Tackling the Mental Health Care Gap in Myanmar

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Sanofi and Myanmar Medical Association Create Community-Based Intervention Program to Increase Access to Treatment; Pilot Launches in Yangon on World Mental Health Day

 

We most often think of the health care journey in terms of treating physical ailments, whether short-term care like setting a broken bone, or long-term treatment for chronic conditions like diabetes. Yet a very large proportion of the world’s population will be affected by a condition affecting the most complex organ in our bodies: the brain.

Mental disorders are not only common – in fact, one in four people will suffer during their life from mental disorders(1), and one in six from neurological disorders(2) –; they can be devastating as well. Major depression, schizophrenia, epilepsy and other brain-related illnesses can have the same effect on the lives of patients and their families as any other serious, chronic diseases.

 

While there are many effective treatments for mental disorders today that combine psychosocial interventions, medication, and rehabilitation, significant numbers of people lack access to them. This is particularly true for patients in low- and middle-income countries, where some studies estimate that as many as 85% of people with mental disorders don’t receive the treatment they need(3).

 

One such nation is Myanmar, where the most recent surveys, carried out in 2004, revealed that approximately 8% of the population likely suffer from a present mental disorder(4). At the same time, the country has a serious shortage of trained psychiatric professionals – perhaps 300 in a nation of 52 million people(5). Primary care physicians also receive little training in the treatment of mental disorders, making the situation for patients even more dire.

Further complicating the situation are traditional beliefs related to mental disorders and epilepsy, which can result in stigmatization and discrimination of people living with these diseases.

 

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To overcome these barriers for patients in Myanmar, Sanofi joined forces with the Myanmar Medical Association late last year to develop and test a fully integrated community care approach for mental health care in the country. The goal of the three-year program is to integrate mental health care with primary care by training community health workers and primary care physicians in mental health care.

With appropriate training, community health workers are able to screen people for mental disorders, while primary healthcare professionals can more effectively assess, diagnose, treat and support those patients, as well as refer them to more specialized care. This approach, coupled with new technology support for health care professionals, has the potential to make access to mental health care better and more widespread.

 

“We have established a baseline assessment of the prevalence of these disorders, developed training materials, behaviour change communication tools and e-health solutions, and have organised the recruitment and training of the various players,” said Prof. Khin Maung Gyee, the Head of the Project and an Advisor in Mental Health and Substance Abuse to the Ministry of Health and Sports. “The program is now moving into its implementation phase and we are very excited about it.”

 

The first pilot for patients will be launched on World Mental Health Day in Hlaing Thar Yar, the largest township in Yangon, the nation’s most populous city. There, some 75 Community Health Workers and 90 Primary Healthcare Professionals trained through the program will begin offering mental health services to patients.

Community Health Workers, who have been equipped with smartphones and interactive screening questionnaires, will identify people with these diseases and refer them to Primary Care doctors. Those physicians have been trained on the diagnosis and management of psychoses, depression and epilepsy. Using electronic tablets, together with an interactive version of the WHO Mental Health Gap Action Programme (mhGAP) intervention guide and e-medical records, they will manage patients and, potentially, seek advice from psychiatrists for difficult cases. Community Health Workers will also play a pivotal role in informing the population, combating the misbeliefs surrounding mental disorders.

The main goal: to reduce the treatment gap* by 20% for psychoses (including schizophrenia), major depressive disorder and epilepsy within 24 months.

 

“Improving access to healthcare for underserved populations is a key driver for Sanofi” said Dr Luc Kuykens, Head of Medical Data Dissemination & Access to Medicines for Sanofi. “This work in Myanmar will not only benefit patients and their families here, but also serve as a model for what can be done in other countries with a similar need.”

 

Beyond the Myanmar Medical Association, the Myanmar Mental Health Society and Sanofi, this program has also benefitted from the expertise of international partners such as the World Association of Social Psychiatry (WASP) and the Université Numérique Francophone Mondiale (UNFM – World Francophone Digital University), which has been developing distance learning and e-health solutions for healthcare professionals in low-resource countries.

 

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* The treatment gap is the number of people with an illness, disease, or disorder who need treatment but do not get it (expressed as a percentage).

References:
(1) WHO. Investing in mental health: is it worth it? 2011.
(2) WHO.Media Centre, Neurological disorders affect millions globally: WHO report. 2007.
(3) WHO. Media Centre, Mental Disorders, Fact Sheet N°396, April 2017
(4) Win Aung Myint et al. Myanmar; Routledge Handbook of Psychiatry in Asia. 2016
(5) WHO-AIMS Report on Mental Health in Myanmar. 2006

 

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