Baseline situational analysis in Bangladesh, Jordan, Paraguay, the Philippines, Ukraine, and Zimbabwe for the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health.

INTRODUCTION: Mental, neurological and substance use conditions lead to tremendous suffering, yet globally access to effective care is limited. In line with the 13th General Programme of Work (GPW 13), in 2019 the World Health Organization (WHO) launched the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health to advance mental health policies, advocacy, and human rights and to scale up access to quality and affordable care for people living with mental health conditions. Six countries were selected as 'early-adopter' countries for the WHO Special Initiative for Mental Health in the initial phase. Our objective was to rapidly and comprehensively assess the strength of mental health systems in each country with the goal of informing national priority-setting at the outset of the Initiative. METHODS: We used a modified version of the Program for Improving Mental Health Care (PRIME) situational analysis tool. We used a participatory process to document national demographic and population health characteristics; environmental, sociopolitical, and health-related threats; the status of mental health policies and plans; the prevalence of mental disorders and treatment coverage; and the availability of resources for mental health. RESULTS: Each country had distinct needs, though several common themes emerged. Most were dealing with crises with serious implications for population mental health. None had sufficient mental health services to meet their needs. All aimed to decentralize and deinstitutionalize mental health services, to integrate mental health care into primary health care, and to devote more financial and human resources to mental health systems. All cited insufficient and inequitably distributed specialist human resources for mental health as a major impediment. CONCLUSIONS: This rapid assessment facilitated priority-setting for mental health system strengthening by national stakeholders. Next steps include convening design workshops in each country and initiating monitoring and evaluation procedures.

"Being a Person of Color in This Institution Is Exhausting": Defining and Optimizing the Learning Climate to Support Diversity, Equity, and Inclusion at the University of Washington School of Public Health.

Learning climate greatly affects student achievement. This qualitative study aimed to understand community definitions of climate; share lived experiences of students, faculty, and staff; and define priority areas of improvement in the University of Washington School of Public Health (UWSPH). Between March-May 2019, 17 focus group discussions were conducted-stratified by role and self-identified race/ethnicity, gender and sexual orientation-among 28 faculty/staff and 36 students. Topics included: assessing the current climate, recounting experiences related to roles and identities, and recommending improvements. Transcripts were coded using deductive and inductive approaches. Race/ethnicity, gender, and sexual orientation appeared to affect perceptions of the climate, with nearly all respondents from underrepresented or minoritized groups recounting negative experiences related to their identity. Persons of color, women, and other respondents who identified as lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual (LGBTQIA) frequently perceived the climate as "uncomfortable." Most felt that UWSPH operates within a structural hierarchy that perpetuates white, male, and/or class privilege and "protects those in power" while leaving underrepresented or minoritized groups feeling like "the way to move up… is to conform" in order to not be seen as "someone pushing against the system." Improvement priorities included: increasing community responsiveness to diversity, equity, and inclusion; intentionally diversifying faculty/staff and student populations; designing inclusive curricula; and supporting underrepresented or minoritized groups academically, professionally, and psychologically.