Summary Cross Cultural Global Mental Health

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Summary - Cross Cultural Global Mental Health

  • 1.1 College

  • Why is it important to look at global mental health?
    Life-time prevalence high

    80% of individuals with mental health problems live in LMIC

    High total burden of disease
  • Where did mental health develop?
    institutions in islamic world (8th century)
  • Of what did treatment consist in 8th century?
    physical and psychosocial treatments
  • When did psychiatric institutions establish in europe+
    12 - 15 century
  • How did mental health care spread around the world?
    During colonialism -> mental asylums across africa and asia

    -> still dominant (LMIC)
  • Why was there a shift in the 50-60s from institutional care to community based mental health care? (5)
    belief in efficacy

    institutionalization was bad (abusive conditions, negative effects)


    discovery of antipsychotics

    appreciation of human rights
  • Wat are universalists and vulture-specific viewpoints?
    universalists: sympotms are producto of universal biological/ psychological process, cultural expression may vary

    culture-specific: experience is shaped by culture, no universal psychiatric syndroms
  • When did research in LMIC grow?
    2000: epidemiological studies

    2005: RCTs
  • What is the circle of adapting and testing complex interventions? (Craig) (4)

    feasibility and piloting


  • What is mixed method research?
    combi of qualitative and quantitative
  • What are characteristics of qualitative research? (7)
    exploratory research


    observations, interviews

    snow-ball or purposive sampling

    no uniform procedures

    audo-recording and transcript

    identifying themes
  • What are characteristics of qualitative reserach? (5)


    numerical data

    large sample size      

    uniform procedures
  • What is therapy of change?
    qualitative way to find causal pathways why intervention works
  • What are four research challenges?
    establish local reesarch capacities 

    ensure rigorous ethical procedures

    engage communities

    room for reserach and innovation    
  • What is STRENGTH?
    Scaling up psychological interventions with syrian refugees
  • What kind of concerns did syrians have?(6)


    family conflicts

    women-> unwanted parriage, sexual harassment

    children -> missing school, child laber. abuse

    limited access to institutions
  • What are common mental disorder in refugees?

    anxiety, PTSD
  • What did Van t hof find about psychological interventions in global context?
    depression and anxiety interventions were significantly more effective than control
  • What are two popular interventions?

  • Why is cultural adaptation needed?
    culturally adapted more effective 

    larger effect sizes
  • What needs to be adapted? (3)

    cultural norms

    local concepts of diseases
  • What are three barriers for refugees to access mental health care in African refugee region?
    financial resources 

    capacity of specialists

    availability evidence based interventions
  • What are barriers for refugees to access treatment in europe? (6)
    limited arabic 


    lack of adapted interventions

    not able to attent longer period of time (moving)

    too far away

  • What is task-shifting?
    task that professionals normally do are transferred to non-specialist community workers of lays
  • What is PM+?
    Problem Management Plus

    short intervention by WHO
  • What does STRENGTH stand for?
    Syrian Refugees mental health care systems
  • What is cognitive interviewing?
    Ask what people undertstand from translation and communicate about better ways to translate
  • What is Step-by-step?
    app for syrian refugees
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What are the symbols?
cord/ rope

flower: positieve gebeurtenissen 
stone: negatieve gebeurtenissen

sticks: daden die gedaan, lust van agressie -> later schuldgevoel   

candles: grief
Wat zijn de twee soorten memories?
expliciet (feitelijk, autobiografisch, context) -> cold memories (hippocampus)

impliciet (automatisch, fight, flight) ->hot memories  (hyperactieve amygdala)
What about trauma and memory?
memory disorder -> koppeling van past and present 

especially amygdala and little hippocampus
What are the 4 steps op WHO evaluating mental health policy and plans module?
1. clarify purpose of evaluation 

2. find evaluators and funding

3. assess and manage ethical issues

4. prepare and manage evaluation plan
What are 6 aspects of policy implementation?
clear implementation plan 

enough resources

link policy and legislation

who implement

find mix of national and international cooperation

What are 5 things that should be the content of a policy?
1. vision, values, goals

2. comprehensive approach

3. primary health care approach

4. promote and protect human rights

5. promote intersectoral collaboration
What are three official tools for policy development?
WHO guidelines for key mental health policy elements  

WHO  mental health Gap Action Programme 

What are 8 important aspects of policy development?
1. motivation 

2. consult affected groups

3. prioritize needs and goals

4. create evidence-based principles

5. obtain cooperation with decision makers!!
6. address stigma directly

7. link to other health priorities

8. use policy window (timeframe for lobbying)
What are three methods to build capacity for mental health policies?
teaching programs 

support and supervision

regional networks for policy
What is the health workforce management and what are three important factors in it?
Quality of good choosing of workers and managing it (take HR-manager in plan)

1. recruitment (needs to be open voor mental heatlh)

2. managing distribution, migration and attrition (work against migration to cities -> improve career possibilities, make more attractive)

3. monitoring and evaluation