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Dabholkar H, Pillai A, Gaonkar D, Deuri SP, Naik S, Chatterjee S. Exploring the feasibility and public health impact of integrating a community-based recovery-oriented intervention for people living with schizophrenia in partnership with a tertiary care mental hospital in India. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231175528. [PMID: 37790166 PMCID: PMC10209590 DOI: 10.1177/26334895231175528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background There is a priority need to make community-based care widely available for people living with schizophrenia (PLwS) in low- and middle-income countries. An innovative approach for increasing access could be to integrate clinical services available in tertiary care hospitals with community-based care through a task-sharing approach. We describe such an integrated intervention that was implemented at Tezpur in northeast India in collaboration with the Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH). Method The objectives of the study were to illustrate the feasibility of integrating and implementing the intervention and to describe its individual, systemic, and public health impacts. Due to the limited resources available, we conducted a pragmatic single-arm longitudinal evaluation of the intervention cohort over 24 months. Results Of the 239 PLwS enrolled in the intervention, 198 (83%) were followed up for 24 months, with nearly three-quarters reporting a >70% reduction in disabilities, most notably between 6 and 18 months. There was a marked reduction in unmet needs across multiple domains, and at 24 months, 62% of the cohort was engaged in individual jobs or other market-linked livelihood opportunities. There was greater uptake and retention with outpatient contacts at the LGBRIMH, and PLwS experienced a marked (82%) reduction in inpatient admissions rates, as compared to before enrolment. Over a period of 24 months, primary caregivers reported that their families experienced significantly fewer social difficulties such as unemployment, interpersonal conflicts, and social isolation. The intervention had a significant public health impact, with an estimated 51.8% effective treatment coverage rate for the integrated intervention. Conclusion Our findings provide preliminary evidence of the feasibility of implementing the integrated intervention and its effectiveness. We believe that there is merit in further in-depth refinement and exploration of this implementation-related research and cost analysis while replicating the intervention in other tertiary care institutions.
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Affiliation(s)
| | | | | | - Sonia Pereira Deuri
- Department of Psychiatric Social Work, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
| | - Smita Naik
- Parivartan Trust, Satara, Maharashtra, India
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Mundt AP, Langerfeldt SD, Maphisa JM, Sourabié O, Yongsi BN, Serri ER, Bukasa Tshilonda JC, Te JH, Bitta MA, Mathe L, Liwimbi O, Dos Santos PF, Atilola O, Jansen S, Diegane Tine JA, Akran C, Jalloh A, Kagee A, Van Wyk ES, Forry JB, Imasiku ML, Chigiji H, Priebe S. Changes in rates of psychiatric beds and prison populations in sub-Saharan Africa from 1990 to 2020. J Glob Health 2022; 12:04054. [PMID: 36056592 PMCID: PMC9440375 DOI: 10.7189/jogh.12.04054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Psychiatric bed numbers (general, forensic, and residential) and prison populations have been considered indicators of institutionalization. The present study aimed to assess changes of those indicators across sub-Saharan Africa (SSA) from 1990 to 2020. Methods We retrospectively obtained data on psychiatric bed numbers and prison populations from 46 countries in SSA between 1990 and 2020. Mean and median rates, as well as percentage changes between first and last data points were calculated for all of SSA and for groups of countries based on income levels. Results Primary data were retrieved from 17 out of 48 countries. Data from secondary sources were used for 29 countries. From two countries, data were unavailable. The median rate of psychiatric beds decreased from 3.0 to 2.2 per 100 000 population (median percentage change = -16.1%) between 1990 and 2020. Beds in forensic and residential facilities were nonexistent in most countries of SSA in 2020, and no trend for building those capacities was detected. The median prison population rate also decreased from 77.8 to 71.0 per 100 000 population (-7.8%). There were lower rates of psychiatric beds and prison populations in low-income and lower-middle income countries compared with upper-middle income countries. Conclusions SSA countries showed, on average, a reduction of psychiatric bed rates from already very low levels, which may correspond to a crisis in acute psychiatric care. Psychiatric bed rates were, on average, about one twenty-fifth of countries in the Organization for Economic Co-operation and Development (OECD), while prison population rates were similar. The heterogeneity of trends among SSA countries over the last three decades indicates that developments in the region may not have been based on coordinated policies and reflects unique circumstances faced by the individual countries.
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Affiliation(s)
- Adrian P Mundt
- Medical Faculty, Universidad Diego Portales, Santiago, Chile.,Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | | | - J Maphisa Maphisa
- Department of Psychology, University of Botswana, Gaborone, Botswana
| | - Oumar Sourabié
- Psychiatrist, Regional Center Hospital of Fada N'gourma, Fada N'gourma, Burkina Faso
| | - Blaise Nguendo Yongsi
- Institute for Training & Research in Population Studies, University of Yaoundé, Yaoundé, Cameroon
| | - Enzo Rozas Serri
- Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.,Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | - Jeronimo H Te
- West African Epidemiology Network on Drug Use (WENDU), Bissau, Guinea-Bissau
| | - Mary A Bitta
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,KEMRI-Welcome Trust Research Program, Kilifi, Kenya
| | | | - Olive Liwimbi
- Zomba Mental Hospital, Ministry of Health, Zomba, Malawi
| | | | - Olayinka Atilola
- Lagos State University College of Medicine (LASUCOM), Lagos, Nigeria
| | - Stefan Jansen
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean A Diegane Tine
- Institute of Health and Development, Cheikh Anta Diop University, Dakar, Senegal
| | | | - Abdul Jalloh
- Sierra Leone Psychiatric Teaching Hospital, Freetown, Sierra Leone.,College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Ashraf Kagee
- Alan Fisher Centre for Public Mental Health, University of Cape Town, Cape Town.,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Elizabeth S Van Wyk
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Jimmy B Forry
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Mental Health and Psychiatry, Faculty of Clinical Medicine and Dentistry, Kampala, International University-Western Campus, Bushenyi, Uganda.,Department of Psychiatry, Mubende Regional Referral Hospital, Mubende, Uganda
| | | | | | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
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Raja T, Tuomainen H, Madan J, Mistry D, Jain S, Easwaran K, Singh SP. Psychiatric hospital reform in low- and middle-income countries: a systematic review of literature. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1341-1357. [PMID: 33884439 PMCID: PMC8316186 DOI: 10.1007/s00127-021-02075-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/07/2021] [Indexed: 12/04/2022]
Abstract
PURPOSE Psychiatric hospitals or mental asylums grew across the world in the colonial era. Despite concerns over quality of care and human rights violations, these hospitals continue to provide the majority of mental health care in most low- and middle-income countries (LMICs). We sought to review the evidence of reform of mental hospitals and associated patient outcomes. METHODS We adopted an integrative review methodology by including experimental and non-experimental research. The review protocol was registered on PROSPERO (CRD42019130399). A range of databases and systematic hand searches were conducted by two independent reviewers. Research conducted between 1980 and May 2019, that focused on any aspect of reform in mental hospitals for adults (age 18 and upwards) with severe mental illness and published in English, were considered. RESULTS 16 studies were included in the review. 12 studies met inclusion criteria, and four additional reports emerged from the hand search. Studies covered-India, China, South Africa, Grenada, Georgia, Sri Lanka, Argentina and Brazil. Key findings emphasise the role of judicial intervention as a critical trigger of reform. Structural reform composed of optimisation of resources and renovations of colonial structures to cater to diverse patient needs. Process reforms include changes in medical management, admission processes and a move from closed to open wards. Staff engagement and capacity building have also been used as a modality of reform in mental hospital settings. CONCLUSION There is some documentation of reform in psychiatric hospitals. However, poor methodological quality and variation in approach and outcomes measured, make it challenging to extrapolate specific findings on process or outcomes of reform. Despite being integral service providers, psychiatric hospitals still do not adopt patient centric, recovery-oriented processes. Hence, there is an urgent need to generate robust evidence on psychiatric reform and its effect on patient outcomes.
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Affiliation(s)
- Tasneem Raja
- Tata Trusts, World Trade Center, Cuffe Parade, Mumbai, 400005, India. .,Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, England.
| | - Helena Tuomainen
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, England
| | - Jason Madan
- Centre for Health Economics, Warwick Medical School, University of Warwick, Coventry, England
| | - Dipesh Mistry
- Warwick Clinical Trials Unit, University of Warwick, Coventry, England
| | - Sanjeev Jain
- Molecular Genetics Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029 India
| | - Kamala Easwaran
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, England ,Founder Sumunum Foundation, Chennai, India
| | - Swaran P. Singh
- Centre for Mental Health and Wellbeing Research, University of Warwick, Coventry, England
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Barbui C, Papola D, Saraceno B. The Italian mental health-care reform: public health lessons. Bull World Health Organ 2019; 96:731-731A. [PMID: 30455525 PMCID: PMC6239006 DOI: 10.2471/blt.18.216002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Corrado Barbui
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Policlinico GB Rossi, Piazzale Scuro 10, 37134 University of Verona, Italy
| | - Davide Papola
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Policlinico GB Rossi, Piazzale Scuro 10, 37134 University of Verona, Italy
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