Florence Baingana
Makerere University
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Featured researches published by Florence Baingana.
The Lancet | 2011
Julian Eaton; Layla McCay; Maya Semrau; Sudipto Chatterjee; Florence Baingana; Ricardo Araya; Christina Ntulo; Graham Thornicroft; Shekhar Saxena
Mental disorders constitute a huge global burden of disease, and there is a large treatment gap, particularly in low-income and middle-income countries. One response to this issue has been the call to scale up mental health services. We assess progress in scaling up such services worldwide using a systematic review of literature and a survey of key national stakeholders in mental health. The large number of programmes identified suggested that successful strategies can be adopted to overcome barriers to scaling up, such as the low priority accorded to mental health, scarcity of human and financial resources, and difficulties in changing poorly organised services. However, there was a lack of well documented examples of services that had been taken to scale that could guide how to replicate successful scaling up in other settings. Recommendations are made on the basis of available evidence for how to take forward the process of scaling up services globally.
PLOS Medicine | 2011
Wietse A. Tol; Vikram Patel; Mark Tomlinson; Florence Baingana; Ananda Galappatti; Catherine Panter-Brick; Derrick Silove; Egbert Sondorp; Michael G. Wessells; Mark van Ommeren
Wietse Tol and colleagues lay out a a consensus-based research agenda for mental health and psychosocial support in humanitarian settings.
The Lancet Psychiatry | 2017
Dinesh Bhugra; Allan Tasman; Soumitra Pathare; Stefan Priebe; Shubulade Smith; John Torous; Melissa R. Arbuckle; Alex Langford; Renato D. Alarcón; Helen F.K. Chiu; Michael B. First; Jerald Kay; Charlene Sunkel; Anita Thapar; Pichet Udomratn; Florence Baingana; Dévora Kestel; Roger Man-Kin Ng; Anita Patel; Livia De Picker; Kwame McKenzie; Driss Moussaoui; Matt Muijen; Peter Bartlett; Sophie Davison; Tim Exworthy; Nasser Loza; Diana Rose; Julio Torales; Mark Brown
Background This Commission addresses several priority areas for psychiatry over the next decade, and into the 21st century. These represent challenges and opportunities for the profession to sustain and develop itself to secure the best possible future for the millions of people worldwide who will face life with mental illness. Part 1: The patient and treatment Who will psychiatrists help? The patient population of the future will reflect general demographic shifts towards older, more urban, and migrant populations. While technical advances such as the development of biomarkers will potentially alter diagnosis and treatment, and digital technology will facilitate assessment of remote populations, the human elements of practice such as cultural sensitivity and the ability to form a strong therapeutic alliance with the patient will remain central. Part 2: Psychiatry and health-care systems Delivering mental health services to those who need them will require reform of the traditional structure of services. Few existing models have evidence of clinical effectiveness and acceptability to service users. Services of the future should consider stepped care, increased use of multidisciplinary teamwork, more of a public health approach, and the integration of mental and physical health care. These services will need to fit into the cultural and economic framework of a diverse range of settings in high-income, low-income, and middle-income countries. Part 3: Psychiatry and society Increased emphasis on social interventions and engagement with societal expectations might be an important area for psychiatrys development. This could encompass advocacy for the rights of individuals living with mental illnesses, political involvement concerning the social risk factors for mental illness, and, on a smaller scale, work with families and local social networks and communities. Psychiatrists should therefore possess communication skills and knowledge of the social sciences as well as the basic biological sciences. Part 4: The future of mental health law Mental health law worldwide tends to be based on concerns about risk rather than the protection of the rights of individuals experiencing mental illness. The United Nations Convention on the Rights of Persons with Disabilities, which states that compulsion based in whole or in part on mental disability is discriminatory, is a landmark document that should inform the future formulation and reform of mental health laws. An evidence-based approach needs to be taken: mental health legislation should mandate mental health training for all health professionals; ensure access to good-quality care; and cover wider societal issues, particularly access to housing, resources, and employment. All governments should include a mental health impact assessment when drafting relevant legislation. Part 5: Digital psychiatry—enhancing the future of mental health Digital technology might offer psychiatry the potential for radical change in terms of service delivery and the development of new treatments. However, it also carries the risk of commercialised, unproven treatments entering the medical marketplace with detrimental effect. Novel research methods, transparency standards, clinical evidence, and care delivery models must be created in collaboration with a wide range of stakeholders. Psychiatrists need to remain up to date and educated in the evolving digital world. Part 6: Training the psychiatrist of the future Rapid scientific advance and evolving models of health-care delivery have broad implications for future psychiatry training. The psychiatrist of the future must not only be armed with the latest medical knowledge and clinical skills but also be prepared to adapt to a changing landscape. Training programmes in an age in which knowledge of facts is less important than how new knowledge is accessed and deployed must refocus from the simple delivery of information towards acquisition of skills in lifelong learning and quality improvement. Conclusion Psychiatry faces major challenges. The therapeutic relationship remains paramount, and psychiatrists will need to acquire the necessary communication skills and cultural awareness to work optimally as patient demographics change. Psychiatrists must work with key stakeholders, including policy makers and patients, to help to plan and deliver the best services possible. The contract between psychiatry and society needs to be reviewed and renegotiated on a regular basis. Mental health law should be reformed on the basis of evidence and the rights of the individual. Psychiatry should embrace the possibilities offered by digital technology, and take an active role in ensuring research and care delivery in this area is ethically sound and evidence based. Psychiatry training must reflect these multiple pressures and demands by focusing on lifelong learning rather than simply knowledge delivery.
JAMA | 2015
James M. Shultz; Florence Baingana; Yuval Neria
citingsymptomaticpatientsescap-ing from treatment units, families concealing sick rela-tives at home, preferential use of traditional healers,andphysicalcontactwithinfectiouscorpses.Neverthe-less, the Roadmap includes few recommendations toalleviate fear behaviors and address mental healthneedsinEbola-affectedcommunities.InWestAfrica,Ebolavirusdiseasearousesfearbe-haviors, in part because many have witnessed thegraphic hemorrhagic manifestations of those infectedandthebodiesofthosewhohavedied.Thecorpsesandbeddingofpatientswhohavediedposeinfectionhaz-ardstohealthcareworkersandfamilymembers.AsofDecember14,2014,649front-linehealthcareworkershavebecomeilland365havedied.
Harvard Review of Psychiatry | 2012
Wietse A. Tol; Vikram Patel; Mark Tomlinson; Florence Baingana; Ananda Galappatti; Derrick Silove; Egbert Sondorp; Mark van Ommeren; Michael G. Wessells; Catherine Panter-Brick
Background: Humanitarian crises are associated with an increase in mental disorders and psychological distress. Despite the emerging consensus on intervention strategies in humanitarian settings, the field of mental health and psychosocial support (MHPSS) in humanitarian settings lacks a consensus‐based research agenda. Methods: From August 2009 to February 2010, we contacted policymakers, academic researchers, and humanitarian aid workers, and conducted nine semistructured focus group discussions with 114 participants in three locations (Peru, Uganda, and Nepal), in both the capitals and remote humanitarian settings. Local stakeholders representing a range of academic expertise (psychiatry, psychology, social work, child protection, and medical anthropology) and organizations (governments, universities, nongovernmental organizations, and UN agencies) were asked to identify priority questions for MHPSS research in humanitarian settings, and to discuss factors that hamper and facilitate research. Results: Thematic analyses of transcripts show that participants broadly agreed on prioritized research themes in the following order: (1) the prevalence and burden of mental health and psychosocial difficulties in humanitarian settings, (2) how MHPSS implementation can be improved, (3) evaluation of specific MHPSS interventions, (4) the determinants of mental health and psychological distress, and (5) improved research methods and processes. Rather than differences in research themes across countries, what emerged was a disconnect between different groups of stakeholders regarding research processes: the perceived lack of translation of research findings into actual policy and programs; misunderstanding of research methods by aid workers; different appreciation of the time needed to conduct research; and disputed universality of research constructs. Conclusions: To advance a collaborative research agenda, actors in this field need to bridge the perceived disconnect between the goals of “relevance” and “excellence.” Research needs to be more sensitive to questions and concerns arising from humanitarian interventions, and practitioners need to take research findings into account in designing interventions.
International Review of Psychiatry | 2004
Walter Gulbinat; Ron Manderscheid; Florence Baingana; Rachel Jenkins; Sudhir K. Khandelwal; Itzhak Levav; F. Lieh Mak; John Mayeya; Alberto Minoletti; Malik H. Mubbashar; R. Srinivasa Murthy; M. Parameshvara Deva; Klaas Schilder; Toma Tomov; Aliko Baba; Clare Townsend; Harvey Whiteford
The concept of the burden of disease, introduced and estimated for a broad range of diseases in the World Bank report of 1993 illustrated that mental and neurological disorders not only entail a higher burden than cancer, but are responsible, in developed and developing countries, for more than 15% of the total burden of all diseases. As a consequence, over the past decade, mental disorders have ranked increasingly highly on the international agenda for health. However, the fact that mental health and nervous system disorders are now high on the international health agenda is by no means a guarantee that the fate of patients suffering from these disorders in developing countries will improve. In most developing countries the treatment gap for mental and neurological disorders is still unacceptably high. To address this problem, an international network of collaborating institutions in low-income countries has been set up. The establishment and the achievements of this network—the International Consortium on Mental Health Policy and Services—are reported. Sixteen institutions in developing countries collaborate (supported by a small number of scientific resource centres in industrialized nations) in projects on applied mental health systems research. Over a two-year period, the network produced the key elements of a national mental health policy; provided tools and methods for assessing a countrys current mental health status (context, needs and demands, programmes, services and care and outcomes); established a global network of expertise, i.e., institutions and experts, for use by countries wishing to reform their mental health policy, services and care; and generated guidelines and examples for upgrading mental health policy with due regard to the existing mental health delivery system and demographic, cultural and economic factors.
International Review of Psychiatry | 2004
Rachel Jenkins; Walter Gulbinat; Ron Manderscheid; Florence Baingana; Harvey Whiteford; Sudhir K. Khandelwal; Alberto Minoletti; Malik H. Mubbashar; R. Srinivasa Murthy; M. Parameshvara Deva; F. Lieh Mak; Aliko Baba; Clare Townsend; Marc Harrison; Ahmed Mohit
This article describes the construction and use of a systematic structured method of mental health country situation appraisal, in order to help meet the need for conceptual tools to assist planners and policy makers develop and audit policy and implementation strategies. The tool encompasses the key domains of context, needs, resources, provisions and outcomes, and provides a framework for synthesizing key qualitative and quantitative information, flagging up gaps in knowledge, and for reviewing existing policies. It serves as an enabling tool to alert and inform policy makers, professionals and other key stakeholders about important issues which need to be considered in mental health policy development. It provides detailed country specific information in a systematic format, to facilitate global sharing of experiences of mental health reform and strategies between policy makers and other stakeholders. Lastly, it is designed to be a capacity building tool for local stakeholders to enhance situation appraisal, and multisectorial policy development and implementation.
Nature | 2015
Florence Baingana; Mustafa al'Absi; Anne E. Becker; Beverly Pringle
The research agenda for global mental health and substance-use disorders has been largely driven by the exigencies of high health burdens and associated unmet needs in low- and middle-income countries. Implementation research focused on context-driven adaptation and innovation in service delivery has begun to yield promising results that are improving the quality of, and access to, care in low-resource settings. Importantly, these efforts have also resulted in the development and augmentation of local, in-country research capacities. Given the complex interplay between mental health and substance-use disorders, medical conditions, and biological and social vulnerabilities, a revitalized research agenda must encompass both local variation and global commonalities in the impact of adversities, multi-morbidities and their consequences across the life course. We recommend priorities for research — as well as guiding principles for context-driven, intersectoral, integrative approaches — that will advance knowledge and answer the most pressing local and global mental health questions and needs, while also promoting a health equity agenda and extending the quality, reach and impact of scientific enquiry.This article has not been written or reviewed by Nature editors. Nature accepts no responsibility for the accuracy of the information provided.
International Review of Psychiatry | 2004
Clare Townsend; Harvey Whiteford; Florence Baingana; Walter Gulbinat; Rachel Jenkins; Aliko Baba; F. Lieh Mak; Ron Manderscheid; John Mayeya; Alberto Minoletti; Malik H. Mubbashar; Sudhir K. Khandelwal; Klaas Schilder; Toma Tomov; M. Parameshvara Deva
Mental disorders are a major and rising cause of disease burden in all countries. Even when resources are available, many countries do not have the policy and planning frameworks in place to identify and deliver effective interventions. The World Health Organization (WHO) and the World Bank have emphasized the need for ready access to the basic tools for mental health policy formulation, implementation and sustained development. The Analytical Studies on Mental Health Policy and Service Project, undertaken in 1999–2001 by the International Consortium for Mental Health Services and funded by the Global Forum for Health Research aims to address this need through the development of a template for mental health policy formulation. A mental health policy template has been developed based on an inventory of the key elements of a successful mental health policy. These elements have been validated against a review of international literature, a study of existing mental health policies and the results of extensive consultations with experts in the six WHO regions of the world. The Mental Health Policy Template has been revised and its applicability will be tested in a number of developing countries during 2001–2002. The Mental Health Policy Template and the work of the Consortium for Mental Health Services will be presented and the future role of the template in mental health policy development and reform in developing countries will be discussed.
Harvard Review of Psychiatry | 2003
Melanie Abas; Florence Baingana; Jeremy Broadhead; Eduardo Iacoponi; Jane Vanderpyl
Common mental disorders (CMDs) fall mainly into two categories: neurotic, stress-related, and somatoform disorders; and mood disorders.1,2 They include unipolar depression, projected to become the second major cause of disability worldwide by 2020.3 Approximately 15% of users of primary health care (PHC) clinics have a CMD, very few of which are recognized or receive adequate treatment.4 Much has been written about the need to improve the detection and treatment of CMDs in PHC.5,6 In view of the evidence from Western settings that effective treatment for depression requires assertive follow-up, continuing contact with mental health specialists, and a reliable drug supply,6–8 one must ask whether and how PHC services in low-income countries will be able to provide such care. What models and patterns of care have been described or are presently in operation? Many of the programs that exist outside of official government services—for example, in the context of nongovernmental organization (NGO) programs for refugees—have already been described elsewhere.9 This review will there-