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Butura AM, Ryan GK, Shakespeare T, Ogunmola O, Omobowale O, Greenley R, Eaton J. Community-based rehabilitation for people with psychosocial disabilities in low- and middle-income countries: a systematic review of the grey literature. Int J Ment Health Syst 2024; 18:13. [PMID: 38486243 PMCID: PMC10941461 DOI: 10.1186/s13033-024-00630-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Community based rehabilitation (CBR) aims to promote the inclusion and participation of people with disabilities, particularly in low- and middle-income countries (LMICs). Yet people with psychosocial disabilities are often excluded from CBR programmes. The restrictive inclusion criteria used by previous reviews make it difficult to identify promising examples that could otherwise help to inform the uptake of CBR for people with psychosocial disabilities. We aim to address this gap using gold standard methods for the review and synthesis of grey literature on CBR for people with psychosocial disabilities in LMICs. METHODS Our search strategy was developed in consultation with an expert advisory group and covered seven grey literature databases, two customised Google Advanced searches, 34 targeted websites and four key reports. A single reviewer screened the search results and extracted relevant data using a standardised format based on the World Health Organisation's CBR matrix. The included programmes were then checked by a second reviewer with experience in CBR to ensure they met the review's criteria. A narrative synthesis with summative content analysis was performed to synthesise the findings. RESULTS The 23 CBR programmes identified for inclusion spanned 19 countries and were mostly located in either rural areas or urban areas where a large proportion of the population was living in poverty. 13 were classified as livelihood programmes, eight as empowerment programmes, seven as social programmes, seven as health programmes and four as education programmes. Only two addressed all five of these components. 12 of the included programmes reported challenges to implementation, with stigma and lack of resources emerging as two of the most prominent themes. CONCLUSION This grey literature review identified several CBR programmes and synthesised key learning that would have otherwise been missed by a more traditional review of the published literature. However, as evaluation by implementing organisations is not always conducted to a high standard, the quality of this evidence is generally poor. A flexible monitoring and evaluation framework for CBR programmes could help to reduce heterogeneity in terms of the quality and content of reporting.
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Affiliation(s)
- Ana-Maria Butura
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Grace K Ryan
- Department of Population Health, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Tom Shakespeare
- International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Olusegun Ogunmola
- Department of Psychiatry and Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, 200212, Oyo, Nigeria
| | - Olubukola Omobowale
- Department of Psychiatry and Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, 200212, Oyo, Nigeria
| | - Rachel Greenley
- Department of Population Health, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Julian Eaton
- Department of Population Health, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- CBM Global Disability Inclusion, Dr.-Werner-Freyberg-Straβe 7, 69514, Laudenbach, Germany
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Daniel M, Kallakuri S, Gronholm PC, Wahid SS, Kohrt B, Thornicroft G, Maulik PK. Cultural adaptation of INDIGO mental health stigma reduction interventions using an ecological validity model in north India. Front Psychiatry 2024; 15:1337662. [PMID: 38356906 PMCID: PMC10864454 DOI: 10.3389/fpsyt.2024.1337662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
Background The International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership is a multi-country international research program in seven sites across five low- and middle-income countries (LMICs) in Africa and Asia to develop, contextually adapt mental health stigma reduction interventions and pilot these among a variety of target populations. The aim of this paper is to report on the process of culturally adapting these interventions in India using an established framework. Methods As part of this larger program, we have contextualized and implemented these interventions from March 2022 to August 2023 in a site in north India. The Ecological Validity Model (EVM) was used to guide the adaptation and contextualization process comprising eight dimensions. Findings Six dimensions of the Ecological Validity Model were adapted, namely language, persons, metaphors, content, methods, and context; and two dimensions, namely concepts and goals, were retained. Conclusion Stigma reduction strategies with varied target groups, based on culturally appropriate adaptations, are more likely to be acceptable to the stakeholders involved in the intervention, and to be effective in terms of the program impact.
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Affiliation(s)
- Mercian Daniel
- Research Department, George Institute for Global Health, New Delhi, India
| | - Sudha Kallakuri
- Research Department, George Institute for Global Health, New Delhi, India
| | - Petra C. Gronholm
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Syed Shabab Wahid
- Department of Global Health, School of Health, Georgetown University, Washington, DC, United States
| | - Brandon Kohrt
- Center for Global Mental Health Equity, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Pallab K. Maulik
- Research Department, George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Brain Sciences, Imperial College London, London, United Kingdom
- Department of Public Health, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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van den Broek M, Gandhi Y, Sureshkumar DS, Prina M, Bhatia U, Patel V, Singla DR, Velleman R, Weiss HA, Garg A, Sequeira M, Pusdekar V, Jordans MJD, Nadkarni A. Interventions to increase help-seeking for mental health care in low- and middle-income countries: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002302. [PMID: 37703225 PMCID: PMC10499262 DOI: 10.1371/journal.pgph.0002302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/24/2023] [Indexed: 09/15/2023]
Abstract
Mental health problems are a significant and growing cause of morbidity worldwide. Despite the availability of evidence-based interventions, most people experiencing mental health problems remain untreated. This treatment gap is particularly large in low- and middle-income countries (LMIC) and is due to both supply-side and demand-side barriers. The aim of this systematic review is to identify and synthesise the evidence on interventions to improve help-seeking for mental health problems in LMICs. The protocol was registered a priori (Registration number: CRD42021255635). We searched eight databases using terms based on three concepts: 'mental health/illness' AND 'help-seeking' AND 'LMICs'; and included all age groups and mental health problems. Forty-two papers were eligible and included in this review. Intervention components were grouped into three categories following the steps in the help-seeking process: (1) raising mental health awareness among the general population (e.g., distribution of printed or audio-visual materials), (2) identification of individuals experiencing mental health problems (e.g., community-level screening or detection), and (3) promoting help-seeking among people in need of mental health care (e.g., sending reminders). The majority of interventions (80%) included components in a combination of the aforementioned categories. Most studies report positive outcomes, yet results on the effectiveness is mixed, with a clear trend in favour of interventions with components from more than one category. Ten out of 42 studies (24%) yielded a statistically significant effect of the intervention on help-seeking; and all targeted a combination of the aforementioned categories (i.e., raising awareness, identification and help-seeking promotion). Only six studies (14%) focused on children and adolescents. Due to the limited number of robust studies done in LMICs and the heterogeneity of study designs, outcomes and components used, no definite conclusions can be drawn with regards to the effects of individual strategies or content of the interventions.
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Affiliation(s)
- Myrthe van den Broek
- Research and Development, War Child, Amsterdam, The Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Yashi Gandhi
- Addictions and related-Research Group, Sangath, Goa, India
| | - Diliniya Stanislaus Sureshkumar
- Unit for Social and Community Psychiatry, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Matthew Prina
- Social Epidemiology Research Group, Kings College London, London, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Urvita Bhatia
- Addictions and related-Research Group, Sangath, Goa, India
- Department of Psychology, Health and Professional Development at Oxford Brookes University, Oxford, United Kingdom
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, United States of America
| | - Daisy R. Singla
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Richard Velleman
- Addictions and related-Research Group, Sangath, Goa, India
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Helen A. Weiss
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ankur Garg
- Addictions and related-Research Group, Sangath, Goa, India
| | | | - Veera Pusdekar
- Addictions and related-Research Group, Sangath, Goa, India
| | - Mark J. D. Jordans
- Research and Development, War Child, Amsterdam, The Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Abhijit Nadkarni
- Addictions and related-Research Group, Sangath, Goa, India
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Semrau M, Gronholm PC, Eaton J, Maulik PK, Ayele B, Bakolis I, Mendon GB, Bhattarai K, Brohan E, Cherian AV, Daniel M, Girma E, Gurung D, Hailemariam A, Hanlon C, Healey A, Kallakuri S, Li J, Loganathan S, Ma N, Ma Y, Metsahel A, Ouali U, Yaziji N, Zgueb Y, Zhang W, Zhang X, Thornicroft G, Votruba N. Reducing stigma and improving access to care for people with mental health conditions in the community: protocol for a multi-site feasibility intervention study (Indigo-Local). RESEARCH SQUARE 2023:rs.3.rs-3237562. [PMID: 37645946 PMCID: PMC10462245 DOI: 10.21203/rs.3.rs-3237562/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Stigma and discrimination towards people with mental health conditions by their communities are common worldwide. This can result in a range of negative outcomes for affected persons, including poor access to health care. However, evidence is still patchy from low- and middle-income countries (LMICs) on affordable, community-based interventions to reduce mental health-related stigma and to improve access to mental health care. Methods This study aims to conduct a feasibility (proof-of-principle) pilot study that involves developing, implementing and evaluating a community-based, multi-component, public awareness-raising intervention (titled Indigo-Local), designed to reduce stigma and discrimination and to increase referrals of people with mental health conditions for assessment and treatment. It is being piloted in five LMICs - China, Ethiopia, India, Nepal and Tunisia - and includes several key components: a stakeholder group workshop; a stepped training programme (using a 'Training of Trainers' approach) of community health workers (or similar cadres of workers) and service users that includes repeated supervision and booster sessions; awareness-raising activities in the community; and a media campaign. Social contact and service user involvement are instrumental to all components. The intervention is being evaluated through a mixed-methods pre-post study design that involves quantitative assessment of stigma outcomes measuring knowledge, attitudes and (discriminatory) behaviour; quantitative evaluation of mental health service utilization rates (where feasible in sites); qualitative exploration of the potential effectiveness and impact of the Indigo-Local intervention; a process evaluation; implementation evaluation; and an evaluation of implementation costs. Discussion The outcome of this study will be contextually adapted, evidence-based interventions to reduce mental health-related stigma in local communities in five LMICs to achieve improved access to healthcare. We will have replicable models of how to involve people with lived experience as an integral part of the intervention and will produce knowledge of how intervention content and implementation strategies vary across settings. The interventions and their delivery will be refined to be acceptable, feasible and ready for larger-scale implementation and evaluation. This study thereby has the potential to make an important contribution to the evidence base on what works to reduce mental health-related stigma and discrimination and improve access to health care.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jie Li
- The Affiliated Brain Hospital of Guangzhou Medical University
| | | | - Ning Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health
| | - Yurong Ma
- The Affiliated Brain Hospital of Guangzhou Medical University
| | | | | | | | | | - Wufang Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health
| | - Xiaotong Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health
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Jiam NT, Chern A, Watson J, Naples JG. Lyrical Trends: An Analysis of Music's (Mis) Use of Vertigo. Otol Neurotol 2023; 44:619-625. [PMID: 37254262 DOI: 10.1097/mao.0000000000003912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Popular culture and music have long served as windows into the common attitudes, trends, and issues of the time. The representation of vertigo in music has not been previously explored. The objective of this study was to analyze the portrayal of vertigo in music through content and sentiment analysis of song lyrics. METHODS A large song lyric database was queried to identify English language song titles containing the word "vertigo." A sentiment and content analysis of the lyrics was performed to delineate the most frequently used words, the accuracy of vertigo depictions, and emotional valence (i.e., the ratio of positive to negative references to vertigo). RESULTS Between 1969 and 2022, there were a total of 54 songs specifically titled "Vertigo." Most songs (73%) portrayed vertigo negatively, and the prevalence of negative sentiment within music increased with each decade. The three most common words being used in association with vertigo within music were "feel" (n = 97), "love" (n = 66), and "falling" (n = 57). In early decades, songs using the word vertigo misrepresented the condition and associated perceptions relative to common medical understanding. In more recent decades, vertigo was used in a way more representative of medical interpretations. CONCLUSION The depiction of vertigo in songs has changed over time, and more recently, usage has reflected Bárány Society definitions. Interestingly, the negative sentiment has also increased with time. This work provides a lyrical analysis of vertigo that may improve physician understanding of the cultural usage of this challenging symptom.
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Affiliation(s)
- Nicole T Jiam
- Department of Otolaryngology- Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | | | - Jowan Watson
- School of Medicine; Harvard Medical School, Boston, MA
| | - James G Naples
- Department of Otolaryngology & Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Rahimi T, Morowatisharifabad MA, Farajkhoda T, Fallahzadeh H. A comprehensive health-promoting neighborhood intervention to improve health care seeking behavior among reproductive age Iranian women. BMC Womens Health 2023; 23:171. [PMID: 37041521 PMCID: PMC10091519 DOI: 10.1186/s12905-023-02308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 03/26/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Women's health care seeking delays remains an unresolved major public health problem in developing and underdeveloped countries. This study aimed to evaluate a health-promoting neighborhood intervention to improve health care seeking behavior (HCSB) among reproductive age Iranian women using Health Promotion Model (HPM). METHOD This randomized controlled trial was conducted on 160 women of reproductive age in two groups: experimental and control. Data were collected by self-administered questionnaire based on HPM constructs and a medical symptom checklist. A health-promoting neighborhood intervention was performed in seven sessions for the experimental group. HCSB and HPM constructs were measured before and 3 months after intervention in the two groups. p < 0.05 was considered significant level. RESULTS The average mean age of participants was 30.45 ± 7.80 years. After intervention, the mean score of self-efficacy, interpersonal influences, commitment to plan and HCSB was increased significantly in women in the experimental group, while negative constructs such as perceived barriers, negative activity-related affect, and immediate competing demands and preferences significantly decreased (p < 0.05). In addition, the mean score of referring for symptoms such as excessive sweating, persistent fatigue or weakness, headache, bleeding or spotting between periods, vaginal itching and irritation, unusual vaginal discharge, flashing, chest pain, rapid heartbeats, aching muscles or joints, urinary problems and some mental disorder was increased significantly in experimental group compared to control group (p < 0.05). CONCLUSIONS The results of study show that an intervention based on the HPM have a positive impact on HCSB and its associated factors and can help improve women's health behaviors and health outcomes.
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Affiliation(s)
- Tahereh Rahimi
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | - Tahmineh Farajkhoda
- Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Fallahzadeh
- Center for Healthcare Data Modeling, Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Ding KR, Wang SB, Xu WQ, Lin LH, Liao DD, Chen HB, Tan WY, Huang JH, Hou CL, Jia FJ. Low mental health literacy and its association with depression, anxiety and poor sleep quality in Chinese elderly. Asia Pac Psychiatry 2022; 14:e12520. [PMID: 36210054 DOI: 10.1111/appy.12520] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mental health literacy (MHL) is rarely reported in the Chinese elderly. This study explored the pattern of MHL in the Chinese elderly in relation to depression, anxiety and poor sleep quality. METHODS A cross-sectional study was conducted among older adults in Guangzhou, south China. Participants were investigated face-to-face using the Chinese National Mental Health Literacy Scale, the Patient Health Questionnaire-9 item (PHQ-9), the 7-item Generalized Anxiety Disorder (GAD-7) and the Pittsburgh Sleep Quality Index (PSQI). Mental Health Literacy Scale contains three dimensions: mental health knowledge, mental health skills (such as social support, cognitive reappraisal and attentional distraction) and mental health awareness. Multivariate logistic regression was used for examining the association between MHL and mental health. RESULTS A total of 506 older adults were recruited. The percentage of depression, anxiety, and poor sleep quality were 16.6%, 7.9% and 40.9%, respectively. MHL dimensions independently associated with depression included cognitive reappraisal (OR = 1.95, p < .001), attentional distraction (OR = 0.61, p = 0.044) and awareness (OR = 0.56, p = 0.027). MHL dimensions independently associated with anxiety symptoms included cognitive reappraisal (OR = 1.90, p = 0.011) and attentional distraction (OR = 0.44, p = 0.016). MHL dimensions independently associated with poor sleep quality included social support (OR = 0.75, p = 0.022), cognitive reappraisal (OR = 1.55, p = 0.003) and attentional distraction (OR = 0.65, p = 0.016). CONCLUSION Given the low MHL and its association with poor mental health in the Chinese elderly, policymakers and health professionals should improve the older adults' MHL, which could be conducive to the prevention and control of their mental health problems.
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Affiliation(s)
- Kai-Rong Ding
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China.,Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shi-Bin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Qi Xu
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Li-Hua Lin
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Dan-Dan Liao
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hong-Bei Chen
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Yan Tan
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jia-Hao Huang
- Yuexiu District Center for Disease Control, Guangzhou, China
| | - Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Fu-Jun Jia
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China.,Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Chu C, Roxas N, Aguocha CM, Nwefoh E, Wang K, Dike C, Iheanacho T. Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project. BMC Health Serv Res 2022; 22:333. [PMID: 35279154 PMCID: PMC8917687 DOI: 10.1186/s12913-022-07703-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) project trains non-specialist and primary health care workers in Imo State, Nigeria. This project adapted the World Health Organization’s Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG), emphasizing stigma reduction among trainees. This convergent mixed-methods proof-of-concept study evaluates the HAPPINESS pilot project mhGAP-IG training’s impact on mental illness stigma among trainees and barriers, facilitators, and opportunities to consider for project improvement. Methods Trainees (n = 13) completed a 43-item questionnaire before and after their 5-day training to assess perceptions of mental disorders and attitudes towards people with mental illness. These responses were analyzed using paired-sample t-tests for four subscales of the questionnaire: acceptance of socializing with people with mental illness, normalizing activities and relationships with people with mental illness, supernatural causation of mental illness, and endorsement of a biopsychosocial approach to mental illness. Semi-structured key informant interviews (n = 11) with trainees, trainers, and local health officials who participated in or supported the HAPPINESS project were thematically analyzed to understand their experiences and perspectives of the project’s barriers, facilitators, and opportunities. Results Trainees showed significant improvements on socializing, normalizing, and supernatural causation subscales of the stigma questionnaire (p < 0.05). No significant effect was seen on the biopsychosocial subscale; however, evidence of biopsychosocial beliefs was found in interview responses. Key informant interviews revealed that the HAPPINESS project enhanced trainees’ diagnostic and treatment abilities, mental health awareness, and empathy towards patients. Misinformation, stigma, inadequate funding, and lack of road access to clinics were identified as barriers to mental health care integration into general care in Imo State. Respondents also suggested ways that the HAPPINESS project could be improved and expanded in the future. Conclusions This study adds to the limited evidence on the implementation of mhGAP-IG in Nigeria. Using mixed methods, it evaluates how mhGAP-IG can impact perceptions and knowledge of stigma among primary care trainees. It also highlights barriers, facilitators, and opportunities to consider for project growth. Future efforts should focus on clinical support, supervision, health outcomes, as well as scaling up and assessing the cost-effectiveness of the HAPPINESS project intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07703-1.
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Adekeye A. Bridging the gap by strengthening the MHGAP: Integrating mental health care into primary health care in Nigeria. ARCHIVES OF MENTAL HEALTH 2022. [DOI: 10.4103/amh.amh_34_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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O’Donnell A, Schulte B, Manthey J, Schmidt CS, Piazza M, Chavez IB, Natera G, Aguilar NB, Hernández GYS, Mejía-Trujillo J, Pérez-Gómez A, Gual A, de Vries H, Solovei A, Kokole D, Kaner E, Kilian C, Rehm J, Anderson P, Jané-Llopis E. Primary care-based screening and management of depression amongst heavy drinking patients: Interim secondary outcomes of a three-country quasi-experimental study in Latin America. PLoS One 2021; 16:e0255594. [PMID: 34352012 PMCID: PMC8341512 DOI: 10.1371/journal.pone.0255594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare. MATERIALS AND METHODS Quasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status. RESULTS 550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained. CONCLUSIONS Training using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19.
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Affiliation(s)
- Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Bernd Schulte
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Christiane Sybille Schmidt
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marina Piazza
- Mental Health, Alcohol, and Drug Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ines Bustamante Chavez
- Mental Health, Alcohol, and Drug Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Guillermina Natera
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, CDMX, Mexico
| | | | | | | | | | - Antoni Gual
- Addictions Unit, Psychiatry Dept, Hospital Clínic, Barcelona, Spain
- Red de Trastornos Adictivos, Instituto Carlos III, Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Adriana Solovei
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Dasa Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Carolin Kilian
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Jurgen Rehm
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Peter Anderson
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
- Univ. Ramon Llull, ESADE, Barcelona, Spain
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11
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Soroye MO, Oleribe OO, Taylor-Robinson SD. Community Psychiatry Care: An Urgent Need in Nigeria. J Multidiscip Healthc 2021; 14:1145-1148. [PMID: 34045861 PMCID: PMC8148654 DOI: 10.2147/jmdh.s309517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022] Open
Abstract
Nigeria's mental health policy was formulated in 1991, but it did not make adequate provision for community-based psychiatric care. Since there are only seven government-owned psychiatry facilities in Nigeria and these are always overwhelmed, there is the need to overhaul the existing policy and emphasise the urgency of a shift from inpatient psychiatric mental healthcare towards a community-based multidisciplinary psychiatric healthcare system.
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Affiliation(s)
- Modupeoluwa Omotunde Soroye
- School of Public Health, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
- Department of Preventive Dentistry, Faculty of Dentistry, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | - Obinna O Oleribe
- Klamath Tribal Health & Family Services, Klamath Falls, OR, 97601, USA
| | - Simon D Taylor-Robinson
- Department of Surgery and Cancer, St Mary’s Hospital Campus, Imperial College London, London, W2 1NY, UK
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12
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Jordans MJD, Luitel N, Lund C, Kohrt BA. Evaluation of Proactive Community Case Detection to Increase Help Seeking for Mental Health Care: A Pragmatic Randomized Controlled Trial. Psychiatr Serv 2020; 71:810-815. [PMID: 32321389 PMCID: PMC7415529 DOI: 10.1176/appi.ps.201900377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Community Informant Detection Tool (CIDT) is a vignette- and picture-based method of proactive case detection to promote help seeking for persons with depression, psychosis, alcohol use disorder, and epilepsy. The authors evaluated the effectiveness of the CIDT to increase help-seeking behavior in rural Nepal, where a district mental health care plan was being implemented. METHODS Twenty-four health facilities were randomly assigned to one of two methods for training their all-female cadre of community health volunteers: standard training or standard training that included the CIDT. The authors compared the number of patients with depression, psychosis, alcohol use disorder, and epilepsy who were registered in the routine health information system prior to and 6 months after the training. RESULTS At health facilities where volunteers received CIDT training, 309 patients were registered as having depression, psychosis, alcohol use disorder, or epilepsy, compared with 182 patients at facilities where volunteers received standard training. The median number of patients registered was 47% greater at facilities where CIDT training was included (24 patients) than at facilities with standard training (16 patients) (p=0.04, r=0.42). The difference in the number of registered patients remained significant when the analysis factored in the population catchment (N=18 patients [CIDT] versus N=14 [standard] per 10,000 population; p=0.05, r=0.40). CONCLUSIONS The median number of patients registered as having a mental illness was 47% greater at primary care facilities in which community health volunteers used the CIDT than at facilities where volunteers received standard training. Proactive case finding holds promise for increasing help seeking for mental health care.
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Affiliation(s)
- Mark J. D. Jordans
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK; and Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Nagendra Luitel
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Crick Lund
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; and Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Brandon A. Kohrt
- Department of Psychiatry, George Washington University, Washington, D.C., USA; and Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
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13
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Yerima MM, Onifade PO, Wakawa IA, Pindar SK, Jidda MS, Musami UB, Ali FA. Convergent Validity of Self-Administered Addiction Severity Index in a Sample of Nigerian Patients in a Residential Treatment Facility. Niger Med J 2020; 61:73-77. [PMID: 32675898 PMCID: PMC7357803 DOI: 10.4103/nmj.nmj_59_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/03/2019] [Accepted: 10/07/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Substance use disorders present with multiple drug-related problems that need to be evaluated with a view to planning and administering holistic interventions that could potentially improve addiction treatment outcomes. Many valid instruments are available for assessing the problems that occur in addiction but most of them require some training and they take a lot of time to administer. This study validates a shorter self-administered version of the Addiction severity Index (ASI) against the Clinician-administered ASI with a view to cutting the time needed to administer the instrument. METHODS The study recruited 142 patients in a residential treatment center. Correlation coefficient and t-test were used to assess for the convergence of the two version. RESULTS The correlation coefficients ranged from 0.52 to 0.97 for the different domain of the ASI with higher endorsement of problems in the self-administered than clinician administered version in most domains. CONCLUSION The self-administered ASI is a valid alternative to the clinician-administered ASI and it saves valuable time especially in resource-constrained settings.
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Affiliation(s)
| | - Peter Olutunde Onifade
- Drug Addiction Treatment Education and Research (DATER) Unit, Neuropsychiatric Hospital, Aro, Abeokuta, Nigeria
| | - Ibrahim Abdu Wakawa
- Department of Mental Health, College of Medical Sciences, University of Maiduguri, P. M. B. 1069, Maiduguri, Nigeria
- Department of Mental Health, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria
| | - Sadique Kwajaffa Pindar
- Department of Mental Health, College of Medical Sciences, University of Maiduguri, P. M. B. 1069, Maiduguri, Nigeria
- Department of Mental Health, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria
| | - Mohammed Said Jidda
- Department of Mental Health, College of Medical Sciences, University of Maiduguri, P. M. B. 1069, Maiduguri, Nigeria
- Department of Mental Health, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria
| | - Umar Baba Musami
- Department of Mental Health, College of Medical Sciences, University of Maiduguri, P. M. B. 1069, Maiduguri, Nigeria
- Department of Mental Health, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria
| | - Fatima Abba Ali
- Department of Mental Health, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria
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14
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Ryan GK, Nwefoh E, Aguocha C, Ode PO, Okpoju SO, Ocheche P, Woyengikuro A, Abdulmalik J, Eaton J. Partnership for the implementation of mental health policy in Nigeria: a case study of the Comprehensive Community Mental Health Programme in Benue State. Int J Ment Health Syst 2020; 14:10. [PMID: 32110245 PMCID: PMC7033947 DOI: 10.1186/s13033-020-00344-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 02/13/2020] [Indexed: 11/14/2022] Open
Abstract
Background 71% of countries in the World Health Organisation’s (WHO’s) African Region have a stand-alone mental health policy or plan, but only 14% have fully implemented it. In Nigeria, integration of mental health into primary care has been a stumbling block to the implementation of the 1991 National Mental Health Policy, 2013 Policy on Mental Health Services Delivery and the National Mental, Neurological and Substance Use Programme and Action Plan. A partnership between public and private not-for-profits in Benue State, the Comprehensive Community Mental Health Programme (CCMHP) has successfully integrated mental health into primary care in alignment with the national mental health policy and the WHO’s mental health Gap Action Programme Intervention Guide (mhGAP-IG). There is a need to document such examples in order to inform policy implementation in Nigeria and other low- and middle-income countries (LMICs). Methods We followed the Case Study Methodology to Monitor and Evaluate Community Mental Health Programmes in LMICs. Four field visits were conducted between 2013 and 2017 to document the first phase of activities of CCMHP, covering the period of January 2011 through June 2016. Results In its first phase, CCMHP trained 19 community psychiatric nurses and 48 community health extension workers in mhGAP-IG, establishing 45 new mental health clinics in primary care facilities across Benue, a state more populous than many countries. As a result, 13,785 clients (55% male, 45% female) were enrolled in mental health services either in primary care or in one of two pre-existing community-based rehabilitation facilities. Most are adults over age 18 (82.75%), and present to services with epilepsy (52.38%) or psychosis (38.41%). Conclusion The case of CCMHP demonstrates it is possible to rapidly scale-up mental health services in line with national mental health policy using the mhGAP-IG, even in a challenging, low-resource setting. Multi-sectoral partnerships may help to overcome some of the barriers to successful integration of mental health into general healthcare by capitalising on the resources and expertise of both state and non-state actors. However, a difficult political context could threaten the sustainability of the programme if funder requirements force a rapid transition to full government ownership.
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Affiliation(s)
- G K Ryan
- 1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - E Nwefoh
- 3CBM International, Stubenwald-Allee 5, 64625 Bensheim, Germany.,Benue State Comprehensive Community Mental Health Programme, Depot Road PMB 0360, Otukpo, Nigeria
| | - C Aguocha
- 4Department of Medicine, Imo State University, Okigwe Road, Ugwu Orji, Owerri, Nigeria
| | - P O Ode
- 3CBM International, Stubenwald-Allee 5, 64625 Bensheim, Germany.,Benue State Comprehensive Community Mental Health Programme, Depot Road PMB 0360, Otukpo, Nigeria
| | - S O Okpoju
- Benue State Comprehensive Community Mental Health Programme, Depot Road PMB 0360, Otukpo, Nigeria
| | - P Ocheche
- Benue State Comprehensive Community Mental Health Programme, Depot Road PMB 0360, Otukpo, Nigeria
| | - A Woyengikuro
- Benue State Comprehensive Community Mental Health Programme, Depot Road PMB 0360, Otukpo, Nigeria
| | - J Abdulmalik
- 6Department of Psychiatry, College of Medicine, University of Ibadan, University College Hospital, PMB 5116, Oyo, Nigeria
| | - J Eaton
- 1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,3CBM International, Stubenwald-Allee 5, 64625 Bensheim, Germany
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15
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Anosike C, Ukwe CV, Oparah AC. Attitudes of pharmacy and non-pharmacy students towards mental illness in Nigeria: a comparative survey. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2020; 28:346-354. [PMID: 32017285 DOI: 10.1111/ijpp.12601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 12/20/2019] [Accepted: 01/02/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Globally, persons with mental illness are victims of stigma, even among healthcare professionals and trainees. However, in Nigeria, little is known about the attitudes of pharmacy students towards people with mental illness. Therefore, the objectives of this paper were to assess and compare the attitudes of pharmacy and non-pharmacy students towards mental illness and explore its associated demographic factors. METHODS A cross-sectional survey was conducted among pharmacy and selected non-pharmacy students of a Nigerian university. The Attitude Scale for Mental Illness was used for data collection. The survey instrument was distributed to and completed by selected students in batches after normal class lectures. Descriptive statistics, chi-square test and Student's t-test were used for data analysis. P < 0.05 was considered statistically significant. KEY FINDINGS The key findings showed that pharmacy and non-pharmacy students generally demonstrated positive attitudes towards mental illness. Pharmacy students had more positive, less stigmatizing attitudes compared with students of non-pharmacy courses. Students' attitudes towards mental illness were significantly influenced by gender, age, a previous visit to a mental hospital and knowing a family member or friend with a mental illness. CONCLUSIONS Our findings suggest that students' attitudes towards mental illness were positive but sub-optimal. Student pharmacists demonstrated more positive attitudes towards mental illness compared with non-pharmacy students. However, the major contributors to positive attitudes were male gender, older age, a previous visit to a mental hospital and having a close associate with a mental illness. Therefore, educational interventions addressing students' misconceptions of mental illness are recommended.
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Affiliation(s)
- Chibueze Anosike
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Chinwe Victoria Ukwe
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Azuka Cyriacus Oparah
- Department of Clinical Pharmacy and Pharmacy Practice, University of Benin, Benin City, Edo State, Nigeria
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16
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Ayanbode OF, Nwagwu WE. Collaborative technologies and knowledge management in psychiatric hospitals in South West Nigeria. INFORMATION DEVELOPMENT 2020. [DOI: 10.1177/0266666919895563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the relationships among KM (knowledge creation, sharing), professional development, therapy team’s (TT’s) operation modes, interaction modes and collaborative technologies’ use determinants. A sample survey research design and mixed methods approach that combined quantitative research methods guided the study. Quantitative data was collected from 283 therapy team members in two psychiatric hospitals in Nigeria using a self-administered questionnaire. SPSS version 22 and SPSS (AMOS) version 23 were used to analyse the data. Knowledge creation and knowledge sharing impacted significantly on professional development. Therapy team members’ Intellectual capability, increased innovation, disciplinary specialisation and professional learning are dependent on their creation and sharing of knowledge. Disciplinary socialisation, transdisciplinary socialisation, collaboration and communication summarise their day-to-day operations. Collaboration and knowledge creation and sharing have a very strong relationship. Working together with colleagues is directly related with creation and sharing of both tacit and explicit knowledge. Learning by practical experience, brainstorming of ideas, sharing of clinical information and best practice of medical profession are positively impacted by collaboration. Documentation of such knowledge is needed to promote its sharing and safeguard knowledge loss in psychiatric hospitals.
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Affiliation(s)
| | - Williams E Nwagwu
- University of South Africa, Pretoria, South Africa
- University of Ibadan, Ibadan, Nigeria
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17
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Jordans MJD, Luitel NP, Kohrt BA, Rathod SD, Garman EC, De Silva M, Komproe IH, Patel V, Lund C. Community-, facility-, and individual-level outcomes of a district mental healthcare plan in a low-resource setting in Nepal: A population-based evaluation. PLoS Med 2019; 16:e1002748. [PMID: 30763321 PMCID: PMC6375569 DOI: 10.1371/journal.pmed.1002748] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/22/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In low-income countries, care for people with mental, neurological, and substance use (MNS) disorders is largely absent, especially in rural settings. To increase treatment coverage, integration of mental health services into community and primary healthcare settings is recommended. While this strategy is being rolled out globally, rigorous evaluation of outcomes at each stage of the service delivery pathway from detection to treatment initiation to individual outcomes of care has been missing. METHODS AND FINDINGS A combination of methods were employed to evaluate the impact of a district mental healthcare plan for depression, psychosis, alcohol use disorder (AUD), and epilepsy as part of the Programme for Improving Mental Health Care (PRIME) in Chitwan District, Nepal. We evaluated 4 components of the service delivery pathway: (1) contact coverage of primary care mental health services, evaluated through a community study (N = 3,482 combined for all waves of community surveys) and through service utilisation data (N = 727); (2) detection of mental illness among participants presenting in primary care facilities, evaluated through a facility study (N = 3,627 combined for all waves of facility surveys); (3) initiation of minimally adequate treatment after diagnosis, evaluated through the same facility study; and (4) treatment outcomes of patients receiving primary-care-based mental health services, evaluated through cohort studies (total N = 449 depression, N = 137; AUD, N = 175; psychosis, N = 95; epilepsy, N = 42). The lack of structured diagnostic assessments (instead of screening tools), the relatively small sample size for some study components, and the uncontrolled nature of the study are among the limitations to be noted. All data collection took place between 15 January 2013 and 15 February 2017. Contact coverage increased 7.5% for AUD (from 0% at baseline), 12.2% for depression (from 0%), 11.7% for epilepsy (from 1.3%), and 50.2% for psychosis (from 3.2%) when using service utilisation data over 12 months; community survey results did not reveal significant changes over time. Health worker detection of depression increased by 15.7% (from 8.9% to 24.6%) 6 months after training, and 10.3% (from 8.9% to 19.2%) 24 months after training; for AUD the increase was 58.9% (from 1.1% to 60.0%) and 11.0% (from 1.1% to 12.1%) for 6 months and 24 months, respectively. Provision of minimally adequate treatment subsequent to diagnosis for depression was 93.9% at 6 months and 66.7% at 24 months; for AUD these values were 95.1% and 75.0%, respectively. Changes in treatment outcomes demonstrated small to moderate effect sizes (9.7-point reduction [d = 0.34] in AUD symptoms, 6.4-point reduction [d = 0.43] in psychosis symptoms, 7.2-point reduction [d = 0.58] in depression symptoms) at 12 months post-treatment. CONCLUSIONS These combined results make a promising case for the feasibility and impact of community- and primary-care-based services delivered through an integrated district mental healthcare plan in reducing the treatment gap and increasing effective coverage for MNS disorders. While the integrated mental healthcare approach does lead to apparent benefits in most of the outcome metrics, there are still significant areas that require further attention (e.g., no change in community-level contact coverage, attrition in AUD detection rates over time, and relatively low detection rates for depression).
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Affiliation(s)
- Mark J. D. Jordans
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | | | - Brandon A. Kohrt
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Department of Psychiatry, George Washington University, Washington, District of Columbia, United States of America
| | - Sujit D. Rathod
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emily C. Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Ivan H. Komproe
- Research and Development Department, Health-Works/HealthNetTPO, Amsterdam, The Netherlands
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Sangath, Goa, India
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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18
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Tora A, Mengiste A, Davey G, Semrau M. Community Involvement in the Care of Persons Affected by Podoconiosis-A Lesson for Other Skin NTDs. Trop Med Infect Dis 2018; 3:E87. [PMID: 30274483 PMCID: PMC6161108 DOI: 10.3390/tropicalmed3030087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/08/2018] [Accepted: 08/11/2018] [Indexed: 12/30/2022] Open
Abstract
Podoconiosis is a neglected tropical disease (NTD) characterized by lower-leg swelling (lymphedema), which is caused by long-term exposure to irritant red-clay soils found within tropical volcanic high-altitude environments with heavy rainfall. The condition places a substantial burden on affected people, their families and communities, including disability, economic consequences, social exclusion, and stigma; mental disorders and distress are also common. This paper focuses on community-based care of podoconiosis, and, in particular, the role that community involvement can have in the reduction of stigma against people affected by podoconiosis. We first draw on research conducted in Ethiopia for this, which has included community-based provision of care and treatment, education, and awareness-raising, and socioeconomic rehabilitation to reduce stigma. Since people affected by podoconiosis and other skin NTDs often suffer the double burden of mental-health illness, which is similarly stigmatized, we then point to examples from the mental-health field in low-resource community settings to suggest avenues for stigma reduction and increased patient engagement that may be relevant across a range of skin NTDs, though further research is needed on this.
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Affiliation(s)
- Abebayehu Tora
- Department of Sociology, Wolaita Sodo University, Sodo, Ethiopia.
| | - Asrat Mengiste
- National Podoconiosis Action Network, Addis Ababa, Ethiopia.
| | - Gail Davey
- Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer Campus, University of Sussex, Brighton BN1 9PX, UK.
| | - Maya Semrau
- Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer Campus, University of Sussex, Brighton BN1 9PX, UK.
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19
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Eaton J, Nwefoh E, Okafor G, Onyeonoro U, Nwaubani K, Henderson C. Interventions to increase use of services; Mental Health Awareness in Nigeria. Int J Ment Health Syst 2017; 11:66. [PMID: 29090016 PMCID: PMC5655828 DOI: 10.1186/s13033-017-0173-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 10/18/2017] [Indexed: 11/23/2022] Open
Abstract
Background Mental health services in Nigeria consist mainly of large government psychiatric hospitals and there are very few mental health professionals to serve the large population of the country. However, more recently, community mental health services, which have been shown to improve access to care and clinical outcomes are beginning to develop in some locations. Despite efforts to promote more accessible services, low levels of knowledge about effective treatment of mental disorders means that even where these services are available, a very small proportion of people utilise these services. Therefore interventions to increase service use are an essential component of health system. Methods This intervention was designed to increase use of a mental health services through the work of community-based Village Health Workers. Fifteen Village Health Workers in each Local Government Area (district) were selected and trained to create mental health awareness in communities. Their function also include identification and referral of persons with mental illness to trained mental health nurses in the clinics. Attendance data prior to and after intervention were collected and compared. Results The incident rate for initial period of intervention is five times higher than the baseline rate (95% CI; 3.42–7.56; p < 0.001) though this diminished in the long term, levelling off above initial baseline. Conclusions This study demonstrated that addition of awareness raising using volunteers in communities as part of health programme implementation can increase services use by a population. Mechanisms such as informing populations of the existence of a service which they were previously lacking; explanation of causation of mental illness and achieving community leaders’ support for a new service can make investment in services more efficient by increasing attendance.
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Affiliation(s)
- Julian Eaton
- CBM International and London School of Hygiene and Tropical Medicine, London, UK
| | - Emeka Nwefoh
- CBM Country Co-ordination Office, Abuja, Nigeria
| | | | | | | | - Claire Henderson
- King's College Institute of Psychiatry, Psychology and Neurosciences, London, UK
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20
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Adeponle A, Groleau D, Kola L, Kirmayer LJ, Gureje O. Perinatal depression in Nigeria: perspectives of women, family caregivers and health care providers. Int J Ment Health Syst 2017; 11:27. [PMID: 28428813 PMCID: PMC5392941 DOI: 10.1186/s13033-017-0134-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 04/01/2017] [Indexed: 11/17/2022] Open
Abstract
Background Perinatal maternal depression is common and undertreated in many sub-Saharan African countries, including Nigeria. While culture shapes the social determinants and expression of depressive symptoms, there is a dearth of research investigating these processes in African contexts. Methods To address this gap, we conducted in-depth interviews with 14 women with perinatal depression, 14 of their family caregivers and 11 health providers, using the McGill Illness Narrative Interview as part of a larger trial of a stepped-care intervention. Interpretation of themes was guided by cultural constructivist and critical anthropological perspectives that situate perinatal depression in its complexity as a disorder that is embedded in webs of social relations and embodied practices. Results Study respondents used idioms of distress that identified perinatal conditions that consist of somatic, affective, cognitive and behavior symptoms found in depressive disorders. Respondents viewed mental health problems in the perinatal period as tied to sociomoral concerns over gender roles and women’s position within the household. Conflict between women’s effort to be assertive to address interpersonal problems, while needing to be seen as non-aggressive contributed to their distress. Causal explanations for depression included husband’s lack of care, family problems, “spiritual attack”, having a female child when a male child was desired, and not resting sufficiently after childbirth. Guilt about breaching social norms for women’s conduct contributed to self blame, and feelings of shame. Conclusions Clinical assessment and interventions as well as public health prevention strategies for perinatal depression in global mental health need to consider local social contexts and meanings of depression, which can be explored with narrative-based methods. Electronic supplementary material The online version of this article (doi:10.1186/s13033-017-0134-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ademola Adeponle
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC H3A 1A1 Canada.,Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, 4333 Côte-Ste-Catherine Road, Montreal, QC H3T 1E4 Canada
| | - Danielle Groleau
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC H3A 1A1 Canada.,Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, 4333 Côte-Ste-Catherine Road, Montreal, QC H3T 1E4 Canada
| | - Lola Kola
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Laurence J Kirmayer
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC H3A 1A1 Canada.,Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, 4333 Côte-Ste-Catherine Road, Montreal, QC H3T 1E4 Canada
| | - Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Cooper S. Research on help-seeking for mental illness in Africa: Dominant approaches and possible alternatives. Transcult Psychiatry 2016; 53:696-718. [PMID: 26759416 DOI: 10.1177/1363461515622762] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is growing concern within the global mental health arena that interventions currently being executed to scale up mental health services in Africa will be ineffective unless simultaneous steps are taken to address people's help-seeking behaviour. Drawing upon two conceptual tools arising from science and technology studies (STS), those of a "classification system" and "the black box," this paper looks critically at discursive constructions of help-seeking in Africa within mental health research over the last decade. Research in this area can be divided into two dominant traditions: the knowledge-belief-practice survey and indigenous-knowledge-system approaches. Although the content and value-codes between these approaches differ, structurally they are very similar. Both are mediated by the same kind of system of classification, which demarcates the world into homogenous entities and binary oppositions. This system of ordering is one of the most stubborn and powerful forms of classification buried in the "black box" of the modernist/colonial knowledge archive and is fraught with many questionable Eurocentric epistemological assumptions. I consider whether there might be other ways of understanding help-seeking for mental illness in Africa and discuss two studies that illustrate such alternative approaches. In conclusion, I discuss some of the challenges this alternative kind of research faces in gaining more influence within contemporary global mental health discourse and practice.
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Affiliation(s)
- Sara Cooper
- London School of Hygiene & Tropical Medicine
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Hanlon C, Fekadu A, Jordans M, Kigozi F, Petersen I, Shidhaye R, Honikman S, Lund C, Prince M, Raja S, Thornicroft G, Tomlinson M, Patel V. District mental healthcare plans for five low- and middle-income countries: commonalities, variations and evidence gaps. Br J Psychiatry 2016; 208 Suppl 56:s47-54. [PMID: 26447169 PMCID: PMC4698556 DOI: 10.1192/bjp.bp.114.153767] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 12/19/2014] [Indexed: 12/04/2022]
Abstract
BACKGROUND Little is known about the service and system interventions required for successful integration of mental healthcare into primary care across diverse low- and middle-income countries (LMIC). AIMS To examine the commonalities, variations and evidence gaps in district-level mental healthcare plans (MHCPs) developed in Ethiopia, India, Nepal, Uganda and South Africa for the PRogramme for Improving Mental health carE (PRIME). METHOD A comparative analysis of MHCP components and human resource requirements. RESULTS A core set of MHCP goals was seen across all countries. The MHCPs components to achieve those goals varied, with most similarity in countries within the same resource bracket (low income v. middle income). Human resources for advanced psychosocial interventions were only available in the existing health service in the best-resourced PRIME country. CONCLUSIONS Application of a standardised methodological approach to MHCP across five LMIC allowed identification of core and site-specific interventions needed for implementation.
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Affiliation(s)
- Charlotte Hanlon
- Correspondence: Charlotte Hanlon, Department of Psychiatry, 6th Floor College of Health Sciences Building, Tikur Anbessa Hospital, Addis Ababa, PO 9086, Ethiopia.
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Shidhaye R, Lund C, Chisholm D. Closing the treatment gap for mental, neurological and substance use disorders by strengthening existing health care platforms: strategies for delivery and integration of evidence-based interventions. Int J Ment Health Syst 2015; 9:40. [PMID: 26719762 PMCID: PMC4696279 DOI: 10.1186/s13033-015-0031-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 12/18/2015] [Indexed: 10/30/2022] Open
Abstract
This paper outlines the main elements and features of a mental health care delivery platform and its delivery channels. These include evidence-based interventions that can be delivered via this platform as well as broader health system strengthening strategies for more effective and efficient delivery of services. The focus is broadly on health systems perspective rather than strictly disorder-oriented intervention analysis. A set of evidence-based interventions within the WHO pyramid framework of self-care, primary care, and specialist care have been identified; the main challenge lies in the translation of that evidence into practice. The delivery of these interventions requires an approach that puts into practice key principles of public health, adopts systems thinking, promotes whole-of-government involvement and is focused on quality improvement. Key strategies for effective translation of evidence into action include collaborative stepped care, strengthening human resources, and integrating mental health into general health care. In order to pursue these principles and strategies using a platform-wide approach, policy makers need to engage with a wide range of stakeholders and make use of the best available evidence in a transparent manner.
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Affiliation(s)
- Rahul Shidhaye
- />Centre for Chronic Conditions and Injuries, Public Health Foundation of India, 19, Rishi Nagar, Char Imli, Bhopal, Madhya Pradesh India
- />CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Crick Lund
- />Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
- />Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Dan Chisholm
- />Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Ventevogel P. Integration of mental health into primary healthcare in low-income countries: avoiding medicalization. Int Rev Psychiatry 2014; 26:669-79. [PMID: 25553784 DOI: 10.3109/09540261.2014.966067] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Since 2008 the World Health Organization (WHO), through its mental health Gap Action Programme, has attempted to revitalize efforts to integrate mental health into non-specialized (e.g. primary) healthcare. While this has led to renewed interest in this potential method of mental health service delivery, it has also prompted criticism. Some concerns raised are that it would contribute to the medicalization of social and psychological problems, and narrowly focus on primary care without sufficient attention given to strengthening other levels of the healthcare system, notably community-based care and care on district levels. This paper discusses seven elements that may be critical to preventing inadvertently contributing to increasing a narrow biomedical approach to mental healthcare when integrating mental health into non-specialized healthcare: (1) using task shifting approaches within a system of stepped care, (2) ensuring primary mental healthcare also includes brief psychotherapeutic interventions, (3) promote community-based recovery-oriented interventions for people with disabling chronic mental disorders, (4) conceptualizing training as a continuous process of strengthening clinical competencies through supervision, (5) engaging communities as partners in psychosocial interventions, (6) embedding shifts to primary mental healthcare within wider health policy reforms, and (7) promoting inter-sectoral approaches to address social determinants of mental health.
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Wilson C, Taghi Yasamy M, Morris J, Novin A, Saeed K, D. Nkomo S. Mental health services: the African gap. JOURNAL OF PUBLIC MENTAL HEALTH 2014. [DOI: 10.1108/jpmh-09-2013-0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Neuropsychiatric disorders account for a substantial proportion of disease burden and disability in Africa. Despite this, mental health systems are under-resourced in Africa, as in most parts of the world, creating a “treatment gap” and denying the African population the right to mental health achieved through access to mental health services. The paper aims to discuss these issues.
Design/methodology/approach
– The mental health systems of African countries were compared with figures for all low- and middle-income countries (LAMICS) using data from the World Health Organization Assessment Instrument for Mental Health Systems. Comparable global figures were also available for some indicators from the WHO's World Mental Health Atlas 2011.
Findings
– Selected indicators of mental health systems are presented for 14 African countries and shows that they are lower as compared to figures for all other LAMICS and also global figures. The treatment gap for mental disorders is much higher in Africa than comparable global figures. For example, the treatment gap for mood disorders has been estimated from 95 to 100 per cent for some African countries.
Originality/value
– There is an imbalance between need and service provision in the area of mental health across the world but particularly in Africa. Despite this, there are a greater number of outpatient than inpatient services in Africa which provides an opportunity for development of community-based services. There are also many encouraging examples of effective approaches to reducing the burden of neuropsychiatic disease in Africa.
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Abstract
The aim of this article was to put community psychiatry into a longitudinal and global perspective and to try to look into the future. Specifically, we set out the following nine proposals:1. Central and regional government should measure the treated percentage of people with mental illness (coverage) and set specific targets to increase coverage over set time periods.2. Health care services need to recognize the far lower life expectancy among people with mental disorders and develop and evaluate new methods to reduce this health disparity.3. Mental health services should provide specific modules to reduce stigma and discrimination experienced by people with mental illness.4. Mental health staff should provide care that service users (and their family members) find accessible and acceptable.5. Mental health care should consist of a careful balance of hospital and community care, with most care provided at or near people's homes.6. Mental health planners, both in times of economic growth and recession, should invest in treatments known to be effective and disinvest from treatments known to be ineffective or even harmful.7. Mental health staff and service users should develop and evaluate methods to improve shared decision making.8. Health care practitioners (of western and nonwestern traditions) should take practical steps to see each other as partners in an integrated system that increases the total amount of mental health care available, while ensuring that only effective and acceptable treatments are provided.9. Mental health services should develop dedicated programs for recovery: this implies that staff understand an individual's personal recovery goals and fully support his/her achievement.
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Jordans MJD, Luitel NP, Tomlinson M, Komproe IH. Setting priorities for mental health care in Nepal: a formative study. BMC Psychiatry 2013; 13:332. [PMID: 24305432 PMCID: PMC4233621 DOI: 10.1186/1471-244x-13-332] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 11/26/2013] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND There is an urgent need to address the massive treatment gap for mental health problems, especially in low income settings. Packages of care integrated in routine primary health care are posited as a strategy to scale-up mental health care, yet more needs to be known about the most feasible and effective way to go about this. METHODS The study follows a combined methods design that includes engaging an expert panel in a priority setting exercise, running workshops to develop a Theory of Change and conducting in-depth qualitative interviews and focus group discussions with key stakeholders. The results of each research step were taken forward to inform the subsequent one. RESULTS There was strong endorsement for a system of care that encompasses both the perspectives of health facility and the community. Issues related to increasing access and demand, guaranteeing a sustainable supply of psychotropic medicine, adequate human resourcing, and ensuring positive family involvement came up as priority areas of attention. CONCLUSION The study underlines many of the known barriers in developing mental health services. At the same time it provides a distinct pathway and concrete recommendations for overcoming these challenges in Nepal.
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Affiliation(s)
- Mark JD Jordans
- Research and Development, HealthNet TPO, Amsterdam, The Netherlands,Center for Global Mental Health, King’s College London, London, UK
| | - Nagendra P Luitel
- Research Department, Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal
| | - Mark Tomlinson
- Psychology Department, Stellenbosch University, Stellenbosch, South Africa,Center for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Ivan H Komproe
- Research and Development, HealthNet TPO, Amsterdam, The Netherlands,Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
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van Ginneken N, Tharyan P, Lewin S, Rao GN, Meera SM, Pian J, Chandrashekar S, Patel V. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database Syst Rev 2013:CD009149. [PMID: 24249541 DOI: 10.1002/14651858.cd009149.pub2] [Citation(s) in RCA: 286] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Many people with mental, neurological and substance-use disorders (MNS) do not receive health care. Non-specialist health workers (NSHWs) and other professionals with health roles (OPHRs) are a key strategy for closing the treatment gap. OBJECTIVES To assess the effect of NSHWs and OPHRs delivering MNS interventions in primary and community health care in low- and middle-income countries. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 21 June 2012); MEDLINE, OvidSP; MEDLINE In Process & Other Non-Indexed Citations, OvidSP; EMBASE, OvidSP (searched 15 June 2012); CINAHL, EBSCOhost; PsycINFO, OvidSP (searched 18 and 19 June 2012); World Health Organization (WHO) Global Health Library (searched 29 June 2012); LILACS; the International Clinical Trials Registry Platform (WHO); OpenGrey; the metaRegister of Controlled Trials (searched 8 and 9 August 2012); Science Citation Index and Social Sciences Citation Index (ISI Web of Knowledge) (searched 2 October 2012) and reference lists, without language or date restrictions. We contacted authors for additional studies. SELECTION CRITERIA Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted-time-series studies of NSHWs/OPHR-delivered interventions in primary/community health care in low- and middle-income countries, and intended to improve outcomes in people with MNS disorders and in their carers. We defined an NSHW as any professional health worker (e.g. doctors, nurses and social workers) or lay health worker without specialised training in MNS disorders. OPHRs included people outside the health sector (only teachers in this review). DATA COLLECTION AND ANALYSIS Review authors double screened, double data-extracted and assessed risk of bias using standard formats. We grouped studies with similar interventions together. Where feasible, we combined data to obtain an overall estimate of effect. MAIN RESULTS The 38 included studies were from seven low- and 15 middle-income countries. Twenty-two studies used lay health workers, and most addressed depression or post-traumatic stress disorder (PTSD). The review shows that the use of NSHWs, compared with usual healthcare services: 1. may increase the number of adults who recover from depression or anxiety, or both, two to six months after treatment (prevalence of depression: risk ratio (RR) 0.30, 95% confidence interval (CI) 0.14 to 0.64; low-quality evidence); 2. may slightly reduce symptoms for mothers with perinatal depression (severity of depressive symptoms: standardised mean difference (SMD) -0.42, 95% CI -0.58 to -0.26; low-quality evidence); 3. may slightly reduce the symptoms of adults with PTSD (severity of PTSD symptoms: SMD -0.36, 95% CI -0.67 to -0.05; low-quality evidence); 4. probably slightly improves the symptoms of people with dementia (severity of behavioural symptoms: SMD -0.26, 95% CI -0.60 to 0.08; moderate-quality evidence); 5. probably improves/slightly improves the mental well-being, burden and distress of carers of people with dementia (carer burden: SMD -0.50, 95% CI -0.84 to -0.15; moderate-quality evidence); 6. may decrease the amount of alcohol consumed by people with alcohol-use disorders (drinks/drinking day in last 7 to 30 days: mean difference -1.68, 95% CI -2.79 to -0.57); low-quality evidence).It is uncertain whether lay health workers or teachers reduce PTSD symptoms among children. There were insufficient data to draw conclusions about the cost-effectiveness of using NSHWs or teachers, or about their impact on people with other MNS conditions. In addition, very few studies measured adverse effects of NSHW-led care - such effects could impact on the appropriateness and quality of care. AUTHORS' CONCLUSIONS Overall, NSHWs and teachers have some promising benefits in improving people's outcomes for general and perinatal depression, PTSD and alcohol-use disorders, and patient- and carer-outcomes for dementia. However, this evidence is mostly low or very low quality, and for some issues no evidence is available. Therefore, we cannot make conclusions about which specific NSHW-led interventions are more effective.
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Affiliation(s)
- Nadja van Ginneken
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, Keppel St, London, UK, WC1E 7HT
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Henderson C, Evans-Lacko S, Thornicroft G. Mental illness stigma, help seeking, and public health programs. Am J Public Health 2013; 103:777-80. [PMID: 23488489 DOI: 10.2105/ajph.2012.301056] [Citation(s) in RCA: 401] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Globally, more than 70% of people with mental illness receive no treatment from health care staff. Evidence suggests that factors increasing the likelihood of treatment avoidance or delay before presenting for care include (1) lack of knowledge to identify features of mental illnesses, (2) ignorance about how to access treatment, (3) prejudice against people who have mental illness, and (4) expectation of discrimination against people diagnosed with mental illness. In this article, we reviewed the evidence on whether large-scale anti-stigma campaigns could lead to increased levels of help seeking.
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Affiliation(s)
- Claire Henderson
- Health Service and Population Research Department, King's College London Institute of Psychiatry, London, UK.
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30
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Drew N, Funk M, Tang S, Lamichhane J, Chávez E, Katontoka S, Pathare S, Lewis O, Gostin L, Saraceno B. Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis. Lancet 2011; 378:1664-75. [PMID: 22008426 DOI: 10.1016/s0140-6736(11)61458-x] [Citation(s) in RCA: 169] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
This report reviews the evidence for the types of human rights violations experienced by people with mental and psychosocial disabilities in low-income and middle-income countries as well as strategies to prevent these violations and promote human rights in line with the UN Convention on the Rights of Persons with Disabilities (CRPD). The article draws on the views, expertise, and experience of 51 people with mental and psychosocial disabilities from 18 low-income and middle-income countries as well as a review of English language literature including from UN publications, non-governmental organisation reports, press reports, and the academic literature.
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31
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Eaton J, McCay L, Semrau M, Chatterjee S, Baingana F, Araya R, Ntulo C, Thornicroft G, Saxena S. Scale up of services for mental health in low-income and middle-income countries. Lancet 2011; 378:1592-603. [PMID: 22008429 DOI: 10.1016/s0140-6736(11)60891-x] [Citation(s) in RCA: 394] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Mental disorders constitute a huge global burden of disease, and there is a large treatment gap, particularly in low-income and middle-income countries. One response to this issue has been the call to scale up mental health services. We assess progress in scaling up such services worldwide using a systematic review of literature and a survey of key national stakeholders in mental health. The large number of programmes identified suggested that successful strategies can be adopted to overcome barriers to scaling up, such as the low priority accorded to mental health, scarcity of human and financial resources, and difficulties in changing poorly organised services. However, there was a lack of well documented examples of services that had been taken to scale that could guide how to replicate successful scaling up in other settings. Recommendations are made on the basis of available evidence for how to take forward the process of scaling up services globally.
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Terry J. Delivering a basic mental health training programme: views and experiences of Mental Health First Aid instructors in Wales. J Psychiatr Ment Health Nurs 2011; 18:677-86. [PMID: 21896110 DOI: 10.1111/j.1365-2850.2011.01719.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Originating in Australia, 'Mental Health First Aid' (MHFA) is a way of providing support to someone who is experiencing a mental health problem before professional help is obtained. Positive evaluations have shown that it both increases confidence while decreasing stigmatizing attitudes. However, the evidence base surrounding the delivery of basic mental health programmes remains underdeveloped. This descriptive qualitative study explored the views and experiences of 14 MHFA instructors from across Wales through semi-structured interviews, as a means to identify the experience of course delivery from their perspective. Data were collected between January and April 2009. The study found individuals benefited from being an MHFA instructor through increased confidence and self-development. However, instructors encountered logistical difficulties in course delivery and noted that as attendees related to the course material, they wished to discuss their own mental health problems during the course. This created considerable challenges for instructors, who noted both positive and negative impacts on themselves, and on their expectations of the role of becoming MHFA instructors. In conclusion, basic mental health training courses must build a clear infrastructure, ongoing quality assurance processes and reliable support structures to train, support and monitor those delivering them.
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Affiliation(s)
- J Terry
- College of Human and Health Sciences, Swansea University, Carmarthenshire, UK.
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James BO, Omoaregba JO. Prevalence and predictors of poor medication adherence among out-patients at a psychiatric hospital in Benin City, Nigeria. Int J Psychiatry Clin Pract 2011; 15:27-34. [PMID: 22122686 DOI: 10.3109/13651501.2010.519034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the prevalence and predictors of poor or non-compliance with medications among respondents attending an adult psychiatry out-patient clinic in Benin City, Nigeria. METHODS Respondents (n = 137) were randomly selected over a 3-month period using a cross-sectional study design. They were administered a questionnaire adapting the Factors Influencing Neuroleptic Medication Taking Scale as well as the Brief Psychiatric Rating Scale (BPRS) to ascertain medication, illness-related and psychosocial variables. Medication adherence was determined by self report and for the purpose of the study confined to the week prior to interview. RESULTS Almost half (42.3%) were poorly adherent to medications. Most admitted to good psychosocial support, but believed that their illness had a spiritual aetiology. Stigma, higher frequency of medication dosing as well as illness severity as measured by their BPRS scores were significant predictors of poor medication adherence. CONCLUSION The prevalence of poor medication adherence in this environment is higher than in studies from Western cultures, and replicates rates from previously published reports in this environment. Factors responsible for poor adherence can form the template for intervention studies and programs to improve compliance.
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Abstract
This paper summarizes the findings for the African Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. We present an overview of mental health policies, plans and programmes in the African region; a summary of relevant research and studies; a critical appraisal of community mental health service components; a discussion of the key challenges, obstacles and lessons learned, and some recommendations for the development of community mental health services in the African region.
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Affiliation(s)
- Charlotte Hanlon
- Department of Psychiatry, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Thornicroft G, Alem A, Antunes Dos Santos R, Barley E, Drake RE, Gregorio G, Hanlon C, Ito H, Latimer E, Law A, Mari J, McGeorge P, Padmavati R, Razzouk D, Semrau M, Setoya Y, Thara R, Wondimagegn D. WPA guidance on steps, obstacles and mistakes to avoid in the implementation of community mental health care. World Psychiatry 2010; 9:67-77. [PMID: 20671888 PMCID: PMC2911080 DOI: 10.1002/j.2051-5545.2010.tb00276.x] [Citation(s) in RCA: 174] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This paper provides guidance on the steps, obstacles and mistakes to avoid in the implementation of community mental health care. The document is intended to be of practical use and interest to psychiatrists worldwide regarding the development of community mental health care for adults with mental illness. The main recommendations are presented in relation to: the need for coordinated policies, plans and programmes, the requirement to scale up services for whole populations, the importance of promoting community awareness about mental illness to increase levels of help-seeking, the need to establish effective financial and budgetary provisions to directly support services provided in the community. The paper concludes by setting out a series of lessons learned from the accumulated practice of community mental health care to date worldwide, with a particular focus on the social and governmental measures that are required at the national level, the key steps to take in the organization of the local mental health system, lessons learned by professionals and practitioners, and how to most effectively harness the experience of users, families, and other advocates.
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Affiliation(s)
- Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
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Read UM, Adiibokah E, Nyame S. Local suffering and the global discourse of mental health and human rights: an ethnographic study of responses to mental illness in rural Ghana. Global Health 2009; 5:13. [PMID: 19825191 PMCID: PMC2770454 DOI: 10.1186/1744-8603-5-13] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Accepted: 10/14/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Global Movement for Mental Health has brought renewed attention to the neglect of people with mental illness within health policy worldwide. The maltreatment of the mentally ill in many low-income countries is widely reported within psychiatric hospitals, informal healing centres, and family homes. International agencies have called for the development of legislation and policy to address these abuses. However such initiatives exemplify a top-down approach to promoting human rights which historically has had limited impact at the level of those living with mental illness and their families. METHODS This research forms part of a longitudinal anthropological study of people with severe mental illness in rural Ghana. Visits were made to over 40 households with a family member with mental illness, as well as churches, shrines, hospitals and clinics. Ethnographic methods included observation, conversation, semi-structured interviews and focus group discussions with people with mental illness, carers, healers, health workers and community members. RESULTS Chaining and beating of the mentally ill was found to be commonplace in homes and treatment centres in the communities studied, as well as with-holding of food ('fasting'). However responses to mental illness were embedded within spiritual and moral perspectives and such treatment provoked little sanction at the local level. Families struggled to provide care for severely mentally ill relatives with very little support from formal health services. Psychiatric services were difficult to access, particularly in rural communities, and also seen to have limitations in their effectiveness. Traditional and faith healers remained highly popular despite the routine maltreatment of the mentally ill in their facilities. CONCLUSION Efforts to promote the human rights of those with mental illness must engage with the experiences of mental illness within communities affected in order to grasp how these may underpin the use of practices such as mechanical restraint. Interventions which operate at the local level with those living with mental illness within rural communities, as well as family members and healers, may have greater potential to effect change in the treatment of the mentally ill than legislation or investment in services alone.
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Affiliation(s)
- Ursula M Read
- Department of Anthropology, University College London, UK
| | | | - Solomon Nyame
- Kintampo Health Research Centre, Kintampo, Brong Ahafo, Ghana
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Abstract
In the third in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Jair Mari and colleagues discuss the treatment of schizophrenia.
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Affiliation(s)
- Mari Jair de Jesus
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
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