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Fellows give their views on the mental health care session's hottest topic

At the most recent session in the Salzburg Global Seminar series Health and Health Care Innovation in the 21 Century, New Paradigms in Behavioral and Mental Health, we asked representatives from each country present: "What are the best and worst practices with regards to mental health care in your country?"

“One of the best practices of mental  health in Uganda has been primary health care provision...unpacking the complex concepts of mental health and making them easily digestible by the general health worker... and also understanding the links when running a maternal health clinic and being able to pick up on the issues around mental health. But one of the things that is impacting our growth is that our laws continue to be oppressive... If we can get this bill that we will presenting to Parliament next year right, then we can revolutionize how mental health services are provided.” 

Tina Ntulo, Chief Executive Officer, BasicNeeds Foundation, Uganda 

“The previous system in Kosovo was hospital-based, so when we talk about mental health services in Kosovo from a systems perspective, I think we have achieved success in [working towards] establishing community-based mental health centers. But this could be further improved in terms of the engagement of patients and their families and the communities in the process of medical decision-making and the process of care delivery.” 

Ilirjana Bajraktari, Founder, Healthcare Professionals for Peace and Social Responsibility, Kosovo 

“The best practices are that we have a very strong consumer movement in the USA and there are more and more peer-run support services for people with addictions and mental health problems... And that has empowered people. But our system, to a very large extent, is determined by an alliance between the pharmaceutical industry and the American Psychiatric Association – what somebody [at the session] called today ‘the medical industrial complex’ – and I think that’s led us to a really awful level of over-diagnosis, over-treatment, and over-medication that’s extremely harmful to people.” 

Robert Drake, Professor of Psychiatry, Community and Family Medicine, Geisel School of Medicine, Dartmouth College, USA 

“In Colombia, one of the best changes in the last few years is the increasing presence of advocacy groups from patients and families that have been organizing and have effectively changed practices at different levels of the delivery system. But the health system is still very fragmented; there are too many actors, and so there is not a unified policy in the mental healthcare delivery system.” 

Miguel Uribe, Former Medical Director, Clinica La Inmaculada, Colombia 

“I think the best thing in Korea is the revising of the Mental Health Act entirely; it hasn’t been enacted yet but will be hopefully by 2015. But many of the mental health illnesses or problems are not insured which means people have to pay extra treatment costs so they have difficulties in accessing treatment, especially low-income people. And the worst thing is the Korean mental health path is following the Western path, treating people only with medication.” 

Jong Hye (Kelly) Rha, Assistant Manager, National Health Insurance Service, South Korea 

“Our best practice in India is that we are involving basic community health workers, and also the opinion leaders from the community in mental health management. For example, we involve teachers, faith-healers, and the families in mental health treatment. 

One of the biggest handicaps is that still, most of the people are unaware of the mental health issues. They have many false beliefs: that the mental conditions are due to black magic or evil spirits. They are taken to religious places, and subjected to all kinds of treatments, and often victimized with human rights violations. Valuable time is lost and some illnesses become incurable.” 

Ramasubramanian Chellamuthu, Founder of M.S. Chellamuthu Trust and Research Foundation, India 

“In Croatia, we have a universal health care system. Every person can approach the system and receive health care. What I also find good is the movement toward community mental health care, which is at its very beginning, but gives people more control and makes them feel they are the captains of their ship. 

People believe more in institutions than in the community and community support. It’s something from previous years, from the socialist way of thinking, that whatever problem you have there is an institution for that. We should break the walls and bring people back to the community.” 

Radmila Stojanovic Babic, President of the Association for Psychosocial Support, Croatia 

“One of the best things is that we have good quality acute care in the [American] Indian health service programs. They’ve done a tremendous job treating communicable diseases like tuberculosis. 

The downside of that program is that about 70 percent of the Native American Indian population lives in big, urban areas where access to services is limited… It’s a changing population in terms of geography, and that system doesn’t address that geography adequately.” 

Pat Walker, Research Assistant Professor in Public Health and Preventative Medicine, Oregon Health & Science University, USA

“The best practice in Chile in terms of policy-making was to recognize the ‘burden of disease.’ We used to establish priorities according to mortality, so mental health conditions were always underrated. But in 2000, we established the new system, which gives an important weight to disability. Mental health became relevant. 

In my country, stigma is still very important, particularly for serious mental health conditions like schizophrenia. Depression is not as stigmatized as it used to be, but schizophrenia still has a huge stigma surrounding it.” 

Rodrigo A. Salinas, Clinical Neurologist and Assistant Professor at University of Chile, Santiago 

“We have good access to our mental health care system. All over Germany, you have good access to general practitioners, specialists, psychiatrists and psychologists. 

Our biggest problem is related to this same system: with so much institutionalized, there is no focus on real community-based health care. Everything goes through big psychiatric hospitals and psychiatrists, so access is limited to diagnostics and medication.” 

Harald Kolbe, Behavioral Profiler and Organizational Ethnographer for Forensic Services of the Westfalia-Lippe, Germany 

“We started to provide outreach services, and some of these services can cover the patient’s whole life, That is good, but it is unbalanced in different areas. The east of China is a priority, so the services are good. It’s better than in the west, which has very low resources. 

The worst part is that in the very beginning we recognized the human resources will be our bottleneck. Some provinces only had one hospital. So the government gave them money to build a new hospital, but up until now, they still have only one. So it becomes very difficult for people in the west to reach services.” 

Hong Ma, Professor at Mental Health Institute, Peking University, China