GFAN AP Webinar: Mental Health Series #2

The Global Fund Advocates Network Asia-Pacific (GFAN AP), United for Global Mental Health (UnitedGMH), and the Seven Alliance jointly hosted the second webinar of the three-part series titled “The Time is Now: Addressing Mental Health Needs of People living with, at risk of, and/or affected by HIV/TB” on 4 September 2024. 

This webinar was organised to provide a space for sharing and exchanges of innovative and integrated mental health, HIV, and TB services in Asia-Pacific, as well as facilitate dialogue and facilitate potential physical space, including domestic resource mobilisation and within Global Fund grants for increased resources towards integrated mental health services. Furthermore, it served as a platform to initiate discussions on how to integrate mental health needs on HIV and TB key populations into community and civil society mobilisation advocacy for the Eighth Replenishment of the Global Fund.

Three key speakers were invited from partner organisations to discuss best practices for the integration of mental health into Global Fund national grants: Choub Sok Chamreun, Executive Director at KHANA (Khmer HIV/AIDS NGO Alliance); Trang Nguyen, Programme Manager, Harm Reduction and Addiction Treatment at SCDI (Centre for Supporting Community Development Initiatives); and Adeline Lautissier, Head of the Southeast Asia and Ukraine Unit at L’Initiative, Expertise France. The webinar was co-moderated by Jennifer Ho (Operations & Governance Strengthening, GFAN AP) and Yves Miel Zuniga (Policy & Advocacy Advisor, UnitedGMH), and was attended by over 30 participants from within and outside of the Asia-Pacific region, including Africa, North America, and Europe.

The webinar commenced with welcome remarks by Rachel Ong (Regional Coordinator, GFAN AP), Yves Miel Zuniga (Policy & Advocacy Advisor, UnitedGMH), and Sita Shahi (Regional Coordinator, ICWAP) representing the Seven Alliance. The floor was then passed to the three key speakers for their respective presentations. Sita highlighted that people living with HIV often face significant mental health challenges due to physical illness, gender violence, stigma, discrimination, taboos, social isolation, familial rejection, loss of employment opportunities, among others. Additionally, women and girls living with HIV and TB face unique mental health challenges due to the combination of the biological, social and cultural factors. An alarming issue currently is anxiety and depression among people living with HIV and TB, due to the burdens of managing chronic illness, treatment side effects, body-shaming, and financial hardship, particularly after the COVID-19 pandemic. The social stigma associated with these diseases contribute to feelings of hopelessness and despair, which is lead to poor adherence of treatment. Sita also highlighted the low number of interventions that address structural issues such as gender-related barriers, myths and taboos on HIV and TB, and reproductive health concerns. Furthermore, there is uncertainty about the future of young people due to economic injustice and a lack of psychosocial support. People living with HIV may use harmful coping mechanisms such as alcohol and drug use to manage stress and anxiety, which can worsen mental health, interfere with treatment adherence, and potentially lead to other health problems. We need to have ongoing conversations, strengthen social support networks, reduce stigma, and provide community-based resources to mitigate these mental health challenges. Lastly, Sita expressed hope to develop a strong action plan for collective advocacy at the country and regional level for the upcoming Global Fund replenishment.

Choub Sok Chamreun presented first on “KHANA’s Mental Health Integration into TB Program: USAID TB MIND Asia”, which provided a high-level overview of KHANA’s work on TB and mental health in Cambodia through a case study on USAID TB MIND Asia (2023-2026) being implemented in Cambodia, as well as in Indonesia and the Philippines. Some key challenges identified for the provision of mental health services for people with TB were the limited amount of data available on mental health issues among people with TB; a lack of mental health and psychosocial support capacity in TB personnel; the prevalence of stigma, discrimination, isolation and lack of support; and the higher risk of depression, anxiety, and psychosis among people with Multidrug-resistant TB (MDR-TB). Other operational challenges identified during the implementation of USAID TB MIND Asia are the limitation of references for developing technical guidelines for TB and mental health integration at the primary health care (PHC) level; the limitation of human resources for developing standard operating procedures (SOPs) / technical guidelines for the integration; and the increase in workloads and responsibility to healthcare providers at the PHC level. In response to these challenges, KHANA plans to develop SOPs / technical guidelines for mental health and TB integration at PHC level alongside Information, Education & Communication (IEC) materials to raise awareness and combat stigma. In summary, there exists a high need for mental health services for people living with TB, however resources are still very limited and much needed to overcome these challenges.

Responding to Chamreun’s presentation, Harry Prabowo (Program Manager, APN+) enquired about the perception of mental health in Cambodia, the prevalence of mental health stigma, and whether it became a challenge for the integration of mental health with TB services. Viengakhone Souriyo (Executive Director, CHIAS) suggested that using a Buddhist approach to stress management and mental health could be helpful in reducing stigma and promoting community uptake of mental health services, while Chamreun stressed the importance of working with community members and leaders, such as schoolteachers and local religious leaders, who can act as caretakers and provide psychosocial support to key populations. Additionally, there is a need for greater sensitisation among mental health care professionals to understand how to support people with TB.

Next, Trang presented on “Building capacity and developing community-based mental health interventions”, which provided insight on SCDI’s integration of mental health services with HIV programming for people who inject drugs (PWID). SCDI had observed cases of suicide, suicidal intent, and a high incidence of psychiatric disorders among PWID in their HIV programming. Despite SCDI referring clients for psychiatric treatment, none of them actually attended the care referral. At the same time, poor mental health affects treatment adherence for HIV and methadone. A study by SCDI on young people who use drugs (YPUD) found that the rate of depression among YPUD is 58%, while the rate of suicidal ideation among adolescents is 26.3% percent, where 12% have a suicide plan and 6.3% have attempted suicide. Two factors preventing access to treatment are the lack of services available for this vulnerable population, as well as societal stigma and discrimination towards mental health. To address this, SCDI organises capacity building activities, such training of trainers, development of a Community Quick Screening Tool (QST) for PWID and YPUD, training on mental health integration in harm reduction counselling, and mindfulness circles and art-based activities. SCDI also pilots an integrated service delivery, which begins with mental health psychoeducation, QST screening, individual counselling, psychiatric referrals, and long-term support through community-based organisations, which is key for continued treatment adherence. SCDI also created a learning platform, the Community Field Lab for Stimulant Harm reduction (C-FLASH) which has been shared with regional partners. However, key challenges remain: traditional donors for HIV and TB tend not to prioritise mental health as an important component; CSOs reliant on HIV, TB and/or malaria funding have difficulty finding and accessing mental health-dedicated funding; and the gap in mental health services available in Viet Nam, which has only 600 psychiatrists across the country. SCDI also shared a few ‘lessons learnt’: traditional donors need to be engage with evidence-based correlation between mental health and funding priorities; community-based interventions are effective and necessary especially given the limited number of psychiatrists available; and data and evidence are critical and much needed. As next steps, SCDI plans to advocate for a “Put People First” approach with traditional donors; approach new donors focused on mental health priority areas; strengthen community’s capacity on mental health issues; expand interventions to reach more key populations; document, share, learn, adapt, and implement mental health interventions across the region; and facilitate the continuum of care from community-based organisations to the domestic health system.

A question was asked regarding challenges faced by women and girls in accessing mental health services. Trang agreed that women and girls face higher risks of developing mental health disorders, and SCDI is currently developing specialised gender-based interventions for mental health issues among women who use drugs.

The third presentation was by Adeline, on “Addressing mental health needs and integrating them into L’Initiative’s activities: a donor perspective”. Adeline introduced L’Initiative, Expertise France, and the channels of support available to AP region: the Project Channel which funds projects through 3-yearly calls for proposals and focused on key and vulnerable populations, health systems strengthening (HSS), and operational research; and the Expertise Channel which provides technical support at the request of a Country Coordinating Mechanism (CCM), Principal Recipient (PR), Sub-recipient (SR), or any other stakeholder working on the three diseases or HSS. L’Initiative is aligned with the French Global Health Strategy and the Global Fund’s strategic framework, where mental health is a relatively new and current priority area. The current challenge is to operationalise this shift each at various levels through an integrated approach so it is materialised into dedicated interventions. Examples of funding interests mentioned include projects focused on advocacy and/or demonstrations of value of interventions, such as professional research which could further demonstrate the impact of mental health on treatment adherence for TB and HIV. Adeline also shared further on the eligibility framework and mental health support opportunities from L’Initiative through their Project Channel and Expertise Channel. L’Initiative recognises the need for mental health support services and current challenges received during project evaluation feedback, such as partial or lack of coverage of mental health component by the Global Fund for certain programmes; the need to strengthen psychological support for peer educators (PE); limited number of psychologists and psychiatrists in public facilities; lack of mental health inclusion in national HIV and TB policies; and the need for high-level political commitment. Adeline ended with a reminder that the 5 countries in the Greater Mekong eligible for Project Channel funding are Myanmar, Thailand, Lao PDR, Viet Nam, and Cambodia, and the next calls for projects (for 2025) will be published in early December 2024. Meanwhile, technical support requests via the Expertise Channel can be submitted throughout the year.

Responding to a question on cross-country collaboration, Adeline affirmed that a regional proposal is eligible and welcomed as long as it is able to demonstrate the added value of a regional approach.

The webinar session concluded with closing remarks by Harry, Yves, and Rachel on behalf of the Seven Alliance, UnitedGMH, and GFAN AP thanking participants for their active participation and engagement and welcomed participants to join us for the last of the three-part mental health series. 

SPEAKERS:

PRESENTATIONS:

• • KHANA’s Mental Health Integration into TB Program: USAID TB MIND Asia. Presenter: Choub Sok Chamreun, KHANA.
  • Building capacity and developing community-based mental health interventions. Presenter: Trang Nguyen, SCDI.
  • Addressing mental health needs and integrating them into L’Initiative’s activities: A donor perspective. Presenter: Adeline Lautissier, L’Initiative.