Advancing Community-Based Mental Health Services for Severe Mental Disorders

On March 4–6 2019, the Harvard Center for Global Health Delivery–Dubai, in collaboration with the Harvard Initiative in Global Mental Health and Sustainable Development GlobalMentalHealth@Harvard, hosted a three day meeting of academic, non-governmental, government, and community experts including mental health service users and advocates to articulate and foster a consensus on the delivery of integrated, evidence-based, and human-rights oriented mental health services for individuals with severe mental disorders (SMDs).  

The GlobalMentalHealth@Harvard Initiative, launched in April 2018, aspires to elevate the profile of mental health as a fundamental public good and a universal human right. The goal of the new initiative is to foster a collaborative and multi-disciplinary community at Harvard and beyond dedicated to transforming the mental health of the world’s population through education, research, innovation, and engagement. The initiative represents collaborative efforts across key constituencies at Harvard including the Department of Global Health and Social Medicine at Harvard Medical School, the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health, the Harvard Global Health Institute and other schools and departments at Harvard and in the surrounding Boston area.

This meeting was the second convened by The Harvard Center for Global Health Delivery – Dubai and the GlobalMentalHealth@Harvard Initiative and welcomed 52 participants and facilitators. The intention of the meeting was to build on the momentum of the findings from the first meeting held in June 2018, “Scaling up Community Health Worker-Delivered Interventions for Common Mental Disorders”, by broadening the discussion of community-based mental health care delivery to include clinical and psychosocial care for adults living with the most serious and enduring mental health conditions, such as schizophrenia and other severe psychosocial and intellectual disabilities.

The organizers of the meeting recognized the need and opportunity in the field of global mental health to articulate the basic tasks and practices of front line health worker-delivered mental health services for SMDs, and to foster consensus on linkages among health system levels and sectors for the delivery of innovative and sustainable community-based mental health services for people living with SMDs. Day one and two of the meeting combined lectures, presentations and panel discussions with breakout working group discussion sessions facilitated by global experts on the specific themes being addressed. Presenters and panelists were chosen from the group of participants based on their varied experience in extensive research, implementation, and lived experience in community-based approaches to care for individuals with SMDs with the aim of sharing different expertise and challenges facing the field of global mental health. Following the presentations and panel discussions, participants were able to choose which working group they wanted to participate in. The individual working groups focused on the following meeting objectives:

• Articulate goals and core components of a human rights and recovery focused value chain for SMD care delivery, incorporating current evidence for packages of person-centered care for SMDs and the linkages among households, communities, general and specialized health care, and other sectors.   
• Define the specific tasks, and related competencies, as well as training and supervision processes for front-line workers within the care delivery value chain described above, based on scientific evidence and experience from the field.
• Describe indicators of quality and success in the delivery of interventions.
• Articulate strategies for the effective implementation of the SMD care delivery value chain, including digital technology strategies.

These working groups then presented key points that arose from their discussion back to the larger group. Finally, on day three a smaller group, the presenters and facilitators of the working groups, came together to focus on summarizing the workshop outputs and discussions concretely to begin the drafting of an action oriented Gray Paper, one of the proposed deliverables of the meeting. This Gray Paper will be directed towards health system planners and community health organizations with the goal of summarizing the vision and implementation strategies for the SMD value chain generated by the meeting participants, highlighting the important role of front-line workers.

Number of Participants: 52
Number of Countries: 20
Countries Represented: Australia, Canada, China, Ethiopia, Ghana, Haiti, India, Kenya, Lesotho, Liberia, Mexico, Nigeria, Peru, Rwanda, Sierra Leone, South Africa, The Gambia, Uganda, United Kingdom, United States of America