via K4D and on our new “Collaborations” page on the MHIN website. We hope these materials will be useful to other development professionals just starting to find their way in global mental health. The Bond sub-group remains an important avenue for dialogue between DFID and representatives of UK NGOs, and will be helping to disseminate the new Topic Guide-- including at an upcoming seminar at LSHTM on 6 April (so mark your calendars!). And while we cannot speak on behalf of our colleagues at DFID, we are expecting exciting things to come.