1 Addressing mental health disorders in the African Region (Dr Steven Shongwe, Acting Director, Noncommunicable Diseases, World Health Organization Regional Office for Africa). 3 Global mental health and the Sustainable Development Goals: aligning research and policy agendas (Prof Crick Lund, Alan J Flisher Center for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town). Addressing mental health disorders in the African Region (Dr Steven Shongwe, Acting Director, Noncommunicable Diseases, World Health Organization Regional Office for Africa).
6 Global Mental Health and the Sustainable Development Goals: Aligning Research and Policy Agendas (Prof. Crick Lund, Alan J Flisher Center for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town).
NEUROSCIENCE AND GENETICS
Prof. Stein raised the question of whether a transition in mental health care can be made from the couch to the bedside and to bundu (i.e. the community). Professor Stein considered this one of the most advanced areas of research in psychotherapy. Complete knockout of Bmal1 expression was achieved in five of the gene-edited monkeys.
There is debate in the field between those who believe that non-human primates can be valuable in developing models for therapies for human disease, and those who believe that non-human primates should be used with caution in contrast to the use of rodents. , although the rodent model has proven not to be useful for the development of drugs for psychiatric disorders (eg, the failure of clinical trials for most drugs for Alzheimer's disease). A paper by Nakatsuka et al., (2017) published in Nature Genetics entitled 'The promise of discovering population-specific disease-associated genes in South Asia' reported the identification of 81 unique clusters, 14 of which had estimated census sizes of more than than one million descended from founder events more extreme than those in Ashkenazi Jews and Finns, both of whom have high rates of recessive disease due to founder events. It is thought to help form a loop structure essential for the expression of the gene.
Furthermore, the striking conservation of the identified variants suggests a role for PCDHG in the development of highly specialized cognitive skills critical to reading. The comment was based on a level of interpretation that is difficult based on the available data. Prof. Stein (UCT): One of the key messages is that phenotypes depend on the intersection of genetics and other factors.
PUBLIC MENTAL HEALTH AND EPIDEMIOLOGY
This is one of the main achievements of the unified health system and the gateway to the entire system. Every population group except black Africans is overrepresented in the data relative to their respective population size. Methamphetamine and heroin, the top drugs of use in 2009, began to decline. The most important substances currently abused are marijuana and alcohol.
The data is not granular enough to provide details of the type of mental health problems patients present with. Dr Allen (Lentegeur Psychiatric Hospital): It is not clear how to understand some of the data presented. Lack of policy integration is a problem (eg the Department of Social Development is responsible for youth but does not work together with the Department of Health).
Due to the lack of implementation, there is a lack of data and policies cannot be implemented due to the lack of data. Core Competencies of Providers for the Nation's Improved Mental Health Care: A Consensus Study (Prof Rita Thom, University of the Witwatersrand, South Africa). The consensus study on “Provider Core Competencies for Improving the Nation's Mental Health Care” is the first mental health project conducted by ASSAf.
How can these core competencies be implemented in South Africa?' The ASSAf consensus study was subsequently conducted in 2015 with Prof. Rita Thom (Wits) as chair and the following expert panel members, approved by the ASSAf Board: Dr. Robin Allen (DoH), Associate Prof Eve Duncan (UCT), Prof Crick Lund (UCT), Prof Bronwyn Myers (SAMRC), Prof Solomon Rataemane (Sefako Makgatho Health Sciences University), Prof Inge Petersen (UKZN), Ms Bharti Patel ( South African Mental Health Federation) and Dr Gayle Langley (Wits). Mental health of children and adolescents: Thirty-four percent of the total population in South Africa is under the age of 18 (2014).
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Adequate training in interventions for people with substance abuse across all providers is lacking. Promotion of mental health and prevention of mental disorders: It will be important to identify specific competencies in these areas and to integrate these into curricula. Other sectors and alternative doctors: Traditional doctors are often the first point of consultation for parallel treatment.
Further research is needed on competencies in the screening, identification and management of MSD disorders in these sectors by alternative health practitioners. Aging population: 8.1% of the population is over 60 years of age and this percentage is increasing, with a high burden associated with non-communicable diseases as well as an increasing burden of neurocognitive disorders that require specific competencies at all levels of providers . They often have physical disabilities that require higher levels of supervision and physical care, and this should be considered in relation to providers who care for this group.
There is very limited training across all categories of providers in caring for this group of individuals. Evidence-based implementation research is needed to test and evaluate the intended system of care. Posts are needed for new cadres, registered counsellors, psychiatrists and other mental health specialists in the district health services.
INTERVENTION RESEARCH
At the request of the DoH, the core tool for community mental health detection is being adapted to the context. The manuals and toolkits for integrating mental health care into the PHC system for both trainers and those being trained are freely accessible on the Center for Rural Health website. Appetitive aggression can therefore give rise to a cycle of violence that is different, but linked to the reactive cycle: in a violent environment, symptoms of psychopathy and antisocial behavior can emerge (for example, the stimulus of blood can become a stimulating signal for combatants in battle) .
The statements of many of the perpetrators of the Rwandan genocide have been documented, for example “The more we killed, the more we got the taste to go on. Facts from the narratives and community sessions are archived as part of the history of the community. There would be an opportunity to do this with the development of the community platform.
The idea is to give community members more control over their own health and that of the community. The indicators of the numbers screened and treated for mental health in primary care have helped. Prof Myers (SAMRC): The community should be seen as an extension of the healthcare system.
BREAK-AWAY: IDENTIFYING POLICY AND RESEARCH PRIORITIES IN MENTAL HEALTH
62 Community-wide interventions can be through community structures led by community leaders, who are often men, where community health workers would sit and discuss community problems. In this environment, there may be an opportunity to use peers; for example, a man who has been a heavy drinker in the past and has stopped might identify with other male drinkers.
Neuroscience and Genetics (Rapporteur: Prof Dan Stein, UCT)
If the goal is prevention and person-centered care, genetics must consider the comorbidity of mental health with communicable and noncommunicable disease. Given that the African population is young, a neurodevelopmental population-based cohort would be needed. Any proposal for such a cohort should be supported by a new professional field of health economics with a specialization in genetics.
Public Mental Health and Epidemiology (Rapporteur: Ms Ravhengani Machaka, Sefako Makgatho University)
Intervention Research (Rapporteur: Dr Gayle Langley, University of the Witwatersrand)
The higher education space has been highlighted, as there has been an increase in mental health issues among the student population, both in terms of incidence and severity. The need for resources to address mental health issues among college students, including depression, violence, substance abuse and suicide, was highlighted. In relation to mental health literacy, a life-span approach has been proposed, spanning from maternal health through childhood, schooling, teenagers and young adults.
There was a proposal to start in a catchment area and develop indicators, look at progression and track outcomes over time, and in that specific context children, teachers, mental health indicators and a cohort study in a bounded space in early childhood development to consider. 65 Prof Lund (UK): One possibility would be to approach the organizers of the National Income Dynamics Study (NIDS) and ask them to take blood samples during the next wave of the study. Prof Bhana (SAMRC): The Public Mental Health and Epidemiology Group (Group 2) recommended the need for better understanding of the burden of disease nationally.
We are not recommending another South African Stress and Health (SASH) study specifically related to mental health. Because of the expense of research of this nature, studies must be carefully designed. Prof Stein (UCT): Most recent nationally representative epidemiological studies of mental health have included DNA.
RESEARCH SUPPORT: FUNDERS
Funding for the mental health field is provided by SAMRC in both formal and less visible ways. Work at the interface of mental health and gender-based violence is potentially fundable through this mechanism. As mental health is underrepresented, SAMRC would welcome strong applications for mental health units.
SAMRC is planning to fund the National Survey of Mental Health and Suicide in Institutions of Higher Education. Work on the interface between mental health and HIV would fall within the remit of the call. Janssen/J&J global public health support for mental health programs in South Africa (Ms Abeda Williams, Senior Director of Technical and Medical Affairs, Janssen Pharmaceutica, South Africa).
Prof Lund (UCT): To what extent can this ASSAf symposium on mental health influence the NRF's and SAMRC's prioritization processes. Determinants of mental health and mental disorders include social, cultural, economic, political and environmental factors. The past 20 years have seen unprecedented growth in global mental health.
The first part will discuss the prevalence of mental health conditions among people seeking an HIV test. The second part will examine the utility of screening for common mental health disorders.
