The CAPE (Compassion, Assertive Action, Pragmatism, and Evidence) vulnerability index - Second Edition: Putting mental health into foreign policy to address globalization, conflict, climate change, and natural disasters.

Background: The CAPE Vulnerability Index serves as a worldwide foreign policy indicator that implies which countries should get assistance first. It provides an evidence-based, well-structured, and well-reasoned strategy for employing aid in bilateral arrangements with mental health as a basis. Objective: The second edition of the CAPE VI has been developed to identify which nations should get priority foreign aid. Materials and Methods: We considered various indices or measures at the country level reflecting the average national health status or factors influencing public health. To make our choice, we used 26 internationally accessible and verified indicators. For the study, we have scored the countries according to these indices and prioritized those with the worst scores. Results: The CAPE Vulnerability Index is based on the number of times a country is ranked among the low-scoring nations. It is based on nine parameters and is an independent measure even though there may be a correlation with similar indices such as life expectancy, disability-adjusted life years(DALYs), physician numbers, and gross domestic product(GDP). Conclusion: We concluded that low-scoring countries were fragile or failed states, such as nations where governments lack complete oversight or power, are often oppressive and corrupt, have allegations of violations of human rights, or are marked by political turmoil in different forms, drawbacks from severe environmental damage, severe impoverishment, inequalities, cultural and racial divisions, cannot supply fundamental amenities, are victims of terrorism, and so on. To address these essential problems impacting fragile nations, administrations, aid donors, local organizations, mental health specialists, and associations should collaborate.

Índice de vulnerabilidad CAPE: Compasión, Acción Asertiva, Pragmatismo y Evidencia - Versión para América Latina y el Caribe (CAPE VI - LAC) "Globalización, conflicto, cambio climático, desastres naturales: poner la salud mental en la política exterior" / CAPE Vulnerability Index: Compassion, Assertive Action, Pragmatism and Evidence - Version for Latin America and the Caribbean (CAPE VI - LAC) "Globalisation, conflict, climate change, natural disasters: putting mental health into foreign policy"

Introducción: El índice de vulnerabilidad CAPE es un índice global de política exterior que identifica a los países a los que se dará prioridad para recibir ayuda exterior. Ofrece un enfoque evidenciado, estructurado y razonado para utilizar la ayuda en acuerdos bilaterales con la salud mental como base. La presente versión está diseñada específicamente para la región de América Latina y el Caribe (ALC), que comprende 33 países. Objetivos: Identificar los países a ser priorizados para la ayuda externa, a través de la versión ALC del Índice de Vulnerabilidad CAPE (CAPE VI-LAC). Materiales y métodos: Al igual que con la versión global del Índice de Vulnerabilidad CAPE, consideramos varios índices o medidas a nivel de país que indican el estado de salud o que puede influir en la salud. Para el análisis, calificamos a los 20 peores países. Utilizamos 26 indicadores validados y disponibles internacionalmente para explorar y realizar el análisis. Resultados: Las cifras y el mapa muestran los 32 países que figuraron entre los 20 peores en al menos un indicador y también los 12 peores dentro de la CAPE VI-LAC en su conjunto. De los 33 países de ALC, sólo San Cristóbal y Nieves no figuraba en ninguno de los 20 países peores en ningún momento. Conclusión: Lo que podemos concluir con un alto grado de certeza es que los 12 países con peores puntuaciones son posiblemente estados frágiles; países donde los gobiernos no tienen el control o la autoridad completos, a menudo son represivos y corruptos, participan en graves abusos de los derechos humanos y se caracterizan por la inestabilidad política de diversas formas, la desventaja por los cambios climáticos extremos, la pobreza extrema, la desigualdad social y étnica divisiones, incapaces de proporcionar servicios básicos y sufren focos de insurgencia en forma de terrorismo, que a menudo son violentos y brutales. Los gobiernos, los donantes de ayuda, las organizaciones regionales y los profesionales y las asociaciones de salud mental deben trabajar juntos para abordar estas situaciones.

Introduction: The CAPE Vulnerability Index is a global foreign policy index that identifies the countries to be prioritise for foreign aid. It offers an evidenced, structured and reasoned approach to using aid in bi-lateral agreements with mental health as a foundation. The present version is specifically design for Latin America and Caribbean (LAC) region, which comprises of 33 countries. Objectives: To identify the countries to be prioritized for foreign aid, through the LAC version of the CAPE Vulnerability Index (CAPE VI-LAC). Materials and methods: Like with the CAPE Vulnerability Index global version we consider various indices or measures at country level that indicate health status or what may influence health. For the analysis we score the worst 20 countries. We used 26 internationally available and validated indicators to explore and perform the analysis. Results: The figures and map show the 32 countries that featured in the worst 20 in at least one indicator and also the worst 12 within the CAPE VI-LAC as a whole. Of the 33 LAC countries only St Kitts and Nevis did not feature in any of the worst 20 countries at any time. Conclusion: What we can conclude with a great degree of certainty that the worst 12 scoring countries are possibly fragile states; countries where the Governments do not have complete control or authority, are often repressive and corrupt, participate in serious human rights abuses and are characterised by political instability of various forms, disadvantage by the extremes of climate changes, extreme poverty, inequality, social and ethnic divisions, unable to provide basic services and suffer from pockets of insurgency in the form of terrorism, which are often violent and brutal. Governments, aid donors, regional organizations, and mental health professionals and associations should work together in order to address these situations.

CAPE Vulnerability Index.

The Compassion, Assertive action, Pragmatism and Evidence (CAPE) Vulnerability Index is a global foreign policy index which has been used to identify countries which require foreign aid and how that can be prioritized. The Index offers an evidenced, structured, and reasoned approach to using aid in bi-lateral agreements with mental health as a foundation. This study used 26 internationally available and validated indicators to explore and perform the analysis leading to the development of the Index. As with many summary statistics used to describe matters across the globe there has to be a fundamental reliance on national reporting or gathering of the underlying information used in their derivation, although their reliability may be in question and, in addition, such an exercise can be refined and repeated every year. It is concluded that the countries which score worse on the Index are likely to be failed states or fragile states: countries where the governments do not have complete control or authority. Such governments can often be repressive and corrupt, may participate in serious human rights abuses, and are characterized by conflict of various forms. These governments are also likely to suffer disadvantage as a result of extremes of climate changes, extreme poverty, inequality, social and ethnic divisions, the inability to provide basic services, and suffer from pockets of insurgency in the form of terrorism, which are often violent and brutal.

Geopolitical factors and mental health I.

Natural and man-made disasters carry with them major burden and very often the focus is on immediate survival and management of resulting infectious diseases. The impact of disasters directly and indirectly on the well-being and mental health of those affected often gets ignored. The reasons are often stigma and lack of attention to mental health consequences. In addition, often the focus is on preventing the spread of infectious diseases such as waterborne or airborne diseases. This is further complicated by the fact that often aid agencies in offering aid tend to focus on communicable diseases and not on mental health of populations. This focus may reflect easily to measure outcomes in comparison with mental illnesses as the global burden of disease is likely to increase in the next few decades. There is an urgent need to apply the principles of social justice on social and health care policies, which will lead to elimination of stigma. In this article, we propose that the impact of mental illness as a result of disasters needs to be taken seriously in any planning and delivery of relief. Mental health is likely to be affected both directly and indirectly as a result of disasters and also likely to be influenced by ongoing factors such as poor housing, overcrowding and other social determinants. In addition to deliver equity between physical and mental illnesses, appropriate and adequate resources are needed so that identifiable needs can be met with clear outcomes.

Geopolitical factors, foreign aid and mental health II: Value for money.

In the previous accompanying paper, we described geopolitical factors which affect mental health of individuals who suffer directly and indirectly. These disasters whether they are natural or man-made often attract significant amounts of aid and resources - financial and human. In addition, those who offer foreign aid need to be aware of where and how the aid is being spent. In this paper, we propose that aid giving agencies give due attention to the impact the aid should have on mental health of recipients. Global mental health has become a movement, but concerns remain about its efficacy. Therefore, it is imperative that any aid given is given and utilised in a culturally appropriate and culturally sensitive way. In an interconnected and interlinked world, it is likely that when one country or nation is affected by disasters or trauma, it will impact upon others around both directly and indirectly. We present a new measurement tool-CAPE Vulnerability Index which can be used to identify most vulnerable communities so that international aid may be more appropriately targeted. We believe that this index may go some way in assisting governments and policymakers in ascertaining the impact of their aid on the emotional and mental health of individuals. We suggest that their needs to be a ring-fencing of aid to ensure that population mental health is protected and enhanced with a strategic approach inbuilt into the foreign policy the focus needs to shift towards public mental health.