Julian Eaton | London School of Hygiene & Tropical Medicine (original) (raw)

Papers by Julian Eaton

Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ, 2015

Mental health services in the Eastern Mediterranean Region are predominantly centralized and inst... more Mental health services in the Eastern Mediterranean Region are predominantly centralized and institutionalized, relying on scarce specialist manpower. This creates a major treatment gap for patients with common and disabling mental disorders and places an unnecessary burden on the individual, their family and society. Six steps for reorganization of mental health services in the Region can be outlined: (1) integrate delivery of interventions for priority mental disorders into primary health care and existing priority programmes; (2) systematically strengthen the capacity of non-specialized health personnel for providing mental health care; (3) scale up community-based services (community outreach teams for defined catchment, supported residential facilities, supported employment and family support); (4) establish mental health services in general hospitals for outpatient and acute inpatient care; (5) progressively reduce the number of long-stay beds in mental hospitals through restr...

Psychiatric Services, 2015

People with severe and enduring mental illnesses, such as schizophrenia, are among the most disab... more People with severe and enduring mental illnesses, such as schizophrenia, are among the most disabled, socially excluded, and underserved populations, especially in low- and middle-income countries. Some programs have been created to target this group. The current global development agenda emphasizes the need to provide care to vulnerable groups. This column compares two long-standing and successful programs for homeless people with mental illness in three West African countries-Nigeria, Côte d&amp;amp;#39;Ivoire, and Bénin. The authors describe essential ingredients of these programs and their integration into existing systems, including funding and other resources, leadership models, and staff. The success of these programs provides support for initiatives to scale up services for people with severely disabling and complex needs, even as the focus is increasingly on cost-effectiveness of mental health integration into decentralized health services.

Global Health Action, 2015

Mental health advocacy groups are an effective way of pushing the mental health agenda and puttin... more Mental health advocacy groups are an effective way of pushing the mental health agenda and putting pressure on national governments to observe the right to health; however, there is limited research that highlights best practices for such groups in low-resource settings. In an effort to improve the scaling up of mental health in Sierra Leone, stakeholders came together to form the country's first mental health advocacy group: the Mental Health Coalition - Sierra Leone. Since its inception, the group has worked towards raising the profile of mental health in Sierra Leone and developing as an advocacy organisation. The study's aim was to investigate views on enabling factors and barriers associated with mental health advocacy in a low-income country using a community-based participatory approach and qualitative methodology. Focus groups (N=9) were held with mental health stakeholders, and key informant interviews (N=15) were conducted with advocacy targets. Investigators analysed the data collaboratively using coding techniques informed by grounded theory. Investigators reveal viewpoints on key factors in networking, interacting with government actors, and awareness raising that enabled mental health advocacy aims of supporting policy, service delivery, service user rights, training for service delivery, and awareness raising. The investigators outline viewpoints on barriers for advocacy aims in framing the issue of mental health, networking, interacting with government actors, resource mobilization, and awareness raising. The findings outline enabling factors, such as networking with key stakeholders, and barriers, such as lack of political will, for achieving mental health advocacy aims within a low-resource setting, Sierra Leone. Stakeholder coalitions can further key policy development aims that are essential to strengthen mental health systems in low-resource settings.

PLOS ONE, 2015

Community-based rehabilitation (CBR) is a multi-sectoral strategy to improve the functioning and ... more Community-based rehabilitation (CBR) is a multi-sectoral strategy to improve the functioning and quality of life of people with disabilities. The RISE (Rehabilitation Intervention for people with Schizophrenia in Ethiopia) trial will evaluate the effectiveness of CBR for people with schizophrenia in Ethiopia. Nevertheless, the components of CBR that are both feasible and likely to prove effective in low and middle-income countries such as Ethiopia are unclear. In this study intervention development work was undertaken to design a CBR intervention that is acceptable and feasible in the local context. The development work consisted of five phases. 1: Identify potential components of CBR for schizophrenia, 2: Situational analysis, 3: Determine feasibility of CBR (Theory of Change workshops with experts and local stakeholders), 4: Determine acceptability of CBR (16 in-depth interviews and five focus group discussions with people with schizophrenia, caregivers, health workers and community leaders) and 5: Synthesise results to finalise intervention. A Theory of Change map was constructed showing the causal pathway for how we expect CBR to achieve its impact. People with schizophrenia in rural Ethiopia experience family conflict, difficulty participating in work and community life, and stigma. Stakeholders perceived CBR to be acceptable and useful to address these problems. The focus of CBR will be on the individual developing the skills and confidence to perform their previous or desired roles and activities. To ensure feasibility, non-health professionals will be trained to deliver CBR and provide supervision, rather than mental health specialists. Novel components of CBR for schizophrenia included family intervention and dealing with distressing symptoms. Microfinance was excluded due to concerns about stress and exploitation. Community mobilisation was viewed as essential to ensure the effectiveness and sustainability of CBR. Extensive formative research using a variety of methods has enabled the design of a culturally appropriate CBR intervention for people with schizophrenia that is acceptable and feasible.

The Lancet Psychiatry, 2015

Nigerians who suffer from severe mental illness also need psychiatric psychosocial rehabilitation... more Nigerians who suffer from severe mental illness also need psychiatric psychosocial rehabilitation. Despite the availability of a wide range of mental health services in Nigeria, majority of Nigerians with mental health relatively have their needs unmet. To fill this unmet gap, Nigerian psychiatrists should also make psychiatric psychosocial interventions available at the primary health care centres and in the rural communities. When these services are available in the community, Nigerians with mental health disorders can easily acquire the available social, emotional and intellectual skills provided by mental health experts to enable them live and work with minimal supervision from clinicians. The aim of this paper is therefore to further sensitize Nigeria mental health care providers on the need to make psychiatric psychosocial services available at the primary health care centres and rural communities for every Nigerian with mental illness.

Nigerian Journal of Psychiatry, 2009

... REFERENCES Aina, OF, Ladapo, HTO, Lawal, RA, Owoeye, OA (2007) Community-orientated services ... more ... REFERENCES Aina, OF, Ladapo, HTO, Lawal, RA, Owoeye, OA (2007) Community-orientated services in a psychiatric hospital. Efforts to reduce stigmatization. ... International Psychiatry, 2,10 12 Gureje, O., Chisholm, D., Kola, L., Lasebikan, V., Saxena, S. (2007). ...

African Journal of Psychiatry, 2008

ABSTRACT In this review article, the issues related to provision of psychotropic drugs in service... more ABSTRACT In this review article, the issues related to provision of psychotropic drugs in services in sub-Saharan Africa are explored. Problems encountered in procurement of drugs, their safe prescription and practical supply systems are discussed, with possible solutions suggested. The evidence-base for the preferential use of first-generation drugs is presented, with the practical implications for cost-effective service delivery shown. Options for sourcing of quality drugs are outlined with practical examples. An argument is made for a wider range of medical personnel to be allowed to prescribe than is often currently the case. This is so as to allow for the scale up of community based psychiatric services which will otherwise fail to meet the needs of the majority of persons with mental illnesses, particularly in rural communities. Drug Revolving Funds are proposed as a means of managing supplies by local projects in a context of a lack of an alternative supply. Some suggestions are made for practical solutions to the problem of those cannot afford even cheaper medications.

Journal of Mental Health, 2014

Health is a crucial prerequisite for sustainable human development, and there can be no health wi... more Health is a crucial prerequisite for sustainable human development, and there can be no health without mental health.

The Lancet Psychiatry, 2014

International Journal of Mental Health Systems, 2014

Background: The Millennium Development Goals have guided development co-operation in the 15 years... more Background: The Millennium Development Goals have guided development co-operation in the 15 years up to 2015, achieving some significant progress in the priorities on which they focused. As the framework for the post-2015 development agenda is negotiated, this article reviews the evidence for the place of mental health in broader development issues that have already been outlined in the run-up to 2015. Discussion: If mental health is going to be recognised as having an essential role in development, there needs to be a consensus on priorities for advocacy. Various key issues emerged from a survey of stakeholders in the Movement for Global Mental Health (MGMH), leading to a Position Statement, which is now available for use by advocates. The priorities that emerged were increasing access to mental health services, and addressing human rights abuse, stigma, and exclusion. Summary: Mental health is a cross-cutting issue, and including it in frameworks for action will increase the likelihood of achieving global priorities for development such as poverty reduction, economic development, improved health, and ensuring the most vulnerable in society are not left behind.