Global Alliance for Chronic Diseases (GACD) prevention and management of mental disorders

Proposals must focus on mental disorders as defined by the WHO (see above), and must focus on implementation research in LMIC, and/or in vulnerable populations in HIC. Proposals must build on interventions with promising or proven effectiveness (including cost-effectiveness) for the respective population groups under defined contextual circumstances. Gender-responsive interventions should be addressed, wherever relevant.

The aim should be to adapt and upscale the implementation of these intervention(s) in accessible, affordable and equitable ways in order to improve the prevention and management of mental disorders in the community in medical health care, psychosocial, and public health and other settings and fields. Interventions should meet conditions and requirements of the local health and social system context and address any other contextual factors identified as possible barriers. When economic factors prevent access to effective, low-cost appropriate medication and other management and treatment modalities, proactive policy and strategies should be encouraged to ensure the availability of such medication or other management/treatment modality or means should be found to overcome these barriers.

Each proposal should:

• Focus on implementation research addressing prevention, and/or early identification and/or management strategies derived from existing knowledge about effective interventions.
• Include a strategy to test the proposed model of intervention and to address the socioeconomic and contextual factors of relevance to the targeted region and community.
• Lead to better understanding of key barriers and facilitators at local, national and international level that affect the prevention and management of mental disorders.
• Include health economics assessments as an integral part of the proposed research, including considerations of scalability and equity.
• Propose a pathway to embed the intervention into policy and practice addressing:
  • A strategy to include policy makers and local authorities (possibly by being part of the consortium), as well as other relevant stakeholders such as community groups, patient groups, formal and informal carers and any other group, where ever relevant from the beginning of the project, which will contribute to the sustainability of the intervention, after the end of project.
  • Relevance of project outcomes/evidence for scaling up the intervention at local, national and international level and then scaled-up appropriateness with respect to the local social, cultural and economic context.
  • Aspects of stigmatisation and potential equity gaps e.g. due to gender or age.

Proposal must address one of or combinations of the following items:

• Structural interventions or evidence based policies designed to improve mental health outcomes;
• Early case detection and other secondary or tertiary prevention strategies as well as modalities of treatment, care and access to care which are amenable to scale-up. Prevention, early identification and treatment may include validated pharmacological, psychotherapeutic, psychosocial support and other approaches of relevance to mental disorders such as accessibility to and enhancing compliance with the intervention, also considering cultural context. Wherever relevant, comorbidities and their impacts on prevention and treatment strategies should be taken into account;
• Ways to empower people with mental health problems as well as professional and informal care-givers like families according to the context are also relevant;
• Exploring the scale-up of family/community engagement in patient treatment and care, without pre-empting their living.

The Commission considers that proposals requesting a contribution from the EU of between EUR 1 and 3 million would allow this specific challenge to be addressed appropriately. Nonetheless, this does not preclude submission and selection of proposals requesting other amounts.

The Global Alliance for Chronic Diseases[[http://www.gacd.org/]] (GACD) call will focus on implementation research proposals on child, adolescent and adult age onset mental disorders[[Mental and behavioural disorders (FOO-F99) of WHO's International Statistical Classification of Diseases and Related Health Problems 10th Revision (lCD-l 0): http://apps.who.int/classifications/icd10/browse/2016/en#/V]] including, but not limited to, dementia, depression, schizophrenia, bipolar disorders, alcohol- and drug-use disorders, etc., in low- and middle-income countries (LMIC) and/or in vulnerable populations[[Applicants must demonstrate that the proposed population under investigation in HIC is considered as vulnerable.]] in high income countries (HIC).

Mental health is an integral part of health as underlined in the World Health Organisation (WHO) definition of health as a 'state of complete physical, mental and social well-being and not merely the absence of disease or infirmity'.

Mental disorders represent an ever-increasing burden, to all ages of the population, challenging mental health and health systems. Depression affects 350 million people in all communities across the world and represents the third leading contributor to the global disease burden[[WHO Fact sheet nr 369, 2012]]. Dementia affects 47.5 million people worldwide with 58% of people living with dementia in low- and middle-income countries[[WHO Fact sheet nr 362, 2015]]. Global costs associated with mental disorders were estimated to € 2.2 trillion in 2010 and are expected to rise to € 5.3 trillion by 2030[[Bloom, D.E. Cafiero, E.T. Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L.R. Fathima, S., Feigl, A.B. Gaziano, T., Mowafi, M., Pandya, A., Prettner, K., Rosenberg, L., Seligman, B., Stein, A.Z. & Weinstein, C. (2011).The Global Economic Burden of Noncommunicable Diseases. Geneva: World Economic Forum.]].

Mental disorders place a heavy burden on individuals, families, communities and societies. They also increase the risk of co-morbidities and social exclusion. There are obstacles to achieving effective prevention, early identification and management of mental disorders and to ensuring patients' adherence to therapies. Effective management approaches exist but their implementation in LMIC and vulnerable groups in HIC is hampered by socioeconomic and contextual factors: gender; the stigma associated with mental disorders at work, in health care and communities; the role of traditional medicine in dealing with mental health including trauma; and barriers to accessing care. There is a need to strengthen the evidence base for the contextual scalability of interventions of promising or proven effectiveness for the promotion of mental health and the early identification and management of patients, taking into account the needs of different population groups across the life course.

(one of or combinations of)

• Advance prevention strategies and implementation of mental health interventions, alleviating global burden of mental disorders;
• Establish the contextual effectiveness of mental health intervention(s), including at health systems level;
• Improve tailored prevention and treatment; Develop affordable management and treatment modalities for mental disorders and expand access to care;
• Inform health service providers, policy and decision makers on effective scaling up of mental health interventions at local, national and regional levels, including affordability aspects for users and health providers;
• Reduce health inequalities and inequities, including due consideration of gender and age issues where relevant, in the prevention, treatment and care of mental disorders at both local and global levels;
• Maximise the use of existing relevant programmes and platforms (e.g. research, data, and delivery platforms);
• Contribute to the United Nations' Sustainable Development Goals 3[[http://www.who.int/topics/sustainable-development-goals/targets/en/]], the Global Action Against Dementia and the First World Health Organisation (WHO) Ministerial Conference on Dementia[[http://www.who.int/mediacentre/events/meetings/2015/global-action-against-dementia/en/]], the WHO Mental Health Action Plan 2013-2020[[WHO Mental Health Action Plan 2013-2020, in particular Objective 2, global target 2 or Objective 3, global target 3: http://www.who.int/mental_health/action_plan_2013/en/;]], and/or the 2015 European Council Conclusions on dementia[[2015 European Council Conclusions on dementia: 'Living with dementia: improving care policies and practices': www.consilium.europa.eu/en/meetings/epsco/2015/12/st14968_en15_pdf/]].

The GACD aims to coordinate research on chronic diseases at global level in order to enhance knowledge exchange across individual projects, and to better understand the impact of socio-economic, cultural, geopolitical and policy on research findings, so as to appropriately adapt health interventions to different geographical, economic and cultural settings. Research under GACD involves regular exchange of research findings and information across participating projects by means of cross-project working groups and annual joint meetings. Wherever feasible, projects should harmonise and standardise their data collection and exchange data.

Applicants must budget for annual costs of having two team members participate in one annual face-to-face meeting of the Global Research Network (location to vary annually). Attendance at this meeting is mandatory for 2 team members, with at least one participant from the LMIC team where relevant. Teams are strongly encouraged to include one junior team member in each annual meeting.