The global health conference recently held in Melbourne may be over, but the reports from it are still coming in.
Thanks to freelance journalist Tamzin Byrne* for coordinating the two posts below – the first from Swinburne University’s Mike Kyrios on the potential for e-health in mental health; and the second from Liz Sime of Marie Stopes International on the broad-ranging importance of women’s sexual health.
How can online therapies help mental health?
Mike Kyrios writes:
At the United Nations conference on global health in Melbourne, we were speculating whether the UN will achieve their heady “Millennium Development Goals” by 2015. There was lots of talk about poverty, hunger, environmental sustainability, education, gender inequality, child mortality and maternal health.
But where is mental health in all of this? Depression is the leading cause of disability in the world. By the end of this decade, it will be the second highest contributor to the global burden of disease. Post-traumatic stress is rife amongst survivors of trauma, disasters and war. As the UN works for peace and freedom, it should also address the mental health problems which arise from war.
So what are the current barriers?
Firstly, we don’t have a workforce that can deal with mental health difficulties throughout the world. We cannot respond effectively to the overwhelming mental health problems that follow natural disasters such as fires, tsunamis, earthquakes, and cyclones.
Secondly, we need to connect with rural and remote communities, and populations with special needs. We need to reach across cultural and linguistic differences.
Thirdly, we must empower individuals and communities to reduce their dependence on pharmaceutical companies and that limited approach to mental health treatment.
These are significant challenges, but promising solutions do exist.
At Swinburne University, in Melbourne, we have developed an ‘e-therapy’ site, a suite of online tools for mental health workers. It includes psychological treatments for a wide range of disorders. Healthcare workers can access training protocols and therapeutic tools. Treatments are offered as self-help or therapist-assisted options. Access to professional training supports is simple, and can easily be adapted for use across different languages and cultural contexts.
‘Jane’ lost her home in the 2009 Victorian bushfires. She developed panic attacks at the sound of fire engines, loud rashes, and even the sight of a lit match or cigarette. Jane’s life was dominated by anxiety, depression, a crippling sense of foreboding, and incapacity.
A friend put her on to our online post-traumatic stress program and, over 12 weeks, she completed relaxation exercises and other tasks, and received support from an online therapist. Her anxiety decreased dramatically, she no longer had distressing intrusive thoughts of fires, her sleep improved, and she could get on with life.
Even though she lives in rural Australia, Jane was able to access quality care from city-based professionals by completing her therapy online.
I acknowledge that there are barriers to the use of e-therapies in the developing world; illiteracy, inadequate access to computers and the internet, poor understanding of mental health, and the physical limitations that follow natural and man-made disasters.
But, as online therapies become more sophisticated, with greater use of interactive and audiovisual material, illiteracy becomes less of an issue. The UN and NGOs, through their offices and camps in disaster areas, can help us to overcome the physical barriers. And the UN’s work towards universal education will ease the skill barrier. With support, we can train mental health workers in developing countries to use these 21st century tools.
• Mike Kyrios works with the NGO Psychology for Global Health, and is the Executive Chair of Australia’s National eTherapy Centre at Swinburne University in Melbourne.
Moving women’s sexual and reproductive health beyond the Cinderella syndrome
Liz Sime writes:
It is a sticky subject. A messy topic, full of taboos and no one really wants to talk about it. The Cinderella of the aid and development world – sexual and reproductive health.
At this United Nations conference, we had a very simple focus: to put sexual and reproductive health on the agenda. We wanted to put sexual and reproductive health into the UN Declaration, the document of outcomes from this conference.
Sexual health underpins all of the Millennium Development Goals. Giving a woman the ability to plan and space the number of children she wants can transform a society. She will most likely decide to have a smaller family. All of her children will be wanted. With fewer children, she will be able properly educate them, feed them, and get them medical attention when they need it.
What happens next is the transformative affect of sexual health. As many of you know, having babies takes a lot of time, effort and planning. If you are unable to plan when you are having your children, then you are unable to plan your whole life.
There are 215 million women in the world who want to use contraceptives to plan to their families but cannot access them. These 215 million women are ‘missing’ from their communities. When you have one child after another, you are unable to consider your own education and employment. You are unable contribute to your community.
You are also more likely to die. Every year over half a million women die from causes related to pregnancy and childbirth. But simply helping these women give birth safely is not enough to save them. Women need urgent and immediate access to voluntary family planning.
We estimate that our work in delivering family planning services preventing 35,000 maternal deaths and over 9 million unintended pregnancies around the world last year. What could we achieve if we gave these 215 million woman access to family planning?
For weeks, an informal group of NGOs whose work ranges from sexual health to public policy advocacy have been quietly working to ensure that the Declaration, which will be taken to New York in September for the UN MDG Summit, reflects how transformative sexual and reproductive health can be to all the Millennium Development Goals.
The final Declaration is a powerful statement of the impact that governments and agencies working together can have on poverty, hunger, lack of education and sanitation – but we still have work to do before sexual and reproductive health is included.
• Liz Sime is Regional Director of Marie Stopes International Australia which provides sexual and reproductive healthcare services throughout Australia and the Asia Pacific. She wants the world to recognise that sexual health for women has a transformative power for whole societies.
These are the previous Croakey posts from the conference:
• Tamzin Byrne produces Panorama, the flagship current affairs show on SYN youth radio in Melbourne. She coordinated a team of student journalists to cover the UN conference.