On April 11, 2011, Global Foundation for Democracy and Development (GFDD) and Fundación Global Democracia y Desarrollo (FUNGLODE), in collaboration with the Permanent Mission of the Domincan Republic to the United Nations, the Columbia University School of Social Work and the International Association of Schools of Social Work, organized the panel discussion “Mainstreaming Mental Health within Public Health Paradigms: A Global Look at Advances and Challenges” at United Nations Headquarters in New York City.
The impetus behind the organization of the panel was the in-depth investigation conducted by GFDD and FUNGLODE’s research fellow, Yosmayra Reyes, M.A. Candidate in Social Work, Columbia University. Ms. Reyes joined the InteRDom Fellows Program in the summer of 2010, as an investigator in the area of mental health care. Her investigation assesses the implementation and awareness of national legislature related to mental health. Her study identifies existing challenges within the field of mental health, with a focus on early detection at the primary care level. In addition to evaluating the impact of health care policy on mental health services nationally, Ms. Reyes’ research also looks specifically at how mental health assessment is integrated within primary care in Monte Plata, Dominican Republic. Ms. Reyes’ investigation was carried out under the guidance of Dr. Alberto Fiallo Billini, Fellows Program Advisor and Advisor on Public Health to President of the Dominican Republic, Dr. Leonel Fernández.
In addition to the findings presented by Ms. Reyes, the event featured presentations by Dr. Janice Wood Wetzel, former Dean and Professor of Social Work at Adelphi University and Main UN Representative for the International Association of Schools of Social Work (IASS); Dr. Ellen Lukens, Firestone Centennial Professor of Clinical Social Work at Columbia University School of Social Work and Research Scientist at the New York State Psychiatric Institute; and Dr. Ramona Torres, Presidential Commission on Public Health of the Government of the Dominican Republic; and remarks byNatasha Despotovic, Executive Director of Global Foundation for Democracy and Development and H.E. Federico Cuello Camilo, Ambassador Extraordinary and Plenipoteniary of the Dominican Republic to the United Nations.
Panelists discussed efforts to integrate mental health within overall health planning at the international, national and local levels, referencing experiences from the Dominican Republic, the United States, Kazakstan and Japan.
Ambassador Federico Cuello expressed the interest of the Mission to continue partnering with GFDD and FUNGLODE to organize events related to international development for the United Nations community.
Dr. Wetzel called attention to the relevance of important international movements to integrate mental health and social policy. Catalytic global actions underscored by the IASS representative were the, the World Health Organization and the Inter-Agency Standing Committee. The Lancet Movement advocates for access to health services as a human right and greater research in low and middle-income countries. Dr. Wetzel expressed that the following WHO developments have been instrumental in mainstreaming mental health within overall health strategies: prioritization of social determinants of health, focus on at risk women, and the White Paper on Disaster Prevention. She also emphasized the significance of the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings published in 2007. Dr. Wetzel concluded by promoting strategies aimed at up-scaling and replicating actions related to self-determination, cultural relativism and gender mainstreaming.
Columbia Professor, Dr. Ellen Lukens presented the psychoeducation model as a practical preventative care strategy. The purpose of the model is to facilitate knowledge exchange between participants and facilitators, promoting knowledge as power. It offers practical strategies for coping in the face of stress, trauma and other challenges and promotes healing through pyschoeducation. Dr. Lukens explained that the goals of the approach are to: enhance communication through the creation of a common language; develop self and community awareness; prioritize a return to normalcy; and situate participants and facilitators as educators, students, translators, consultants, advocates and monitors.
Ms. Ramona Torres provided an overview of mental healthcare servicing in the Dominican Republic. To date, 6.8% of GDP is devoted to health care spending, totaling RD$ 36,033,871,310, of which a mere 0.03% is allocated for mental health services – RD$ 10,326,400. Over the last decade, various laws have been enacted that impact mental health, including: General Health Law 42-01, Social Security Law 87-01, Mental Health Law 12-06, Law 68-03 responsible for creating the Colegio Médico Dominicano, Law 22-01 responsible for creating the Colegio Dominicano de Psicologos. Furthermore, as part of the State’s ten-year health plan (2005-2015), psychiatric hospitals are being restructured and modified and mental health is being mainstreamed within primary care.
Ms. Torres indicated that in order for national legislature to be effectively implemented, the following norms and actions must also be established and put in place: minimum national mental health norms; minimum substance abuse and/or dependency norms; health care norms concerning violence against women; elaboration of Mental Health Law 12-06; and establishment of intervention programs related to intra-family violence, child abuse and substance abuse, employment programs for persons with mental disorders and psychoeducation programs for family members.
The Dominican psychologist put forth the subsequent recommendations: increased access to essential medications; enhanced participation of service users and their family members; creation of effective monitoring mechanisms; expansion of service coverage; development of a national database of statistics; greater budgetary allocations in the area of mental health; increased respect for the rights of persons with mental disabilities; capacity building for service workers; increased worker salaries; and further development of research on topics related to mental health.
Ms. Reyes recommended that the Dominican Republic implement a progressive agenda in the development of social welfare, similar to the model adopted in Cuba, in order to address budgetary restrictions and to improve mental health services at the primary care level. The Columbia graduate student recommended that implementation of a reconstructionist approach that involves increased privatization and some reduction of expenditures.
She advocated for enhanced action related to decentralization of services; increased transparency among public health agencies; and the need for human resource administration. She concluded by stressing the important potential of community practice as a way to understand the social causes of diseases.
Ms. Despotovic discussed the important work GFDD’s InteRDom Program, through its Fellows initiative, is realizing to expand scholarship related important sustainable development goals, and conveyed the interest of the foundation in recruiting more research students like Ms. Reyes.
The coordination of the panel was part of a larger commitment of Global Foundation for Democracy and Development and Fundación Global Democracia y Desarrollo to contribute to ECOSOC’s agenda of work. The foundations have had consultative status with ECOSOC since the year 2004.
Through the InteRDom Fellows Program, GFDD and FUNGLODE seek to develop scholarship on issues at the forefront of the United Nations’ agenda in order to give voice to national and regional concerns and offer viable solutions to domestic and international challenges. The Fellows Program provides research opportunities to M.A. and Ph.D. students interested in conducting high-level investigation on sustainable development related topics.