Basic Course: Mental Health and Chronic Diseases Integrated Approach for Prevention and Control of Mental Health & Chronic Diseases at Primary Health Care in the Caribbean Countries Tomo Kanda Advisor on Chronic Diseases Pan American Health Organization Office for Barbados and Eastern Caribbean Countries
OUTLINE 1. Non Communicable Diseases (NCDs) and Mental Health (MH) as Major Burden of Diseases 2. Current Health System Response to NCDs (inclduing Risk Factors) and MH in the Caribbean countries 3. Challenges and Opportunities 4. How to best utilize mhgap as a tool for integration of MH and NCD prevention and Control
Chronic Diseases: the Health Care Challenge of the 21 st century Source: World Health Organization, 2005
Leading Causes of Death in CARICOM Countries by Sex, 2004 MALES 1. Heart Disease 2. Cancers 3. Injuries and violence 4. Stroke 5. Diabetes 6. HIV/AIDS 7. Hypertension 8. Influenza/pneumonia FEMALES 1. Heart Disease 2. Cancers 3. Diabetes 4. Stroke 5. Hypertension 6. HIV/AIDS 7. Influenza/pneumonia 8. Injuries and violence
NCDs and Mental Health: Burden of Diseases via DALYs
Leading causes of years of life lived with disability 1 Unipolar depressive disorders 10.9% 2 Hearing loss, adult onset 4.6% 3 Refractory errors 4.6% 4 Alcohol use disorders 3.7% 5 Cataracts 3.0% 6 Schizophrenia 2.7% 7 Osteoarthritis 2.6% 8 Bipolar affective disorder 2.4% 9 Iron-deficiency anaemia 2.2% 10 Birth asphyxia and birth trauma 2.2% (Both sexes, all ages)
Predictions for the leading causes of disability and mortality in 2030 World 1 HIV/AIDS 2 Unipolar depressive disorder 3 Ischaemic heart dis. High-income countries (Both sexes, all ages) 1 Unipolar depressive disorder 2 Ischaemic heart disease 3 Alzheimer Middle-income countries 1 HIV/AIDS 2 Unipolar depressive disorder 3 Cerebrovascular Low-income countries 1 HIV/AIDS 2 Perinatal disorder 3 Unipolar depressive disorder
Comorbidity Behavioral Health and Chronic Medical Conditions Chronic Medical Condition % with depression/anxiety Arthritis 32.3% 7.1% Hypertension 30.5% 5.5% Chronic Pain 61.2% 5.9% Diabetes Mellitus 30.8% 5.2% Asthma 60.5% 6.8% % treated for depression/anxiety Coronary Artery Disease 48.2% 5.7% Cancer 39.8% 5.7% 2006 Milliman, Inc US Health Care Study
Mental Health and Chronic Illness 10 Mental disorders share common features with other chronic communicable and non-communicable diseases, including heart disease, stroke, diabetes, and HIV/AIDS: They share many underlying causes and overreaching consequences; They are highly interdependent and tend to cooccur; They are best managed using integrated approaches. mhgap-ig base course - field test version 10
Health System Response to Mental Heath & NCDs at Primary Health Care in the Caribbean Countries
Assessment of Chronic Illness Care Average Score by Country 0: lowest 11: highest 11 10 8 6 4 2 0 Basic Reasonable 4 4 4 4 4 5 5 5 5 5 6 6 6
Chronic Care Model COMMUNITY Resources & Policies Self- Management Support HEALTH SYSTEM Organizations of Diabetes care Delivery System Design Decision Support Clinical Information System Informed, Empowered Patient Productive Interactions Prepared, Proactive Practice Team Improved Outcomes Ed Wagner et al.
Breakthrough Series for the Improvement of Chronic Care (6 to 13 months time frame) Select Topic (develop mission) Participants Pre-work Planning Group Develop Framework & Changes LS 1 A P S D A LS 2 P S D A LS 3 P S D FINAL Support E-mail Visits Assessments Telephone Monthly Team Reports Institute for Healthcare Improvement
Integration of NCD and Mental Health into PHC NCD Quality of Care Project Barbados (being implemented) Antigua and Barbuda (being implemented) St Kitts and Nevis (being implemented) St Vincent and the Grenadines (being implemented) Dominica (being implemented) Grenada (being implemented) St Lucia (being implemented) Anguilla (being implemented) British Virgin Island (underway) Jamaica (being implemented) Surinam (being implemented) Trinidad & Tobago (being implemented) Belize (underway) mhgap Implementation Barbados (underway) Antigua and Barbuda (being implemented) St Kitts and Nevis (being implemented) St Vincent and the Grenadines (being implemented) Has not started yet Grenada (being implemented) St Lucia (underway) Anguilla (underway) Has not started yet Jamaica Surinam Trinidad & Tobago Belize (being implemented)
INTERDISCIPLINARY APPROACHES NCD PREVENTION 16 mhgap-ig base course - field test version
Chronic Care Model COMMUNITY Resources & Policies Self- Management Support HEALTH SYSTEM Organizations of Diabetes care Delivery System Design Decision Support Clinical Information System Informed, Empowered Patient Productive Interactions Prepared, Proactive Practice Team Improved Outcomes Ed Wagner et al.
Clinical Information (Record) Health Information CDEMS is the Chronic Disease Electronic Management System System Clinical Record of Mental Health has not been well integrated into existing clinical record. Accessibility still remains as challenge.
Delivery System Design Clear role and responsibilities for all health team members Access to information system Monitor use of standard procedures Visits to patients Patients share information with people in similar situations
PHC provides numbers of screening and assessment tools for NCDs; Mental Health Services need to be well integrated into existing health services at PHC; Region 1: Gros-Islet Polyclinic, SAL
Region 2: Babonneau Wellness Center Good example of integration of MH into existing health services
Decision Support Use of protocols and evidence-based guidelines Caribbean Health Research Council (CHRC)- Caribbean Public Health Agency (CARPHA) Hypertension Management (PAHO&CDC)
Self Management Support Educate and empower patients and their family Provide self-management & self-monitoring Support goal setting, measurement, planning, problem solving, and monitoring of the activities PAHO Stanford University Programme: Chronic Disease Self- Management Programme (mental health component Included)
Community Policy & Resources Mobilize resources through the community Advocate for policies to improve patients care Castle Bruce Type I Health Center, Dominica Some countries started conducting screening and assessment At community by using mhgap Cariacou, Grenada
Need to think about efficient use of limited resources and time for an Integration of NCD and Mental Health into existing Health Services Opportunity Nevis 2012
Challenges Limited resources (man power, limited time etc.) Integration of existing health services Need individual capacity building and system improvement Lack of policy support Lack of support for organizational change (health system) Lack of incentives
Opportunity Reorganization of Health Care System Integration of Mental Health and NCD Prevention & Control at PHC with existing successful health services such as Family and Child Health Care etc. Primary Health Care Reform New policy development Harmonization with public and private health services Technical Cooperation with other countries (human resource mobilization within the Sub-Region) exchange lessons learned; Develop Assessment Form to best utilize mhgap (each Module requires different assessment form)
Basic Course: Mental Health and Chronic Diseases Thank you Tomo Kanda Advisor on Chronic Diseases Pan American Health Organization Office for Barbados and Eastern Caribbean Countries E-Mail: kandatom@ecc.paho.org