Grand Challenges Canada announces 11 seed grants to improve mental health in developing countries

Grand Challenges CanadaOct 10 2014

Marking World Mental Health Day, Grand Challenges Canada announces 11 seed grants totaling $2.9 million

On the day the world is collectively raising awareness on mental health issues, Grand Challenges Canada, funded by the Government of Canada, announced new funding for 11 novel ideas to improve mental health in developing countries, one of the biggest unmet needs of our time. Seed grants of up to $270,000 are awarded to 11 innovators from Canada and low- and middle-income countries, totalling $2.9 million CAD.

"Our Government recognizes the profound impact that mental health conditions have on individuals and societies at home and abroad," said the Honourable Rona Ambrose, Canada's Minister of Health. "Canada has been a leader in advancing global, collaborative and innovative approaches to tackle mental illness. "We are proud to be supporting Grand Challenges Canada and these novel projects that address the often neglected problem of mental health disorders among the poorest in developing countries."

Among the novel ideas:

• Working with spiritual leaders in Haiti (the main informal providers of mental health care) to deliver Cognitive Behavioural Therapy interventions to treat mental illnesses
• Reducing the high suicide rate among indigenous youths in troubled northern Colombia
• An alternative to institutionalization of the mentally ill in India: opening rooms for the homeless.
• Reducing corporal punishment in Jamaica where, according to UNICEF, 90 percent of males and 87 of females 2–14 years old experience violent discipline (psychological aggression and/or physical punishment).

The 11 projects announced today are the result of a worldwide call for proposals for bold ideas with real-world impact and the potential to scale up. The innovators address critical challenges in low-resource settings, e.g., integrating screening and services into routine primary healthcare, improving the supply of effective medications, developing IT technologies to increase access to care and improving affordable, community-based care and rehabilitation.

In total, 10 innovators from low- and middle-income countries and one from Canada are receiving funding. The projects will be implemented in eight developing countries.

Schizophrenia, depression, epilepsy, alcohol dependence and other mental, neurological and substance-use disorders make up 13 percent of the global disease burden, surpassing both cardiovascular disease and cancer. More than 450 million people across the globe suffer from mental disorders. Almost three quarters of them live in low- and middle-income countries, where a devastating link between mental illness and poverty has long been ignored. Yet mental health remains acutely under-resourced and patients are often misdiagnosed or untreated, and face social alienation, stigmatization, perpetual poverty and grim health outcomes.

Proof-of-Concept Grants

Working with spiritual leaders to deliver Cognitive Behavioural Therapy interventions in Haiti

Centre for Addiction and Mental Health (CAMH), Canada (Implementation: Haiti)

After the 2010 earthquake, depression and post-traumatic stress disorder (PTSD) have become major barriers for many Haitians, as they strive to live productive lives and to contribute positively to economic recovery and development. The gap between the needs in the field and the available resources for mental health is alarming and marked by a shortage of trained professionals, a lack of integration between formal and informal mental healthcare providers and a long tradition of spiritual beliefs that attribute the causes of mental disorders to curses and spirits.

Cognitive Behavioural Therapy (CBT) is a talking therapy that is effective for treating mental illnesses, including depression. Used in a timely and culturally-relevant way, it can be a useful tool for those striving to address common mental disorders early in the illness. The goal of this project is to introduce the Culturally Adapted Cognitive Behavioural Therapy (CACBT) approach to the Haitian context to enhance the knowledge, understanding and skills of spiritual leaders in Haiti, since they serve as the main informal providers of mental health care. This innovative approach will significantly improve the breadth of delivery of mental health programs and services for depression within the existing infrastructure, and will be sustainable at a community level.

Reducing the high suicide rate among indigenous youths in troubled northern Colombia

Heartland Alliance International, LLC – Colombia (Implementation: Colombia)

The Emberá community in Colombia consists of approximately 90,000 persons and has one of the highest rates of suicide and attempted suicide, particularly in children, adolescents and young adults. This trend is congruent with other indigenous communities in this and other regions of the world, and is attributed to many reasons, including rapid cultural change, loss of land, family disintegration, exposure to conflict and violence, and extreme poverty. Emberá communities recognize suicide as a major problem, but there is no organized community response and there is insufficient information to determine whether current beliefs about suicide and communication of events reinforce incentives and result in epidemic outbreaks. Suicide is both a symptom and a cause of community destabilization; the direct economic costs cannot easily be determined.

This project will develop a time-limited, psychosocial intervention, combined with culturally- appropriate suicide education and prevention for Emberá indigenous communities in the Choco region of Colombia that are affected by violence related to the internal conflict and resource extraction and interests in the region. This project will target adolescents and young adults through the modification of a service model that is currently implemented by Heartland Alliance International in Colombia that focuses on the Afro-Colombian community of the Pacific, employing paraprofessionals from the same community, testing its efficacy and adaptability for use in indigenous communities. Over 150 adolescents and young adults with depression or suicide related symptoms will receive treatment by psychologists and trained paraprofessional care givers. At the same time, 30 community leaders, traditional healers and local authorities will be trained in how to better identify at-risk youth within their communities.

An alternative to institutionalization of the mentally ill in India: Opening rooms for the homeless

The Banyan, India (Implementation: India)

For people living with serious mental disorders and intellectual disability, specifically those formerly homeless or living in poverty, institutionalization at state mental health hospitals is often the only option. This overburdened public infrastructure generally only provides psychiatric medication, with no other interventions. This lack of appropriate care limits exit options for patients, ignores long-term needs, decreases recovery outcomes and puts them at risk of spiralling further down into poverty and homelessness. An estimated 48% of the inpatient stays are long-term users – those who have been in the institution for more than two years.

Building on lessons from the Banyan's hospital, this project will offer alternative living spaces in urban and rural communities for women living with moderate-to-severe mental disorders and intellectual disability, who otherwise face homelessness or institutionalization. Providing housing options with graded levels of support, the project aims to offer inclusive, long-term housing solutions for people living with mental health in a sustainable and a cost effective manner. It is expected that access to such living arrangements will improve the well-being of at least 80 people.

PASS PLUS (PASS+): Parent mediated intervention for Autism Spectrum disorderS Plus

Sangath, India (Implementation: India)

Over 80 percent of children with autism spectrum disorders live in low-and middle-income countries, posing challenges for the local health systems. Not addressing autism at a young age has a profound influence on development into adulthood and results in a high economic cost, exceeding the lifetime costs of asthma, intellectual disability and diabetes. India has about five million children with autism but, outside major cities, there are no services for diagnosis or community-based care available, due to low awareness and a shortage of mental health specialists. The PASS+ project will develop a community-based method for the early detection and identification of children affected by autism. It will also evaluate a parent-mediated package of care for autism, delivered by non-specialist health workers, building on an existing communication intervention to address a range of needs for families who have children with autism. During this project, over 100 children with autism will be referred for treatment by trained community gatekeepers.

A community-oriented approach for treating alcohol dependence in India (CONTAD)

Sangath, India (Implementation: India)

Alcohol-use disorders are the second leading cause of global mental health-related burden of disease. Alcohol Dependence (AD) often leads to violence, domestic abuse, stigma, reduced productivity, job loss, social isolation and healthcare costs. In India alone, upwards of 26 percent of people who drink have AD. Healthcare for AD is restricted to de-addiction services delivered in underfunded, tertiary-care centres. These centres focus primarily on providing institutional, medically-assisted detoxification without any psychosocial interventions or structured follow-up. CONTAD aims to develop two care packages that will address both acute care needs related to alcohol detoxification and the longer-term goals of relapse prevention and recovery. These packages will be delivered by lay health workers. The project's community orientation and use of low-cost human resources will achieve considerably greater coverage.

Using mobile phones to conduct mass screening for, and deliver help to, people suffering depression and anxiety in Karachi

Interactive Research & Development (IRD), Pakistan (Implementation: Pakistan)

Depression is the most frequently encountered mental health disorder in Pakistan. Due to the stigma associated with mental health diseases, those who suffer often remain undiagnosed, misdiagnosed or untreated. There is an urgency to develop new interventions to increase early detection and treatment of mental illness, especially in the case of disease co-morbidity. The widespread use of mobile phones provides a unique opportunity for the implementation of mHealth in Pakistan, allowing cost-effective, efficient and integrated screening and detection, analysis and follow-up in a context of high patient volumes. This project will focus on three community-based lung health centres in Karachi, a city with an estimated population of 20 million. Community Mental Health Workers (CMHWs) will use an mHealth application to mass screen for depression and anxiety, and will be trained to provide basic counselling support to those in need. The mHealth system will include an interactive Short Message Service (SMS) delivery tool to provide support messages for positive mental health to all individuals screened.

Addressing maternal depression in the violence-wracked mountains of Pakistan

Human Development Research Foundation, Pakistan (Implementation: Pakistan)

Untreated depression in pregnant women is of particular concern, due to its adverse effects on the health of the infant. The economic burden of depression in pregnant and postnatal women goes beyond the cost of treating depression itself. The scope and magnitude of the problem is magnified in humanitarian crisis settings. Scaling up existing and proven interventions for depression is slowed down by the costs, equity and quality concerns, along with service delivery issues. The lack of skilled specialists is another major barrier. The Thinking Healthy Program is an evidence-based psychological intervention, delivered by non-specialists, with proven impact on maternal depression. The key innovation is the development of a technology-assisted cascade training and supervision system to assist scale-up of the Thinking Healthy Program. This will tackle the major challenge of providing quality training and supervision at scale, especially where health systems are weak. Partnering with World Vision will foster cross-learning in preparation for a future collaboration and scaling. Throughout the life of this project, 6,000 women in the Swat region of Pakistan will be screened and referred for treatment when necessary by la health workers, using both traditional and technology-assisted methods.

Screening and home-based intervention for children with Autism Spectrum Disorder in Vietnam: "There's an app for that"

Centre for Creative Initiatives in Health and Population, Vietnam (Implementation: Vietnam)

Early diagnosis of autism spectrum disorder (ASD) is crucial, as it enables the start of interventions that support the best outcomes for children living with ASD. In Vietnam, ASD is often not recognized, and children with the condition do not receive the support they require to live fulfilled and active lives. This project will bring together expertise from Vietnam, Canada and Australia, to ensure children with ASD are able to access early and affordable services. Using the latest technology developed by social entrepreneurs, the Smart Care project will combine technical, social and business innovation, to provide an integrated and scalable package of services and support for children living with ASD, based on a mobile platform. This includes apps to support screening and home-based intervention, and a model of piloting screening development and ASD in health check-ups for children.

Spare the rod, help the child: reducing corporal punishment in Jamaica's classrooms

University of the West Indies, Jamaica (Implementation: Jamaica)

Experiences in early childhood have long-term effects on children's development; exposure to a safe, secure and nurturing environment promotes children's physical and mental health over the long term. Children's behaviour problems at school are a major concern for Jamaican teachers and corporal punishment is widely used in schools across Jamaica. This project aims to develop and evaluate a training intervention with teachers of 6- and 7-year-old children. Teachers will be trained in classroom management, in strategies to reduce child aggression and to promote children's social-emotional competence. The intervention aims to increase the emotional quality of the classroom environment, reduce the use of corporal punishment, promote child mental health and improve teachers' mental health in 28 classrooms in inner-city Kingston. The intervention is low-cost, integrated into the existing educational system and involves the training of existing staff to make it feasible and sustainable at scale.

Integrating Mental Health into Primary Care: Expanding a Community-based Mentorship and Enhanced Supervision (MESH) Model to Address Severe Mental Disorders in Rwanda

Partners In Health Rwanda (Implementation: Rwanda)

Although Rwanda boasts a progressive health policy environment, public sector funding for mental health care is limited. Many disorders go undiagnosed or untreated, potentially resulting in unnecessary institutionalization, suicide and/or poor physical health, all of which combine to account for the leading factors in loss of productivity and general economic insecurity. Inshuti Mu Buzima (IMB, Partners in Health Rwanda) proposes to integrate a core package of mental health services into primary care services through a proven model of extended clinical mentorship. Based on the success of such a model in HIV/AIDS care, the Mentorship and Enhanced Supervision (MESH) Model is an innovative mentoring model that aims to improve mental health service provision in primary healthcare. Expanding the MESH Model to mental health in Rwanda's Burera District (burdened by a high prevalence of mental disorders) can result in a comprehensive system for improving the delivery of mental healthcare throughout the entire country.

Preventing stigmatizing assumptions among public healthcare workers who deliver care to persons with mental illness in Peru

Universidad Peruana Cayetano Heredia, Peru (Implementation: Peru)

Mental health stigma and discrimination is a worldwide public health problem that impedes access to effective and affordable community-based care and rehabilitation for people living with mental disorders. Health professionals are not immune to stigmatizing beliefs and practices. This can result in unintended negative consequences for people seeking care for mental illness, which may compromise their recovery. This novel project plans to reduce stigmatizing assumptions among public healthcare workers who deliver care to persons with mental illness and substance use problems in Peru, by implementing a comprehensive anti-stigma and anti- discrimination intervention. Emphasizing a recovery-oriented approach in service provision, it is anticipated that this model will increase access and quality of care, and may be transferable and scalable to other stigmatized health conditions and locations.