[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.43,0:00:03.20,Default,,0000,0000,0000,,I want you to imagine this for a moment.
Dialogue: 0,0:00:03.20,0:00:06.10,Default,,0000,0000,0000,,Two men, Rahul and Rajiv,
Dialogue: 0,0:00:06.10,0:00:07.96,Default,,0000,0000,0000,,living in the same neighborhood,
Dialogue: 0,0:00:07.96,0:00:11.25,Default,,0000,0000,0000,,from the same educational background, similar occupation,
Dialogue: 0,0:00:11.25,0:00:14.02,Default,,0000,0000,0000,,and they both turn up at their local accident emergency
Dialogue: 0,0:00:14.02,0:00:16.84,Default,,0000,0000,0000,,complaining of acute chest pain.
Dialogue: 0,0:00:16.84,0:00:19.96,Default,,0000,0000,0000,,Rahul is offered a cardiac procedure,
Dialogue: 0,0:00:19.96,0:00:22.77,Default,,0000,0000,0000,,but Rajiv is sent home.
Dialogue: 0,0:00:22.77,0:00:25.28,Default,,0000,0000,0000,,What might explain the difference in the experience
Dialogue: 0,0:00:25.28,0:00:28.53,Default,,0000,0000,0000,,of these two nearly identical men?
Dialogue: 0,0:00:28.53,0:00:32.02,Default,,0000,0000,0000,,Rajiv suffers from a mental illness.
Dialogue: 0,0:00:32.02,0:00:35.12,Default,,0000,0000,0000,,The difference in the quality of medical care
Dialogue: 0,0:00:35.12,0:00:37.98,Default,,0000,0000,0000,,received by people with mental illness is one of the reasons
Dialogue: 0,0:00:37.98,0:00:39.90,Default,,0000,0000,0000,,why they live shorter lives
Dialogue: 0,0:00:39.90,0:00:41.48,Default,,0000,0000,0000,,than people without mental illness.
Dialogue: 0,0:00:41.48,0:00:44.15,Default,,0000,0000,0000,,Even in the best-resourced countries in the world,
Dialogue: 0,0:00:44.15,0:00:48.92,Default,,0000,0000,0000,,this life expectancy gap is as much as 20 years.
Dialogue: 0,0:00:48.92,0:00:50.84,Default,,0000,0000,0000,,In the developing countries of the world, this gap
Dialogue: 0,0:00:50.84,0:00:53.47,Default,,0000,0000,0000,,is even larger.
Dialogue: 0,0:00:53.47,0:00:56.33,Default,,0000,0000,0000,,But of course, mental illnesses can kill in more direct ways
Dialogue: 0,0:00:56.33,0:00:59.69,Default,,0000,0000,0000,,as well. The most obvious example is suicide.
Dialogue: 0,0:00:59.69,0:01:02.34,Default,,0000,0000,0000,,It might surprise some of you here, as it did me,
Dialogue: 0,0:01:02.34,0:01:05.28,Default,,0000,0000,0000,,when I discovered that suicide is at the top of the list
Dialogue: 0,0:01:05.28,0:01:07.84,Default,,0000,0000,0000,,of the leading causes of death in young people
Dialogue: 0,0:01:07.84,0:01:09.49,Default,,0000,0000,0000,,in all countries in the world,
Dialogue: 0,0:01:09.49,0:01:12.88,Default,,0000,0000,0000,,including the poorest countries of the world.
Dialogue: 0,0:01:12.88,0:01:15.72,Default,,0000,0000,0000,,But beyond the impact of a health condition
Dialogue: 0,0:01:15.72,0:01:18.09,Default,,0000,0000,0000,,on life expectancy, we're also concerned
Dialogue: 0,0:01:18.09,0:01:20.78,Default,,0000,0000,0000,,about the quality of life lived.
Dialogue: 0,0:01:20.78,0:01:23.03,Default,,0000,0000,0000,,Now, in order for us to examine the overall impact
Dialogue: 0,0:01:23.03,0:01:25.40,Default,,0000,0000,0000,,of a health condition both on life expectancy
Dialogue: 0,0:01:25.40,0:01:28.56,Default,,0000,0000,0000,,as well as on the quality of life lived, we need to use
Dialogue: 0,0:01:28.56,0:01:29.95,Default,,0000,0000,0000,,a metric called the DALY,
Dialogue: 0,0:01:29.95,0:01:34.24,Default,,0000,0000,0000,,which stands for a Disability-Adjusted Life Year.
Dialogue: 0,0:01:34.24,0:01:36.76,Default,,0000,0000,0000,,Now when we do that, we discover some startling things
Dialogue: 0,0:01:36.76,0:01:39.58,Default,,0000,0000,0000,,about mental illness from a global perspective.
Dialogue: 0,0:01:39.58,0:01:42.84,Default,,0000,0000,0000,,We discover that, for example, mental illnesses are
Dialogue: 0,0:01:42.84,0:01:47.43,Default,,0000,0000,0000,,amongst the leading causes of disability around the world.
Dialogue: 0,0:01:47.43,0:01:50.17,Default,,0000,0000,0000,,Depression, for example, is the third-leading cause
Dialogue: 0,0:01:50.17,0:01:53.14,Default,,0000,0000,0000,,of disability, alongside conditions such as
Dialogue: 0,0:01:53.14,0:01:56.49,Default,,0000,0000,0000,,diarrhea and pneumonia in children.
Dialogue: 0,0:01:56.49,0:01:58.59,Default,,0000,0000,0000,,When you put all the mental illnesses together,
Dialogue: 0,0:01:58.59,0:02:00.86,Default,,0000,0000,0000,,they account for roughly 15 percent
Dialogue: 0,0:02:00.86,0:02:04.06,Default,,0000,0000,0000,,of the total global burden of disease.
Dialogue: 0,0:02:04.06,0:02:08.57,Default,,0000,0000,0000,,Indeed, mental illnesses are also very damaging
Dialogue: 0,0:02:08.57,0:02:14.02,Default,,0000,0000,0000,,to people's lives, but beyond just the burden of disease,
Dialogue: 0,0:02:14.02,0:02:16.73,Default,,0000,0000,0000,,let us consider the absolute numbers.
Dialogue: 0,0:02:16.73,0:02:18.79,Default,,0000,0000,0000,,The World Health Organization estimates
Dialogue: 0,0:02:18.79,0:02:21.89,Default,,0000,0000,0000,,that there are nearly four to five hundred million people
Dialogue: 0,0:02:21.89,0:02:24.08,Default,,0000,0000,0000,,living on our tiny planet
Dialogue: 0,0:02:24.08,0:02:25.74,Default,,0000,0000,0000,,who are affected by a mental illness.
Dialogue: 0,0:02:25.74,0:02:27.46,Default,,0000,0000,0000,,Now some of you here
Dialogue: 0,0:02:27.46,0:02:30.06,Default,,0000,0000,0000,,look a bit astonished by that number,
Dialogue: 0,0:02:30.06,0:02:32.55,Default,,0000,0000,0000,,but consider for a moment the incredible diversity
Dialogue: 0,0:02:32.55,0:02:35.70,Default,,0000,0000,0000,,of mental illnesses, from autism and intellectual disability
Dialogue: 0,0:02:35.70,0:02:38.38,Default,,0000,0000,0000,,in childhood, through to depression and anxiety,
Dialogue: 0,0:02:38.38,0:02:40.66,Default,,0000,0000,0000,,substance misuse and psychosis in adulthood,
Dialogue: 0,0:02:40.66,0:02:42.30,Default,,0000,0000,0000,,all the way through to dementia in old age,
Dialogue: 0,0:02:42.30,0:02:45.25,Default,,0000,0000,0000,,and I'm pretty sure that each and every one us
Dialogue: 0,0:02:45.25,0:02:48.61,Default,,0000,0000,0000,,present here today can think of at least one person,
Dialogue: 0,0:02:48.61,0:02:51.93,Default,,0000,0000,0000,,at least one person, who's affected by mental illness
Dialogue: 0,0:02:51.93,0:02:56.36,Default,,0000,0000,0000,,in our most intimate social networks.
Dialogue: 0,0:02:56.36,0:02:59.56,Default,,0000,0000,0000,,I see some nodding heads there.
Dialogue: 0,0:02:59.56,0:03:02.53,Default,,0000,0000,0000,,But beyond the staggering numbers,
Dialogue: 0,0:03:02.53,0:03:05.54,Default,,0000,0000,0000,,what's truly important from a global health point of view,
Dialogue: 0,0:03:05.54,0:03:08.09,Default,,0000,0000,0000,,what's truly worrying from a global health point of view,
Dialogue: 0,0:03:08.09,0:03:11.26,Default,,0000,0000,0000,,is that the vast majority of these affected individuals
Dialogue: 0,0:03:11.26,0:03:13.26,Default,,0000,0000,0000,,do not receive the care
Dialogue: 0,0:03:13.26,0:03:15.73,Default,,0000,0000,0000,,that we know can transform their lives, and remember,
Dialogue: 0,0:03:15.73,0:03:18.79,Default,,0000,0000,0000,,we do have robust evidence that a range of interventions,
Dialogue: 0,0:03:18.79,0:03:21.24,Default,,0000,0000,0000,,medicines, psychological interventions,
Dialogue: 0,0:03:21.24,0:03:24.73,Default,,0000,0000,0000,,and social interventions, can make a vast difference.
Dialogue: 0,0:03:24.73,0:03:26.98,Default,,0000,0000,0000,,And yet, even in the best-resourced countries,
Dialogue: 0,0:03:26.98,0:03:29.92,Default,,0000,0000,0000,,for example here in Europe, roughly 50 percent
Dialogue: 0,0:03:29.92,0:03:33.04,Default,,0000,0000,0000,,of affected people don't receive these interventions.
Dialogue: 0,0:03:33.04,0:03:35.35,Default,,0000,0000,0000,,In the sorts of countries I work in,
Dialogue: 0,0:03:35.35,0:03:37.50,Default,,0000,0000,0000,,that so-called treatment gap
Dialogue: 0,0:03:37.50,0:03:42.39,Default,,0000,0000,0000,,approaches an astonishing 90 percent.
Dialogue: 0,0:03:42.39,0:03:45.60,Default,,0000,0000,0000,,It isn't surprising, then, that if you should speak
Dialogue: 0,0:03:45.60,0:03:48.03,Default,,0000,0000,0000,,to anyone affected by a mental illness,
Dialogue: 0,0:03:48.03,0:03:50.84,Default,,0000,0000,0000,,the chances are that you will hear stories
Dialogue: 0,0:03:50.84,0:03:54.89,Default,,0000,0000,0000,,of hidden suffering, shame and discrimination
Dialogue: 0,0:03:54.89,0:03:57.84,Default,,0000,0000,0000,,in nearly every sector of their lives.
Dialogue: 0,0:03:57.84,0:04:00.55,Default,,0000,0000,0000,,But perhaps most heartbreaking of all
Dialogue: 0,0:04:00.55,0:04:03.24,Default,,0000,0000,0000,,are the stories of the abuse
Dialogue: 0,0:04:03.24,0:04:05.77,Default,,0000,0000,0000,,of even the most basic human rights,
Dialogue: 0,0:04:05.77,0:04:08.63,Default,,0000,0000,0000,,such as the young woman shown in this image here
Dialogue: 0,0:04:08.63,0:04:10.70,Default,,0000,0000,0000,,that are played out every day,
Dialogue: 0,0:04:10.70,0:04:14.64,Default,,0000,0000,0000,,sadly, even in the very institutions that were built to care
Dialogue: 0,0:04:14.64,0:04:18.47,Default,,0000,0000,0000,,for people with mental illnesses, the mental hospitals.
Dialogue: 0,0:04:18.47,0:04:21.50,Default,,0000,0000,0000,,It's this injustice that has really driven my mission
Dialogue: 0,0:04:21.50,0:04:23.89,Default,,0000,0000,0000,,to try to do a little bit to transform the lives
Dialogue: 0,0:04:23.89,0:04:26.64,Default,,0000,0000,0000,,of people affected by mental illness, and a particularly
Dialogue: 0,0:04:26.64,0:04:30.49,Default,,0000,0000,0000,,critical action that I focused on is to bridge the gulf
Dialogue: 0,0:04:30.49,0:04:33.28,Default,,0000,0000,0000,,between the knowledge we have that can transform lives,
Dialogue: 0,0:04:33.28,0:04:35.72,Default,,0000,0000,0000,,the knowledge of effective treatments, and how we actually
Dialogue: 0,0:04:35.72,0:04:39.14,Default,,0000,0000,0000,,use that knowledge in the everyday world.
Dialogue: 0,0:04:39.14,0:04:42.30,Default,,0000,0000,0000,,And an especially important challenge that I've had to face
Dialogue: 0,0:04:42.30,0:04:45.22,Default,,0000,0000,0000,,is the great shortage of mental health professionals,
Dialogue: 0,0:04:45.22,0:04:46.90,Default,,0000,0000,0000,,such as psychiatrists and psychologists,
Dialogue: 0,0:04:46.90,0:04:49.68,Default,,0000,0000,0000,,particularly in the developing world.
Dialogue: 0,0:04:49.68,0:04:52.37,Default,,0000,0000,0000,,Now I trained in medicine in India, and after that
Dialogue: 0,0:04:52.37,0:04:55.79,Default,,0000,0000,0000,,I chose psychiatry as my specialty, much to the dismay
Dialogue: 0,0:04:55.79,0:04:58.02,Default,,0000,0000,0000,,of my mother and all my family members who
Dialogue: 0,0:04:58.02,0:04:59.72,Default,,0000,0000,0000,,kind of thought neurosurgery would be
Dialogue: 0,0:04:59.72,0:05:02.89,Default,,0000,0000,0000,,a more respectable option for their brilliant son.
Dialogue: 0,0:05:02.89,0:05:05.62,Default,,0000,0000,0000,,Any case, I went on, I soldiered on with psychiatry,
Dialogue: 0,0:05:05.62,0:05:07.92,Default,,0000,0000,0000,,and found myself training in Britain in some of
Dialogue: 0,0:05:07.92,0:05:10.29,Default,,0000,0000,0000,,the best hospitals in this country. I was very privileged.
Dialogue: 0,0:05:10.29,0:05:13.83,Default,,0000,0000,0000,,I worked in a team of incredibly talented, compassionate,
Dialogue: 0,0:05:13.83,0:05:17.08,Default,,0000,0000,0000,,but most importantly, highly trained, specialized
Dialogue: 0,0:05:17.08,0:05:19.28,Default,,0000,0000,0000,,mental health professionals.
Dialogue: 0,0:05:19.28,0:05:21.25,Default,,0000,0000,0000,,Soon after my training, I found myself working
Dialogue: 0,0:05:21.25,0:05:23.69,Default,,0000,0000,0000,,first in Zimbabwe and then in India, and I was confronted
Dialogue: 0,0:05:23.69,0:05:26.55,Default,,0000,0000,0000,,by an altogether new reality.
Dialogue: 0,0:05:26.55,0:05:29.90,Default,,0000,0000,0000,,This was a reality of a world in which there were almost no
Dialogue: 0,0:05:29.90,0:05:32.26,Default,,0000,0000,0000,,mental health professionals at all.
Dialogue: 0,0:05:32.26,0:05:34.30,Default,,0000,0000,0000,,In Zimbabwe, for example, there were just about
Dialogue: 0,0:05:34.30,0:05:37.36,Default,,0000,0000,0000,,a dozen psychiatrists, most of whom lived and worked
Dialogue: 0,0:05:37.36,0:05:39.48,Default,,0000,0000,0000,,in Harare city, leaving only a couple
Dialogue: 0,0:05:39.48,0:05:41.88,Default,,0000,0000,0000,,to address the mental health care needs
Dialogue: 0,0:05:41.88,0:05:45.54,Default,,0000,0000,0000,,of nine million people living in the countryside.
Dialogue: 0,0:05:45.54,0:05:49.16,Default,,0000,0000,0000,,In India, I found the situation was not a lot better.
Dialogue: 0,0:05:49.16,0:05:51.58,Default,,0000,0000,0000,,To give you a perspective, if I had to translate
Dialogue: 0,0:05:51.58,0:05:53.79,Default,,0000,0000,0000,,the proportion of psychiatrists in the population
Dialogue: 0,0:05:53.79,0:05:56.17,Default,,0000,0000,0000,,that one might see in Britain to India,
Dialogue: 0,0:05:56.17,0:06:01.78,Default,,0000,0000,0000,,one might expect roughly 150,000 psychiatrists in India.
Dialogue: 0,0:06:01.78,0:06:04.81,Default,,0000,0000,0000,,In reality, take a guess.
Dialogue: 0,0:06:04.81,0:06:07.38,Default,,0000,0000,0000,,The actual number is about 3,000,
Dialogue: 0,0:06:07.38,0:06:09.84,Default,,0000,0000,0000,,about two percent of that number.
Dialogue: 0,0:06:09.84,0:06:12.34,Default,,0000,0000,0000,,It became quickly apparent to me that I couldn't follow
Dialogue: 0,0:06:12.34,0:06:15.40,Default,,0000,0000,0000,,the sorts of mental health care models that I had been trained in,
Dialogue: 0,0:06:15.40,0:06:18.34,Default,,0000,0000,0000,,one that relied heavily on specialized, expensive
Dialogue: 0,0:06:18.34,0:06:20.87,Default,,0000,0000,0000,,mental health professionals to provide mental health care
Dialogue: 0,0:06:20.87,0:06:23.33,Default,,0000,0000,0000,,in countries like India and Zimbabwe.
Dialogue: 0,0:06:23.33,0:06:25.98,Default,,0000,0000,0000,,I had to think out of the box about some other model
Dialogue: 0,0:06:25.98,0:06:27.61,Default,,0000,0000,0000,,of care.
Dialogue: 0,0:06:27.61,0:06:30.72,Default,,0000,0000,0000,,It was then that I came across these books,
Dialogue: 0,0:06:30.72,0:06:33.96,Default,,0000,0000,0000,,and in these books I discovered the idea of task shifting
Dialogue: 0,0:06:33.96,0:06:36.03,Default,,0000,0000,0000,,in global health.
Dialogue: 0,0:06:36.03,0:06:38.31,Default,,0000,0000,0000,,The idea is actually quite simple. The idea is,
Dialogue: 0,0:06:38.31,0:06:41.32,Default,,0000,0000,0000,,when you're short of specialized health care professionals,
Dialogue: 0,0:06:41.32,0:06:44.37,Default,,0000,0000,0000,,use whoever is available in the community,
Dialogue: 0,0:06:44.37,0:06:47.31,Default,,0000,0000,0000,,train them to provide a range of health care interventions,
Dialogue: 0,0:06:47.31,0:06:50.18,Default,,0000,0000,0000,,and in these books I read inspiring examples,
Dialogue: 0,0:06:50.18,0:06:53.11,Default,,0000,0000,0000,,for example of how ordinary people had been trained
Dialogue: 0,0:06:53.11,0:06:54.46,Default,,0000,0000,0000,,to deliver babies,
Dialogue: 0,0:06:54.46,0:06:58.10,Default,,0000,0000,0000,,diagnose and treat early pneumonia, to great effect.
Dialogue: 0,0:06:58.10,0:07:00.85,Default,,0000,0000,0000,,And it struck me that if you could train ordinary people
Dialogue: 0,0:07:00.85,0:07:03.07,Default,,0000,0000,0000,,to deliver such complex health care interventions,
Dialogue: 0,0:07:03.07,0:07:05.14,Default,,0000,0000,0000,,then perhaps they could also do the same
Dialogue: 0,0:07:05.14,0:07:07.14,Default,,0000,0000,0000,,with mental health care.
Dialogue: 0,0:07:07.14,0:07:10.00,Default,,0000,0000,0000,,Well today, I'm very pleased to report to you
Dialogue: 0,0:07:10.00,0:07:13.12,Default,,0000,0000,0000,,that there have been many experiments in task shifting
Dialogue: 0,0:07:13.12,0:07:15.89,Default,,0000,0000,0000,,in mental health care across the developing world
Dialogue: 0,0:07:15.89,0:07:17.95,Default,,0000,0000,0000,,over the past decade, and I want to share with you
Dialogue: 0,0:07:17.95,0:07:20.65,Default,,0000,0000,0000,,the findings of three particular such experiments,
Dialogue: 0,0:07:20.65,0:07:22.73,Default,,0000,0000,0000,,all three of which focused on depression,
Dialogue: 0,0:07:22.73,0:07:25.17,Default,,0000,0000,0000,,the most common of all mental illnesses.
Dialogue: 0,0:07:25.17,0:07:28.51,Default,,0000,0000,0000,,In rural Uganda, Paul Bolton and his colleagues,
Dialogue: 0,0:07:28.51,0:07:32.36,Default,,0000,0000,0000,,using villagers, demonstrated that they could deliver
Dialogue: 0,0:07:32.36,0:07:34.71,Default,,0000,0000,0000,,interpersonal psychotherapy for depression
Dialogue: 0,0:07:34.71,0:07:37.38,Default,,0000,0000,0000,,and, using a randomized control design,
Dialogue: 0,0:07:37.38,0:07:39.63,Default,,0000,0000,0000,,showed that 90 percent of the people receiving
Dialogue: 0,0:07:39.63,0:07:41.59,Default,,0000,0000,0000,,this intervention recovered as compared
Dialogue: 0,0:07:41.59,0:07:45.13,Default,,0000,0000,0000,,to roughly 40 percent in the comparison villages.
Dialogue: 0,0:07:45.13,0:07:49.27,Default,,0000,0000,0000,,Similarly, using a randomized control trial in rural Pakistan,
Dialogue: 0,0:07:49.27,0:07:51.61,Default,,0000,0000,0000,,Atif Rahman and his colleagues showed
Dialogue: 0,0:07:51.61,0:07:54.34,Default,,0000,0000,0000,,that lady health visitors, who are community maternal
Dialogue: 0,0:07:54.34,0:07:57.13,Default,,0000,0000,0000,,health workers in Pakistan's health care system,
Dialogue: 0,0:07:57.13,0:07:59.35,Default,,0000,0000,0000,,could deliver cognitive behavior therapy for mothers
Dialogue: 0,0:07:59.35,0:08:01.86,Default,,0000,0000,0000,,who were depressed, again showing dramatic differences
Dialogue: 0,0:08:01.86,0:08:04.70,Default,,0000,0000,0000,,in the recovery rates. Roughly 75 percent of mothers
Dialogue: 0,0:08:04.70,0:08:07.27,Default,,0000,0000,0000,,recovered as compared to about 45 percent
Dialogue: 0,0:08:07.27,0:08:09.55,Default,,0000,0000,0000,,in the comparison villages.
Dialogue: 0,0:08:09.55,0:08:12.64,Default,,0000,0000,0000,,And in my own trial in Goa, in India, we again showed
Dialogue: 0,0:08:12.64,0:08:15.17,Default,,0000,0000,0000,,that lay counselors drawn from local communities
Dialogue: 0,0:08:15.17,0:08:17.85,Default,,0000,0000,0000,,could be trained to deliver psychosocial interventions
Dialogue: 0,0:08:17.85,0:08:20.43,Default,,0000,0000,0000,,for depression, anxiety, leading to 70 percent
Dialogue: 0,0:08:20.43,0:08:22.52,Default,,0000,0000,0000,,recovery rates as compared to 50 percent
Dialogue: 0,0:08:22.52,0:08:25.72,Default,,0000,0000,0000,,in the comparison primary health centers.
Dialogue: 0,0:08:25.72,0:08:27.69,Default,,0000,0000,0000,,Now, if I had to draw together all these different
Dialogue: 0,0:08:27.69,0:08:30.22,Default,,0000,0000,0000,,experiments in task shifting, and there have of course
Dialogue: 0,0:08:30.22,0:08:32.60,Default,,0000,0000,0000,,been many other examples, and try and identify
Dialogue: 0,0:08:32.60,0:08:34.62,Default,,0000,0000,0000,,what are the key lessons we can learn that makes
Dialogue: 0,0:08:34.62,0:08:37.69,Default,,0000,0000,0000,,for a successful task shifting operation,
Dialogue: 0,0:08:37.69,0:08:41.55,Default,,0000,0000,0000,,I have coined this particular acronym, SUNDAR.
Dialogue: 0,0:08:41.55,0:08:45.78,Default,,0000,0000,0000,,What SUNDAR stands for, in Hindi, is "attractive."
Dialogue: 0,0:08:45.78,0:08:47.100,Default,,0000,0000,0000,,It seems to me that there are five key lessons
Dialogue: 0,0:08:47.100,0:08:50.60,Default,,0000,0000,0000,,that I've shown on this slide that are critically important
Dialogue: 0,0:08:50.60,0:08:52.78,Default,,0000,0000,0000,,for effective task shifting.
Dialogue: 0,0:08:52.78,0:08:55.81,Default,,0000,0000,0000,,The first is that we need to simplify the message
Dialogue: 0,0:08:55.81,0:08:58.19,Default,,0000,0000,0000,,that we're using, stripping away all the jargon
Dialogue: 0,0:08:58.19,0:09:01.51,Default,,0000,0000,0000,,that medicine has invented around itself.
Dialogue: 0,0:09:01.51,0:09:04.47,Default,,0000,0000,0000,,We need to unpack complex health care interventions
Dialogue: 0,0:09:04.47,0:09:06.70,Default,,0000,0000,0000,,into smaller components that can be more easily
Dialogue: 0,0:09:06.70,0:09:09.35,Default,,0000,0000,0000,,transferred to less-trained individuals.
Dialogue: 0,0:09:09.35,0:09:11.92,Default,,0000,0000,0000,,We need to deliver health care, not in large institutions,
Dialogue: 0,0:09:11.92,0:09:14.14,Default,,0000,0000,0000,,but close to people's homes, and we need to deliver
Dialogue: 0,0:09:14.14,0:09:16.92,Default,,0000,0000,0000,,health care using whoever is available and affordable
Dialogue: 0,0:09:16.92,0:09:19.30,Default,,0000,0000,0000,,in our local communities.
Dialogue: 0,0:09:19.30,0:09:22.18,Default,,0000,0000,0000,,And importantly, we need to reallocate the few specialists
Dialogue: 0,0:09:22.18,0:09:24.24,Default,,0000,0000,0000,,who are available to perform roles
Dialogue: 0,0:09:24.24,0:09:27.72,Default,,0000,0000,0000,,such as capacity-building and supervision.
Dialogue: 0,0:09:27.72,0:09:30.06,Default,,0000,0000,0000,,Now for me, task shifting is an idea
Dialogue: 0,0:09:30.06,0:09:33.01,Default,,0000,0000,0000,,with truly global significance,
Dialogue: 0,0:09:33.01,0:09:35.55,Default,,0000,0000,0000,,because even though it has arisen out of the
Dialogue: 0,0:09:35.55,0:09:39.04,Default,,0000,0000,0000,,situation of the lack of resources that you find
Dialogue: 0,0:09:39.04,0:09:42.00,Default,,0000,0000,0000,,in developing countries, I think it has a lot of significance
Dialogue: 0,0:09:42.00,0:09:44.88,Default,,0000,0000,0000,,for better-resourced countries as well. Why is that?
Dialogue: 0,0:09:44.88,0:09:48.40,Default,,0000,0000,0000,,Well, in part, because health care in the developed world,
Dialogue: 0,0:09:48.40,0:09:50.88,Default,,0000,0000,0000,,the health care costs in the [developed] world,
Dialogue: 0,0:09:50.88,0:09:53.46,Default,,0000,0000,0000,,are rapidly spiraling out of control, and a huge chunk
Dialogue: 0,0:09:53.46,0:09:56.88,Default,,0000,0000,0000,,of those costs are human resource costs.
Dialogue: 0,0:09:56.88,0:09:59.36,Default,,0000,0000,0000,,But equally important is because health care has become
Dialogue: 0,0:09:59.36,0:10:03.20,Default,,0000,0000,0000,,so incredibly professionalized that it's become very remote
Dialogue: 0,0:10:03.20,0:10:05.96,Default,,0000,0000,0000,,and removed from local communities.
Dialogue: 0,0:10:05.96,0:10:09.68,Default,,0000,0000,0000,,For me, what's truly sundar about the idea of task shifting,
Dialogue: 0,0:10:09.68,0:10:11.32,Default,,0000,0000,0000,,though, isn't that it simply makes health care
Dialogue: 0,0:10:11.32,0:10:14.48,Default,,0000,0000,0000,,more accessible and affordable but that
Dialogue: 0,0:10:14.48,0:10:17.04,Default,,0000,0000,0000,,it is also fundamentally empowering.
Dialogue: 0,0:10:17.04,0:10:20.67,Default,,0000,0000,0000,,It empowers ordinary people to be more effective
Dialogue: 0,0:10:20.67,0:10:23.49,Default,,0000,0000,0000,,in caring for the health of others in their community,
Dialogue: 0,0:10:23.49,0:10:24.98,Default,,0000,0000,0000,,and in doing so, to become better guardians
Dialogue: 0,0:10:24.98,0:10:28.26,Default,,0000,0000,0000,,of their own health. Indeed, for me, task shifting
Dialogue: 0,0:10:28.26,0:10:30.95,Default,,0000,0000,0000,,is the ultimate example of the democratization
Dialogue: 0,0:10:30.95,0:10:36.20,Default,,0000,0000,0000,,of medical knowledge, and therefore, medical power.
Dialogue: 0,0:10:36.20,0:10:39.65,Default,,0000,0000,0000,,Just over 30 years ago, the nations of the world assembled
Dialogue: 0,0:10:39.65,0:10:42.62,Default,,0000,0000,0000,,at Alma-Ata and made this iconic declaration.
Dialogue: 0,0:10:42.62,0:10:44.23,Default,,0000,0000,0000,,Well, I think all of you can guess
Dialogue: 0,0:10:44.23,0:10:47.94,Default,,0000,0000,0000,,that 12 years on, we're still nowhere near that goal.
Dialogue: 0,0:10:47.94,0:10:50.61,Default,,0000,0000,0000,,Still, today, armed with that knowledge
Dialogue: 0,0:10:50.61,0:10:53.26,Default,,0000,0000,0000,,that ordinary people in the community
Dialogue: 0,0:10:53.26,0:10:56.43,Default,,0000,0000,0000,,can be trained and, with sufficient supervision and support,
Dialogue: 0,0:10:56.43,0:10:59.70,Default,,0000,0000,0000,,can deliver a range of health care interventions effectively,
Dialogue: 0,0:10:59.70,0:11:03.58,Default,,0000,0000,0000,,perhaps that promise is within reach now.
Dialogue: 0,0:11:03.58,0:11:07.22,Default,,0000,0000,0000,,Indeed, to implement the slogan of Health for All,
Dialogue: 0,0:11:07.22,0:11:09.01,Default,,0000,0000,0000,,we will need to involve all
Dialogue: 0,0:11:09.01,0:11:10.67,Default,,0000,0000,0000,,in that particular journey,
Dialogue: 0,0:11:10.67,0:11:13.62,Default,,0000,0000,0000,,and in the case of mental health, in particular we would
Dialogue: 0,0:11:13.62,0:11:16.52,Default,,0000,0000,0000,,need to involve people who are affected by mental illness
Dialogue: 0,0:11:16.52,0:11:17.97,Default,,0000,0000,0000,,and their caregivers.
Dialogue: 0,0:11:17.97,0:11:20.51,Default,,0000,0000,0000,,It is for this reason that, some years ago,
Dialogue: 0,0:11:20.51,0:11:22.43,Default,,0000,0000,0000,,the Movement for Global Mental Health was founded
Dialogue: 0,0:11:22.43,0:11:26.45,Default,,0000,0000,0000,,as a sort of a virtual platform upon which professionals
Dialogue: 0,0:11:26.45,0:11:29.26,Default,,0000,0000,0000,,like myself and people affected by mental illness
Dialogue: 0,0:11:29.26,0:11:31.97,Default,,0000,0000,0000,,could stand together, shoulder-to-shoulder,
Dialogue: 0,0:11:31.97,0:11:34.45,Default,,0000,0000,0000,,and advocate for the rights of people with mental illness
Dialogue: 0,0:11:34.45,0:11:37.67,Default,,0000,0000,0000,,to receive the care that we know can transform their lives,
Dialogue: 0,0:11:37.67,0:11:40.68,Default,,0000,0000,0000,,and to live a life with dignity.
Dialogue: 0,0:11:40.68,0:11:44.20,Default,,0000,0000,0000,,And in closing, when you have a moment of peace or quiet
Dialogue: 0,0:11:44.20,0:11:47.02,Default,,0000,0000,0000,,in these very busy few days or perhaps afterwards,
Dialogue: 0,0:11:47.02,0:11:49.78,Default,,0000,0000,0000,,spare a thought for that person you thought about
Dialogue: 0,0:11:49.78,0:11:52.35,Default,,0000,0000,0000,,who has a mental illness, or persons that you thought about
Dialogue: 0,0:11:52.35,0:11:53.94,Default,,0000,0000,0000,,who have mental illness,
Dialogue: 0,0:11:53.94,0:11:57.75,Default,,0000,0000,0000,,and dare to care for them. Thank you. (Applause)
Dialogue: 0,0:11:57.75,0:12:01.81,Default,,0000,0000,0000,,(Applause)